Professor Steven Broomhead Chief Executive Town Hall Sankey Street Warrington WA1 1UH Co-opted Members: Statutory Co opted Members Roman Catholic Representative: Mr D Littlewood Church of England Representative: Mr S Harrison Parent Governor Representative: Vacancy Parent Governor Representative: Vacancy 20 January 2014 Scrutiny Committee Tuesday, 28 January 2014 at 6.30pm Council Chamber, Town Hall, Sankey Street, Warrington, WA1 1UH Agenda prepared by Julian Joinson, Principal Democratic Services Officer – Telephone: (01925) 442112 Fax: (01925) 656278 E-mail: [email protected]A G E N D A Part 1 Items during the consideration of which the meeting is expected to be open to members of the public (including the press) subject to any statutory right of exclusion. Item Page Number 1. Apologies for Absence To record any apologies received. To: Members of the Scrutiny Committee Councillors: Cllr T Higgins - Chair Cllr B Lines-Rowlands - Deputy Chair Cllrs C Fitzsimmons, G Friend, J Guthrie, L Hoyle, W Johnson, I Marks and H Mundry
Transcript
Professor Steven Broomhead Chief Executive
Town Hall
Sankey Street Warrington WA1 1UH
Co-opted Members: Statutory Co opted Members Roman Catholic Representative: Mr D Littlewood Church of England Representative: Mr S Harrison Parent Governor Representative: Vacancy Parent Governor Representative: Vacancy 20 January 2014
Scrutiny Committee Tuesday, 28 January 2014 at 6.30pm Council Chamber, Town Hall, Sankey Street, Warrington, WA1 1UH Agenda prepared by Julian Joinson, Principal Democratic Services Officer – Telephone: (01925) 442112 Fax: (01925) 656278 E-mail: [email protected] A G E N D A Part 1 Items during the consideration of which the meeting is expected to be open to members of the public (including the press) subject to any statutory right of exclusion. Item Page
Number 1.
Apologies for Absence To record any apologies received.
To: Members of the Scrutiny Committee
Councillors: Cllr T Higgins - Chair Cllr B Lines-Rowlands - Deputy Chair Cllrs C Fitzsimmons, G Friend, J Guthrie, L Hoyle, W Johnson, I Marks and H Mundry
2. Code of Conduct - Declarations of Interest Relevant Authorities (Disclosable Pecuniary Interests) Regulations 2012 Members are reminded of their responsibility to declare any disclosable pecuniary or non-pecuniary interest which they have in any item of business on the agenda no later than when the item is reached.
3. Minutes (to follow) To confirm the minutes of the meeting held on 10 December 2013 as a correct record.
Pages 1 - 8
4. Budget 2014/15 and Medium Term Financial Plan
(to follow) To consider a report from Councillor Russ Bowden, Executive Member Corporate Resources and Assignments, and Lynton Green, Director of Finance and Information Services, giving information on the Council’s Budget proposals for 2014/15.
Pages 9 - 24
5. Cheshire and Merseyside CCGs - Commissioning Policy Review To consider a presentation and supporting information from Simon Kenton, Assistant Director Integrated Commissioning, on the outcome of a Commissioning Policy Review undertaken by the NHS Cheshire and Merseyside Commissioning Support Unit, on behalf of the 12 Clinical Commissioning Groups (CCGs) in the region.
Pages 25 - 36
6. Review of Cancer Care across the Region To consider a presentation and report on the outcome of a pre-consultation on the review of cancer care across the region commissioned by the Merseyside and Cheshire Cancer Network (MCCN). The presentation will be provided by Fiona Jones, Project Director, Dr Nicky Thorpe, Associate Medical Director and Clinical Lead for the Project and Jackie Robinson, from NHS Cheshire and Merseyside Commissioning Support Unit. The review contains proposals in relation to Clatterbridge Cancer Centre.
Pages 37 - 98
7. OFSTED Inspections of Children’s Homes (to follow) To consider a report from Fiona Waddington, Assistant Director, Children and Young People’s Targeted Services on the outcome of OFSTED Inspections regarding children’s homes.
8. New Cut Heritage and Ecology Trail (to follow) To consider information submitted by Cllr Ian Johnson, Chair of Poulton-with-Fearnhead and Woolston Parish Councils, in connection with the development of the New Cut Heritage and Ecology Trail. Cllr C Froggatt, Cllr Pat Wright and (Parish) Cllr Jim Greenslade may also attend to speak to this item.
9. Work Programme 2013/14 and Monitoring of Actions/Recommendations 2012/13 – 2013/14 (to follow) To consider a report of the Cllr Higgins, Chair of the Scrutiny Committee, as to progress on the Work Programme for 2013/14.
10. Date of Next Meeting To note to the date of the next meeting of Wednesday, 19 March 2014.
Part 2 Items of a "confidential or other special nature" during which it is likely that the meeting will not be open to the public and press as there would be a disclosure of exempt information as defined in Section 100I of the Local Government Act 1972.
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SCRUTINY COMMITTEE MEETING 10 DECEMBER 2013
Present: Councillor T Higgins – In the Chair Councillors C Fitzsimmons, G Friend, J Guthrie, L Hoyle, B Lines-Rowlands, I Marks and H Mundry. Co-optees: Not Present Also in Attendance: Cllr R Bowden, Executive Board Member Corporate
Resources and Assignments Apologies Apologies were received from Councillor W Johnson. SC31 Code of Conduct – Declarations of Interest There were no declarations of interest made. SC32 Minutes Decision
That the minutes of the meeting held on 17 September 2013 be confirmed as a correct record.
SC33 Budget 2014/15 and Medium Term Financial Plan The Committee considered a report from Councillor Russ Bowden, Executive Member Corporate Resources and Assignments, and Lynton Green, Director of Finance and Information Services, giving pre-budget information. Cllr Bowden and Shaer Halewood, Chief Accountant, were in attendance for this item. The report included information about Warrington’s funding position; a financial overview for 2014-18; inflation and budget pressures; savings proposals; budget consultation; the capital programme; and the budget approval process. Cllr Bowden referred to background information in the following published reports:-
• SIGOMA (Special Interest Group of Municipal Authorities) – A Fair Future or a Growing Divide;
• Joseph Rowntree Foundation – Coping with the Cuts? Local Government and Poorer Communities; and
• Audit Commission – Tough Times 2013 – Councils’ Responses to Financial Challenges from 2010/11 to 2013/14.
Cllr Bowden also highlighted the following matters:-
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• The cuts, following the Governments 2010 Spending Review, had been
quicker and deeper than originally thought; • Warrington had received an average cut in Government Funding of 10%
for the last three years; • There was no visible end in sight to the financial pressures, with around
£40M of funding cuts anticipated aver the next four years – with cuts of £17M in 2014/15 on top of the £13M cut in the current year;
• Council Tax income was based on a assumption of a 1.98% increase in each year (i.e. below the 2% referendum limit)
• The Business Rate Retention scheme had begun on 1 April 2013. Using current estimates Warrington was expecting its proportion of business rates income to be £1.4m over baseline in 2014/15. This would mean an additional £0.8m income to Warrington, and £0.6m income to the Business Rate Pool, from which Warrington would retain £0.2m. The Executive Board, in October 2013, had agreed that Warrington would join a Business Rate Pool with St Helens and Halton to create the Mid Mersey Business Rate Pool;
• Area graphs showed the split of expenditure by Directorates in 2013/14 and the changing pattern of income from 2013/14 to 2017/18. It would not be possible to freeze Council Tax income in future years;
• Current savings target were being met. The earliest savings had been simper to introduce, but future options would be more limited. Savings proposals had been made for 2014./15 through the service challenge process and a consultation process would be launched on 12 December 2013;
• The Council had an ambitious Capital Programme, which included working with Registered Social Landlords and the regeneration of Bridgefoot. Assessment of the potential risks associated with the Capital Programme had been the subject of discussions with the external auditors;
• The Chancellors Autumn Statement had been announced last week; and • Some minor amendments to the report were as follows:- the final bullet
at Paragraph 4.1 was to be deleted and the Retail Price Index (RPI) figure at Paragraph 4.6 should say 2% not 3.3%.
