Previous meetings-Welcome to Sheffield Save Our NHS
Changing the Balance - A 2020 Vision of Health and Social Care in Sheffield; (Health and Wellbeing Board) The notes of the first 2020 vision meeting in May are at https://www.sheffield.gov.uk/caresupport/health/health-wellbeing-board/what-the-board-does/events/engagementevent.html
Wednesday 12 August 2015, 10am – 12pm / Wednesday 16 September 2015, 6 – 8pm at The Circle, Rockingham Lane, S1 4FW
Friday 4 September 2015, 1 – 3pm at Medical Education Centre, Northern General Hospital, Herries Road, S5 7AU
There is a growing crisis in primary care - which is commissioned by NHS England not the CCG. Surgeries in Beighton and Westfield have been earmarked for closure although the latter (following the imminent retirement of the well-respected single practice holder) is still subject to consultation and protests are developing (Nov 14)
Sheffield Clinical Commissioning Group have decided to work with Sheffield Teaching Hospitals NHS Foundation Trust as the primary provider for a new commissioning for musculoskeletal services. They considered there was no need for competitive tendering. This is an important step in preserving NHS provision in Sheffield.
At the May meeting we asked the CCG how much had been spent on legal advice. We have now received the answer - The amount spent on legal advice in 2013/14 was £161k. The amount spent on legal advice relating to competition legislation was £2.3k. Fortunately this is a relatively small amount.
Sheffield Councilhave begun a competitive tender for Supported Living Services including Learning Disability Services currently provided by Sheffield Health and Social Care NHS Foundation Trust. This appears to be for financial reasons rather than quality issues because of overspending last year. The process opens up the services to organisations like Care UK, where support workers transferred from the NHS last year are on strike against serious worsening of their pay and conditions. Sheffield Unison (?Community Health Branch) has been leading a campaign against this. The tenders are now in and the Council is consulting formally with users of the services about what is on offer.
Sheffield NHS meetings
Sheffield Clinical Commissioning Group-
business meeting in public 4th December 2014 4pm - 5.30pm
722 Prince of Wales Road Sheffield S9 4EU - This meeting will discuss the Stevens 5 year forward view: read it here.
The web page also links to details about other consultation events for Adult Social Care
Sheffield Healthwatch, the Sheffield branch of the national patient watchdog on health and social care. http://www.healthwatchsheffield.co.uk/
Information Hub at The Circle, 33 Rockingham Lane, Sheffield, S1 4FW. The hub is on the ground floor of The Circle building with an internet connected computer which can be used, free of charge, by anyone wanting to find information on health or social care.
Cardiology Diagnostics + 24 hour ECG; (overall value £325,000pa) "high quality 24-hour tape ambulatory cardiology diagnostic services in a community setting across Bassetlaw, Barnsley, Doncaster, Rotherham and Sheffield as part of an integrated pathway of diagnostics and care. Providers will have responsiblity for an element of the adult cardiac pathway to investigate those at low risk who might have cardiac pathology. "
Carpal Tunnel; (overall value (£800,000pa). "To provide a community carpal tunnel treatment service to provide an accessible, prompt, comprehensive and confidential service whith increased patient choice on treatment options." This is a new service as such.
Flexible Sigmoidoscopy. overall value (£221,000pa). "A more responsive and local service model with the overall aim to provide routine, clinically appropriate diagnostic flexible sigmoidoscopies that help primary care clinicians manage a range of conditions commonly seen in the primary care setting and which do not need secondary care. The provider might wish to use existing endoscopy suites or provide new ones (which must meet the regulatory standards). The service may be mobile."
Was NHS Sheffield consulted by STHFT over its plans to centralise older people's health care at the Northern General Hospital? Was any consultation undertaken with older people on this specific proposal
1. NHSS was fully aware that STHFT have been reconfiguring the services provided across the two hospital sites (RHH and NGH), which started in the summer of 2010. NHSS was approached to respond as part of the formal consultation process. This has also enabled the creation of a centre of excellence for stroke care and the introduction of ‘hospital at night’ service at the Royal Hallamshire Hospital, both of which have had significant patient benefits.
