The Director of Performance and Corporate Affairs, West Leicester Clinical Commissioning Group (WLCCG) submits a report on Planned Care Policies. The report explains that the Planned Care Policies enable the Clinical Commissioning Groups to prioritise their resources using the best evidence about what is clinically effective and to provide the greatest proven health gain. The Committee is asked to receive the report and comment as it sees fit.
Ket Chudasama, Director of Performance and Corporate Affairs, West Leicester Clinical Commissioning Group (WLCCG) submitted a report on Planned Care Policies. Mr Chudasama presented the report and explained that the Planned Care Policies enabled the CCGs to prioritise their resources using the best evidence about what is clinically effective and to provide the greatest proven health gain. Following the review, it was agreed that 49 of the existing 51 policies would not be changed, 2 of the existing policies would be changed (Hip and Knee Replacement and Male Circumcision) and 50 new policies would be introduced. The committee heard that a small number of patients who would have received treatment a year ago, would now not receive a procedure, where it was deemed it was not right for them to have it.
The Chair stated that due to time pressures, she would send in some questions after the meeting. Dr Feltham CC also said that he had a detailed question which he would submit by email. The Chair explained that responses to questions would be sent out with the minutes of the meeting and would therefore be in the public domain.
The Chair referred to engagement events and expressed concerns that the one she had attended had been held in a back room and she did not consider such engagement events to be meaningful.
During the ensuing discussion, questions and comments were raised which included the following:
· Councillor Waller asked what coverage there had been in the press as she had not seen anything in her local newspapers in Rutland. The Director said that he would check with his CCG colleagues to make sure this was happening in the county and Rutland.
· It was questioned whether there was still a matter of choice; if so, people would be able to go outside of the area for certain treatments. The Director said that they intended to work with all providers to make it clear what the referral guidelines and thresholds were. There were some clinical reasons why the treatments for certain patients, based on the threshold, had little benefit.
· The committee heard that strong concerns had been expressed that Ear Wax Removal was listed as one of the new policies being introduced. People who required a hearing aid, needed to have ear wax removed prior to the aid being fitted. Dr Tim Daniel, Public Health Consultant responded that the situation would need to be managed for those people who required a hearing aid.
· A request was made that the wording of the Gynaecology Policy be changed as the reference to the ‘female parts of the body used to make babies’ was patronising. Mr Chudasama apologised for the wording used and said that this would be looked at.
· A Member commented that the policy was over complex; there were too many policies and it would be preferable for it to be in smaller more manageable sections. A request was also made for consultations on the policies to take place in those clinics where people attended for their appointments.
Mr Chudasama responded that half of the policies were already in existence and they had considered implementing the other polices in smaller sections, but the view of the clinicians was that it would be easier to implement this way. They were trying to introduce the policies as straightforwardly as possible, but they also had to ensure that they were workable and clear as to when someone did or did not meet the threshold.
· Members asked to see the Equality Impact Assessment (EIA) particularly in relation to women, older people and the LGBT community. There was also a concern that a withdrawal of some of these services could have a psychological impact on the patient. Mr Chudasama noted the request for the EIA to be brought back to the committee.
· A question was raised relating to the training of GPs, including locums. Mr Chudasama explained that they were engaging with local clinicians and there were monthly meetings with GP groups, but in relation to secondary care, they did need to make the reasons clear why a patient was being referred back to primary care if that patient did not meet the threshold.
· A Member asked how much consultation had taken place with East Leicestershire and said that there were three major areas in Rutland where people needed to know what was happening. Mr Chudasama explained that they had presented at a GP Reference Group; one of their colleagues was from Rutland and had been involved in the process, along with other GPs. Their governing bodies had been supportive.
· A comment was made that the system was inequitable as some people who were now denied treatment under the NHS would go privately; but others could not afford to pay. A request was made for this to be addressed. The Chair commented that she hoped this would be drawn out in the Equality Impact Assessment.
The Chair drew the discussion to a close and asked Members to submit any further questions, which would be forwarded on for a response.
1) that the committee have concerns about some of the wording in the Gynaecology Policy and seek assurances as to how that will be rectified;
2) that the committee note that the Planned Care Policies document is complex with numerous different policies and express a hope that engagement can be broken down to make it more meaningful for service users. The committee however also recognise that there was a reason why it was considered easier to implement all the policies in one go;
3) that the committee express concerns relating to the continuity of care and the application of policies across different postcodes;
4) that the committee want to see a full Equality Impact Assessment to include impacts on mental health. The committee are of the view that a procedure might not be needed medically but any impact on a person’s mental health should allow for some discretion in the way the policy is applied;
5) that the CCG ensure that GPs and locums are fully trained and where treatments cannot be provided in the settings where they are, that primary care provide the treatment, particularly in relation to patients who require ear wax removal prior to having a hearing aid fitted; and
6) that Members of the committee be given the opportunity to submit further questions with responses to be sent out and included in the minutes.