Cllr Marks asked whether the Business Rate Pool would be affected by the total NNDR collected nationally and about the benefits of pooling. Shaer Halewood confirmed that the figures would depend on the national picture. Cllr Bowden confirmed that the pooling arrangements would generate savings which would be shared across the authorities. Decision
To note the 2014-18 Pre-Budget report.
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SC34 North West Ambulance Service Update The Committee considered a presentation from Madeline Edgar, Acting Head of Communications, and Karl Hough, Advanced Paramedic, North West Ambulance Service. The presentation included information on the following issues:-
• core services; • key facts and figures; • key achievements; • headline performance in Warrington; • staffing, accommodation and vehicular resources in Warrington; • community care services in Warrington; • complaints; • progression to Foundation Trust Status; • estates review; and • current initiatives.
Members asked questions on a number of issues. Decision
(1) To note the presentation from the North West Ambulance Service; and
(2) To request further information on the level and detail of
complaints made locally. SC35 Cheshire, Warrington and Wirral NHS England Area Team –
Update on Reconfiguration of Vascular Services The Committee considered a presentation from Alison Tonge, Director of Commissioning Cheshire, Warrington and Wirral Area Team, NHS England, and Mike Chambers, Chief Executive, the Countess of Chester Hospital on the progress as to implementation of the reconfiguration of vascular services. Ms Tonge provided an overview of the commissioning landscape, which formed the background and context to the reconfiguration of vascular services. NHS England, Cheshire, Warrington and Wirral Area Team commissioned local primary care and specialised services, against a backdrop of national standards and rules. These included the recommendations of Clinical Reference Groups and the application of National Standards. Drivers for change included the national approach and local change programmes. A compliance process existed and the Area Team had used this to measure all the NHS Trusts in the North West. This had led to the identification of a number of gaps in service standards. NHS England would be seeking to close these gaps by one of two methods:-
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• a process of ‘derogation’ (a temporary delay in meeting the full commissioning requirements with a view to full implementation); and
• commissioner reviews (which might lead to reconfigurations where significant issues were identified).
There were a number of significant service reviews now under consideration in the region:-
• vascular services • CAMHS • neuro-rehabilitation • cancer surgery • HIV
It was likely that these reviews would result in consultation and service change. The Area Team would seek to synchronise these changes with other on-going and inter-connected changes in the system. The review of vascular services had been slightly ahead of the other reviews and, therefore, a formal reconfiguration plan had already been developed. The proposals would be implemented by April 2014. The purpose of the presentation today was to provide assurance to the committee that the project was on track and would deliver the anticipated benefits. Mr Chambers, commented that he was chair of the vascular network and that he was looking forward to the implementation of the revised service. Some challenges included delivering the overall changes, managing the transition and not upsetting the services remaining at Warrington Hospital. For example, there might be implications for the network model supporting radiology. The cost of transition was a major issue and detailed consideration was being given to this. It was likely that this service would be the start of a number of similar changes. Potentially there were some difficult decisions to take in the future. The net result was not about ‘winning’ or ‘losing’, but about delivering better outcomes. Mel Pickup, Chief Executive, Warrington and Halton Hospitals Foundation Trust commented that a key driver for change was quality improvement. Some feelings of pain and a sense of loss were inevitable, but the public would be compensated by improved outcomes and patient experiences. Better access and 7 day working were likely to be the shape of things to come. The Chair commented that he was glad to see the various NHS partners coordinating their activities and vascular services moving forward. He questioned what impact a further group of major service reviews might have on Warrington Hospital. He also pointed out the difficulties of carrying out multiple consultations with health overview and scrutiny committees across the region across. It was suggested that standard briefing notes could be produced. Mr Joinsion, Principal Democratic Services Officer, indicated that work was already underway, led by Knowsley Council, to develop a joint protocol for responding to health consultations in the region.
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Members commented on a number of issues. Decision
To note the presentation on the commissioning landscape and the implementation of the reconfiguration of vascular services
SC36 NHS Warrington Clinical Commissioning Group - Update The Committee considered a presentation from Dr Andrew Davies, Chair of Warrington Clinical Commissioning Group (CCG), which provided an update of the work of the CCG. The presentation covered the following key topics:-
• the journey – including establishment and full delegation to the CCG and its place in the new architecture of the NHS;
• the challenge – including funding issues, causes of death, rates of non-elective admissions, GP referrals and elective admissions, the shared vision and the need for a service review of urgent care;
• engagement issues – including the CCG’s overall approach, the Warrington System, the framework to support change, the Concordat, visioning events and current issues;
• outcomes – including successes, progress as to urgent care, reductions in non-elective care and unscheduled admissions and other positive outcomes; and
• the future – including risks to the NHS and the on-going need to change the health landscape.
Members raised a number of issues with Dr Davies. Decision
To note the presentation from Warrington Clinical Commissioning Group on its achievements following the commencement of its work.
SC37 Warrington and Halton Hospitals NHS Foundation Trust - Update The Committee considered a presentation from Mel Pickup, Chief Executive, and Simon Wright, Deputy Chief Executive, Warrington and Halton Hospitals NHS Foundation Trust about the current performance of the Trust and potential future challenges. The presentation provided information on the following key areas of interest:-
• the three Quality Agenda priorities: people, quality and sustainability; • achievements as to Quality issues; • the three strands of the transformational work identified in the 2012/13
Plan: emergency care, elective care and community care; • achievements against the Plan’s priorities; • capital investment undertaken;
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• investment in and development of the workforce; and • sustainability and areas of uncertainty.
Members asked a range of questions in relation to the Hospitals Trust. Decision
To note the presentation from Warrington and Halton Hospitals NHS Foundation Trust.
SC38 Golden Gates Housing Trust – Progress on Delivering the
Council’s Offer Document The Committee considered a report and presentation from Peter Mercer, Chief Executive, Golden Gates Housing Trust (GGHT), as to the progress on delivering the Council’s Housing Offer Document. David Cowley, Head of Service, Housing Standards and Options Division, Families and Wellbeing Directorate was also in attendance to provide information from the perspective of the Council’s strategic housing function. The GGHT report included an update on the following Offer Document promises:-
• the investment programme; • energy efficiency issues; • employment, apprentices and training; • service improvements; • contributions to ‘closing the gap’; • the Longford Quality of Life Project (LQoL); • delivering wellbeing in Bewsey and Dallam; • new build buy backs; • governance;
Further information was also provided in the report about:-
• the establishment, finances and status of GGHT; • customer satisfaction results; • implications of welfare reform; • restructure of service delivery; • GGHT partnerships and working in the community; and • priorities moving forward.
Members made a number of observations and raised some detailed questions. Decision
(1) To note that GGHT has had a successful first three years delivering the Offer Document promises, achieving high levels of customer satisfaction and enhancing its local reputation; and
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(2) To note that the challenges for GGHT and its customers will be
on-going and that the Board has expressed a commitment to exploring the best opportunities to deliver quality services, homes and neighbourhoods.
