Agenda item

Improving Health Services in Dulwich and the Surrounding Areas – stakeholder list for consultation is attached

5.1  The chair noted the consultation documents on Health Services in Dulwich, as well as the thorough list of organisations to be consulted with. Representatives from the Southwark Clinical Commissioning Group (CCG)  introduced themselves : Rebecca Scott, Programme Director- Dulwich ; Andrew Bland , Managing Director CCG; Robert Park - non executive director, PCT, and shortly to be a lay member of the CCG,  as from the 1st April. The team distributed printed colour versions of the brochure of the consultation plan (as in the agenda pack).

5.2  The Programme Director said that amendments to the consultation plan have been done following suggestions received at the January meeting, and the consultation plan is on the website, as agreed. She explained that a marketing company it targeting 300 outlets. In addition to this there has been a direct mail to 800 organisations, and many of these are being following up, if it is indicated that they serve particularly important groups, such as communities that are more excluded.

5.3  The programme is targeting three important groups: those that need short term interventions, women who are pregnant and families and people with long term health conditions. The consultation document provides a table of things that the CCG want to see provided, but this will not be all in one place. The Programme Director explained that there are two main options: Option A is more centralized with back up from GP practices; Option B devolves more services to larger GP practices. She explained that if Option B is followed the CCG would want to increase equality of access.  The Programme Director ended by saying the CCG think these options will work well, but if people have other ideas we want to hear them.

5.4  A member asked how people could suggest other options and the Programme Director explained that if people make suggestions at events this will be an opportunity to explore issues; for example transport. The Managing Director added that there is a case for change as the CCG is spending too much. He explained as long as people make suggestions that fit within the needs of spend and clinical safety then they can be considered.  The commissioners emphasised that points made during the consultation need to reflect the needs of the whole population.

5.5  A member complemented the consultation document by noting how easy and clear it was to read. He said it was one of the best he had seen. He queried if there was an existing bias, and noted that Option B has more ticked boxes. The Managing Director clarified that this numerical detail does not add weighting and that both are deliverable; there is no preferred view.

5.6  A member asked if the blood taking (phlebotomy) service was an efficient use of resources at Dulwich Hospital and the officer responded it was used at full capacity. The chair asked for detailed figures.  The Managing Director commented that members are right to raise the issue of efficiency of services like this and that some practices supplying phlebotomy services struggled to break even. A member commented the aim is surely to lure people away from hospitals and queried if efficiency is the most important question? The commissioners agreed that they are trying to encourage people to use community settings, but efficient use of resources is a key issue. A member said in his view the Dulwich Hospital is the most viable site, however he thought that we need to get community buy in.

5.7  A member asked if the site will be owned by the new NHS Prop co [NHS Property Services Ltd]. The Managing Director confirmed that it would be in April.

5.8  A member commented that a majority of his constituents are very happy with devolved services, as the Acute Hospital can have very long waits. A member asked why the consultation document plays down Dulwich Hospital’s already central role, and asked why the CCG are not clearer about the services presently being delivered there. He noted page 43 mentions Dulwich Hospital, but the list does not mention Dulwich Hospital under ‘Health Centre’ on page 44. The Programme Director said the CCG do make clear that this is the only viable place for the Health Centre. A member asked if the CCG can make that clearer in the future? The Managing Director agreed, with the small caveat that if a site search later revealed another site then the CCG would consider that; but he said that this is very unlikely.

5.9   A member asked if there is a risk that the NHS Prop Co. could dispose of the site? The Managing Director responded that this is very unlikely as the CCG have existing services there, and in any event this would be subject to consultation with scrutiny and others. A member raised the risk that a ‘nasty capitalist controller organisation’ could get hold of this data and see that there was no mention of Dulwich Hospital, and then use the efficiency argument to look at other sites. The Programme Director said given that Dulwich Hospital sits right in the middle of Dulwich a better location is very unlikely. The lay member added that he is local, with connections, and given the importance of the site to the community this would be resisted.

5.10  Members asked about the cost implications of investing in bricks and mortar. The Managing Director explained that a Health Centre would cost slightly more – but the CCG can do both options. A member asked if people will still need to go to King’s, for tests such as scans? The Managing Director responded that there will still be some things that are too expensive to be devolved at local level, such as complex procedures or tests that involve expensive machines.

5.11  A member asked about the coordination of services delivered in the community, for example older people are often being cared for by other older people at home. She voiced concerns about the level of coordination. The Managing Director commented that there is an integrated pathway for frail and elderly people. He acknowledged that it does need development, but emphasised its existence. Members asked if this can be monitored. The Managing Director noted that this consultation will not cover everything and that the CCG do need to think about skills and workforce redesign. The member responded that this is a new development and care in the community requires enormous time and resources from friends and families. She asked where the CCG would find additional resources and reported that people are feeling the impact of community care.

5.12  A member commented that her GP practice (Paxton Green) was one of the last to reorganise and she now finds it very inaccessible. She reported that it used to be possible to easily get an early appointment. The Managing Director responded that this surgery is in Lambeth, rather than Southwark, and GPs are commissioned by NHS Commissioning, rather than the CCG. He said that the CCG do, however, collect comments and can influence the delivery of GP practices.

5.13  The chair commented that at the start of the administrative year he does want to do a review of GPs. He reported that he too has received complaints from constituents, both of GPs and the GP patient complaint process. Another member supported this and commented that he used to be able to get an appointment on the same day, and now you can wait 8 to 9 days.

5.14  A local resident, Elizabeth Rylance Watson, commented that there are no flyers about the Dulwich consultation on the ground. She reported that she did receive the consultation plan at a consultation event, but received no follow up information. She added that there is nothing on the notice board outside the Dulwich Hospital, or on the door of the closed library. She also reported that she went to the well attended Southwark Pensioners Forum and they raised concerns about the consultation period of three months.

5.15  Another resident, Kenneth Hoole, commented that he thought the plan was a propagandist document and not an outcome of an open consultation. He described the document as photographic and typographical bling: as if produced by Saatchi and Saatchi. He said that the proposals were hand me downs from the old PCT, and said that there are pre-existing plans for practices to be located there , in the proposed option of a Health Centre at Dulwich, including Dr Shama’s surgery. He mentioned a private meeting that he was concerned about.  He said that the plan makes no mention of respite care, and there is little about mental health. He said that there were flaws and gaps in the consultation plan, and he viewed this as deliberate, and that the plan was following a managerial agenda. He ended by saying he considered the slot at the end for alternative views could not remedy the emphasis on monopoly views.

5.16  The Managing Director said he would provide a response in writing to the committee on these points and reported that the CCG have already responded to many of the points already. The chair asked Kenneth Hoole to provide a written copy of his presentation, which he agreed to do, after making any amendments, to avoid the risk of litigation.

RESOLVED

Southwark Clinical Commissioning Group agreed to provide an update on:

• The numbers of people using the Dulwich Hospital phlebotomy service, with a brief comment on its capacity and efficiency.

• An update on the integrated pathway for frail and elderly people, with a particular comment on coordination of care and support for carers.