Agenda item

Public Representation

The Gloucestershire Health Overview and Scrutiny Committee is currently piloting an approach whereby members of the public can make representations at committee

meetings.

 

At each meeting of the Health Scrutiny Committee, there shall be up to 20 minutes set aside for representations, (3 minutes allocated per member of the public).

 

Any person who lives or works in the county, or is affected by the work of the County Council, may make a representation on any matter which relates to any item on the Health Overview and Scrutiny Committee agenda for that meeting.

 

Notification of your intention to attend the meeting and make a representation should be given by 4.00 pm three clear working days before the date of the meeting, (excluding the day of the meeting).

 

The notification deadline to make representation at the committee meeting on Tuesday 17 November 2020 is 4.00 pm on Wednesday 11 November 2020.

 

To confirm your request to make a representation, please email Jo Moore on jo.moore@gloucestershire.gov.uk

 

Please note, this meeting will be held as a remote access meeting, for which it will be necessary to join the meeting by electronic means via the Webex application. An invitation to join the meeting will be provided prior to the meeting. If you have any questions on this process, please include in the email.

Minutes:

Phlebotomy Services in the South Cotswolds

 

One public representation was made at the meeting.

 

The following statement (including several questions) was submitted by Marco Taylor in response to concerns relating to Phlebotomy Services in the South Cotswolds.

 

Statement (taken as read at the meeting)

 

Further to my earlier representation, (at the Health and Overview Scrutiny Committee meeting on 15 September 2020), regarding the un-consulted degradation in access to phlebotomy services in the South Cotswolds, I note that the Clinical Commissioning Group has provided a report regarding the background.

 

There are a number of inaccuracies and omissions that I wish to highlight to the committee for further scrutiny. Wait times for blood tests at local GP practices have now typically increased to 3-4 weeks and in addition local evidence of inexperienced staff requiring several attempts to successfully find a vein and take a blood sample are common, creating a distressing experience especially for nervous patients.

 

I can contrast this to my direct experience of the pre-bookable hospital service in August where I was able to get a next day appointment and have my blood sample taken very easily. The result is many patients requiring primary care blood tests are now having to unnecessarily having to travel to Gloucester as they cannot wait a month for a test and as there is no direct bus service to Gloucester from Cirencester this is having a disproportionate impact on those who are unable to access a car or drive, typically older and more vulnerable people. Furthermore, this is exposing more people unnecessarily to environments with a higher risk of COVID-19 transmission.

 

In addition to raising the serious concerns, I would like to raise the following key questions for the CCG to respond to and the committee to scrutinise their responses:-

 

1)    At the previous meeting I requested evidence of what consultation had taken place with the local community about the changes to phlebotomy services. No evidence was provided other than reference to engagement with the patient participation group.

 

I have searched the last two years' agendas of the CCG PPG and have found only one agenda item in February 2020 with the description:  "Jo gave a brief update on how Phlebotomy Services are currently provided in Gloucestershire".

 

There is no indication of a discussion about future changes nor any form of meaningful consultation, let alone how many members of the Cirencester community were involved.

There is also reference to a link to an "Experiences of using Phlebotomy Services in Gloucestershire (blood tests)", which it is noted no reference has been made to as part of any decision making process.

 

Please can the CCG provide details of the full extent of consultation that took place related to this change in care setting for key community health services be provided including specifically how many members of the Cirencester community were involved?

 

2)    Also at the previous meeting, I requested evidence that the needs and challenges reflecting the Cirencester area were examined separately from the conurbations of Cheltenham and Gloucester, (where access to alternative phlebotomy services is far more readily available).

 

The report submitted again states that one of the reasons for the change was that  "High levels of demand within the hospital setting led to long waiting times for many patients.  At least once a week on average, hospital services had to close earlier than scheduled in order to manage safely the number of patients waiting, with some patients then needing to come back on another date".

 

However, any such instances have not been known at Cirencester hospital nor has any further evidence of such an issue existing in the Cirencester area been provided.

 

Please can the CCG provide this evidence specific to Cirencester and, if not available, acknowledge there was in fact no such need for this change?