SC39 Work Programme 2013/14 and Monitoring of
Actions/Recommendations 2012/13 – 2013/14 The Committee considered a report of its Chair, Cllr Higgins, as to progress on the Work Programme for 2013/14. Members were reminded that the work programme was a living document and that it was subject to continual developed. Decision
(1) To note the Work Programme for 2013/14 at Appendix 1; and
(2) To note the progress on actions and recommendations at Appendix 2.
SC40 Date of Next Meeting To note that the next meeting of the Committee will be held on 28 January 2014.
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WARRINGTON BOROUGH COUNCIL SCRUTINY COMMITTEE – 28 January 2014 Report of Executive Board Member:
Councillor Russ Bowden, Executive Board Member, Corporate Resources and Assignments
Report Author:
Lynton Green, Director of Finance & Information Services
2014/15 BUDGET UPDATE 1 PURPOSE 1.1 To present to Members of the Scrutiny Committee the Council’s proposed
budget for 2014/15 prior to receipt of the Final Local Government Settlement and other information essential to the setting of the budget. The report deals with:
• Proposed 2014/15 Revenue Budget • Proposed 2014/15 – 2017/18 Medium Term Financial Plan • Proposed 2014/15 – 2016/17 Capital Programme • Proposed 2014/15 Treasury Strategy • Proposed 2014/15 Council Tax Level • Proposed 2014/15 Schools Budget • Budget Risk Assessment & Adequacy of Reserves
2. CONFIDENTIAL OR EXEMPT 2.1 The report is not confidential or exempt. 3. 2014/15 REVENUE BUDGET 3.1 This report presents the Executive Board’s proposed 2014/15 budget which
includes £16.2m of savings. These proposals build upon the work that has been undertaken by the Council in previous financial years to address budget challenges and to ensure that over the next 12 months there will be a further underpinning of the Council’s medium term financial plan. This will enable the Council to deliver financial stability and investment opportunities through a long term efficiency programme based on sound financial management arrangements.
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3.2 The Executive Board Member, Corporate Resources and Assignments has worked closely with officers over the past six months to formulate the 2014/15 budget. During the autumn there have been two rounds of Service Challenge meetings which examined savings proposals from all of the Directorates. These sessions were led by the Executive Board Member, Corporate Resources and Assignments, the Leader and the Deputy Leader of the Council and supported by the Director of Finance & Information Services.
3.3 The formulation of the budget has been influenced by the continuation of the
major cuts that National Government have imposed on Local Government since the 2010 Spending Review. It was announced in the provisional settlement, announced on 18 December 2013, that Warrington’s Government funding has fallen by a further 9.4% in 2014/15.
3.4 This equates to a drop in Government Funding of £6.5m, which is equivalent
to over £32 per Warrington resident. This drop in funding has been partly mitigated by the increase in New Homes Bonus (an increase for 2014/15 of £1.3m to £3.9m).
3.5 The Council have already made savings of £14.1m and £13.9m in 2012/13
and 2013/14. However, £49.1m of additional savings will also need to be made over the next four years, with £16.2m of savings needed in 2013/14. Legislative and other unavoidable pressures which have been built into the budget total £12.4m in 2014/15, a break-down of which can be seen in Appendix 1.
3.6 The savings proposals needed to balance the 2014/15 budget are set out in
Appendix 2. The proposed 2014/15 budget totals £144.011m and the departmental analysis of the draft budget is shown below:
Council Revenue Spending Plans 2013/14 2014/15
Cash Limit Cash LimitDirectorate Responsible Officer £000 £000Resources and Strategic Commissioning Katherine Fairclough 11,319 10,070Families & Wellbeing Kath O'Dwyer 94,040 96,406Ecomomic Regeneration, Growth & Environment Andy Farrall 24,459 22,668Corporate Financing Lynton Green 17,705 14,867Total 147,523 144,011 3.7 These cash limits will be expanded in a detailed budget book when the final
budget is discussed at Budget Council on 3 March 2014. 3.8 The Director of Finance and Information Services has a statutory responsibility
to report to Council, as part of his annual budget statement on the adequacy of reserves, and the robustness of budget proposals. A full risk assessment of all budget options has been undertaken to enable the Director of Finance and Information Services to discharge this responsibility.
3.9 The current estimate of possible redundancies is 75 posts. As in previous
years, the Council will take every opportunity to keep compulsory redundancy
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numbers to a minimum through vacancy management and voluntary redundancies.
4. MEDIUM TERM FINANCIAL PLAN 4.1 The table below shows the Council’s budget position for the next four years.
Due to a number of budget pressures and a reduced funding position the Council will need to achieve savings of £49.2m over the next four years. As previously noted the Council has a budget gap of £16.2m for 2014/15
4.2 The funding positions for 2016/17 to 2017/18 are estimates only as the
Government have only provided provisional details on the financial settlement for 2014/15 and 2015/16. However it is clear from most communication that austerity measures are likely to continue until at least 2018
2014/15 2015/16 2016/17 2017/18
Ref £000 £000 £000 £000Budget set for 2012/13 146,973 In-year changes to funding 549 Net Budget Brought Forward 147,522 160,161 168,038 173,255
Budget Shortfall 16,151 31,159 41,545 49,943 A brief synopsis of the above table is given below:
• Inflation pressure - This has been calculated as 1.5% for price
inflation and a 3.0% predicted rise in Fees and Charges income. Pay inflation has been provided for as a 1.0% increase.
• Additional budget pressures - This consists of legislative
pressures imposed. For further detail for 2014/15 see Appendix 1.
• Reversal of one year savings proposals – This reverses the ‘one-off savings that were agreed in 13/14 MTFP
• Funding adjustments - Shows minor adjustments to Government
grant funding, where the grants are used for a specific purpose.
• Funding - This shows the funding that will be received in 2014/15, the provisional figures for 2015/16 and estimated funding for future years. This is made up of Formula Grant, Council Tax and unringfenced Government Grants.
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4.3 The graphs below show how the gross expenditure is currently distributed, and how the Income received will change between 2014/15 and 2017/18. Please note that benefits payments and the Dedicated Schools Grant have been removed from this model as although we receive this funding, it is passported directly out of the authority.
Gross Expenditure 2013-14
Families & Wellbeing£127.2m
conomic Regeneration, Growth
& Environment£43.8m
Resources & Strategic Commissioning
£30.8mCorporate Financing
£19.7m
Gross Income 2013-14
Fees & Charges£44.2m
Other Government Grants£23.6m
Other Grants & Contributions
£5.0m
Interest Income£1.2m
Council Tax£71.4m
Business Rates£27.4m
Other Ringfenced Government Grants - £7.6m
Revenue Support Grant£41.1m
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Gross Income 2017-18
Council Tax£79.5m
Fees & Charges£49.7m
Other Government Grants£23.6m
Other Grants & Contrinutions
£5.0m
Intrest Income
Business Rates
£30.4m
Revenue Support Grant£9.3m
Other Ringfenced Government Grants£7.4m
5. BUSINESS RATE RETENTION SCHEME
5.1 The Business Rate Retention Scheme was implemented on 1 April 2013. 5.2 Previously all income raised from Business Rates was transferred directly to
Central Government, and any surplus or shortfall would have no impact on the Council’s Funding. As part of the Business Rate Retention Scheme, 50% of all Business Rates are transferred to Local Authorities and any movement in business rates will have a direct funding impact. This is to provide a greater incentive for local Government to increase the Business Rate income in their area.