The centralisation of elderly care services at the Northern General Hospital site is part of the reconfiguration. The NGH site is where the majority of older patients are admitted, either through A&E or the Medical Assessment Units, and where the specialist services they need are located.
We know that older people generally prefer to receive care, if possible, in their own homes. According to STHFT over £3m has been spent to provide substitute non-hospital care. Has this been spent by STHFT or NHS Sheffield? Is this primarily home-based care or does it include a residential element? What effect has it had on reducing the number of people in hospital who are classed as not actually needing to be there? Is there an evaluation of whether the substitute health care being provided in the community is at a level acceptable to older people and their carers and if so what are the results?
NHS Sheffield is working in partnership with Sheffield Teaching Hospitals NHS Foundation Trust (STHFT), the local Authority, Sheffield Health and Social Care NHS Foundation Trust (SHSCFT) and GPs to implement a strategy which results in the right patients being cared for in the right place at the right time and in the most efficient way. In addition to the 2011/12 programme, NHS Sheffield, STHFT, SHSCFT and Sheffield City Council have committed to a longer term transformational programme for Urgent Care that will develop the capacity and capability of community services to reduce avoidable admissions and to support the shortening of length of stay where clinically appropriate.
The strategy is predicated on delivering as much care as possible in the community, either in or closer to patients’ homes, and only admitting patients to hospital when it is clinically necessary to do so. Currently at any one time there are up to 150 patients in the City’s two adult acute hospitals who no longer require acute hospital care. Sheffield also has some of the highest rates of admissions for vulnerable elderly patients and many of these stay well beyond the national average length of time in hospital. By improving discharge arrangements, community or nursing home support and rehabilitation we can reduce the reliance on hospital care.
As part of the implementation of this strategy there is a joint plan this year that includes a range of initiatives to reduce delayed discharges and avoidable admissions, including:
These initiatives are being supported by over £3million of investment in 2011/12 from NHS Sheffield and will support the reduction of bed capacity at the hospital with additional services and intermediate care beds. The alternative services in the community will also be led by highly skilled nurses and Allied Health Professionals with the back up of GPs and Community Geriatricians.
It is too early to confirm that the combined efforts of the above schemes have produced a sustainable reduction in avoidable longer stays in hospital, but there are encouraging signs that the number of reported delays are reducing. In addition some of the investment this year is going into existing services (Community Intermediate Care Services as an example) that have already evaluated very positively in reducing length of stay and improving patient outcomes and experience
20th of July, 2011
A SHAKE-UP of community mental health services in Sheffield is set to be introduced by bosses as they work to cope with a 10 per cent cut in funding over the next three years.
Sheffield Health and Social Care NHS Foundation Trust is consulting with people who use the Community Mental Health Teams in the city. But they have been criticised for the short notice given to people of meetings organised. Meetings took place yesterday and Monday, with another planned for today but people only received letters informing them last Friday or Saturday.
The proposals centre on the creation of four separate Community Mental Health Treatment teams in the south east, south west, north and west of the city. These would replace the eight community mental health teams that work in the city. The Sheffield Out Reach Team – for people with complex care needs – is also set to be reduced from dealing with around 160 people to around 100 in 18 to 24 months’ time. Health chiefs hope the four teams will provide greater continuity of care, which can be delivered where people need it. Staff would also work later with a centralised out-of-hours team in place to take over once the teams finish at 8.30pm. Bosses have pledged there will be no redundancies as a result of the reconfiguration but have suggested a reduction of around 15 members of the teams as a result.
Sean Colliver, aged 50, a service user from Lower Shiregreen, said: “It will provide better continuity of care, more focused in the area where it is needed”
Jane Barrell, 54, who is supported by the Hillsborough team to help her manage her schizophrenia, said: “Nobody likes change, but the in the bigger picture it is going to happen. “If they localise the service, it will be able to come to your home and that will make it a lot less intimidating for the patient.”
Sue Sibbald, 48, of Norfolk Park, who lives with borderline personality disorder, said: “My worry is that there is nothing for me now, there will still be nothing for me and if there are less staff, there might be less for others.”
Douglas Macdonald, whose son uses mental health services in the city, slammed the consultation exercise – criticising the short time frame given.
