Agenda item

Jacqui Tuffnell, Head of Commissioning at NHS Rotherham Clinical Commissioning Group (CCG) gave the following short presentation outlining the rationale for change to the respiratory pathway, what was being proposed and the plans for engagement.

Why do we need to make changes?

• Poorer outcomes for our patients than our counterparts across the integrated care system (NHS Right Care data)
• Fragmentation across the respiratory pathway
• Fragmentation of the home oxygen service
• Improve diagnosis across Rotherham – accreditation needed for spirometry testing
• Improvement the management of respiratory patients
• High numbers of patients going into hospital – for example other areas support patients with low level pneumonia at home
• Longer stays for patients when they are in hospital
• Long term plan states care should be provided closer to home

What changes are proposed?

The development of the enhanced respiratory pathway has been a clinically led process, developed in line with best practice and the clinical benefit for patients has been at the forefront of discussions

The enhanced model for respiratory includes:

• Standardising the care across primary care for diagnosis and management – engagement on what this should look like.
• Improving patient education and access to support patients to self-manage – including digital options/apps
• Delivering care closer to home, with a specialist community respiratory team, reducing the requirement for inpatient care
• Delivering care during the day, at evenings and weekends to fit in with patients’ lives
• For those who do require inpatient support a dedicated respiratory unit at TRFT
• Increased support for high intensity users to help stabilise their conditions

Service user, carer and stakeholder engagement

Patient and public and stakeholder engagement on the proposed changes is scheduled throughout September and will be via the following forms:

• Surveys, online and paper
• Face to face drop in sessions across Rotherham, including breathing space – different days and times so working population also have opportunity to be involved
• Mjog (Memory Jogger) text messages to patients, aimed at those with a specific respiratory condition
• Media messages
• Animation – to follow

The intention is to try and involve the wider population of respiratory patients, not just the 20% who particularly use Breathing Space.

Next Steps

• Incorporate engagement responses into the business proposal
• Governing body 2 October 2019/ Trust Board
• Commence recruitment to the new structure

The following issues were raised and discussed:-

·         Mjog

– Mjog or Memory Jogger was a well-used texting system from GPs for sending reminders and messages, for example to alert people about flu jabs.  It would be used to inform a large number of people about the engagement sessions.

·         Current relatively poor outcomes - to what extent was there still a legacy from the old mining industry?

- Not so much now and there had been changes in smoking habits associated with that, but respiratory conditions were still growing.  It appeared to be linked more with how the pathway actually worked.

·         What was the scale of the poor outcomes for our patients and being worse than counterparts?

- It was significant enough to need to do something because as well as poor outcomes Rotherham had the highest spend in relation to respiratory across South Yorkshire.  The main areas were in relation to pneumonia care but also COPD management.  It was around 10% difference with spend about 30% more.  A slide pack with all the information could be circulated to Members. 

·         Improving patient education and access – would this include prevention as well as self-management?

- Regarding prevention, other work had taken place in relation to smoking cessation, in particular through the QUIT programme which secondary care were on board with, including in the hospital.  Smoking cessation was within the Public Health team as well and would be looked to see how it could be enhanced as part of this programme.  My COPD on the app would support patients in terms of whether they were doing things that were unhelpful.  Having more dedicated support from the respiratory specialist community nurses and physiotherapists within the communities would definitely support them to remain in the community as well.

·         Face-to-face drop-in sessions – would these be in any particular locations or would they be borough-wide?

- These had all been planned to take place at Breathing Space but Members were invited to suggest other locations.

·         Rotherham Show – would the NHS have a presence at this?
- The materials were not quite ready.

·         Timeline and length of the engagement, as once live it would only really be two weeks.

- During September the surveys would go online with messages through Mjog to people on how to access them.  Sessions were planned during the whole of September to inform the pathway.  Something was needed in preparation for winter in relation to respiratory care, hence it was important to engage but also to get on with implementing a model as described.  The clinical model needed to be right, so the timeline included the winter period.  Ideally there would be more engagement and the comments would be taken on board and if it was felt that the CCG had had insufficient input during that time they would be prepared to extend the process.

·         When would success measures be seen for whether the changes were of benefit, as presumably one of those would be to save at least the 30% of current spending?

- The pathway focused on improving outcomes, which was the reason for the changes proposed, whilst anticipating that those efficiencies would be made.  The slide pack to follow would say that 12 months after implementation significant improvement was expected in order to achieve the same level as our peers.

·         Clear information was requested to show what the CCG expected that significant improvement to look like.

·         Would Rotherham Hospital and other health premises such as doctors' surgeries have a presence or information?

- Literature would go out to GP practices as well as using Mjog but as Public Health TV was quite difficult to change information would not be on there.

·         Would this link in with the Rotherham Health App in terms of people being able to access the services through that mechanism?

- Absolutely.

·         What changes had resulted from the relocation of inpatients from Breathing Space to the hospital for their care?

- Patients were relocated to the main hospital site a number of months ago due to some patient safety measures that needed to be put in place.  The Trust had issues with sickness within Breathing Space and within the acute hospital and had to rationalise the nursing team to ensure safe patient care was provided.  This was separate to the pathway review and until the review had been completed had not been identified as a permanent position.

·         The Chair requested that the consultation materials be shared with the committee.

Resolved:-

1)    That the Health Select Commission note the information provided regarding the proposed changes to the respiratory pathway.

2)    That the following be provided for the Commission:

- the slide pack;

- consultation materials;

- animation;

- success measures for the pathway.