To receive a presentation by Simon Cox (Associate Locality Director, North Yorkshire and York Primary Care Trust)
Minutes:
The Committee considered a verbal report by Amanda Brown, Locality Director, NHS North Yorkshire and York (NHSNYY), in respect of the future of Whitby Hospital. Ms Brown referred to a briefing and list of questions which had been previously circulated to members of the Committee. The briefing stated that the clinical model of Enhanced Community Teams (ECT) or ‘Hospital at Home’ was piloted at Whitby Hospital in 2010, leading to the temporary closure of Abbey Ward from November 2010 to July 2011. The objective of the pilot was to ensure that unnecessary hospital admissions were avoided, with quicker discharge and better coordinated follow-up care for people who are admitted to hospital. Earlier in the year, the National Clinical Advisory Team (NCAT) undertook a review to form part of the overall evaluation of the pilot. They endorsed this model of care, but viewed it within the context of a new wider strategic vision for community hospitals based on intermediate care (including rehabilitation and palliative care), outpatient services, diagnostics and minor injuries. However, they saw GP support for the new clinical models as pivotal, and advised against full implementation of the ECT and closure of the ward because of lack of local stakeholder support, and in particular of GPs. The NCAT also referred to the poor estate of Whitby Hospital and that any capital planning should flow from the future strategic direction agreed for the hospital. NCAT’s findings and recommendations were further reinforced by Professor Mascie-Taylor’s Independent Review of Health Services in North Yorkshire and York which concluded in August 2011 that community hospitals such as Whitby should be reviewed and redesigned as part of a wider strategy for improved community services. They should provide ‘step-up’ care for patients from the community and ‘step-down’ care for patients from acute hospital settings, so that care was matched to patient need and was provided in the right place. Mascie-Taylor specifically referred to the Whitby ECT pilot as a model which should be considered. Mascie-Taylor provided a stark assessment of the North Yorkshire and York health economy, estimating that the efficiency savings required in North Yorkshire in the next four years would be in excess of £230 million. To meet this challenge he called for a radical solution and a shift in how healthcare is provided, including
Ms Brown then provided further information to supplement the briefing. She reported that earlier this year the York/Scarborough Trust had taken over community services in the area including Whitby Hospital, and GPs representing the Whitby area had joined the Clinical Commissioning Group for Hambleton and Richmondshire. Mascie-Taylor’s recommendations to provide more integrated healthcare services also needed to be seen in the context of radical changes in the way healthcare was to be commissioned which were proposed in the Health and Social Care Bill. Locally a new integrated approach to commissioning across primary, secondary and community care was therefore being developed with local GPs at the forefront. This was still in its very early stages but gave rise to new relationships and new opportunities. It was very important for the public and local stakeholders to be engaged in this developmental work. The strategic review of services provided at Whitby Hospital had aimed to report by the end of October, but Ms Brown added that this was an ambitious target, and if patients were to get involved which they needed to be, then the review may well take longer. Ms Brown recognised that the ECT pilot could have been managed better by NHSNYY. Although the GPs broadly agreed with the direction of travel, they wanted more control over the process and felt the pilot was rushed. They also had concerns over the closure of hospital beds. NHSNYY was now taking a broader, steadier and more inclusive approach to developing a vision for services at Whitby Hospital. Once this vision had been established, then the buildings and estate would be tailored to support the delivery of services in accordance with this vision. Ms Brown cited the example of Selby where the development of new healthcare facilities took some ten years. She added that the existing building had its problems – NHSNYY had recently invested some £1M to address major problems in the fabric of the building to enable services to continue to be provided from the premises. Ms Brown admitted that NHSNYY had tended historically to present proposals and potential solutions for Whitby as a fait accompli, but through the new Clinical Commissioning Group and new relationships this entailed, this work had to be done differently, with the public consulted earlier in the process, and the proposals opened out for discussion. The Chairman then invited Sarah Wyatt of Whitby Hospital Action Group (WHAG) to address the Committee and put questions to Ms Brown and Dr Van Dam. Ms Wyatt agreed there was a need for a much wider forum to include patients and other stakeholders to discuss the development of services at Whitby Hospital. The Chairman welcomed Ms Brown’s recent letter to the Whitby Hospital Action Group requesting a meeting to consider this issue. However, Ms Wyatt felt there were still questions which NHSNYY needed to answer about Whitby Hospital: for example, why did NHSNYY decide against investing in the theatres at Whitby Hospital?, what will be the fate of the Minor Injuries Unit? why was the decision made to close the operating theatre? In respect of the latter question, Mr Hayward, Director of Facilities at SNEYHT agreed to meet with WHAG to explain in detail the clinical reasons for closing the theatre. Dr Van Dam explained that the new Clinical Commissioning Group would be developing its vision over the coming months, but he agreed with Professor Mascie-Taylor that given the increasing number of older people with long term conditions, the model of care needed to change from the current very expensive scenario of patients with relatively simple medical needs taking up hospital beds. Mr Proctor, the Deputy Chief Executive of YTHFT which now ran Whitby Hospital, acknowledged that there needed to be more clarity, honesty and better communication between patients and NHS managers, but he also called for a break with the past, and a focus on developing improved healthcare facilities in Whitby. He identified four basic elements of the debate: what do patients want?, what do patients need?, what can be afforded?, and what is the clinical view about what is possible? It was the latter that was changing through the Mascie-Taylor report and other developments. The evidence needed to be presented and then discussed with stakeholders. There would not always be agreement – there remained an element of interpretation and judgement – but there needed to be honesty and transparency in the debate. Various suggestions were then made about how services could be improved at Whitby Hospital. Reference was made to problems in accessing healthcare facilities for Whitby residents because of distance from other hospitals and deprivation. In reply, Mr Proctor reiterated that he saw a bright future for Whitby Hospital, but by providing clinically appropriate services such as rehabilitation which could take pressure off other hospitals in the area. A further question was: who would be leading on the public engagement in the strategic review of health services in Whitby? NHSNYY or YTHFT? Ms Brown replied that the Clinical Commissioning Group would be taking the lead, which has to demonstrate how it has fulfilled its obligations to engage the public, to higher standards than NHSNYY has previously had to meet. The Chairman thanked all speakers for their contributions.
RESOLVED that:
(i) the report be received;
(ii) Ms Brown and representatives of the Clinical Commissioning Group be invited to the meeting on 23 November 2011 to give a progress report on the strategic review of services at Whitby Hospital and public engagement in this process; and
(iii) Messrs Proctor and Hayward be invited to the meeting on 25 January 2012 to give an update on the integration of YTHFT and SNEYHT.