Clive Clarke, executive director at the trust, said: “We need to make our services as efficient and effective as possible in a time of reducing resources. “The trust does have to make cost savings and there will be some reduction in the overall numbers of staffing, but until the consultation period has been completed, we cannot be more specific. There will be no redundancies. As we are reorganising services rather than ceasing provision of them, we are not required to conduct a three-month public consultation and therefore we are currently holding a one-month external consultation.” He said staff talks would be held after the consultation before any changes are made
NHS Sheffield answers to questions to the NHS Sheffield Board 5 July 2011 from Sheffield Save Our NHS
GP CONSORTIA AND LOCAL COMMISSIONING ARRANGEMENTS
In Appendix 1 of item 9 of the Board papers, the governance structure chart at 31 March 2011 shows 10 committees under the NHS Sheffield Board; the proposed governance structure for 31 March 2012 (appendix 4) shows 12 committees under the NHS Sheffield Board. Will this represent an increase in cost from 2011 to 2012 and if so of what order? Under the now to be amended Bill how many bodies or committees for commissioning will there be in Sheffield from April 2013?
The proposals are subject to change and would be provided within the financial envelope.
As at 31 March 2011 there were 10 committees of the Board but by March 2012 it was proposed these would be streamlined to five committees.
How will the operation of these various bodies be supported administratively, professionally and managerially? Who will be the employer of the staff who will be needed?
The Health & Social Care Bill proposes that PCTs and SHAs will be abolished by 31 March 2013. The commissioning support, both managerial and transactionally, that Clinical Commissioning Groups require, will be delivered in a number of ways. First, CCGs will be able to directly employ staff who have the necessary skills to support the commissioning process. It is not envisaged this would be for all the commissioning functions. Much of the transactional type functions, such as IT, HR, Informatics, planning, could be provided by Commissioning Support Organisations. These would be developed by the clusters of PCTs to provide services across a range of CCGs. Finally, some of the residual functions of PCTs, such as primary care contract management and specialised service commissioning, would be undertaken by the NHS Commissioning Board and some of the PCT staff associated with these functions could be aligned to the NHS B.
Over the last 12 months (apart from the transfer of Provider Services) what staffing reductions have there been within NHS Sheffield in preparation for implementation of the Health and Social Care Bill? What further reductions are planned? How will the consortia replace the considerable expertise that has been allowed to leave the PCT under VR? Will this mean that some of these people released under VR will need to be re-employed?
PRIVATE PROVIDERS AND PRIVATE PATIENTS
What are the amounts and proportions of the NHS Sheffield budget which have been used to commission healthcare service from private sector providers during the last three years?
The table below provides information on spend with independent providers in the last three years.
Spend with private providers
Total NHS Sheffield spend
% of total spend
* all primary care contractors are non NHS providers. However, we have not included them as private sector providers, with the exception of services provided at the new city centre GP led health centre which covers services for walk in as well as registered patients. For information, the total expenditure on services from GPs, Opticians, Dentists and Pharmacists is shown below:
What are the current caps set in Sheffield for private patients in Sheffield hospitals and how is this situation predicted to change if the Bill is passed?
Private Patient Income (PPI) caps are set at individual trust level. Section 15 of the 2003 Act requires that the Trust’s proportion of private patient income in relation to its total patient related income does not exceed that same percentage whilst the Trust was an NHS Trust. The table below shows the caps and recent figures for the three main NHS providers in Sheffield.
PPI Cap Proportion
Actual PPI 10/11 proportion
Actual PPI 09/10 proportion
As shown above, the % of private patient income for both Sheffield Teaching Hospitals (STHFT) and Sheffield Children’s (SCFT) is small. Sheffield Health and Social Care Trust (SHSCT) do not have any private patient income.
The PPI caps are a relatively low percentage cap compared with most other hospitals. This reflects the specialist element of each of the Trusts’ services as well as the existence of Thornbury and Claremont Hospitals in close proximity who tend to dominate the mainstream private patient market in Sheffield. The STH PPI tends to occur in niche services, such as Stereotactic Radiosurgery, Assisted Conception and Sheffield Vision Centre (mainly laser eye surgery).