 

3)    Despite numerous local residents writing in to advise of the lack of access to testing for those requiring phlebotomy services related to secondary care. When the hospital service was discontinued, there was no phlebotomy provision for those requiring secondary care in the Cirencester area for some weeks until the half a day a week service was introduced (resulting in six week waits for appointments.

 

Can the CCG please explain why there was no provision made prior to the change in the service?

 

4)    The report to the health overview & scrutiny committee in March 2020 stated that: "[the CCG] are confident that when fully implemented these new local arrangements for taking blood will make a real difference for patients".

 

Further to this, the report provided for the November 2020 meeting adds: "The CCG wanted to improve this service for patients by ensuring all patients have timely access to a safe and high quality community phlebotomy". It is clear that the new arrangements are unable to provide either a timely service, nor a high quality experience.

 

Can the CCG please explain how they are monitoring the impact of these changes to ensure the same level of service (near universal access to next day high quality blood testing) will be provided and what further corrective action is planned to reduce wait times and increase the quality of service?

 

5)    The report submitted states that: "A reduction in footfall at these sites has also allowed Page 2 3 them to provide a COVID-secure service, which would not have been possible prior to the changes.". This is false and mis-leading.

 

With effect from August 2020 phlebotomy appointments at Cirencester hospital were only available via an on-line booking system. This allowed demand for the services to be readily managed and still retained access to at worst next-day appointments, thus proving the above assertion as false. The new approach for secondary care appointments is now by phone only, not only narrowing the window people have to book access to these, but also reducing transparency of the extent of waiting times for vital community health services.

 

Please can the CCG acknowledge this statement is incorrect and misleading?

 

6)    The report submitted also states:  "For those patients who would have made use of hospital ‘drop in’ phlebotomy clinics for GP requested blood tests, the move to a new service model with phlebotomy provided from their GP practice, is intended to result in reduced travel and waiting times and the avoidance of hospital car parking charges". This is again false.

 

Waiting times for blood tests have increased from a next day service to a near one month wait at GP practices. Car parking at Cirencester hospital is free and in fact with more patients now having to drive to Gloucester to get timely blood tests as they cannot wait a month, this means far more Cotswold patients have to pay parking charges that they would not of needed to accessing services at Cirencester hospital under the old regime.

 

Again, can the CCG confirm how they are monitoring the impact of these changes and will ensure the promised benefits are realised?

 

7)    Lastly, the concluding section of the paper states:  "COVID-19 concerns around patients attending an acute hospital setting, coupled with the general direction of travel towards more non-face to face consultant appointments, has led to a significant increase in demand within primary care for blood tests, including blood tests for oncology patients and patients with long term conditions. This rapid increase in demand is such that it is frequently outstripping the phlebotomy capacity available within primary care".

 

This risk was clear when the CCG announced the un-consulted changes to phlebotomy in Cirencester in July and flagged by a number of local residents.

 

Can the CCG explain why they chose to press on with these damaging changes in the middle of an international pandemic when it was clear primary care services were already under stress?

 

Also, given these changes can the CCG confirm that full blood testing services will be reinstated at Cirencester hospital that has the facilities to provide this much needed capacity ready and waiting?

 

At the meeting itself, Mr Taylor reiterated his concerns and spoke of a ‘clear deterioration’ in blood testing services accessible to people living in the South Cotswolds area. Relating the concerns to the length of time people had to wait for blood tests; an unacceptable number of people needing to travel to Gloucester Royal Hospital for blood tests; travel limitations of people requiring blood tests but reliant on public transport in a rural location; inexperienced staff issues; additional pressures placed on GP’s and the lack of public consultation prior to making the changes.

 

Mr Taylor referred to the overall negative impact of the concerns and the disappointment in the promise of the Public Participation Group, a group he believed had only met on one occasion.

 

The concerns were noted, with the agreement that the responses would be made during consideration of item 5 of the agenda (Community Phlebotomy Services).

 

Mr Taylor was thanked for his participation at the meeting.