Agenda item

Sarah MacLennan, Head of Communications, NHS Wiltshire, and Dr Steve Rowlands, Chairman, Wiltshire Clinical Commissioning Group, will explain what reforms to NHS Wiltshire are taking place and the regional and local implications they will have.    

Simon Truelove, Director of Finance for Wiltshire Clinical Commissioning Groups, explained the reforms taking place to NHS Wiltshire. This included the following main points:

·       Our vision – providing care closer to home, managing and improving health, community-based provision led by GPs and new ways of working and sharing best practice.

·       Six key priorities – planned care, unplanned (i.e. emergency) care, mental health, services for people with long term conditions, end of life care, community services and integrated care.  

·       A diagram to show how the patient would be put first, supported by primary care, community teams, expert providers and tertiary care for specialist services.

·       Challenges faced by NHS Wiltshire – an ageing population and disease associated with older people (for instance dementia), long stays in hospital, delayed transfers of care, use of community beds, mental health and limited resources.

·       Developing the plan for Devizes – information was gathered from the Joint Strategic Needs Assessment, Clinical Commissioning Groups, meetings with GPs, stakeholder events and more.

·       Finance – investment to bring services where appropriate from acute providers into the community.

This was followed by an extensive question and answer session, assisted by Maggie Rae, Corporate Director of Public Health and Public Protection, Sarah MacLennan, Head of Communications, NHS Wiltshire, Dr Dick Sandford Hill and Dr Helen Osborne.

Question: What would the drive to reduce hospital stays and the move from acute providers mean on a practical level?

Answer: Step up and step down beds would be used (these were a way of enabling people to leave hospital by moving to and being specially cared for in a residential care home bed). A move from acute providers into the community was best in terms of end of life care. This would involve working with social services and organisations such as Dorothy House to help people access services at the right time.

Question: How much money would it cost to set up the Clinical Commissioning Groups? How different were these in structure to the Primary Care Trusts?

Answer: In its primary year 2011/12, resource directed to GPs was just under £1 million and this was an ongoing commitment for 2012/13. For 2013/14 the funding envelope would be approximately £10 million. In terms of structure, Wiltshire’s Clinical Commissioning Group had established a Governing Board, which had 14 voting members. These were a Chairman, three GPs who would act as ‘locality representatives’, three additional GPs, a registered nurse and a secondary care doctor, one Chief Accountable Officer, one Chief Finance Officer, one practice manager and two lay members. The CCG was considering its staffing structure while developing those commissioning functions it intended to keep in house.            

Question: What were the plans for Devizes hospital?

Answer: The plans were to maintain and in some cases improve local services. The rebirth of the hospital was not a potential option. However there would be the provision of services in the community, with day care surgery, ultrasound and a pilot for x ray services.

Question: Devizes had been promised a Primary Care Centre ten years ago, would this no longer happen?

Answer: There were plans to revisit Primary Care Centre proposals, however this was at a very early stage and would take time to develop.

Question: What would happen to Devizes hospital as an asset?

Answer: The NHS estate would be divided up, with some assets going to a new organisation and the majority transferred to the new providers from 1 April, i.e. to Great Western Hospital, for them to manage on behalf of the community.       

Question: Could we have the assurance we would not lose the current services in Devizes without a form of replacement?

Answer: With regards to x ray services, we have met with radiology providers and could guarantee x ray provision would continue in Devizes. This may be transferred to a treatment centre, but if anything, current services would be improved with the development of ultrasound services.

Question: Would funds from Devizes hospital be spent in the community area? If not, this could be seen as asset stripping?

Answer: Assets were not being stripped as the hospital would remain within the NHS estate. There was now the need to engage with Great Western Hospital and GPs to look into plans for the site and how best to make it useful.

Question: At present, ultrasound was only available for one day a week and there were long delays for patients of approximately six weeks. A minor injuries facility was also needed in the town.

Answer: the provision of ultrasound was a new development and in a sense the service had been a victim of its own success. Feedback was always welcome and there were plans to increase capacity. Over the years, the types of minor injury patients were changing and most minor injury patients could now be seen at a GP surgery.

Question: The presentation mentioned £18 million savings that would be made. Where were these savings coming from?

Answer: Improved procurement of services would be a focus. The three providers would all look to reduce the length of stays in hospital as patients had been staying for longer than was required. Concern was raised by a member of the public who lived alone and had been sent home the day after an operation. The Chairman of the area board assured the individual that she understood her concerns and that after care would remain a priority for the NHS.

Question:  How would young people be taken into account and how would the boundaries of the new provision work?

Answer: The transition was taking a bottom up approach and was working with young people already. The GP answering the question commented she would be delighted to work with any interested young people and would share contact details with the Youth Services Co-ordinator concerned. While there was a disconnect between the three areas of acute providers and the structure of social services, the providers would work closely together and share priorities and best practice.