Given that STHFT are significantly below their cap, and they have no notified strategic intention to increase its proportion of PPI, the removal of the cap is not anticipated to have a significant impact. SCFT are closer to their cap and so removal of the cap might have a small impact, but we have not been notified of any strategic intention for the trust to increase its proportion of PPI.
PATIENT AND PUBLIC INVOLVEMENT
What is this year’s predicted NHS local spend on patient and public involvement (excluding council commissioning of the LINK) compared with the last two years? What service reductions in this area of work have taken place in any part of Sheffield’s health services?
This year (April 2011-March 2012) NHS Sheffield is planning to spend approx. £50k on patient and public involvement consultations and engagement. This is broadly in line with what has been spent on consultation exercises in previous years.
We have made a number of changes to the patient and public involvement service this year, however this involves only a small reduction in work. In line with Transforming Community Services, which aimed to ensure that NHS Sheffield’s primary focus was on commissioning rather than service delivery, NHS Sheffield transferred the patient information and advice service and volunteering service to Sheffield Teaching Hospitals (we did this through contracting and still pay for the service), a limited advocacy service that had been provided in some GP practices ended at the end of March, and the Expert Patient Programme transferred to the Public Health directorate at NHS Sheffield.
We cannot answer your question for the whole of Sheffield’s health services – other Sheffield NHS organisations will be able to help with the response to this question for you.
During the transition period and beyond, how will the proposed changes to commissioning deliver greater choice for patients and more involvement in their care, when consortia are likely already to have decided from which of the ‘any willing and qualified providers’ they will purchase services?
The Department of Health is currently developing guidance on the application of the Any Qualified Provider (AQP) policy following the recent “listening exercise”. At the moment AQP is a process to accredit providers for particular services and does not offer a guarantee of activity. We expect that new CCGs will be able to accredit a variety of AQPs.
Existing contracts with local NHS trusts have different expiry dates but all with a maximum notice period of 1 year and hence CCGs will have the ability to influence where services are purchased from in the future.
Below is an email from Nick Clegg's office to one of our list supporters who has had exchanges of correspondence with Clegg and attended his "listening" meeting.
Thank you for your further comments on the NHS. Your comments have been duly noted with interest. I am very proud of the influence that the Liberal Democrats have exerted to change the Government's NHS plans. It is now clear that the proposals to be taken forward are dramatically different to those originally proposed. And more improvements will emerge as the Bill returns to the Committee Stage for re-examination and passes to the Lords for detailed scrutiny and further revision inthe autumn. There is also much more work to be done during the implementation process.
What will actually happen in your area will be crucially determined by the new local clinical consortia. The consortia will be publicly accountable bodies with lay representation answerable to the wider community through Health and Well Being Boards. Consortia practice will bescrutinised not only by the local council but by new powerful local organisations called Healthwatch.
As you are genuinely interested in the future of the NHS, I would urge you to consider this information and to consider applying to join your local Healthwatch when it is set up. You can help to ensure that we get things right in your local area.
With the Bill kicked into a committee with a built in coalition majority, the government amendments are going through. Labour's attempt to keep the duty of the Secretary of State to provide health services was kicked out on Thursday.
The government is proposing a lot of changes to the Bill but it it is difficult to tell how significant they are. The search is more for a form of words which will satisfy both the Right and the Lib Dems than for any sensible vision of how to go forward. Lansley has always said that presentation is the main issue at stake. The proposed local changes are a dog's breakfast and seem likely to cost even more than the present management system. And the latest news is that government will bring back Strategic Health Authorities after all!
During the committee stage, publicity seem to have died down. The result of the 38 degrees poll on what should be done next was to keep the NHS as top priority but do other campaigns as well, their recent circulations have been on the other campaigns. We need to keep the pressure on.
Clive Peedell, co chair of the NHS Consultants Association, has been a vociferous opponent of the entry opportunities which the reforms will bring for private companies. The meeting will be a vital opportunity to help disentangle the government's smokescreen and develop the arguments which we will need to deploy as the Bill goes to the Lords. Maybe the adopt a Peer idea (circulated last week) isn't such a bad idea.