Agenda item

To receive a report from the Head of Scrutiny and Member Development providing an opportunity for the Scrutiny Board to further consider and formally respond to consultation around proposed changes to 14 Specialised Service specifications. 

The Head of Scrutiny and Member Development submitted a report which introduced the following:

·  Proposed changes to 14 specialised service areas

·  Written submission/ briefing by Leeds Teaching Hospitals NHS Trust

The following additional information was provided for the Scrutiny Board to consider (Minute 122 refers):

·  Written submission by Embrace – the specialist transport service for critically ill infants and children in Yorkshire and the Humber

The following representatives were in attendance to help the Scrutiny Board consider the information presented:

·  Laura Sherburn (Interim Head of Specialised Commissioning) – NHS England (South Yorkshire & Bassetlaw Area Team)

·  Dr Mark Smith (Chief Operating Officer – Leeds Teaching Hospitals NHS Trust)

·  David Berridge (Medical Director (Operations) – Leeds Teaching Hospitals NHS Trust)

In addressing the Scrutiny Board, the Interim Head of Specialised Commissioning (NHS England (South Yorkshire & Bassetlaw Area Team)) provide a brief reminder of the Board’s previous consideration on proposed changes to specific service specifications. 

As outlined in the paper presented to the Scrutiny Board, it was confirmed that of the proposed changes to 15 specialised service areas, it was considered appropriate that the specific impact assessments in the following areas warranted specific consideration by the Scrutiny Board:

·  Adult Cardiac Surgery Service Specification (A10/S/a);

·  Complex Disability Equipment Prosthetics Service Specification (D01/S/d); and,

·  Paediatric Critical Care – Level 2 (E07/S/b)

Members were assured there were no ‘patient safety’ issues to consider and the overall purpose of the proposed changes was to improve the quality of services; to standardise and raise the level of consistency in the provision of specialised services across the country.

Members were also assured that the proposed changes to the Adult Cardiac Surgery and Complex Disability Equipment Prosthetics Service Specifications sought to clarify and strengthen the previous specifications.  There was no indication that the proposed changes would necessitate any changes to the existing provider landscape across Yorkshire and the Humber. 

Representatives from Leeds Teaching Hospitals NHS Trust were supportive of the comments made at the meeting and confirmed that the proposed changes would not present any significant challenges to the Trust. 

It was highlighted that the Paediatric Critical Care – Level 2 represented a new specification for 2014/15 and the key impacts were highlighted as follows:

·  Potentially more patients treated in tertiary centres or Level 2 Units – although any increase in activity was unquantified.

·  Potential increase in paediatric transport activity across the region.

·  The need for more work to assess the volume of activity, in order to understand the impact of the proposed change on both the receiving and referring organisations in terms of capacity and sustainability.

·  The need for more work around the potential impact of rapid repatriation, steps on the care pathway and patient and carer choice.

·  It was not known how readily new standards relating to staffing numbers and training packages could be met. 

The issues around the potential increase in paediatric transport activity across the region and the potential impact of rapid repatriation were further emphasised by the written submission from Embrace.  However, it was reported that Embrace was well placed to absorb a moderate increase in paediatric activity, with paediatric transfers making up around one third of the total workload for the service. 

The Principal Scrutiny Adviser advised the Scrutiny Board that the Yorkshire Ambulance Service (YAS) had been invited to comment on the proposed changes to the specialised service changes and, for the majority of the proposed changes, no significant implications were anticipated.  However, in relation to Paediatric Critical Care, any increase in demand and/or journey length would need to be reflected in changes to relevant contracts.

The Scrutiny Board discussed the report and the details highlighted at the meeting.  A number of matters were raised and discussed – particularly relating to the proposals around Paediatric Critical Care, including:

·  The balance between specialisation / the development of centres of excellence and care closer to home.

·  The potential shift from clinically led services to a time led specification.

·  Assuming the revised specifications are approved, queries around the communication with parents and families in terms of what level of service should be expected.

·  The potential need for a two-stage engagement process that allows some form of ‘sense checking’ followed by more formal consultation once local impacts have been considered and assessed.

·  Any impact on the parallel process for developing the 5-year strategy for specialised services. 

RESOLVED –

(a)  To note the information presented and discussed at the meeting.

(b)  That, based on the information presented and discussed, the Principal Scrutiny Adviser draft a formal response to the current consultation around NHS Specialised Service specification, and consult members of the Scrutiny Board on its content ahead of the 21 May 2014 deadline.

(c)  That the Scrutiny Board maintain an overview of progress and, subject to the revised specification for Paediatric Critical Care (Level 2) being adopted, that a further report detailing the precise implications be presented to the Scrutiny Board at a future date.

At the conclusion of the discussion, the Chair thanked those in attendance for their contributions to the meeting.