Overview of the consultation process

1
Overview of the consultation process
Gareth JonesConsultation Co-ordinatorHertfordsh
ire PCTs
2
Some of the main aims

• Engage with individuals and groups including
  hard to reach groups
• Clinical leadership
• A wide range of information available
• Encourage open debate
• Listen to what people have to say
• Collect and analyse comments

3
The headlines
From 12 June to 1 October 2007, the consultation
office has 
Received 6,000 questionnaires
Received 300 letters and emails
Responded to 330 phone calls
Had 6,000 hits on the website
Attended 160 community events
Talked to 1,400 NHS staff
Hosted 22 public meetings for 800 people  
Noted 160 articles in local newspapers
Held events in 32 towns and villages
Received petitions of 60,000 signatures
Placed documents in all 47 libraries
Fulfilled 700 requests for more information
4
Findings of Health Scrutiny Committee
On balance it would not be in the interests of
delivering a wide range of services across
Hertfordshire to refer the consultation process
to the Secretary of State for Health as being
inadequate Hertfordshire Health Scrutiny
Committee24 October 2007
5
Health equality impact assessment
Dr Jane HalpinDirector of Public
Health Hertfordshire PCTs
6
Background
Equality Impact Assessments (EqIAs) provide a
practical way of examining new and existing,
policies, and practices, to determine what effect
they may have on different groups in the
population
7
Strands of diversity

• Deprivation
• Age
• Race, religion and belief
• Gender
• Disability
• Sexual orientation

8
The purpose of this assessment

• To identify which areas of the county have the
  highest numbers of people who might be affected
  by these proposals
• To review the impact of decisions on these areas

9
Conclusions

• Groups likely to be most affected (minority
  ethnic communities, young children, older people,
  particularly the very old) are clustered in
  different ways across the county
• None of the options have distinctly different
  potential effects on such groups
• Any option would need to ensure that the
  services are adequately accessible for these
  groups in terms of transport and communication

10
Delivering quality health care for
HertfordshireQuality Assurance

• John Eversley and Janet McMillan
• ppre Limited

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Cabinet Code of Practice on consultation

• Consult widely minimum of 12 weeks for written
  consultation  
• Be clear about what your proposals are, who may
  be affected, what questions are being asked and
  the timescale for responses
• Be clear, concise and widely accessible
• Give feedback regarding the responses received
  and how the consultation process influenced the
  policy
• Monitor your organisations effectiveness  
• Ensure your consultation follows best practice

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Our approach

• Was the design of the consultation appropriate?
  
• Did it hear what Hertfordshire people had to
  say?
• Neither counsel of perfection nor minimum
  acceptable standard but looking for good practice

13
Appropriateness has it been?

• Comprehensive and relevant
• Coherent and co-ordinated
• Well-planned in advance
• Communicated well

14
Comprehensive and relevant

• Not pursuing Hatfield option- Reasons late, not
  accessed but no material difference
• Cancer services, maternity services
• Transport- Public transport
• Hemel Hempstead

15
Coherent and co-ordinated

• Trusts within Hertfordshire
• Barnet, Enfield and Haringey
• Pre-consultation planning
• Quality of communication material- Urgent Care
  Centres- Local General Hospitals

16
Did it hear what Hertfordshire people had to say?

• Profile
• Awareness
• Participation
• Responding to concerns during consultation
• Post-consultation decision-making

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Profile

• Present and future demographic patterns
• - Age
• - Deprivation
• - Ethnicity
• - Migration
• Equality Impact Assessment

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Awareness

• Our audit of consultation awareness
• 30 aware
• 51 in Welwyn and Hatfield, one third in
  Stevenage, less than 1 in 5 in St Albans
• Older more than young people

19
Participation

• 9
• Website 2,733 unique visitors
• Questionnaire response ORS
• Leaflet distribution
• Clinician, staff and contractor involvement
• Partner agencies and other stakeholders

20
Listening

• Responding to questions during consultation
• Analysis of responses
• Transparent criteria for decision-making
• Access to care
• Clinical quality
• Sustainability
• Equality impact
• Cost, including opportunity cost
• Barnet, Enfield and Haringey decisions

