Agenda item

To consider outputs from the Fit for the Future Consultation (information to follow).

The committee received an update on the NHS Fit for the Future Consultation from the Gloucestershire NHS Clinical Commissioning Group, (representing One Gloucestershire Integrated Care System), on the proposals for the ICS Consultation on the development of specialist hospital services at Cheltenham General Hospital (CGH) and Gloucestershire Royal (GRH) Hospital. The consultation forms part of the Gloucestershire Fit for the Future Programme and long term vision of ensuring Gloucestershire is placed at the forefront of healthcare delivery nationally. The consultation ran from 22 October 2020 until 17 December 2020.

 

Details of the consultation are available on the NHS One Gloucestershire website and can be viewed here

 

Details of the interim output of consultation report (published on 11 January 2021) can be viewed here

 

Responding to comments about the limited time for members to consider the interim output report, it was explained that the proximity of the closing date of the consultation, (on 17 December 2020), to the date of the meeting had made it difficult to publish the information with the agenda. Members were advised that there would be other opportunities, including the Health Overview and Scrutiny Committee meeting on 2 March 2021, to express their views.

 

The purpose of the Fit for the Future Consultation is to seek views on the future provision of five specialist hospital services in Gloucestershire, comprising:-

 

a)    Acute Medicine – the coordination of initial medical care for patients referred to the Acute Medical Team by a GP or an Emergency Department and where decisions are made on whether patients require a hospital stay;

b)    Gastroenterology inpatient services - medical care for stomach, pancreas, bowel or liver problems;

c)    General Surgery conditions relating to the gut, (specifically, emergency general surgery, planned lower gastrointestinal (GI) (colorectal) and day case upper and lower GI surgery);

d)    Image Guided Interventional Surgery (IGIS) including vascular surgery;.

e)    Trauma and Orthopaedic inpatient services, including diagnosis and treatment of conditions relating to the bones and joints.

 

Noting concerns about consulting during a pandemic and the challenges of having to adhere to government guidelines, it was confirmed that the Fit for the Future Consultation included a broad range of communication channels, involving;

 

a)    The distribution of approximately 5,000 consultation booklets;

b)    The distribution of 297,000 door-to-door leaflets, generating 1700 plus requests for information;

c)    Over 75 consultation events;

d)    More than 1000 socially distanced face-to-face contacts with the public, plus 350 staff;

e)    Facebook postings involving a reach of over 140,000 people, 1,500 engagements, and over 1,000 clicks on the consultation link;

f)     35 plus tweets, generating 30,000 plus impressions and almost 800 engagements;

g)    700 plus Fit for the Future surveys completed

 

Feedback to the consultation was received in two ways; from the responses to the Fit for the Future Survey (Main Survey and Easy Read Survey), and from other correspondence and written responses, including an alternative survey set up by REACH to inform their response to the proposals. The responses can be viewed on the REACH website at https://www.reachnow.org.uk/

 

Feedback from the completed surveys and from other correspondence has been grouped into a series of themes, comprising: Access, Capacity, Diversity, Efficiency, Environment, Facilities, Interdependency, Integration, (with primary and community services), Patient Experience, Staff Experience, Quality, Resources, Transport and Workforce.

 

An overview of the quantitative FFTF survey responses are detailed below:

 

Acute Medicine

 

Preferred option: to develop a ‘centre of excellence’ for Acute Medicine (Acute Medical Take) at Gloucestershire Royal Hospital;

 

Ø  67.61% (Easy read: 72.09%) strongly supported or supported the proposal

 

Ø  24.83% (Easy read: 18.6%) strongly opposed or opposed the proposal

 

Emergency General Surgery

 

Preferred option: to develop a ‘centre of excellence’ for Emergency General Surgery at Gloucestershire Royal Hospital; 

 

Ø  68.31% Fit for the Future survey respondents strongly supported or supported the proposal. Easy read survey respondents: 66.67% strongly supported or supported the proposal

 

Ø  23.44% Fit for the Future survey respondents strongly opposed or opposed the proposal. Easy read survey respondents: 22.99% strongly supported or supported the proposal

 

Planned Lower GI (colorectal) surgery

 

Preferred option: to develop a ‘centre of excellence’ for Planned Lower GI (colorectal) general surgery at Cheltenham General Hospital (CGH) or Gloucestershire Royal Hospital (GRH); 

 

Ø  79.1% Fit for the Future survey respondents strongly supported or supported the proposal. Easy read survey respondents: 72.84%) strongly supported or supported the proposal.

 

Ø  7.83% Fit for the Future survey respondents strongly opposed or opposed the proposal. Easy Read survey respondents: 14.81% strongly opposed or opposed the proposal.

 

Where should planned Lower GI (Colorectal) General Surgery take place?

 

Ø  50.76% Fit for the Future survey respondents chose Cheltenham General Hospital (27.50% Easy Read respondents chose Cheltenham General Hospital).

 

Ø  20.27% Fit for the Future survey respondents chose Gloucestershire Royal Hospital. 27.50% Easy Read respondents chose Gloucestershire Royal Hospital.

 

Ø  30.30% Fit for the Future survey respondents had no opinion. 45% Easy Read respondents had no opinion.

