RESOLVEDto refer the motion below to the Health and Care Overview and Scrutiny Committee:
This Council notes:
· The value communities place upon the Accident and Emergency units in both Gloucester and Cheltenham
· The enormous and varied contributions made by the seven minor injury units spread across Gloucestershire
· The great value that communities across Gloucestershire place upon having hospital facilities close by
This Council further notes that all Walk in Centres, Urgent Care Centres, and Minor Injury Units will be rebranded as Urgent Treatment Centres by the end of 2019.
This Council resolves to write to Gloucestershire Clinical Commissioning Group, to appeal in the strongest possible terms, that none of the services currently on offer to walk-in patients at any of the nine hospitals are removed, including that Cheltenham General Hospital must not be further downgraded to an Urgent Treatment Centre from an Accident and Emergency department.
2.1 The Committee noted the motion that had been referred from full Council and welcomed a presentation from the Senior Commissioning Manager for Urgent Care on developing the Gloucestershire model of care for Urgent Treatment Centres. It was explained that she was unable to confirm any details of Urgent Treatment Centres at this stage as further work and engagement was planned. Following engagement in the Spring and Summer a review would be undertaken and a more formal process of consultation would take place in Autumn/ Winter.
2.3 Members noted the national requirements including the March 2017: ‘Next steps of the NHS Five Year Forward View) and the July 2017 NHSE’ Principles and Standards. The NHS Long Term Plan stated the implementation of the Urgent Treatment Centre model by Autumn 2020. It was explained that the overarching principle of establishing Urgent Treatment Centres was to remove confusion and provide consistency of service offer to the people of Gloucestershire.
2.4 In terms of outlining the need for change it was explained that the systems were confusing with fragmented pathways with multiple hand-offs, as well as staffing/ workforce constraint. Making the change would improve the quality of the patient experience, Urgent care was to become more planned in order to address system ‘surge’. It was explained that urgent care activity was very predictable but did create known demand surges that created pressures.
2.5 The national guidance had been reviewed and there had been a mapping of current services, reviewing patient experience feedback. Workshops were held involving clinical, managerial, Healthwatch and patient and public representatives. Draft service specifications had been prepared. There was still more to be done and there was encouragement for everyone to get involved.
2.6 Members were informed about what the Urgent Treatment Centre model would provide and how it would be less confusing for public, patients and staff and that it would provide a largely bookable service to allow it to be more planned. All services needed to be aligned so there was a less fragmented approach that provided the best use of staff skills. This would ensure the Emergency Department was preserved largely for people with ‘life and limb’ threatening conditions.
2.7 It was explained that the system was undertaking a number of test and learn initiatives via a ‘Plan, Do, Study, Act’ approach to test assumptions and new ways of working.
2.8 Some members felt that there was confusion around the details of Urgent Treatment Centres (UTC) and asked for confirmation that there would be no downgrading of Cheltenham A & E to a UTC. In response it was explained that there was still a significant amount of engagement with the public and so no details could be confirmed.
2.9 In response to a question, it was clarified that it was a minimum 12 hours open time for UTCs and that where need arose this could be extended. It was also confirmed that there would be full integration with the out of hour’s services.
2.10 Some members spoke positively about UTCs and emphasised the importance of ensuring the best outcomes for patients. It was suggested that in many instances UTCs represented an upgrade for patients.
2.11 One member emphasised the rurality of the county and asked whether the changes would satisfy rural communities. In response, it was explained that there was a clear commitment around travel times and that modelling had been carried out to look at how to address the challenges presented in rural areas.
2.12 In response to a question, it was suggested that more could be done to enhance the overnight offer at Cheltenham General Emergency Department and that the service currently provided was not replicating an urgent treatment centre model. Further work would be carried out to integrate Cheltenham’s overnight emergency service and the out of hour’s service, testing new ways of working.
2.13 Members agreed that they were in favour of steps to reduce confusion and ensure the services were more joined up. Alan Thomas from HealthWatch emphasised the importance of enhancement of patient experience and warned against confusing the NHS Long Term Plan with the steps being taken in Gloucestershire.
2.14 It was clarified that GPs in Gloucestershire provided support and care for people who were ill. Injury was not included in the current contract and so people should call the 111 service in future if they are injured.
2.15 Members requested that a letter be put together from the Committee drawing their attention to motion 825 as well as providing information in relation to ensuring a focus on outcomes for patients and the need for clear communication of plans. This letter would go to the CCG and include a request that Cheltenham General Hospital not be downgraded.
ACTION Cllr Carole Allaway Martin/ Democratic Services
2.16 The Committee requested that they receive a timetable for engagement and clarity of what stage they could encourage people to fully engage. They would have a separate agenda item at future committee meetings to monitor progress.
ACTION Cllr Carole Allaway Martin