5.3 We are predicting a surplus of 756k for the 2013/14 financial year. This
estimate will be distributed as part of our business rate funding for 2014-15. 5.4 Due to the increasing number of developments on Omega, we are predicting a
surplus on our Business Rates of for 2013/14, which is split as shown below: • 50% to Central Government • 1% to Cheshire Fire & Rescue • 49 to Warrington Borough Council
Levy Payments & Mid-Mersey Business Rate Pool
5.5 As part of the Business Rate Retention Scheme any authority who pay a tariff
(ie that there business rate collected is less than the business rates funding due to the authority) then they need to pay a levy payment to central government. Warrington’s levy is calculated as 45%
5.6 As Warrington has joined a Business Rate Pool with Halton Borough Council
and St Helens Metropolitan Borough Council the levy payment that would have been paid to Central Government will be distributed shown below, as agreed in the Governance Arrangements of the Pool:
• 20% Economic Regeneration & Shared Working Fund • 30% Safety Net Reserve • 25% to Warrington Borough Council
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• 13% to Halton Borough Council • 12% to St Helens Metropolitan Borough Council
5.7 We are currently estimating Warrington’s share of the Pool savings to be £62k
for 2014/15 financial year. Though this saving is only small, we have built in a prudent estimate for the cost of appeals, and are expecting these savings to be much larger in future years.
NNDR1 Return 5.7 The NNDR1 return (which informs Central Government of our estimate of
Business Rate income for 2014/15) was not distributed until 20th January 2014, and has therefore had not been finalised when this report had been written. All the Business Rate Funding figures shown above are liable to change, and will have an impact on the funding income and budget position shown earlier in the report.
6 CAPITAL PROGRAMME 6.1 At the time of writing this report officers are still in the process of agreeing
individual directorate capital programmes. However, similar to last year’s capital programme the Council are proposing to set an ambitious capital programme for the next three years. Currently incorporating new corporate schemes of £46.1m and invest to save schemes of £711.5m. It is forecast that the Councils 2014/15 – 2016/17 will be in the region of £1.2bn.
7. TREASURY MANAGEMENT STRATEGY
7.1 The Council’s Treasury Management Strategy will be presented to the Audit and Corporate Governance Committee (body charged with the scrutiny of treasury management), at their meeting of 13 February 2014 and to full Council on 3 March 2014 for approval.
8. COUNCIL TAX
8.1 For the 2011/12 and 2012/13 financial years Warrington Borough Council accepted the Governments Council Tax Freeze funding, which was equivalent to a 2.5% Council Tax Freeze. In 2013/14 Warrington increased the Council Tax by 1.97%
8.2 The Government have offered a 1% Council Tax Freeze grant for the 2013/14
financial year, which is payable for two years only. This funding would equate to approximately £0.7m, which will stop in the 2015/16 financial year. It was considered that due to the ever decreasing funding from Central Government it would be too costly for the Council to accept this freeze.
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8.3 The 1% Council Tax Freeze offer is to be continued for 2014/15 and 2015/16. 8.4 As part of the Localism Act in 2011, Central Government announced that any
Council tax rise of over 3% would trigger a referendum, this was reduced to 2% for the 2013/14 financial year. The 2% referendum limit will continue for the 2014/15 financial year.
8.5 Due to the increasing financial pressures facing local government, it is not
thought that Warrington can rely on 1% temporary funding to balance the budget for 2014/15 onwards. Increasing the Council’s base level of Council Tax ensures this funding is available for future years also. This report is therefore based on an assumed 1.98% Council Tax increase for each of the next four years.
PRECEPTS
8.6 At the current time, precepts have not been set for Cheshire Constabulary, Cheshire Fire & Rescue Service or all of the Parish Councils. It is expected that these will be reported to Executive Board on 10 February and Full Council 3 March 2013.
8.7 It is possible that the Cheshire Constabulary budget will not be set before the
Executive Board meeting of 10 February 2013. In line with previous years practice it is proposed to recommend to the Executive Board that the Director of Finance & Information Services and the Executive Member for Corporate Resources and Assignments be delegated with the responsibility to agree the Police Precept and report this to Council at the meeting of 3 March 2013.
9 BUDGET CONSULTATION 9.1 The Council’s budget 2014/15 consultation ran from 12 December 2013 until
Friday 17 January 2014. Residents of Warrington, local businesses, council staff, elected members, partner agencies and other stakeholders were asked to submit their savings proposals by competing a form, sending an email or getting in touch via social media.
9.2 The Council’s finance team also held a series of engagement events with key
groups including trade union representatives, young people, local businesses and local third sector organisations.
9.3 16 responses to our consultation were received, 1 written response, and the
remainder by e-mail as detailed below: 6 responses from Warrington Borough Council employees:
• Responsibility of Care Packages being passed back to providers • Reduce early retirement age by 5 years to encourage VR • Use phased approach to VR so we do not lose essential knowledge • Review the usage, and cost of staff mobile phones
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• Remove manager’s essential car allowances and make better use of pool cars
• Cuts to early intervention for Children’s Services would have a bigger cost implication in the long run
4 responses from community groups. • Children in Care Council • Warrington Disability Partnership • IMPACT • Eastern European Youth Group
6 responses from residents of Warrington covering a number of issues such
as: • Turning empty town centre buildings into residential use • Toilets at the bus station should be free • Remove parking wardens and reduce the cost of parking • Consider reducing the number of Councillors • To reduce the salaries of the highest paid members of staff • To invest in recycling to save the council money
10 SCHOOLS BUDGETS
10.1 The Dedicated Schools Grant (DSG) is the main funding source for schools and Academies. It is a ring-fenced grant with the majority of funding delegated to schools and the Warrington Schools Forum is the decision making body on how this funding is spent.
10.2 The DSG allocation comprises 4 notional blocks:
• Schools Block – supports mainstream activities in primary and secondary schools (i.e. basic school delegated budgets)
• Early Years Block – supports nursery provision in dedicated nursery
schools, nurseries attached to mainstream schools, and private, voluntary or independent nursery providers in Warrington.
• High Needs Block – intended to support special school budgets, New
Horizons Pupil Referral Unit, designated/specialist provision in mainstream schools, pupil placement in independent schools or non-mainstream special schools outside of the home Authority. It also funds all Special Educational Needs requirements for Warrington pupils. Any other whole-school activities should likewise be funded by this block, as there is no specific allocation for central education functions.
• Additions/Amendments
Adjustments for the induction of Newly Qualified Teachers and 2-year olds’ free nursery entitlement (for 800 children, doubled from 2013/14).
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10.3 Schools Block funding levels vary with Numbers on Roll; 2014/15 funding is based upon the October 2013 census. Early Years funding will ultimately be based upon census numbers from January 2014, but previous year’s numbers will be used for an interim calculation until they are available.
10.4 Indicative DSG allocation for Warrington in 2014/15 is £147.7 million (see below). Not all of this will be administered by Warrington Borough Council; Academies will have their relevant funding paid direct, through a process known as recoupment.
14/15
£ value CENSUS
NOR ALLOCATION
£ Schools Block £4,218.52 28,371 119,684,000 Early Years Block (Provisional) £3,333.72 1,976 6,587,000 High Needs Block 19,417,000 Additions 2 year-old funding 2,216,000 NQT induction 43,000 Carbon Credit reduction -210,000 2,049,000 Total DSG (before recoupments) 147,737,000
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10.5 The remainder of schools’ allocations are through the Pupil Premium, based on historical pupil entitlement to Free School Meals, status as a Looked After Child, or being from a Services family. Each qualifying student will attract varying bands of funding:
Secondary FSM £935 All other FSM £1,300 Looked After Children £1,900 Service Children £300 This total approximates to £6.6 million for Warrington. 11 TIMETABLE FOR CONSIDERATION OF THE BUDGET 11.1 Following the meeting of the Scrutiny Committee on 28 January 2014. The key
dates in the budget process are:
• 10 February 2014 – Executive Board to approve budget proposals and refer to Full Council.