21
Conclusions

• Overall structure intact
• Cracks dont undermine basic integrity of
  process

22
The centralisation of acute services at either
the Lister or QEII
Dr Richard Dent and Sarah CrowtherEast and North
Hertfordshire NHS Trust
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Overwhelming evidence

• Larger hospital units save more lives
• Specialist doctors save more lives
• New technologies, used by specialist staff, save
  more lives
• Better availability of consultants saves more
  lives
• Improving paramedic skills saves more lives

24
Patient benefits

• Better clinical outcome for patients who need
  treatment for complex medical or surgical
  problems in an acute hospital
• Increased consultant availability to care for
  patients, particularly those needing emergency
  care
• Hospital doctors and nurses would be more able
  to retain and develop specialist skills and
  expertise
• Clinical services would be sustainable in the
  long term
• More efficient in the long term

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Key themes within responses

• Questionnaires
• Access to care
• Clinical quality
• Sustainability
• Retention of the status quo

• Comments from letters, events and other sources
• Hatfield
• Cancer Centre services
• Impact on out of county hospitals

26
Access to care

• Majority of respondents tended to prefer site
  closest to their home
• Concern about travel times, especially at peak
  periods
• Recognition of public transport limitations
• Desire for more integrated transport to support
  access
• Recognition that Lister has better road access
  and is closer to A1(M) than QEII
• Health equality impact slightly favours Lister
  on balance
• Transport and access are not significant
  discriminating factors between options but
  marginally favour Lister

27
Clinical quality

• Overwhelming clinical support for consolidating
  acute care on a single site
• Site must be fit for purpose
• Public tended to equate proximity to acute site
  and clinical quality/safety
• Recognise public will require ongoing
  reassurance and information
• Lister preferred as offers better potential
  clinical adjacencies majority of NHS
  respondents preferred Lister
• QEII site more challenging financially would
  only be able to offer limited ongoing investment
  in services and quality

28
Sustainability

• Recognition of the need for sustainable acute
  services in the future
• Need for acute site to have sufficient capacity
• Capacity for the future space and flexibility
  for efficient expansion
• Lister gt QEII by 9 acres and site layout lends
  itself more easily to development of future
  services

29
Retention of two acute sites

• IIYH agreed clinical model of consolidation
• Consolidation strongly supported by clinicians
  locally and nationally
• Key to improving quality and sustainability
• Population growth will not negate the need for a
  single acute site - has much greater impact on
  demand for primary care
• Maintaining two acute sites likely to cause
  deteriorating clinical quality and unsustainable
  services

30
Hatfield

• Disappointment at lost opportunity to develop
  this new hospital
• Preferred option non-financially
• Not affordable would lead to recurrent deficit
  and inability to meet statutory duty to break
  even
• Not possible to make scheme affordable without
  making it too small and unfit for purpose
• Assessment confirmed by NPV - revealed Lister to
  be best value
• Lister option offers greatest scope for ongoing
  investment in service quality and development

31
Cancer Centre services

• Important issue for Hertfordshire
• 10 cancer patients undergo treatment at Mount
  Vernon Cancer Centre (MVCC)
• MVCC serves wider population than just
  Hertfordshire
• Cancer Reform Strategy (December 2007)
• Commissioner-led review in 2008
• MVCC response supports consolidation of acute
  services on Lister site

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Impact on out of county hospitals

• Patients choices will not be impeded by acute
  site consolidation
• Patients can continue to choose to travel out of
  Hertfordshire for care
• Current activity flows incorporated onto
  modelling
• Commissioners linking into out of county
  hospitals planning
• Proposals designed to improve clinical outcomes
  in Hertfordshire
• Emergency access complemented by Urgent Care
  Centres

33
Summary

• Access most frequently cited issue, Lister
  site marginally more accessible
• Sustainability scope for future growth, Lister
  site 9 acres larger than QEII site
• Clinical quality optimal flexibility and
  clinical adjacencies, Lister site has superior
  potential
• Financial meet statutory duty plus ongoing
  investment in services, Lister site superior
• Public views tended to support nearest site
  and concerned about safety, ongoing need for
  reassurance and information
• Clinical views strong support for acute
  consolidation, NHS staff favoured the Lister site

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Local General Hospitals
Dr Steve Laitner and Heather Moulder Hertfordshire
PCTs
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Proposal

• The NHS is committed to maintaining and
  developing a vibrant mix of health services in
  Hemel Hempstead and whichever of Stevenage and
  Welwyn Garden City is not chosen for the acute
  hospital site
• What services do you think should be provided at
  the Local General Hospital Hemel Hempstead and
  either Lister or the QEII?

