Indicative Timing – 11:15 to 11:30
At the Committee meeting on 13 November 2018, members were provided with details of the need to implement a temporary service change.
At the meeting Members were concerned regarding the impact on those people who would usually visit the community hospitals most affected by this change. They asserted that it would be important that there was clear communication on what services were available and when, otherwise there was the potential for the acute hospitals to be adversely affected by an increased footfall.
Presentation slides will be published to follow.
7.1 Paul Roberts provided members with context ahead of the discussion around the temporary change to X ray services. The decision had been made to set up a Diagnostic Programme Board to handle the significant numbers of challenges and opportunities around imaging services. It was felt that a full strategic approach was required in conjunction with the NHS long term plan, which placed an increased emphasis on the use of diagnostics. Members received details of the Diagnostics Programme Board with initial priorities around community x-ray, workforce, One Place programme, point of care testing and managed equipment programme. There was a service user group for pathology and looking to establish one for radiology.
7.2 The Diagnostics Programme Board was considering strategies around the issue of recruitment of diagnostics staff and how to take advantage of developments in technology. It was explained that a large proportion of imaging equipment was in need of replacement which would take a large capital investment. Thanks for generous public fundraising activity was noted.
7.3 Since November 2018 there had been a reinstatement of an additional 44 hours of X-ray provision in community hospitals of the original reduction. Members were informed that 9.5 full time equivalent radiographers had been recruited to the county but that 11 had left in the same period. Agency workers and bank staff had been used successfully to fill the gaps in rotas. A range of initiatives were being put in place to improve recruitment including working with the University of Gloucestershire on an accredited course and having overseas and regional recruitment plans.
7.4 Waiting times for X-rays at every community hospital in the county had increased apart from in Cirencester. Members noted that the biggest waits were at the North Cotswold and Tewkesbury hospitals. One member expressed specific concerns about the waiting times in Tewkesbury. It was explained that some patients chose to wait to have an x-ray at a more convenient location when it was not urgent and patients who were clinically urgent would always be seen promptly and transport could be arranged if necessary.
7.5 Members noted that the temporary changes had been due to shortages in radiographers and that more immediate and longer term solutions were being worked on.
7.6 The Committee noted the petition discussed at a previous meeting regarding the waiting times in the North Cotswold and members sought clarification over the definition of a temporary change, asking if this was a pilot. It was explained that this was a temporary change in relation to staff shortages and this was not something that would have been desired or designed. Paul Roberts explained that in his view it was important to have a flexible approach. In some communities there would need to be an extension in the range of services provided and in others less to enable focus where the demand was expected. In response to a question it was explained that the default plan was to reinstate services when and where possible, but a more strategic plan for diagnostics across the county was being developed by the newly established Diagnostics Programme Board..
7.7 Further discussion was held around the use of the term ‘temporary’, Deborah Lee stated that in her view a pilot was something that was being tested with a view to future implementation. These arrangements were not being tested, they were changes that had been unavoidable due to safety concerns and would remain temporary until the Trust was able to reinstate the former arrangements or chose to consult on a different permanent solution.
7.8 There was some discussion around MIIUs and how referrals were being made for X-rays. In response to a question it was explained that there wasn’t a wait time, if X- ray facilities were available locally then that would be carried out immediately or, if facilities not available on site at the site, the standard procedure would be to treat conservatively and either come back the next day or be sent to another site where X-ray facilities were available. It was explained that this was the standard procedure before the temporary change.
7.9 A brief update would be brought to the committee in July 2019.
ACTION Work Plan
7.10 In response to the discussion on the Committee’s role in relation to temporary service change and pilots. A memorandum of understanding or ‘check-list’ would be drawn up that would clarify the terminology and provide a local interpretation of what constituted a substantial variation and how the Committee would act in relation to this.
ACTION Cllr Carole Allaway Martin/ Deborah Lee/ Mary Hutton