• 3 March 2014 – Full Council approve budget. 12 CONFIDENTIAL OR EXEMPT 12.1 This report is not confidential or exempt. 13 FINANCIAL CONSIDERATIONS 13.1 The financial considerations are dealt with in the main body of the report. 14 RISK ASSESSMENT 14.1 The budget is prepared in accordance with detailed guidance and timetable to
ensure that statutory requirements are met and a balanced budget is prepared that aligns resources with corporate objectives.
14.2 As part of the Service Challenge process the risk of each savings proposal
was discussed with the panel before being agreed, and these risks, along with the risk of slippage around the delivery of savings proposals will be closely monitored during the year. The Council already has robust systems in place for monitoring the delivery of savings and will continue to use the existing approach to ensure the delivery of savings throughout 2014/15.
14.3 Due to the volatile nature of the Business Rates income the predictions of
funding could change significantly from the estimates that were reported on the NNDR1 form. Although this of a high risk to the Council, any change from the current estimates will not alter the funding for 2014/15, but will be carried
19
Agenda Item 4
forward to 2015/16. The Business Rates income will be monitored throughout the year and will be incorporated into next-years budget monitoring process.
Adult Social Care
14.4 The Council’s Adult Social Care strategy supports vulnerable people to live independently in their own homes. Where that is not possible, the Council has a statutory duty to make arrangements to provide accommodation for adults who by reason of age, illness, disability or any other circumstance, are in need of care and attention in a residential or nursing home setting. This duty is mainly discharged by the Council via contracts with external providers of such accommodation and care services
14.5 To ensure there is a good quality and sustainable local offer to meet needs
and its duties, the Council must regularly review the fees paid to Residential and Nursing providers. This process includes identifying and giving due regard to the actual cost of care and full consultation with service users, their families, representatives and providers. A review is underway currently that may affect fee levels in 2014/15 and subsequent years. The different potential scenarios are covered in detail within a report to Executive Board on the 10th February 2013. The significance of the statutory requirements and duties associated with this mean that Elected Members will need to consider the outcome of this decision before concluding the 2014/15 budget setting process.
15 EQUALITY AND DIVERSITY / EQUALITY IMPACT ASSESSMENT 15.1 The Finance Service undertakes Equality Impact Assessment in its wider
functions. Service changes that emerge from proposals contained in the MTFP are subject to Equality Impact Assessments by each directorate.
15.2 All proposals put forward as part of the budget process have been subject to
an Equality Impact Assessment during the service challenge. Each assessment will be reconsidered further before the implementation of any of the proposals and will follow the recognised consultation process for each specific activity.
20
Agenda Item 4
16 REASONS FOR RECOMMENDATION 16.1 That the Executive Board approves the budget recommendations included in
this report and refers the budget to full Council on 3 March 2014. 17 RECOMMENDATION
17.1 It is recommended that the Committee considers the report and makes any comments on the proposals to the Executive Board as appropriate.
18 BACKGROUND PAPERS MTFP Papers Contacts for Background Papers:
Resources & Strategic Commissioning1 Service pressures due to inability to charge internally and shortfall in
staffing structure90
2 Unachievable Employee Services income pressure due to charges being reduced to maintain businesses
150
3 Unachievable cross cutting saving relating to a full authority review of support to Governance arrangements and decision making bodies
100
Total 340
Families & Wellbeing (Childrens)4 Budget pressure resulting from Court orders decisions for Children in
Care150
5 New responsibility for LA's to treat all children remanded to Youth detention accommodation as looked after children
200
6 Pressure required to meet the accommodation needs of Warrington's externally placed Children in Care
2,500
Total 2,850
Families & Wellbeing (Adults)7 Risk of ILF Funding 106 8 Court of Protection Pressures (Mental Capacity Act) 25 9 New Homes Bonus Post - permanent funding 40 10 Mental Health & Learning Disabiltiy transitional client costs 2,000 11 Contracts Review - Older People Residential Domicilary. Unachieved
savings due to risk of judicial review & inflationary increase on residential costs
2,740
Total 4,911
Economic Regeneration, Growth and Enviornment12 Staff recharged to capital (calculated from time recording to comply
with Audit requirements) does not meet budget that has historically increased
250
13 Loss of income as a result of transferring asset into Joint Venture Company as part of Sothern Gateway Development
250
14 Capital Recharge target still exists but work no longer undertaken by service so target cannot be achieved
200
15 Income target unachievable due to current economic climate 290 16 Net loss of income as a result of contract not being renewed. 150 17 Funding for post never transferred from Directorates 30
Total 1,170
Corporate Financing18 Pension Revaluation 392 19 Cost of borrowing for Capital programme 2,520 20 Reduction in MTFP Contingency (2,486)21 Housing Benefit Subsidy - Base Pressure 550 22 Shortfall in Corporate Restructure Savings 300 23 Increase in Insurance Premium 850 24 Integrated Service Provision 150 25 Reduction in Exec Initiatives Fund (100)
1 Service redesign in Legal including vacancy management 72 2 LEAN reviews within Democratic and Member services 71 3 Review of Election service incl external funding, fees, staff structure and
possible "all out" election 66
4 Efficiency Savings achieved from retendering Occupational Health 60 5 Service Efficiencies across Partnerships and Performance team, incl
additional income72
6 HR - service redesign and increased income generation 120 7 Non-staffing efficiencies in Employment Learning and Skills 90 8 Sports Development Service to be funded via Public Health 138 9 Removal of SLA costs associated with Birchwood Leisure Link 46 10 Performance related payment with Livewire and Culture Warrington 350 11 Deletion of vacanct post and recharge additional support to Loans &
Investments and Capital projects86
12 External Income generation for provision of Audit Services to other bodies 17 13 Centralise and improve Income Collection - Debtors Service 60 14 Additional revenue - Salary Sacrifice Car Leasing Scheme. 18 15 Efficiencies from the introduction of localised welfare support 100 16 Review and Restructure of ICT Service 61 17 Review of Service Delivery of Contact Warrington (incl Saturday closure) 27 18 Reduction of External Support and Corporate initiatives 49 19 Reduction in Deputy Mayoral budget to generate savings 5 20 School Appeals funding - charge schools for administration/exclusion
appeals10
21 Registrars post deleted following retirement 18 22 Additional savings based on Divisional restructure plus additional income 20 23 PCSO's 10% reduction in Council's financial contribution 25 24 Employee Services - Public Health funding returned as additional work
absorbed into team7
25 Employment Learning and Skills - Vacancy Management 60 26 HR Advisory - increased income generation target 10 27 0.5FTE Admin Post 1228 Accountancy - Public Health funding returned as aditional work absorbed
within team 3229 ICT - Public Health funding returned as aditional work absorbed within team 3730 Discretionary Charitable Rate Relief. Budget no longer required as part of
Localised Business Rate Support Scheme 16431 Benefits and Exchequer - Removal of vacant post, overtime, Public Health
funding returned as aditional work absorbed within team & withdraw contribution to AGMA Benefit Bus
33 Implement changes to Home to School Transport Policy - post 16 and aided, M/stream & SEN
527