36
Feedback from consultation

• Everything as clinically safe and as local as
  possible
• Diagnostics
• Outpatients
• AE
• Urgent care

• Surgery
• Maternity services
• Intermediate care services

37
Core services

• Pathology
• Minor surgery
• Ante-natal and post-natal care

• Outpatients
• Urgent care
• Diagnostics
• Plus opportunities for local health campus
  development

38
Intermediate careAdditional requirement
39
Intermediate careNext steps

• Short term provision at Hemel Hempstead and
  existing facilities
• Review of existing facilities
• Integration with social care
• Local provision

40
Future vision

• Vibrant campus development vision not a poor
  second best but a real community resource
• Phased development hand in glove with acute
  hospital changes
• We want to involve the community in making these
  changes happen
• We have the resources to make these changes
  happen

41
Urgent Care Centres
Andrew Parker Hertfordshire PCTs
42
Proposals

• Establish network of 7 Urgent Care Centres- One
  at each of the two acute hospitals open 24/7-
  One at each of the two Local General Hospitals
  open 24/7- Herts and Essex Hospital and St
  Albans
• Either Cheshunt Community Hospital or Hertford
  County Hospital

43
Key themes

• Clarification of what an Urgent Care Centre will
  be?
• How will I know where to go?
• Need to provide viable, safe and sustainable
  services
• Significant support for both Cheshunt and
  Hertford

44
Hertford County Hospital andCheshunt Community
Hospital

• The following proposals were considered
• 7th Urgent Care Centre at Hertford County
  Hospital or
• 7th Urgent Care Centre at Cheshunt Community
  Hospital or
• Both Hertford County Hospital and Cheshunt
  Community Hospital
• Considerations taken into account
• Proximity to other proposed service developments
  e.g. Barnet and Chase Farm Hospitals, Princess
  Alexandra Hospital
• Health Equality Impact Assessment deprivation
  in Cheshunt but more population growth in
  Hertford
• Demand for services
• Nurse-led model with GP out of hours
• Viability of two smaller Urgent Care Centres at
  both sites?

45
Hertford County Hospital andCheshunt Community
Hospital

• Assessment and analysis
• Staffing model
• Number of attendances expected
• Patient flows out of areas
• Non-pay variable costs and overheads
• Hours of opening
• Financial assessment indicates little to choose
  between the costs

46
Recommendations

• Establish network of Urgent Care Centres
• Pilot Urgent Care Centres at both Cheshunt and
  Hertford
• Review opening hours following pilot
• Acknowledge need for communication campaigns

47
Access
Jacqui BunceAssistant Director Strategic
Planning Hertfordshire PCTs
48
Key issues

• Major issue for consultation
• 78 of all responses received across all options
  related to access to care
• Raised at public meetings
• Mentioned in letters and feedback from groups

49
Major themes

• Concern about further distance to travel
• Ambulance capacity and capability
• The increased time it may take to reach a major
  acute hospital
• Congestion and infrastructure
• Car parking provision on hospital sites

50
Work undertaken

• Independent analysis of a range of transport
  issues
• Review of current transport support
• Travel Summit
• Proposals for investment

51
Findings of Travel Summit

• The need to replicate and extend successful
  initiatives
• Communication and information
• Need for an overarching coherent strategy and
  greater co-ordination
• Sustainable transport projects
• Improvements to car parking at hospital

52
Proposals

• Strategic planning
• Revive the Hertfordshire Integrated Transport
  Project- Senior director lead with
  accountability for access to health issues -
  Project officer to be recruited
• Link access to health into Local Area Agreement
  targets
• Emergency transport
• Additional 2m funding for ambulance service
• Non-emergency transport
• ongoing support for community transport scheme
• 0.75m investment prioritising local initiatives
  e.g. shuttle scheme

53

• Health cannot solve all the transport and access
  problems but can help reduce them
• Through investment in local initiatives
• Through strategic partnership working

