MIU – ERYC responds

 

As we await the verdict in March over the future of our Minor Injuries Unit this is the response of the East Riding of Yorkshire Council’s Health, Care and Wellbeing Overview and Scrutiny Sub-Committee Response to East Riding of Yorkshire Clinical Commissioning Group’s Urgent Care Services Consultation

Local people care passionately for and value their local NHS services and this has never been more so recognised than during this consultation.  The consultation has provided a huge outcry of strong public feeling regarding the consultation options.  Representations have been made by the public to this Sub-Committee, ward, town and parish councillors, MPs, the media and GPs.  Strength of public opinion for their local services has been encapsulated by the sheer number of signatories to the many petitions established across the East Riding.  The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee can only but echo East Riding residents’ concerns and fears for their local NHS services and urge East Riding of Yorkshire Clinical Commissioning Group to give these due consideration when making its decision.

The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee do, however, understand the need for change across health and social care sector and recognise the financial challenges facing East Riding of Yorkshire Clinical Commissioning Group set against the context of the Humber, Coast and Vale Sustainability and Transformation Plan and the directive from NHS England for urgent care centres.

Proposed Options for Urgent Care Centres

Summary of Health, Care and Wellbeing Overview and Scrutiny Sub-Committee views

  • The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee agrees there is a need to standardise service provision across the East Riding and support, in principle, the creation and development of Urgent Care Centres across the East Riding.
  • The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee believes that the Urgent Care Centre guidance issued by NHS England does not differentiate between very well populated urban settings and large rural areas such as the East Riding.  The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee believes the guidance issued has been too rigidly applied by East Riding of Yorkshire Clinical Commissioning Group and is not reflective of the East Riding geography, which covers almost 1,000 square miles and population need.
  • The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee does not believe that the options consulted on provide East Riding residents with equal access to quality health and care services.
  • The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee does not feel the options consulted on meet all residents’ needs, particularly when taking into account rurality, highways network and transport provision.
  • The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee is extremely disappointed that the options consulted on were limited and, for example, did not provide any options for Driffield and the Holderness coast.
  • The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee believes that the list of 81 options used for short-listing did not consider maintaining one Minor Injury Unit (for example in Driffield or along the Holderness coast), or some other form of placed based service, whilst creating two or three Urgent Care Centres.  The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee believes this to be a missed opportunity in the pre-consultation work and consultation options put forward.
  • The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee feels the bespoke model developed by East Riding of Yorkshire Clinical Commissioning Group has not been tested robustly based on current operations and due diligence applied to provide the necessary levels of assurance.

Alternative option proposed by the Health, Care and Wellbeing Overview and Scrutiny Sub-Committee

  • That the East Riding of Yorkshire Clinical Commissioning Group maintains some place based services in the Driffield, Hornsea and Withernsea even if this means reduced hours – whether this be a Minor Injury Unit, a reduced Urgent Care Centre or something else to meet need, including seasonal variation.

This alternative provision could be funded by re-considering the way place-based services are commissioned across the system, for example in the Driffield and Holderness area (ie how community services, ambulance services, patient transport services and primary care services etc are provided).

Concerns of the Health, Care and Wellbeing Overview and Scrutiny Sub-Committee

  • The opportunity provided to better understand the modelling process was welcomed by the Health, Care and Wellbeing Overview and Scrutiny Sub-Committee but confidence is still lacking as the model used should have been tested on current financial costs, not on predicted operational costs, to ensure a truer picture.  There is therefore a lack of due diligence in the model and the Health, Care and Wellbeing Overview and Scrutiny Sub-Committee do not have the assurance that the options proposed are viable.
  • Assumptions in the model are founded on changes being made to primary care but the Health, Care and Wellbeing Overview and Scrutiny Sub-Committee heard that no firm proposals have been agreed by primary care providers.  It is evident that some primary care providers are not supportive of the proposals, even though some of these are part of East Riding of Yorkshire Clinical Commissioning Group’s Council of Members and the Health, Care and Wellbeing Overview and Scrutiny Sub-Committee believe this to be a significant challenge for the East Riding of Yorkshire Clinical Commissioning Group to overcome.
  • It would appear that the opportunity has not been taken to develop plans on the proposed options with providers given the changes on the horizon (ie new community services provider and the role of Yorkshire Ambulance Service).  The Health, Care and Wellbeing Overview and Scrutiny Sub-Committee is unconvinced that there will be the resources and skilled workforce necessary across the whole of the East Riding and that the opportunity has been missed to consider place based strategic solutions in the first instance before developing the options for consultation.
  • Whilst acknowledging that rurality has been considered by East Riding of Yorkshire Clinical Commissioning Group, the assumptions in the model show approximately 30 percent of patients will not present anywhere (due to the rural nature of the East Riding, its highways infrastructure and transport provision).  This may result in their eventual presentation at Hull Royal Infirmary Accident & Emergency, something that goes against what the options are trying to avoid.

Recommendations

  1. That East Riding of Yorkshire Clinical Commissioning Group maintains some place based services in the Driffield, Hornsea and Withernsea areas (even if this means reduced hours – whether this be a Minor Injury Unit, a reduced Urgent Care Centre or something else to meet need, including seasonal variation) by re-considering the way place based services are commissioned across the system.
  2. Providing some place based services in the Driffield, Hornsea and Withernsea are maintained then the Health, Care and Wellbeing Overview and Scrutiny Sub-Committee would then support the creation of three Urgent Care Centres at Goole, Beverley and Bridlington.

 

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