34 Increaser Music Hub income 30 35 Review arrangements and funding for the Vulnerable Pupils Team 20 36 Reduce Staff Superannuation budgets to reflect opt in percentage 500 37 Reduce CYPS facilities management budgets 30 38 Reduce Access and Assets supplies and services budgets 30 39 Recode Specialist High Needs services activity where appropriate 378 40 Reduce funding for activities for disabled children and young people 108 41 Fund 1:1 tuition using Pupil Premium where appropriate 30 42 Reduce Direct Payment Budget 50 43 Recode some appropriate aspects within the Youth Service to Public
Health funding167
44 Review of funding and structures within Central Procurement 35 45 Explore sharing CYPS Fostering Service with other LAs 30 46 Explore sharing CYPS Conference & Review and Quality Assurance other
LAs 30
47 Explore sharing CYPS Commissioning Services with other LAs 20 48 Explore sharing aspects of SEN Service with other LAs 20 49 Charging for some care and respite 20 50 Review of Youth Service Team Structures 150 51 Review of Children with disabilities Team Structures 20 52 Review of CAF/Development and Brighter Futures Team structures 25 53 Reduce grant payable to Private, Voluntary & Independent Sector 70 54 Alternative Delivery Models - Governor Advisory Service 57 55 Review of Team Structures - School Advisory Team 70 56 Undertake and implement a full review of Children's Centre provision 150 57 Undertake and implement a full review of Children's Centre contracts 70 58 Service Review & Redesign across new FWB Directorate 800
59 Review Of commissioning arrangements for Respite Care for older people who require Residential and Nursing services
60
60 Review Neighbourhood Services Staffing Structure 381 61 Recode appropriate service activity to Public Health budgets 728 62 Review the cost variance policy for all client groups to ensure cost effective
commissioning 50
63 Review commissioning of respite for adults with Learning Disability 50 64 Fully implement the existing policy of charging for intermediate care after 6
weeks delivery40
65 Explore sharing Out of Hours / EDT Service with other LAs 80 66 Update budget calculator categories and costs and implement changes 300 67 Utilise increase in support from Social Care grant 2014-15 827 68 Achieving reduction in expenditure relating to external Service Level
Agreements50
69 Explore joint commissioning of specialist provision with other LAs regionally 50 70 Deliver savings on Social Enterprise for Adult Social care across all areas 100 71 Implement a cross cutting contract review 357
TOTAL - Families & Wellbeing (Adults) 3,073
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Agenda Item 4
Savings Proposals - Economic Regeneration, Growth and Environment 2014/15£000
Economic Regeneration, Growth and Environment72 Service Redesign
- Warrington Waste 816 - Warrington Gardens 404 - Transport for Warrington 629 - Warrington & Co 215 - Regulation & Enforcement 275 - Highways & Environment 123
73 Development Control Saving / Income Generation 15 74 Continued commercialisation of subsidised bus services 100 75 Increased Income - Bus departure charges 10 76 Cheshire Road Safety Group - Reduction in Expenditure 4 77 Reduce WBC Funding for Community Transport (Dial a Ride) 18 78 Vehicle Maintenance - Provide MOT service to individuals and Companies 20 79 Redesign Allotment Charges 3 80 Cease Payment of recycling credits to 3rd parties 6 81 Charge School / Council Buildings for recycling collections 55 82 Increase Cremation Charges 50 83 Review delivery arrangements for CCTV proactive coverage of the Town
Centre183
84 To review the Street Cleaning contract 60 TOTAL - Economic Regeneration, Growth and Environment 2,986
Savings Proposals - Corporate Finance 2014/15£000
Corporate Financing Savings85 Cross Cutting Savings, including Admin and Accomodation Reviews 1,000 86 Revised reimbursement rate for Cheshire Consortium Concessionary
Travel Contract380
87 Registered Social Landlords - Loan Arrangement Fees (one-off) 1,000 88 Registered Social Landlords - Loan Ongoing Charges/Fees 300 89 Additional Treasury Management and Corporate Financing Savings 2,000
TOTAL - Corporate Financing 4,680 Grand Total 16,151
Working Smarter for Better Health
Cheshire & Merseyside CSUCommissioning Policies Review to be undertaken by the
CSU on behalf of the Cheshire and Merseyside CCGs(Includes Infertility Policy)
Working Smarter for Better Health
Working Smarter for Better Health
What is the Commissioning Policy?
• The current commissioning policy was written in 2011 is now due for review.
• A number of areas have had new evidence published.
• A number of areas have now moved and are the responsibility of other NHS bodies e.g. Specialised Commissioning NHS England.
• It contains statements on what the Clinical Commissioning groups (CCGS) will provide for their patients.
• It includes statements on areas e.g. infertility service, treatments for viral warts & cosmetic surgery.
Working Smarter for Better Health
Why do CCGs have a Commissioning Policy Document?
• CCGs have a duty to spend public money wisely. As there is only a set amount of money available to spend CCGs sometimes have to make difficult decisions about which treatments are routinely provided.
• CCGs have to make decisions on the range of health services/treatments that they commission (buy). The majority of services/treatments commissioned are commissioned for the whole population, however some are only clinically effective in very specific situations or for a very narrow group of patients.
• In such cases CCGs commission the service/treatment on a named individual (patient) basis having first assessed that there is evidence that the proposed treatment is clinically effective and that the patient should see a demonstrable benefit from receiving the treatment.
Working Smarter for Better Health
What are the main Commissioning Policy Changes?
Key Description Number Red Important change 3
Amber Criteria changes. 9
Green Minor word or no changes made.
37
NewStatement
New – Important change
1
NewStatement
New – Moderate Change
30
NewStatement
New – Minorimpact
19
1. Removing statements on services that now sit with NHS England (following the recent NHS restructuring).
2. Updating the guidance based on new evidence.
3. Adding in new services/treatments/procedures.
We have rated the policy statements and proposed changes using the following colours described in the key (above).
Sept 2013
Dec2013
Jan 2014
Feb 2014
Mar 2014
April 2014
Oct 2013
Nov 2013
Stage 2 Evidence Review Stage 3
Final Equality Impact Assessment
Commissioning Policy Review Timeline Version 5
Stages 4 & 5
Policy for CCG primary
approval
Stage 6 Public,
referrers and providers engagement.
Stage 1 Policy Review Set up
Stage 7
Findings and Decision Point by
CCG, Policy Implementation
via provider contracts
(Monitoring from April)
Stage 3 Initial Equality Impact
Assessment
Working Smarter for Better Health
Communication & Engagement Stakeholder Group ActionPatients and the Public – Web content publication date is 6 January 2014. Items to be uploads are:• CSU website – full policy document, two page
summaries and on-line survey• CCG website – overview statement and colour-coded
list of treatments (content in plain English)
Central CSU Communications Team to advise and direct locality communication leads on timelines and provide all documentation and links. Locality communication leads to utilise local communication channels/mechanisms to direct patients and the public to CCG website.
PPG/Local Health Forums and/or interested groups CCG Engagement Leads sending to practices/colleagues. CSU Engagement Leads will do this on behalf of the CCGs who buy this service.
Third Sector partners • CVS• HealthWatch• Carers Organisations
Central CSU Communications Team to manage this and support 3rd sector partners in web material and supply links. CSU Engagement Lead to ensure consistency in process across 12 CCG localities.
Clinical Engagement:• Intranet uploads• GP Bulletin• Provider Bulletin• CCG Boards• Health & Well-Being Boards
Central CSU Communications Team to advise and direct locality leads on timelines and provide documents & links.CSU Project Lead & Executive Lead to deliver to CCG Boards.GP & Provider Bulletin disseminated throughout the engagement phase.
Overview & Scrutiny CommitteesMPs
To be determined by CCG, inform MPs at their discretion. CCG to advise CSU Engagement Lead how they wish to proceed re their local OSC, briefing or face to face presentation.