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The financial position
Alan PondDirector of Finance Hertfordshire PCTs
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Summary of updated figures related to 2008/09
56
Conclusion

• Affordable
• Funds available for investment
• Contingency cover

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West Hertfordshire Hospitals NHS Trust proposals
Professor Graham RamsayMedical Director and
Deputy Chief Executive West Hertfordshire
Hospitals NHS Trust
58
Current status

• 2003 Investing in your health agreed concept of
  single acute site and separating planned from
  emergency care
• 2005 Better care for sick children determined
  inpatient childrens services centralised at
  Watford
• 2006 Delivering a healthy future reaffirmed
  Watford as the acute site and St Albans as the
  short term elective care site

59
Just to remind you of the overwhelming evidence

• Larger hospital units save more lives
• Specialist doctors save more lives
• New technologies, used by specialist staff, save
  more lives
• Better availability of consultants saves more
  lives
• Improving paramedic skills saves more lives

60
The centralisation of acute hospital
services in west Hertfordshire
61
Although not part of the consultation a number of
concerns were raised about acute centralisation
at Watford

• If Hatfield is not to be the main acute site in
  east and north Hertfordshire, then all the
  Investing in your health decisions should be
  revisited
• Access to Watford is very poor, particularly on
  match days
• Hemel Hempstead General Hospital is in a better
  condition than Watford
• The catchments area of Hemel Hempstead would be
  larger

62
Response

• Centralisation of acute hospital services at
  Watford not included in this consultation
  addressed in Delivering a Healthy Future and
  subsequent judicial review (July 2007)
• During this consultation patient flows were
  re-examined and did not alter earlier
  assumptions
• The business case supports the decision for
  centralisation at Watford
• Consultation responses did not raise any
  alternative solutions to the current proposals

63
Centralisation of childrens emergency care and
childrens planned surgery
64
The case for change

• Paediatric services focus on keeping children
  out of hospital and supporting them at home
• A single site will provide improved clinical
  quality through
• - 24 hour paediatric staffing- Centralisation of
  specialist staff and skills- Paediatric pharmacy
  5 days per week
• Centralisation of childrens emergency care will
  create a service that is clinically superior and
  sustainable and financially viable
• Benefits of co-locating childrens services
  alongside major acute centre
• The proposal is supported by paediatric
  clinicians

65
The case for change

• Department of Health guidance from National
  Service Framework supports childrens acute
  services on one site
• Two sites for childrens planned care is not
  sustainable
• Increased outpatient-based services at Local
  General Hospitals mean that the majority of
  children will receive all or most of their care
  closer to home
• Urgent Care Centres will treat children who do
  not need full AE support

66
Response to consultation

• Location of site - 75 of west Hertfordshire
  respondents preferred Hemel Hempstead they voted
  for site nearest their home
• The transport infrastructure is inadequate and
  road access to Watford is very poor
• The clinical model is broadly supported but
  several respondents raised concerns about the
  wards at Watford
• Concern whether Urgent Care Centre staff would
  have the appropriate assessment skills

67
Trust response

• Recognise the concerns of Hemel Hempstead
  residents but note that relative response rate
  for Watford was low
• Cant sustain full range of paediatric services
  on two sites
• Concerns about access must be balanced against
  quality of care
• Investment in Watford to extend wards
• Emphasis on local access

68
Consolidation of planned surgery at St Albans or
Hemel Hempstead
69
The case for change

• The need to separate planned from emergency care
  will produce fewer cancellations and improved
  infection control
• Investing in Your Health consulted on this
  concept and accepted the case
• Should planned care be at St Albans or Hemel
  Hempstead?

70
Responses to consultation

• Questionnaire 58.7 favour St Albans
• Letters and emails 16 support St Albans, 4
  support Hemel Hempstead
• Public meetings 6 support St Albans, 2
  support Hemel Hempstead

71
Trust response

• Public support for St Albans
• Both sites clinically suitable
• Trust preferred option is St Albans as less
  costly

72
Summary

• Previous comprehensive consultation on acute
  centralisation at Watford
• Strong clinical case to apply this to childrens
  acute care
• St Albans planned care centre supported by
  public and Trust
• Local General Hospital at Hemel Hempstead
  retains extensive local access