Agenda item

Simon Perks (Accountable Officer, NHS Ashford and NHS Canterbury and Coastal CCGs) was in attendance for this item.

(1)       The Chairman welcomed Mr Perks to the meeting and asked him to introduce the item. Mr Perks thanked the Committee for the opportunity to present the community care review undertaken by NHS Ashford CCG and NHS Canterbury and Coastal CCG.

(2)       Mr Perks noted that he had recently attended the NHS Confederation conference; a major theme of the conference had been the importance of community services. The review of health and social care services provided within a community setting was the CCGs response to this challenge. 

(3)       He explained that NHS Ashford CCG and NHS Canterbury and Coastal CCG were committed to providing health services closer to people’s homes. The CCGs had inherited a significant number of community-based contracts covering a number of different services. To ensure that these services were high quality, value for money and fit for the changing health needs the CCGs had initiated a review of a cross-section of these services. The review was carried out in the broader context of tighter healthcare budgets and an ageing population. It had been acknowledged that efficiencies would not meet these needs; new ways of care, both formal and informal, would need to be introduced. A joint appointment of a programme manager had been made by the CCGs and Kent County Council to lead this work. Mental health and children’s services were excluded to make the scope of the project manageable.

(4)       The review focused on actions which could be taken tactically to remove duplication of payments (without directly affecting services) and the strategic options for improving the commissioning of community-based services. Five work streams were identified:

1.    Contracting and Procurement

2.    Customer and Market Analysis

3.    Finance and Information

4.    Patient and Public Engagement

5.    Quality and Safety

(5)       Two key findings of the review were highlighted. Physiotherapy services were predominately used by adults of working age rather the frail and the elderly. More community spend did not mean better outcomes or improved patient experience; Canterbury spent more than £10 million on community services than Ashford but the quality of service was found to be the same.

(6)       Community services principles were established, based on the findings of the review, to underpin commissioning of community-based services in the future. The principles were service development; market development; contracting and procurement; and performance management. 

(7)       A draft framework for commissioning community-based services was developed to ensure that health, social care and voluntary services were based around individuals and the communities they live and work. The framework had been termed Community Hubs and would be based around clustering of GP practices and local communities which the CCGs service. The CCGs would commission an integrated suite of health, social and voluntary services from local providers within a defined budget with more service-user centric outcomes. Selection and design of these services would be carried out in partnership with local patients, services users, provider and partner organisations. The services provided would be based on the needs of each local population.

(8)       The concept had been well regarded by the CCGs’ partners, providers and patients. The intention for the project was to move from the exploratory and high-level design phase into the localised detailed design and implementation phase of the community hubs. A high level implementation plan had been developed which set out a timescale and funding. It was estimated that £80 million (out of the current £400 million CCGs’ funding) would be required by 2016/17 for Community Hubs.

(9)       The Chairman asked Dr Eddy and Mr Crowther to comment on their visit to Victoria Memorial Hospital in Deal on 29 April with representatives from NHS South Kent CCG and Kent Community Health NHS Trust. The visit was arranged for Members to gain a better understanding of the nature of the site and the services currently provided as well as have the opportunity to hear about how commissioning plans for developing community and outpatient services on the East Kent Coast were developing. Dr Eddy had found the trip to Deal Hospital very helpful. There had been discussions around potential services which could be provided at  the hospital, these had yet to be confirmed. Mr Crowther found the visit to be interesting and informative; he was disappointed that only two Members attended.

(10)     Members of the Committee then proceeded to ask a series of questions and make a number of comments. A question was asked about the involvement of local elected Members in the review. It was explained that the CCGs had learnt a lot, following the situation at Faversham MIU, regarding the importance of involving The CCGs’ now viewed elected Members as key stakeholders and wanted them to be involved in the process.

(11)     A number of comments were made about the ‘well’ consuming a high proportion of community services and a higher community spend not leading to better outcomes. It was recognised that the CCGs needed to carry out more detailed analysis before commissioning in order to have a greater understanding of the need in their areas. It was recognised that commissioning should not be done in isolation as resources were scarce and it was difficult to map.

(12)     A number of questions were asked about the development of community services in Ashford including the introduction of an x-ray facility. It was explained that the CCGs needed to explore the development of a community hospital in Ashford. The CCGs were looking to develop a community hubs at the William Harvey Hospital and the Kent and Canterbury Hospital which would enable the provision of acute and community services at the same site. The provision of an x-ray service to a small population would be economically very difficult; a potential option for Faversham MIU had been found.

(13)     In response to a specific question about the implementation of the community hubs. It was recognised that it would take time to develop and implement the complex health and social care community-based services.  The importance of moving services out of acute hospitals into the community was also stressed. A Member commented that they had felt a sense of déjà vu but believed that the CCGs were moving in the right direction.

(14)     A Member highlighted a case which had been brought to their attention regarding access to equipment. It was acknowledged that long waits were associated with accessing equipment. This issue needed resolving as long waits could result in patients’ requiring the use of acute services.

(15)     A number of comments were made about co-funding, community services data, patient transport services and the style of the paper. It was acknowledged that co-funding was difficult as the CCGs were only responsible for the funding of NHS services. Partnership arrangements with social care and the voluntary sector were extremely important to develop community hubs. It was explained that there was only a limited amount of data held on community services; the CCGs were exploring ways to centralise community services data. The importance of patient transport services was recognised and would be included in future designs. It was noted that the paper was written with the help of a management consultant.

(16)     RESOLVED that:

(a)          Mr Perks be thanked for his attendance and contributions to the meeting along with his answers to the Committee’s questions.

(b)          NHS Ashford CCG and NHS Canterbury & Coastal CCG be invited back to the Committee in the autumn to provide an update.

(c)          A written update on the design of the community hubs to be produced by the CCGs and circulated to Members informally.