Working Smarter for Better Health
Leaving Feedback Patient and Public respondents can leave feedback either of the following ways:• Online – by visiting the CCG website and follow the link to the CSU website
where they can read in more detail about the draft policy.
• If people do not have access to the internet please provide the CSU Customer Solutions Service Freephone 0800 281 2333 number and the team will post out the information to enquirers, or complete the on-line survey on their behalf over the phone.
• If people are hard of hearing, have sight impairment, English is not their first language or they require the information in an alternative format, please contact the Customer Solutions Centre Freephone 0800 281 2333. (This statement will be put onto the overview page and at the foot of the summaries).
Working Smarter for Better Health
Next Steps • We need your views on Commissioning Policy, the go-live date
for full public and patient engagement is 6th January 2014 to 26th January 2014.
• An email address has been established for all clinical responses and questions [email protected]
• Audit and evidence of engagement is absolutely an essential requirement in any engagement process. The CSU will hold this on behalf of all the CCGs with the exception of West Cheshire CCG who will run their own engagement process.
Cheshire and Merseyside Commissioning Support Unit have recently undertaken a Commissioning Policy Review on behalf of the 12 Clinical Commissioning Groups (CCGs) across Cheshire & Merseyside.
A full review has now been undertaken and the latest guidance from the National Institute of Clinical Excellence and other identified best practices has been incorporated into the ‘first’ draft of the policy.
You will know that CCGs have to make decisions on the range of health services/treatments that they commission. The majority of services/treatments commissioned are commissioned for the whole population; however some are only clinically effective in very specific situations or for a very narrow group of patients.
In such cases CCGs commission the service/treatment on a named individual (patient) basis having first assessed that there is evidence that the proposed treatment is clinically effective and that the patient should see a demonstrable benefit from receiving the treatment.
The NHS never stands still. Advances in science mean it is constantly evolving to keep pace with the invention of new drugs, new treatments and new technology.
As new treatments and services become available, demand goes up and CCGS have to make the difficult decisions on how to spend their limited budgets for the benefit of their whole population.
They do this in a number of ways:
• They prioritise certain treatments and procedures. • They set “thresholds” (or a defined set of criteria) that a patient must fit before they
can be referred for particular treatments or procedures. This is because some treatments only work in very specific clinical situations or for a very narrow group of patients.
• There are circumstances when we can only fund certain procedures or treatments if there are clinical grounds for doing so.
CCGs have only existed since 1 April 2013. As a result, their policies need reviewing and updating which will include financial decision making.
Agenda Item 5
34
What are the main policy changes?
1. Updating the guidance based on new evidence.
2. Adding new services/treatments/procedures that have become available since the old policy was adopted.
Some services have now transferred to NHS Specialised Commissioning which is part of NHS England that was formally led by Primary Care Trusts which no longer exist. To learn more about NHS Specialised Commissioning go to http://www.england.nhs.uk/resources/spec-comm-resources/
We have used a colour key to show you whether the changes to a specific service/treatment area are big, small or non-existent.
*These numbers may differ depending on the previous PCT local commissioning policies (sometimes referred to as local addendums)
Click here to view the draft policy https://www.cheshiremerseysidecsu.nhs.uk/commissioning-policy-review.htm
What happens next…? Following a period of consultation which ends at 12pm on 7th April 2014, the CCG needs to consider:
• Whether it wants to put this updated policy into practice • If it does want to put it into practice, it needs to find the funds to pay for it from its
The CCG has two options: (1) Put the new policy into practice as soon as possible. (2) Phase in over a period of time to reduce the financial impact.
Before it can make these key decisions, the CCG needs to seek feedback from a wide range of people – not just doctors and nurses and other health care experts but importantly members of the public and existing patients.
We appreciate that the timescale for patient and public engagement on the draft document could have been a longer period. However, the timings were determined by the need to ensure that contracts were in place to enable continuity of safe and effective services for patients during 2014/15, and constrained by the process of transition to a new commissioning system. In future, patient care will remain the priority, and actions have been taken to ensure more extensive patient engagement in the future.
If you have any questions or queries pertaining to this brief please do not hesitate to contact Julia Curtis, Project Lead for the Commissioning Policy Review on [email protected] or alternatively Hilda Yarker, Head of Patients and Information on [email protected] .
WARRINGTON CCG ASKS YOU TO HAVE YOUR SAY ON NEW DRAFT HEALTH POLICY Warrington CCG have to make decisions on the range of health services/treatments that they commission (buy) for their local population.
CCGs have only existed since 1 April 2013, as a result, their policies need reviewing and updating which will include financial decision making.
The majority of services/treatments are commissioned for everyone in Warrington; however some are only clinically effective in very specific situations or for a very small group of patients.
In these cases, the service/treatment is commissioned on a named individual (patient) basis. This follows an assessment to ensure the proposed treatment is clinically effective and that the patient should see a demonstrable benefit from receiving the treatment.
Advances in science mean that treatments offered by the NHS are constantly evolving to keep pace with the invention of new drugs, new treatments and new technology.
As new treatments and services become available, demand goes up and CCGS have to make the tough decisions on how to spend their limited budgets for the benefit of their whole population.
We are taking part in a formal 90-day consultation on some of our policies for these services and treatments, along with several local CCGs.
AS A PATIENT OR PUBLIC MEMBER:
You have the right to feed your views into this decision-making process. Your feedback is needed by 1pm on Monday 7th April 2014
All the feedback that is received will be taken into account before a decision is made.
To view more details, the draft policy and take part in the online survey please go to: https://www.cheshiremerseysidecsu.nhs.uk/commissioning-policy-review.htm
If you do not have access to the internet and require a copy of this information via post please contact the Customer Solutions team on 0800 218 2333.
If you are hard of hearing, have sight impairment, English is not your first language or you require this in an easy read format please contact the Customer Solutions team on 0800 218 2333.
An independent review of cancer care across the region (the Baker Cannon Report 2008) commissioned by the Merseyside and Cheshire Cancer Network (MCCN) developed a series of recommendations to ensure that cancer services were delivered in the best way to improve outcomes for patients across the region. Following the review PCTs in Cheshire and Merseyside supported:
• The establishment of six additional Consultant Oncology posts across the region, seven new nurse specialist appointments and two tumour specialist Cancer nurses at The Clatterbridge Cancer Centre (CCC)
• The enhancement of clinical services at The Clatterbridge Cancer Centre to improve care for acutely ill patients
• The opening of a CCC satellite radiotherapy unit on the Aintree Hospital site
• Appointment of a Chair in Medical Oncology by the University of Liverpool
• Opening of a CRUK research centre in Liverpool adjacent to the Royal Liverpool Hospital (RLBUHT) site
The report also concluded that big benefits could be gained for patients and their families by expanding the services provided by The Clatterbridge Cancer Centre.
The proposal would see Clatterbridge Cancer Centre services expanded with the building of a new cancer centre for Cheshire and Merseyside next to the new Royal Liverpool University Hospital.
Inpatient services will move from Wirral to the Liverpool site and additional outpatient services will also be provided.
Only those Wirral based patients, who need more complex treatment, or an overnight hospital stay, will need to travel to the new centre in Liverpool, as outpatient radiotherapy, chemotherapy and proton therapy services for the more common cancers – such as breast or prostate – will continue to be provided at the Wirral site.
