Provision of Adult Thoracic Surgery in South Wales Mid-Point Review

Transcription

1 Provision of Adult Thoracic Surgery in South Wales Mid-Point Review Status For Review Version Number 1.0 Publication Date 27th July 2018 V rd July

2 Contents 1. Introduction Context Consultation Plan Stakeholders Scope of Consultation The Consultation Document Methods of Engagement Responding to the Consultation Mid Way Review Responses to date Key Themes Demographic Profile of Respondents Public and Staff Event Schedule Risks Actions arising from the mid-point review: Post consultation Phase Appendices

3 1. Introduction This paper sets out the progress to date against the plan for public consultation on the proposal to locate a single adult thoracic surgery centre at Morriston Hospital in Swansea serving patients from South East Wales, West Wales and South Powys (throughout the document this will be referred to as South Wales ). The public consultation plan for the proposed centre have been developed in collaboration with the local health boards (LHBs) in South Wales, and have also involved input from the third sector and Community Health Councils. 2. Context WHSSC is a Joint Committee of the seven Local Health Boards (LHBs) in Wales. The seven LHBs are responsible for meeting the health needs of their resident population, and have delegated the responsibility for commissioning a range of specialised services to WHSSC. Specialised services generally have a high unit cost as a result of the nature of the treatments involved. They are a complex and costly element of patient care and are usually provided by the NHS. The particular features of specialised services, such as the relatively small number of centres and the unpredictable nature of activity, require robust planning and assurance arrangements to be in place to make the best use of scarce resources and to reduce risk. Specialised services have to treat a certain number of patients per year in order to remain sustainable, viable and safe. This also ensures that care is both clinically and cost effective. Thoracic surgery is one of the specialised services that WHSSC commissions for the people of Wales. For patients living in north Wales this service is provided by Liverpool Heart and Chest Hospital NHS Foundation Trust. This is one of the largest thoracic surgical centres in the United Kingdom, with six consultant surgeons, serving a catchment area that spans across the north west of England and North Wales. Patients in the north of Powys access the thoracic surgery service at Heartlands Hospital, Birmingham, which has recently become part of the University Hospitals Birmingham NHS Foundation Trust. By contrast, in South Wales there are two smaller services based at Morriston Hospital, Swansea and the University Hospital of Wales, Cardiff. The service at Morriston has two consultant surgeons, whereas the service at the University Hospital of Wales, has three consultant surgeons. There has been concern for a number of years that these two smaller services are not sustainable, and may not be able to fully meet the needs of the population of South Wales. A Project Board was established to form recommendations on the future provision of adult thoracic surgery in South Wales. The Project Board was informed by a review of the adult thoracic surgery services which was undertaken by the Royal College of Surgeons. Following an extensive 3

4 engagement exercise across South Wales, in which the views of service users and other stakeholders were sought on the information required in order to make a recommendation on the future provision of thoracic surgery services in South Wales, the Project Board recommended that a single thoracic surgery centre should be developed for South Wales. Following the recommendation from the Project Board, an Independent Panel was convened to review the options for locating the centre and to make a recommendation on the preferred location for the single thoracic surgery centre. The Independent Panel recommended that Morriston Hospital should be the location for the proposed single adult thoracic surgery centre. The recommendation from the Project Board and the recommendation from the Independent Panel were considered and endorsed by the WHSSC Joint Committee for further consideration by the six affected health boards, subject to further discussions with the Community Health Councils about the need for public consultation. Following the discussions with the Community Health Councils, it was agreed that the affected health boards, with assistance from WHSSC, should be asked to consider undertaking a formal public consultation in which they would ask the public, staff and interested organisations for their views on the recommendations of the Independent Panel to locate the single adult thoracic surgery centre at Morriston Hospital. 3. Consultation Plan A consultation plan was developed in collaboration with health board engagement leads and WHSSC to support the consultation process. An Equality Impact Assessment (EqIA) was also completed and used to inform the consultation plan and the stakeholders that should be consulted in the proposal. This is attached as appendix 1. In order to assess the demographic profiles of respondents the hard copy and online versions of the consultation document include a series of survey questions in multiple choice format Stakeholders There are a number of stakeholders that have been considered in this consultation and a variety of methods which employed. The table below outlines the stakeholder groups together with a high level summary of the consultation actions and responsibilities being undertaken. General public Health boards will be responsible for undertaking consultation with the general public in their area. This will include public sessions held across each health board. Details of planned activity will be available on the consultation web page and also available on individual 4

