Agenda item

Michael Wilson, New CHD Review Programme Director and Jon Gulliver, Local Service Specialist, Specialised Commissioning - East Midlands will attend the meeting to provide an update on the Congenital Heart Disease Review and answer members questions.  A copy of a presentation is attached.

Michael Wilson, New Congenital Heart Disease (CHD) Review Programme Director and Jon Gulliver, Local Service Specialist, Specialised Commissioning - East Midlands attended the meeting to provide an update on the Congenital Heart Disease Review and answer members’ questions.  A copy of their presentation was previously circulated to Members with the agenda.

In addition to the comments set out in the presentation notes, Mr Wilson, made the following observations:-

a)         External consultants, Dialogue by Design, had been commissioned by the NHS England to receive the responses to the consultation, analyse the response and produce a report, which had been published on 2 March 2015.

b)       There had been 373 responses, from both organisations and individuals. The responses were mixed with approximately a third disagreeing with the proposals, a third agreeing and a third either not knowing or neutral to the proposals.   Differing views were expressed by organisations to those expressed by individuals.  The responses were currently being analysed to see if these differences in responses could be explained. 

c)         Although the presentation was giving a high level overview; the questions in the consultation had been aimed at testing whether the proposals were appropriate and, if not, what could be done to improve them.

d)         NHS England had not yet formally considered its own view on the outcome of the consultation.

e)         Approximately half of the responses were from patients or families of patients and approximately 20% of responses were from 18 year olds or under.

f)          There were growing numbers of adults with a CHD and these numbers would continue to grow because of the success of the service.  The service would, therefore, need to develop to keep pace with the increase in future demand and the likelihood of more patients requiring complicated forms of treatment as they grew older.

g)         Most of the comments relating to teams of 4 surgeons undertaking 125 operations a year expressed views rather than indicating whether they were for or against the proposed standard.

h)        Concerns about access to other services were also expressed as CHD patients often had other health conditions which required treatment.

i)          In relation to the proposals for co-location, it was understood that it may take time to relocate services and this was reflected in the proposed standards.

j)          After the responses had been analysed, the Clinical Advisory Group would be asked to determine if the standards were appropriate or needed to be revised, whether any new evidence required the standards to be amended and whether any of the comments that didn’t specifically relate to the proposed standards raised any issues which needed to be considered further.

k)         Recommendations would then be made to the NHS England Task and Finish CHD Group and, following this, the proposal would go through an internal assurance process with the aim of the submitting the final proposals to the NHS England Board meeting in July.  If this was not possible, it would be considered at the September Board meeting.

l)          Commissioning models would then be designed for the standards specifications with the aim of commissioning services from October 2015 to March 2016 and services being in place from April 2016 onwards.

m)        Work on the review in public has been paused during the pre-election period and it is intended to use this time for internal preparatory work and for the existing centres to work on their responses to the issues now asked of them by NHS England.  

During the presentation Members made the following comments:-

a)         The Commission’s original submission to the IRP had also highlighted regional variations in demand which had resulted from catchment areas being ill-defined.  This resulted in patients in Northamptonshire travelling to centres in the south, rather than to Leicester.

b)         It was felt that the flows from catchment areas were determined more by consultants referring patients to other centres rather than the NHS determining that all patients in a catchment area should be referred initially to the local centre.

c)         The consultation process had not been considered to be fully representative, as the consultation had followed a conventional approach. There had not been any specific targeted consultation with specific communities or hard to reach groups.

d)         The Chair had raised similar issues at the meeting in Birmingham and had commented that, whilst local government was used to engaging in widespread consultation methods to reach all parts of the community, the NHS were more used to undertaking conventional consultation methods.  It was suggested that the NHS should engage with the Local Government Association in future major consultation exercises to address these shortfalls.

e)         There was a responsibility for public bodies under equal opportunities legislation to consult all groups in the community and, as half of the population of Leicester were from BME groups, it was surprising that targeted or pro-active sampling of these communities was not considered.

In response to questions made by Members of the Commission during the presentation, Mr Wilson commented that:-

a)         The issue of defined catchment areas had been recognised as an issue in the consultation documents, and differing views had been received, which required further consideration.  It was recognised that the rules on competition were at variance with those on collaboration and centres were expected to undertake both.  Views had also been submitted that there was sufficient case work for all surgeons in all the centres to achieve 125 operations per year if the NHS determined catchment areas for each centre.  Trusts had also been asked to see how proposals to establish regional networks rather than a network based upon a single hospital could be achieved.

b)         There were current variations in number of operations per year carried out by each surgeon.  These varied from 70 - 200.  There was a view expressed in the consultation that different complexities of operations should be weighted differently and not equally as at present.  The Clinical Advisory Panel had been asked to look at this aspect again.  Originally it was considered that there did not need to be a different weighting for each operation as there would be a natural mix of complexities undertaken by each surgeon.  However, as this issue had been raised frequently during the consultation, it was felt appropriate to reconsider the original viewpoint.

d)         It was recognised that the older and more experienced surgeons were carrying out more operations than less experienced surgeons, and, whilst there was no pressure being expressed to reduce these numbers; it had been suggested that mentoring of younger and less experienced surgeons by the more experienced ones should be considered.

e)         It was recognised that not all providers of Congenital Heart Services would meet all the standards as currently proposed.  The standards were seen as being aspirational and all services would be improved when the standards were eventually met.  Currently, communications with patients and better management of end of life care could be improved.

f)          The issues of not receiving care closest to the place where the patient lived were well understood.  However, this issue was likely to remain whichever model was chosen.

g)         The responses from BME communities to the consultation were not as high as it was expected to have been.  Material in various languages was made available during the consultation process.  Members’ comments were noted and would be referred back to the group responsible for engagement.

h)        An Equality Impact Assessment had been carried out and was available to the public on the website.        

Kate Shields stated that the Review had made Leicester look at the provision of children’s services on one site and whilst the de-minimus limits were good; a network solution would be needed to achieve the best service outcomes in Leicester.

RESOLVED:

That the presentation be received and Mr Wilson be thanked for his responses to Members questions.