Chase Farm Paediatric Assessment Unit Engagement and Consultation Report
Background A Paediatric Assessment Unit (PAU) opened at the Chase Farm site in November 2013 as part of the reconfiguration of local hospital services known as the Barnet, Enfield and Haringey Clinical Strategy. The PAU Chase Farm Hospital is open from 9am-9pm, every day. The service is led by a Paediatric Consultant supported by nurses and is co-located with the Urgent Care Centre. It sees and treats children between 0-18 years old who have minor illnesses, injuries or a worsening long-term condition like asthma. The PAU at Chase Farm is not a self-referral unit. Ninety-four per cent of children attending the Chase Farm site are managed within the Urgent Care Centre, with very few children referred across into the PAU. Access to the PAU is usually through a patient s GP who requests a referral to the service or via a clinician at another service, such as the Urgent Care Centre. The PAU also provides telephone advice to local GPs. There are also PAUs at Barnet Hospital and North Middlesex Hospital. Both these hospitals have Accident and Emergency departments as well as paediatric hospital beds for children who need to be admitted.
PAU Review In 2015 it was noted that admissions to the had been consistently low, and a review of the unit was agreed prior to Commissioning Intentions being published in September 2015. A group to review the PAU was established in July 2015, chaired by the CCG Paediatric lead, and including clinicians and managers from RFLH, CCG Commissioners, and a representative from local Health Watch. The Local Authority was also invited. The focus was on gathering evidence including: A data review of the service including an analysis of the numbers of patients using the service and the types of cases seen A discussion about care pathways Engagement with member practices about the changes including the review of a GP survey conducted after one year of the Chase Farm PAU being opened. There was consensus that the PAU in its current form is not viable. There was an initial discussion about the PAU at the PPE event on the 9 th September 2015. 3
Commissioning Intentions 2016/17 Every year Enfield CCG publishes Commissioning Intentions which describe which current services it intends to review and consider decommissioning or develop and improve over the next year. In October 2015, Enfield CCG published our Commissioning Intentions for 2016/17. The Commissioning Intentions describe the key services that the CCG wishes to prioritise, commission or review in the coming year to respond to the health needs of our local population. In the Commissioning Intentions for 2016/17 Enfield CCG stated that starting from 1 April 2016, it intended to review the usage and model of care of the Paediatric Assessment Unit at Chase Farm Hospital.
An alternative model? Following the publication of the Commissioning Intentions, the review group continued to meet, and it was agreed that the following option would be explored as alternative model of care to the current PAU service at the Chase Farm site. Children with urgent care needs would still be seen and managed within the Urgent Care Centre; Some children may require a transfer to Barnet Hospital or NMUH for more specialist paediatric inpatient care and those transfers would continue as they do now; However, there will be some children who would benefit from seeing a paediatrician but who do not have immediate needs. Those children could be given access to an urgent outpatient appointment within two weeks. GPs and clinicians in other services such as the Urgent Care Centre will be able to refer into the service, following discussion with a paediatrician. A quality impact assessment and an equality impact assessment (EIA) was undertaken on these proposals and the EIA was published alongside the consultation document.
Health Scrutiny Following the development of the proposal, and discussions at the Clinical Reference Group, the Chair of Enfield CCG attended the Health Scrutiny Panel on 9 March 2016 to discuss the CCG s alternative proposal. The following context was provided: Since the Barnet, Enfield and Haringey Clinical Strategy finalised changes to local hospital services in 2013, the new Older People s Assessment Unit and the Urgent Care Centre at Chase Farm have been well utilized with good numbers of attendance. In comparison, the PAU has consistently low figures and the numbers of attendances are dropping. The PAU provides a service for children to be seen and treated by consultants, referred by their GP or who are unable to be managed within the Urgent Care Centre. However, on average, the unit receives only 2-3 patients a day and as a result, specialist staff and resources are not being utilized efficiently. Enfield CCG invests 409,000 a year in the PAU. Ninety-four per cent of children attending the Chase Farm site are managed within the Urgent Care Centre, with very few children needing referral across into the PAU. Enfield CCG confirmed with the Health Scrutiny Panel that the CCG would be conducting a 90 day public consultation on the alternative proposal.
Pre Consultation Before proceeding to Public Consultation it was agreed to get some feedback from the general public about the proposal, with particular focus on urgent health care, and preferences if a child is unwell, and an engagement exercise was agreed over the summer of 2016. There was a discussion at the PPE Event on 20 July 2016 Dates for Parent and Child Focus Group were circulated but no interest was shown There was a discussion with GPs at a Locality Commissioning Meeting There were 30 response to an on-line survey The response to proposals was broadly positive. The on-line survey indicated that the parents or responsible adult would prefer to take a child to the GP in the first instance, but if unwell out of hours then the majority would take their child to the Urgent Care Centre (UCC) nearest to their home. For this reason 53% would chose the UCC at Chase Farm Hospital. The outcomes of the pre consultation were discussed at the Enfield CCG Governing Body meeting on the 21 September 2016 and it was agreed to commence the Consultation.
Consultation launch The consultation launched on 17 October 2016. The following actions were taken to advertise the consultation as widely as possible: The Consultation was hosted on the CCG s website. Adverts were placed in the local newspaper and in Our Enfield The CCG wrote letters to our key stakeholders including: partner organisations such as Enfield Council, Healthwatch Enfield and local NHS organisations, patient and voluntary sector groups and political representatives such as MPs, Councillors and the Health Overview and Scrutiny Panel. The letter gave details of the consultation launch and how to get involved, including an offer to attend meetings on request. Events were organised for Wednesday 9 November, Thursday 8 December and Wednesday 11 January Both the CCG and the Royal Free regularly tweeted about the consultation.
