To consider a report from Leeds City Council’s Head of Democratic Services introducing an update around the West Yorkshire and Harrogate Health and Care Partnership acute care collaboration priority; the West Yorkshire Association of Acute Trusts (WYAAT) collaborative forum and the associated Committee in Common.
Further to minute 34 of the meeting held 5th December 2018, the Joint Committee received a report from Leeds City Council’s Head of Democratic Services introducing an update from the West Yorkshire Association of Acute Trusts (WYAAT).
The report included the WYAAT Annual Report 2019 which provided an outline of progress made since December 2018 alongside the ‘Our Progress and Achievements during 2018/2019’ document. An extract of the Joint Committee minutes of the meeting held 5th December 2018 was included for reference.
The following were in attendance to present the report and contribute to discussions:
- Matt Graham – WYAAT Programme Director
- Helen Barker – Chief Operating Officer, Community Health Foundation Trust
- Debbie Graham – Head of Integration and Partnerships, Calderdale CCG
- Matt Walsh – Chief Officer Calderdale Clinical Commissioning Group.
In introducing the report, the following matters were raised:
At its previous meeting on 10 September 2019, the Joint Committee had briefly considered concerns raised by dermatology patients regarding changes to services; and requested an update for early consideration. A verbal update was provided at the meeting – specifically for the Calderdale and Huddersfield NHS Foundation Trust (CHFT) area. The main points raised included:
· A Community Dermatology Service had been commissioned and recently established to deal with primary care patients initially. The development of a new service model was dependant on recruitment to the second tier consultant led dermatology provision, which remained a challenge.
· CHFT was keen to utilise the support available through the West Yorkshire and Harrogate Health and Care Partnership (WYH HCP) approach of using West Yorkshire wide resources.
· In respect of waiting lists, data collected showed an increase in referrals from Calderdale to Leeds, with Calderdale patients amounting to 22% of overall waiting lists. Predominantly however, the demand in Leeds remained Leeds based. The Joint Committee welcomed the offer to share the data with Members.
· A national review of dermatology services had identified 100+ consultant vacancies. WYAAT had therefore determined to recruit an additional consultant to the Leeds team with the intention for that post-holder to also deliver services to CHFT.
The Joint Committee
additionally discussed the following matters:
· The impact of previous service models on the uptake of training by potential consultant practioners as a factor in the deficit of consultants.
· Concern that as Trusts struggle to recruit; services could be reconfigured and as a result, patients have to travel to the centralised service rather than practitioners delivering the service in areas of need. Alternatively, in those areas where staff do deliver service between Trusts, there was a need to assess any impact on the availability of clinical appointments at the substantive location.
· Acknowledgement that first point of contact practitioners were required to enable the service to balance the spread of specialist practioners across the Trusts to ensure that service needs are met.
· The Joint Committee heard that the intended service model of making appointments to a Service Hub which would deliver across the WYH footprint would mirror the British Association of Dermatologists model of care. This would ensure that clinical consultants worked to the top of their specialism and clarified the roles of the supporting team to identify which tier provided which level of care. WYH HCP needed to create that scale of team to ensure the success of that service delivery model.
· Additionally any identified service gaps could be supported by those GPs, consultant Nurses and Clinician Associate roles keen to expand their role in dermatology, with training available to GPs to provide dermatology services and advance the case of the patient to get the right treatment. In response to comments over the availability of GP appointments and that a patient would need to be able to identify which, if any, GP in their practice had the specialism, it was reported that specialist GPs will work community wide using national criteria and technology to make the right referral but it was acknowledged that the new model still required a clinical consultant to ensure clinical governance.
· The future role of digital technology to support the service – for example, tele-medicine; whereby a patient can visit a local clinic and via video link connect to a practitioner based elsewhere.
· The structure of Dermatology Services in Bradford, and concern that although the team structure was reported to be stable, it was a vulnerable service and posed a significant risk due to it functioning under a single consultant.
The Joint Committee discussed the following issues in respect of the wider report.
WYAAT Annual Report and Programmes:
· The sustainability of the other specialisms referenced within the WYAAT Annual Report. It was noted that six programmes formed the 2 work-streams, defined by the level of challenge they represented (cardiology, urology and maxilla-facial surgery) or their willingness to trial networking (ophthalmology/gastroenterology/dermatology).
· The role of scrutiny and the Joint Committee in particular in the development of WYAAT service proposals and the mechanism to ensure an early overview of proposals. It was noted that the current WYAAT decision making model prevented an early opportunity for the Joint Committee to take an overview of any service development proposals and provide advice, if appropriate.
· The Joint Committee noted and welcomed the offer for WYAAT to report to the Joint Committee more regularly (six monthly being proposed) to help ensure proposals are presented in good time.
· Portability of staff working across the Trusts was beginning to happen where it could, such as within Vascular Services, but WYH HCP and WYAAT needed to agree the future models of care for all services. Although portability between Trusts provided staff with opportunities for training and experience, it could also alter the relationships established to ensure trust/good working practices within place based teams and this would form part of future discussions with staff.
a) That the contents of the report and discussions held at the meeting be noted
b) To note the intention for WYAAT to present update reports to the Joint Committee at six monthly intervals.
c) To receive the statistical data relating to the Calderdale/Huddersfield and Leeds waiting lists for Dermatology Services.
d) That the following be identified as matters for further scrutiny, with the requested information to be circulated to Members in advance of the next meeting:
I. an overview of the Networks
II. the timescales for delivery of the WYAAT priorities.