5 Patients, their families and carers NHS Wales Community Health Councils Third Sector Organisations National bodies/organisations including Professional Societies and Royal Colleges concerned with the delivery of Thoracic Surgery Local authorities and elected representatives Assembly Members and Members of Parliament health board websites. Particular consideration will be given to providing opportunities for the engagement of people with protected characteristics who the Equality Impact Assessment has identified may be impacted by the proposal. Health boards will be responsible for undertaking consultation with patients, their families and carers within their area. The Equality Impact Assessment has highlighted that the number of cases of thoracic surgery increases with age, peaking in the age group. It also highlighted that someone from the most deprived section of society is nearly twice as likely to develop lung cancer, as someone from the least deprived section of society. Therefore, particular consideration will be given to patients, families and carers with protected characteristics including older people and those with low socioeconomic status people. This will include staff working across the NHS in South, West and Mid Wales. Health boards will undertake consultation with their local Community Health Council. WHSSC will engage with Third Sector organisations through the Wales Council for Voluntary Action on behalf of health boards, and health boards with Third Sector organisations through local County Voluntary Councils. A list of national bodies/organisations will be developed and a copy of the consultation pack sent to these organisations by WHSSC on behalf of health boards. It is proposed that the national bodies will have an open invitation to attend any of the consultation events across South Wales. Health boards will send a copy of the consultation pack to the Local Authorities, and leaders within the area. It is proposed that an open invitation will be extended to elected representatives to attend any of the consultation events across South Wales. WHSSC will send a copy of the consultation pack will be sent to all Assembly Members and Members of Parliament across South Wales, on behalf of health boards. It is proposed that an open invitation will be 5

6 Other stakeholders extended to elected representatives to attend any of the consultation events across south Wales. Health boards will consult with groups in line with the Guidance on Engagement and Consultation on Changes to Health Services. As a minimum this will include: Stakeholder Reference Groups Healthcare Professional Forums Partnership Forums Public Services Boards And any other groups which are part of the Health Boards processes for ongoing engagement 3.2 Scope of Consultation To ensure the consultation process is meaningful, consideration was given to key messages to be shared with the public and the evidence available to support the proposed development of a single adult thoracic surgery centre at Morriston Hospital, serving patients from South Wales. In light of the key messages, the consultation is asking people to respond to two questions: 1 The Independent Panel recommended that the adult thoracic surgery centre serving patients from South and West Wales and South Powys should be located in Morriston Hospital Swansea. Do you agree or disagree with the proposal? 2 If we develop the adult thoracic surgery centre for South East and West Wales and South Powys in Morriston Hospital in Swansea, what are the important things that you would like us to consider about the planning and delivery of the new service? 3.3. The Consultation Document A main consultation document, response form and covering letter has been written by WHSSC and formally approved by Health Boards at their meetings in June. The Consultation document is also available in an Easy Read format. 3.4 Methods of Engagement Alongside the main consultation document the following methods for sharing information have been employed: Website A web page for the consultation has been created via WHSSC at the following address: There is both an English and Welsh web page and a short film has been produced outlining the key elements of the consultation. 6

7 Public Sessions Across the consultation period there are a number of planned sessions led by health boards in each region. This will provide the opportunity for staff, stakeholders and the wider public to provide feedback on the proposals in the consultation document. 3.5 Responding to the Consultation Individual and collective responses are being captured using the following methods: Hard Copy via a FREEPOST ADDRESS via a generic mail address Online 4. Mid Way Review The rest of this document will review the responses received to date and inform the discussion around the need to make any adjustments to the consultation for the remaining period. As of 26 th of July 130 responses have been received with the majority being online responses. Each individual response has been compiled into a spreadsheet which is being shared weekly with health boards. Where notes from staff or public events have been provided these have also been captured and included within the analysis and consideration of FAQ s but not recorded as an individual responses. 4.1 Responses to date In response to the question The Independent Panel recommended that the adult thoracic surgery centre serving patients from south and west Wales and south Powys should be located in Morriston Hospital Swansea. Do you agree or disagree with the proposal? 38 or 29.2% agree with the decision. 83 or 63.8% disagree with the decision. 7 or 5.4% neither agree nor disagree with the decision. 2 or 1.5% did not answer the question. 7

8 The Geographical Profile of Respondents based on LHB of residence together with their response to the recommendation of the Independent Panel is: Agree Disagree Not Answered Neither agree nor disagree Grand Total LHB of Residence n. n. n. n. ABM AnB C&V CT 2 2 HD NA Powys Grand Total The response method used is Response Method: With detail of Health Board of Residence Hard Copy Online Grand Total ABM AnB C&V CT 2 2 HD NA PT Grand Total Respondent Type Overall Not specified NHS Employee Organisation Elected Representative % % 48.46% 3.08% 0.77% 8