Online survey feedback Question 1
Online survey feedback Question 2 Which GP practice are you registered at? Locality North west South west North east South east There were 94 responses to this question. The majority of respondents were patients at practices that are closest geographically to Chase Farm Hospital.
Online survey feedback Question 3
Online survey feedback Question 4
Online survey feedback Question 5 If you are not sure, or you disagree, please tell us why. There were a total of 81 responses to this question. The answers to this question have been categorised under the following headers. Some answers included more than one comment, so have been assigned to more than one theme. It s really important to have access to a paediatrician at Chase Farm 6 responses Barnet and North Middlesex Hospitals are overloaded 23 responses PAU at Chase Farm is offering a good service 17 responses North Middlesex and Barnet are not convenient / Concerns about travel time 11 responses Two week wait not acceptable 16 responses Too many closures at the Chase Farm site 12 responses Have used/been referred from the Urgent Care Centre 7 responses Decommissioning the PAU will put children s health at risk/quality concerns 23 responses Too many cuts are being made for financial reasons 10 responses Concerns about how the two week wait will work and what it is 2 responses Will the UCC at Chase Farm be able to cope/level of paediatric skills 8 responses More education needed on minor illnesses and injuries where to take a sick child 1 response
Online survey feedback Question 6 Please add any other comments you would like to make. There were a total of 37 responses to this question. The answers to this question have been catagorised under the following headers. Some answers included more than one comment, so they have been assigned to more than one theme This is adding barriers to accessing care 1 response I can t get a GP appointment so this service is needed 1 response Two week wait is too long 2 responses Travel issue with going to Barnet or North Middlesex 4 responses North Middlesex and Barnet Hospitals too busy 7 responses Chase Farm is being asset stripped and concerns about new housing on this site 5 responses Money could be better spent if the centre is under-utilised - 2 responses Children need a local specialist paediatric service 12 responses The NHS is underfunded, leading to these cuts 2 responses Chase Farm PAU offers a good service - 2 responses Could the centre be better used or publicised? 4 responses
Online survey feedback Question 7 Please tell us your date of birth Age Range 0-18 19-30 31-40 41-64 65+ There were 83 responses to this question. One was invalid. The corresponding numbers are: 0-18 4 respondents 19-30 9 respondents 31-40 - 35 respondents 40-65 33 respondents 65+ - 1 respondent
Online survey feedback Question 8 Please tell us your gender Gender Female Male There were 94 responses to this question. 89 people declared themselves female and 5 male.
Online survey feedback Question 9 How would you describe your ethnic origin? Ethnic Origin White British British Afro Carribbean White other English Greek Cypriot White European Irish Mixed White Asian Other Chinese
Online survey feedback Question 10 Do you consider yourself to have a disability? There were 93 responses to this question. One person stated that they had a disability.
Online survey feedback Question 11 How would you describe your sexual orientation Sexual orientation Heterosexual/ Straight Bisexual Not completed There were 67 responses to this question. 63 declared themselves as straight, 3 as bisexual and 2 people did not declare.
Online survey feedback Question 12 What is your religion or belief? Religion Christian Atheist Buddhist Humanist Muslim N/A
Consultation Event 1 Wednesday 9 November The two people who attended were supportive of the proposal and thought rapid access outpatients were a good idea. It was noted that the 111 service could be improved. Also that GPs working in primary care and at the front end of the Urgent Care Centre are part of a network of support. GPs are trained and experienced in assessing and treating children. Concerns raised about consultant to consultant referrals. These referrals were allowed when the issue related to the same condition/speciality.
Consultation Event 2 Thursday 8 th December This event was held at Community House, in Edmonton. Only one person attended this event, despite it being widely advertised and at an accessible and popular venue. The feedback given by the person attending is that as the PAU has a low number of attendances, it would be better to disinvest in this service given the financial deficit and to support other existing services.
Consultation Event 3 Wednesday 11 th January 31 women attended the third meeting which was held in a children s centre where there was a wide ranging discussion. There was concern about the proposal to decommission the PAU and provide an alternative model of care on the Chase Farm site. Few people had used the unit, and it was felt the issue might be lack of publicity about the services offered, although it was explained that was not felt to be the issue, particularly as it is not a self referral unit. The pressures on the North Middlesex Hospital, which was the closest hospital for most of the women, and the difficulties in accessing GP services, were the main issues of concern.
Summary Online Consultation The online consultation was completed by 101 people. Some of the feedback indicated that there is confusion about how patients access the PAU at Chase Farm. It is primarily a GP referral unit, but the majority of respondents had experienced the PAU by being referred through the Chase Farm Urgent Care Centre. The majority responses to the consultation were in favour of keeping the current model of care. This could be directly linked to the respondents experiences of the current services. Concerns were raised about travelling times, quality of care, the future of services at the Chase Farm site, the two-week outpatient appointment times and the demand at Barnet and North Middlesex Hospital. These were understandable comments, given that parents and carers had already accessed the Chase Farm PAU and had a preference to use the unit again.
Summary Actions to take Whatever decision is taken on the future commissioning of the PAU at Chase Farm, a communications and engagement plan will need to developed post-consultation to explain the outcome with a focus on the services available for children at the Chase Farm. The patient education comments could also be taken forward, with information for parents and carers on minor illnesses and injuries and what services they can access including: pharmacy, GP, NHS 111, outpatients, Urgent Care and A&E. As some of the feedback was about the Chase Farm Urgent Care Centre and not the PAU it will also be important to explain the relationship between urgent care, PAU and A&E. Also as the very sickest children are already being directed to Barnet and North Middlesex in case they need to be admitted to hospital, the location of children s inpatient services will need to be communicated.