Meeting documents

To consider a report by the Transformation Programme Lead for the Adult and Community Services Forward Together Programme (attached).

The Committee considered a report providing an update on the work of the Task & Finish Group - Clinical Services Review (CSR).

The Chairman of the Task & Finish Group presented the report and explained that the Group had spent much time learning and listening from the public and from the NHS commissioners and providers.  A great deal had been achieved from these meetings and he thanked those involved for their input.  He confirmed that, as a result of the two meetings, a clear explanation for some of the issues had been provided. 

The Dorset Clinical Commissioning Group (CCG) had listened and had answered the Group's questions that arose following the meeting with the public representatives.  This had ultimately led to the recommendation outlined in the report and it was important to keep talking and to trust the committee to work on a way forward to achieve what the public wanted.

In future it was anticipated by the CCG that ambulance times to the Royal Bournemouth Hospital (RBH) would be much quicker due to the major road improvements in that area and that this would assist in reducing ambulance journey times. The Group had also been promised that the Swanage ambulance station would remain open 24/7, fully manned with ambulances. There were also additional new ambulance vehicles in the pipeline for Dorset.

The Chairman of the Group emphasised that the NHS needed to improve and that this would come about by some of the changes proposed in the CSR.  The £147m funding for PGH and RBH would be essential elements in improving care for residents across the whole County.

The Group therefore recommended to continue to negotiate with the CCG to do what was right and to make the case on behalf of residents.

Following the introduction, the CCG Chief Officer read from a statement which is attached as an annexure to these minutes.  In summary, he highlighted the following points:-

·            All parties acknowledged the financial pressures and the unsustainability of the current system. 

·            Dedicated NHS staff were going above and beyond to provide services that were not sustainable.

·            The CSR plans had been backed by NHS organisations in Dorset and were underpinned by the Sustainability and Transformation Plan approved by local authority partners in Dorset.

·            Centres of excellence and care closer to home would improve patient care and was an evolutionary process that could not be implemented until such time safe services were in place. 

·            That the CSR plans had been subject to various governance process, including the Dorset Health Scrutiny and Joint Health Scrutiny Committees. 

·            That further work was ongoing with the South Western Ambulance Service NHS Foundation Trust (SWAST) in relation to ambulance travel times and that the focus of the CSR concerned getting a patient to the right place the first time and dedicated emergency care on one site with a 24/7consultant led service. 

·            33,000 patients currently attend A&E where there was no consultant on site.

·            That paramedics may spend a significant time providing medical assistance on scene to give patients the best chance of survival. 

·            Some of the original proposals in the CSR had subsequently been revised. 

·            That the 7 grounds for the Judicial Review had been dismissed and it had been confirmed at that time that the CCG had acted on the grounds set out by Parliament.

·            The assertion that the consultation results from Weymouth & Portland had been grouped together with West Dorset was unfounded as Weymouth & Portland had its own set of consultation results.

·            That CCG officers lived in Dorset and used NHS services.  The CCG wanted to ensure high quality services were in place in future, but there were no easy solutions and some courageous decisions would be required in order to move forward.

At the Chairman's discretion Debby Monkhouse addressed the Committee and showed evidence of an NHS presentation showing a travel time of 47 minutes to DCH and 57 mins to RBH. She also advised that an FOI request by Langton Parish Council had shown a journey time of 1 hour 45 minutes.

She explained that the crucial issue was the South Western Ambulance Service NHS Foundation Trust (SWAST) report and that further review by a wider group of clinicians who had requested more time to access hospital records had not been completed.

The meeting was adjourned for a short period at this juncture.

Councillor Ireland, who was a member of the Task & Finish Group, commended Councillor Bryan on his chairmanship.  He had not been able to attend the last meeting, but had listened to a recording and concluded that no new information had been provided that would change his mind.  The Committee had resolved to refer the CSR proposals to the Secretary of State in November 2017 and many councils in the Dorset area had requested that the Committee made such a referral. The CCG was an unelected body, and councillors were the elected representatives and the only recourse against the outcome of the CSR. He considered that councillors would be failing in their duty to represent the people to their detriment. He proposed that a referral to the secretary of state was made, however, the Monitoring Officer advised that such a proposal would negate the report recommendation and that in order to support a referral to the Secretary of State that members should simply vote against the report recommendation.  In the event that the Committee resolved to make a referral then there needed to be a clear basis on which the referral should be made.

Councillor Alison Reed suggested the ambulance times and moving care closer to home in the context of the large loss of community beds as relevant areas.

The CCG Chief Officer stated that SWAST supported the proposal as a way of reducing transfers between the PGH and RBH.  Poole would remain a vibrant community hospital that would continue to provide a variety of services as well as DCH.  The travel analysis had been undertaken by a private company with no vested interest in the outcome

Members highlighted that community hospitals had already been shut with no alternative provision in place including the imminent closure of Wareham Hospital in 2 weeks' time and no commitment for services on Portland.  Members were therefore supportive of deferring some of the changes until alternative provision had been identified.

Members asked whether there would be additional funding for the DCH A&E Department under the proposals. The Chief Executive of DCH advised that the increase in footfall at DCH A&E had been recognised and a capital bid had been put forward to extend the department, the outcome of which would be known the following month.

Councillor David Walsh left the meeting prior to the vote being taken on this item.

In accordance with Standing Order 44, the votes for and against recommendation 1 were recorded as follows:-

For (4): Bill Pipe, Ray Bryan, Kevin Brookes and Bill Batty-Smith

Against (6): Beryl Ezzard, Nick Ireland, Peter Shorland, Alison Reed, Peter Oggelsby, Mike Lovell

Abstain (0)

Following the recorded vote, it was agreed that recommendation 3 was no longer valid. A vote on recommendation 2 was taken by a show of hands.

Resolved

1.      That the CSR proposals be referred to the Secretary of State for Health and Social Care for the reasons outlined below:-

• concern that the travel times by the South West Ambulance Service NHS Foundation Trust have not been satisfactorily scrutinised and that the evidence needs further investigation to the current claim that these travel times will not cause loss of life.
• no local alternative to the loss of community hospitals given Dorset's demographic with its ageing population and how that service will be delivered.

2.      That the Joint Health Scrutiny Committee hosted by the Borough of Poole to undertake the work requested in relation to the ambulance service be convened as soon as possible.