9 4.2 Key Themes A number of themes have been identified when analysing the responses the 5 most common being represented in the table below: Key Themes Identified (Top 5) n. Accessibility & Travel 58 Major Trauma Centre 51 Benefit of single large centre 14 Concerns with loss of expertise and ability to recruit 12 Patient Safety 11 Co-Location with the Major Trauma Centre is the most cited single reason for disagreement with the decision of the Independent Panel. 47 of the 51 respondents citing major trauma location are in disagreement with the recommendation of the Independent Panel Patient safety, speed of response and disagreement with the rationale represented in the consultation document are the most common sub themes. A smaller number of respondents raise the question of interdependencies with other services such as neurosurgery and radiology As with the public engagement exercise in the autumn of 2017 accessibility and travel represent the single largest theme in responses. Sub themes in this category include availability of parking, public transport and distance/time of travel. The number of responses from staff of Cardiff and Vale 70 represents the largest respondent type in terms of LHB of residence with 44 of the 70 respondents indicating they are NHS employees. There is a strong regional bias in terms of agreement with location of the Thoracic Surgery unit. 4.3 Demographic Profile of Respondents All versions of the consultation document contain a series of questions designed to review the reach of the consultation. The responses to each question are listed in the tables below: Where a demographic profile is significantly over or under represented when compared to demographic information available from Census or StatsWales sources a RAG indicator has been applied with red being significantly under and green being significantly over. 9

10 Do you identify with the sex you were assigned at birth? % n. Not answered 10.77% 14 Prefer not to say 6.15% 8 Yes 83.08% 108 What sex are you? % n. Female 47.69% 62 Male 37.69% 49 Not Answered 10.00% 13 Prefer not to say 4.62% 6 What is your ethnic group? % n. Any other ethnic group 1.54% 2 Asian or Asian British 6.92% 9 Black, African, Caribbean, or Black British 0.77% 1 Not Answered 10.77% 14 Prefer not to say 5.38% 7 White 74.62% 97 Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months? % n. na 11.54% 15 No 70.77% 92 Prefer not to say 4.62% 6 Yes, limited a little 7.69% 10 Yes, limited a lot 5.38% 7 10

11 What is your sexuality? % n. Gay or lesbian 3.08% 4 Heterosexual or straight 78.46% 102 Not Answered 9.23% 12 Prefer not to say 9.23% 12 What is your religion? % n. Christian (all denominations) 46.92% 61 Hindu 5.38% 7 Muslim 0.77% 1 Not Answered 9.23% 12 No religion 29.23% 38 Other 0.77% 1 Prefer not to say 7.69% 10 Are you a Welsh speaker? % n. Not Answered 10.77% 14 No 73.85% 96 Prefer not to say 5.38% 7 Yes 10.00% 13 Are you a carer? % n. Not Answered 12.31% 16 No 71.54% 93 Prefer not to say 5.38% 7 Yes 10.77% 14 11

12 4.4 Public Event Schedule Public events have been arranged throughout the consultation period and a schedule has been published on the WHSSC website.. A weekly exception report has been agreed which is sent to each Health Board Engagement Lead to provide details to WHSSC of any deviation from the published schedule. At the time of the mid-point review there was no deviation from the published schedule or the broader consultation plan. 5. Risks A Risk register has been developed for the consultation exercise and will continue to be reviewed and updated throughout the course of the consultation. It is attached as appendix 2 6. Actions arising from the mid-point review: Addition of a new FAQ relating to the requirements of the Major Trauma Centre for emergency support from consultant thoracic surgeons Addition of a new FAQ relating to the lay membership of the Independent Panel To ensure work is undertaken to provide outline arrangements for delivering Thoracic Surgery support to the Major Trauma Centre (for the small number of cases where this may be required). This information will be included in the evidence pack that will be submitted to Boards with the consultation outcome. 7. Post consultation Phase WHSSC will continue to receive and log responses to the consultation. This information will be shared with health boards and the CHC s for consideration and response. Responses will be analysed by WHSSC and themes identified. All responses will be provided verbatim but anonymised and demographic information redacted. A report will be produced which will include the findings of the consultation, details of how responses have been considered and where these have influenced the proposal. This will be considered by health boards in their public Board meetings in the autumn. 12

13 7. Appendices Appendix 1 EqIA Appendix 2 Risk Register 13