Outcomes from the Business Case Sub Committee 8 th February 2013 Business Case Summary Committee Decision Designated Nurse Child Transfer of post from Your Healthcare (YHC) to Safeguarding Kingston CCG. Recent OFSTED report identified conflict of interest with this post being employed by YHC Comment Following actions were requested to be completed before the transfer of the post on 1 st April 2013: That the CCG explore with YHC whether agreement could be reached around the use of some the Designated Nurse Child Protection time to cover the gap left by the post transfer rather than give money to YHC for backfill That the JD be revised to reflect the commissioning needs and this is agreed by the IGC That an annual work plan for the Designated Nurse Child Protection post is agreed by the IGC and that progress against this work plan is regularly reported to the IGC Nurse Specialist Safeguarding Adults Community Neurological Rehabilitation Funding for a Band 7 Nurse Specialist to be part of the multi-disciplinary Kingston Adult Safeguarding Provision of a Community Neurological Rehabilitation by Your Healthcare. The service will provide an integrated rehabilitation and support team for people who have experienced: stroke, acquired brain injury or who have a progressive/ long term neurological condition, Need to identify funding stream Funded from reablement money 1
Community Neurology Kingston Hospital Business Cases Paediatric Phlebotomy Dermatology Inflammatory Bowel Disease (IBD) Nurse Specialist across the GP registered practice population of Kingston. The service will also include Early Supported Discharge (ESD) for patients following a stroke and therapy input into the specific step down beds currently at the Cedars Unit, Tolworth Hospital. Recommendation to mainstream the pilot service based on the option to continue with the existing GPwSi provider with a cap on referrals into the service to manage demand within the capacity. Introduction of a local tariff for Paediatric Phlebotomy of 85 per attendance. Currently charged at a Paediatric Outpatient F-up tariff of 156. To provide a telephone service for the monitoring of stable patients on Isotretinoin (used in the treatment of moderate to severe acne) rather than face to face consultations Stable IBD patients to be follow-up by a Nurse Specialist - The Nurse Specialist led clinic proposed charge will be 75 per attendance. This compares to the alternative of a consultant tariff of 124 for a follow-up. Breast s Re-design Endoscopic Retrograde Cholangiopancreatography (ERCP) Changes in the Breast to ensure that there is consistency of access and that patients are seen within the 2 week waiting time standard Kingston Hospital patients requiring ECRP are transferred to St George s Hospital. By providing this service locally patients will not have to be transferred and there will be a cost saving as the CCG will only have to fund one admission rather than the two currently Unsure why this was presented as Business Case as activity is charged for using national tariff 2
Gastroenterology Virtual Clinics Introduction of virtual clinics which will: Improve communication between the hospital and the patient and the hospital and the GP. Lead to the diagnosing and treating of patients more quickly Reduce unnecessary follow up appointments for patients who could be treated equally as well by letter correspondence. Provide cost benefit as fewer patients will be scheduled for routine follow up. Increase capacity in gastroenterology clinics for chronic patients. Tysabri Infusion Recovery of Blood Component Costs Increase in capacity for Multiple Sclerosis patients to receive Tysabri at Kingston Hospital South West London and Surrey PCT s agreed the following products to be funded at locally agreed costing levels: part Multiple Sclerosis falls under Specialist Commissioning from 1 st April 2013 Business Case should be referred to National Commissioning Board Either National Commissioning Board costs (Haemophilia) or part of Non-PbR s Factor VIIa Recombinant IFR unless agreement to fund Fresh Frozen Plasma All Indications Pro thrombin Complex All indications Factor VIII Paediatric Regular Day Attenders Paediatric Oncology and Haematology conditions To provide a regular course of treatment to children as a day attender to the children s ambulatory care close to the children s home. Paediatric Oncology falls under Specialist Commissioning from 1 st April 2013 Business Case should be referred to National Commissioning Board 3
Community Based Dietetic To provide a community based service to patients, carers and care homes which will include home visits, training and audits in order to reduce malnutrition and inappropriate prescribing of Oral Nutrition Supplements (ONS) in the community. Overall service & current investment in clinics and needs a review to determine best future pathway Anticoagulation Bridging On Patients Discharged From Care Provided by Kingston hospital NHS Trust The anticoagulation service at Kingston Hospital maybe asked to support or advice on bridging arrangements for patients whose care pathway is being managed in primary care. This is a service additional to current service agreement and may involve complex decision making and the possible distribution of fragmin. Objective of the Business Case not clear. Appears to be the existing service of taking patients of Warferin to Heparin and covered by tariff This service is unrecognised and costs associated with both the prescription and transport of fragmin are currently picked up by the Directorate of Pathology Urodynamics Provision of Specialist Nursing Team Unclear how this fits into existing pathway. This is not a new service as the Specialist Nurse already in post. Paediatric Outreach Nursing Team Review of Pathology High Cost Tests To provide nursing care, support and advice to children aged 0-18 years and their families in their home, nursery or school in order to optimise health outcomes, reduce length of stay and prevent hospital admission whenever possible NICE guidance Measurement of Ca125 to support diagnosis of Ovarian Cancer. Measure serum Ca125 in primary care in women with symptoms that suggest ovarian cancer. If ovarian cancer is raised further ultrasound diagnostic tests are required 4 Local tariff for this test declined Objective of the Business Case not clear. Seems to propose conversion of current block funding to to cost and volume with no prices suggested. Rejected by committee who point out there is existing precedent for separate funding for expensive cases Screening should be provided as part PbR Tariff
Day Case Management of Hyperemesis Gravidarum Sleep Apnoea Wolverton Centre Sexual Health To have a care pathway for patients with hyperemesis that ensures effective hydration, continuity of care, reduces hospital IP admissions and flags-up cases that require more intense pharmacological treatment (e.g. steroids Establishment of Sleep Apnoea at Kingston Hospital To increase capacity and GUM access available by appointment, provide an alternative access to our current walk in service and hence a more comprehensive service to patient throughout the week. Local tariff for this pathway declined Pathway should be provided as part of ante natal service and funded through PbR Tariff Existing links with St George s Hospital work well and no benefit to add extra capacity locally commissioned by Local Authority from 1 st April 2013. discussions to date with Public Health commissioners suggest a reconfiguration of existing services rather than a provision of additional services 5