 

Planned day case, Upper and Lower GI

 

Preferred option: to develop a ‘centre of excellence’ for planned day case Upper and Lower GI (colorectal) surgery at Cheltenham General Hospital (CGH); 

 

Ø  73.49% Fit for the Future survey respondents strongly supported or supported the proposal. (Easy read respondents: 67.47% strongly supported or supported the proposal.

 

Ø  8.52% Fit for the Future survey respondents strongly opposed or opposed the proposal. Easy read respondents: 13.25% strongly opposed or opposed the proposal.

 

Image Guided Interventional Surgery (IGIS) including Vascular Surgery

 

Preferred option: to develop a 24/7 Image Guided Interventional Surgery (IGIS) ‘Hub’ at Gloucestershire Royal Hospital and a ‘Spoke' at Cheltenham General Hospital;

 

Ø  66.54% Fit for the Future survey respondents strongly supported or supported the proposal. Easy read respondents: 76.54%) strongly supported or supported the proposal.

 

Ø  15.39% Fit for the Future survey respondents (Easy read: 9.88%) strongly opposed or opposed the proposal. Easy read respondents: 9.88% strongly opposed or opposed the proposal.

 

Vascular Surgery

 

Preferred option: to develop a ‘centre of excellence’ for Vascular Surgery at Gloucestershire Royal Hospital;

 

Ø  60.27% Fit for the Future survey respondents strongly supported or supported the proposal. Easy read respondents: 68.35% strongly supported or supported the proposal.

 

Ø  19.97% Fit for the Future survey respondents strongly opposed or opposed the proposal. Easy read respondents: 15.19% strongly opposed or opposed the proposal.

 

Gastroenterology inpatient services

 

Preferred option: to develop a ‘centre of excellence’ for Gastroenterology inpatient services at Cheltenham General Hospital;

 

Ø  71.96% Fit for the Future survey respondents strongly supported or supported the proposal. Easy read respondents: 68.35% strongly supported or supported the proposal.

 

Ø  6.67% Fit for the Future survey respondents strongly opposed or opposed the proposal. Easy read respondents: 10.13% strongly opposed or opposed the proposal.

 

Trauma and Orthopaedics (T&O) inpatient services

 

Preferred option: Develop two permanent ‘centres of excellence’ for Trauma at Gloucestershire Royal Hospital and Orthopaedics at Cheltenham General Hospital

.

Ø  76.02% Fit for the Future survey respondents strongly supported or supported the proposal

 

Ø  10.53% Fit for the Future survey respondents strongly opposed or opposed the proposal

 

The easy read survey for this option was divided into two questions: -

 

Trauma: Support: 70.51% Oppose: 12.82% Not sure: 16.67%

 

Orthopaedics: Support: 73.08% Oppose: 14.10& Not sure: 12.82%

 

 

 

Observations from the survey concluded that:

 

•      Proportionally more people from Cheltenham competed the survey

•      More women than men completed the survey (55% / 39%)

•      There was a good age range of respondents from the under 18 and over 75 year groups

•      Between a quarter and a third of the responses came from staff

•      Over 20% of the responses came from people who considered themselves to have a disability

•      Over a quarter of the respondents were ‘unpaid’ carers

•      15% of respondents were not white British

 

Targeted consultation activities targeted people from Black, Asian and Minority Ethnic (BAME) communities; people living with long term conditions such as cardiovascular disease, obesity or diabetes; people living with a disability, (including physical impairments; learning disability; sensory impairment; and mental health conditions); people with long-term medical conditions; Adult Carers and Young Carers; Homeless people; Gypsy/Traveller Communities  and LGBTQ people.

 

Acknowledging the challenges of consulting during a pandemic and responding to concerns about the reliability of the data included in the output report, the committee was advised that, to pause the consultation at this time, was not an option. The investment in the work already undertaken during the previous 3 years was quite extensive and would need to be repeated, if the consultation was halted at this stage in the process.

 

Responding to questions, including the request that the consultation be paused to allow the NHS to concentrate on the coronavirus pandemic, it was suggested members, (having considered the output report in more detail), submit any further questions after the meeting. Members were reminded that at the committee meeting on 22 October 2020, there had been a full discussion on the timings of the consultations

 

Expressing their appreciation to everyone who had participated in the consultation, NHS professionals agreed that the responses to questions, (including any questions received after the meeting), would be included in an update to the committee on 2 March 2021. Action by – NHS CCG 

 

Chairman of the Committee, Cllr Brian Robinson, believed it was important to maintain momentum and for the committee to support the consultation process, in spite of the pandemic. The majority of members agreed with this viewpoint and welcomed the news that some of the new methods of communication that had been used had been well received.

 

The committee noted the next stages of the consultation, involving: -

 

January 2021 – Citizens Jury Sessions (8 independent 2 hour sessions)

January 2021 – Refreshment of the Integrated Impact Assessment

February 2021 – Confirmation of Recommended solution for General Surgery

January/Feb 2021 – Consultation review period/implementation planning

January/Feb 2021 – Decision Making Business Case Preparation

March 2021 – Final Decision making

April 2021 onwards – Implementation (pending the outcome of decisions to implement change in March 2021)

 

The committee to receive a further update at the committee meeting on 2 March 2021.