The new centre in Liverpool means that for the first time Cheshire and Merseyside Cancer patients will have access to expert clinical services, surgery, in-patient care, radiotherapy, chemotherapy, critical care, outpatient clinics and enhanced research and development with clinical trials all on one site. Developing a new Clatterbridge Cancer Centre on a thriving biomedical campus, alongside the new Royal Liverpool Hospital and Liverpool University is a once in a generation opportunity to make cancer services in this region the very best than can possibly be.
Introduction
The benefits
The proposal
2 2
Being co-located with the Royal Liverpool Hospital and the University of Liverpool will allow The Clatterbridge Cancer Centre to:
• Have physical links to an acute teaching hospital where patients can have rapid access to critical care services when they are required.
• Develop its research programme further, giving patients access to a broader portfolio of clinical trials and leading edge treatments as soon as they are developed.
• Be located at the centre of the population we serve. Around 70% of our patients currently travel to the Wirral site from north of the River Mersey.
• More than 5,500 people die each year from cancer in Cheshire and Merseyside.
• The burden of cancer for people in Merseyside and Cheshire is greater than anywhere else in England.
• Our mortality rate from all cancer is 20% higher than England as a whole – the worst in the country.
• The number of new cancer cases in the region is higher than the national average and expected to rise significantly in the next few years.
• New cases of lung cancer in Merseyside and Cheshire are 15% higher than the national average for men and 23% higher for women.
All Primary Care Trusts (PCTs) in the Merseyside and Cheshire Cancer Network received and approved two papers relating to non-surgical oncology services and The Clatterbridge Cancer Centre. The first paper (March/April 2008) sought PCT boards’ support for an expansion of radiotherapy services through the development of two satellite services: one adjacent to the Walton Centre and one adjacent to the Royal Liverpool University Hospital.
The second paper (June/July 2009) presented the recommendations from the Baker Cannon report. That paper noted that expansion of CCC into Liverpool, whilst desirable, would take several years to plan and deliver, and so a series of interim measures were proposed which included endorsing Liverpool PCT to lead on the procurement of radiotherapy facilities on the Royal Liverpool site through an open competitive tender.
Progress achieved to date
How cancer affects our region
3 3
Work to take forward the procurement of satellite radiotherapy facilities at the Royal Liverpool Hospital site was initiated and involved detailed analyses of clinical models of care, informed by a number of clinical experts from both within the network across England. Following detailed consideration the cancer network and the radiotherapy procurement team led by Liverpool PCT agreed that the benefits to patients that could be derived from a satellite facility at the Royal would be outweighed by the cost of delivery and confirmed that a larger-scale relocation of CCC, as per the central recommendation of the Baker Cannon report and within an earlier timescale, would offer greater benefits to all patients Cheshire and Merseyside and would represent greater value for money. Liverpool PCT and the Cancer Network agreed the need to support the development of proposals for the establishment of a new Clatterbridge Cancer Centre on the Royal Liverpool Hospital site in tandem with plans to rebuild the new Royal Liverpool Hospital. A high level affordability study was undertaken to review the cost and affordability of building a new comprehensive Cancer Centre co-located with a redeveloped Royal Liverpool hospital.
Following this study senior colleagues from CCC, RLBUHT, the University of Liverpool and the Cancer Network worked together to produce a strong, collective agreement on a joint vision for the future provision of Cancer Services: “The creation of a World Class Comprehensive Cancer Centre, co-located on the new RLBUH site for the Merseyside and Cheshire Network, which brings together in partnership for the first time specialist NHS cancer services with the University of Liverpool and other research partners on a single acute campus.”
At this point the total cost of proposals had been estimated at £94.5m. At the September 2011 meeting the NHS Merseyside Board approved funding to meet the project costs to deliver an Outline Business Case and one-off investment of up to £20m for the new Centre. In addition further on-going revenue support of £6.5m will be required from 2012/13 onwards to enable the scheme to proceed. Given the significant benefits that would accrue to Merseyside residents of the proposals, and the high levels of cancer morbidity and mortality in Merseyside, it was proposed that the NHS Merseyside Cluster included, in the Cluster’s Commissioning Intentions for 2012/13 onwards, the requirement for an additional £6.5m. This intention was confirmed by the NHS Merseyside Cluster Board at the March 2012 meeting when the Commissioning Plan was approved.
CCC has continued to develop the proposal to build a new centre, next to the redeveloped Royal Liverpool Hospital and the University of Liverpool.
Transforming Cancer Care
4 4
The development of the Strategic Outline Case completed in March 2012 followed the support given by The Merseyside and Chester, Warrington & Wirral PCT Clusters to this investment. The current project timescale is as follows: • Outline Business case approved by Q3 2014 • Contractor appointed by Q2 2014 • Full business case approved by Q2 2016 • Construction work starts Q2 2016 • New hospital opens Q3 2018 • Work complete on Wirral site Q3 2019
Work has included a programme of public engagement to share the real and continuing benefits for patients that these plans are designed to bring with a wide range of stakeholders. This has ensured that people are informed about the reasons for the proposed changes and that they have an opportunity to comment on and influence these plans.
We need to get the views of patients, families and the wider public if we are to develop services that fully meet their needs. We wanted to know what the public think about our proposals so we used a variety of different ways to give people the opportunity to share their views with us. From August 2012 to March 2013 members of the public attended events, completed an online survey or visited our customised ‘Action on Cancer Trailer’ which we took to busy shopping centres across Cheshire and Merseyside for 38, three day roadshow events. Voting boxes were also placed in hospitals and a variety of community venues, cancer support groups and charities across both regions. Our staff spoke to members of the public about the proposals, distributed information leaflets and showed a short DVD before asking people: ‘Having heard about the proposals do you think they are a good idea?’
We reached approximately 90,000 people; with 14,000 people accessing the Action on Cancer trailer and a total of 4,164 responses returned. 96 visits were made to 53 unique groups across Cheshire and Merseyside to speak to patients and members of the public. Analysis of the questionnaires returned showed that respondents came from the following postcode
Getting public feedback
Who responded?
5 5
areas:
‘Having heard about the proposals do you think they are a good idea?’
Responses broken down by Postcode Area
What they told us
6 6
CH –includes Wirral, Flintshire, Cheshire West and Chester
L – includes Liverpool, Sefton (including PR8 and PR9 postcodes) and Knowsley
7 7
WA – Warrington, Widnes, Runcorn and St Helens
The emerging themes identified were:
• Travel
• Accessibility
• Cost
• Good Current Services
• Ill health
• Loss of Services
Travel
Travel is a key emerging theme. The majority of comments relating to travel came from respondents
in support of the proposals and reflect the opinion that the existing Cancer Centre is ‘too far’ from
where they live and the new centre will be beneficial in terms of distance, time and money saved.
“My family have been affected by cancer and the travel to Clatterbridge took a lot out of them when they were unwell. It was too far.” Costs, parking and tunnel were also key words mentioned by South Mersey residents many of whom stated that they were happy with the current service provision at The Clatterbridge Cancer Centre. Accessibility The accessibility theme covers issues of transport and travel and also includes references to the
Main themes
8 8
availability of public and private transport, parking and congestion. Those respondents in support of the plans felt that accessibility would be improved because of the transport infrastructure in Liverpool. “I live in Wallasey but I am sure it would be easier for me to use public transport to get to Liverpool rather than Clatterbridge.” In general, those people who don’t think the proposals are a good idea felt that the new centre would reduce accessibility for them. They consider The Clatterbridge Cancer Centre Wirral to be accessible as it is close to the motorway and that Liverpool would be inaccessible due to parking and congestion. “Clatterbridge should stay as main hospital. It has the space for development. The Royal is congested by area and accessibility.” Cost The majority of the cost references were in respect of the additional costs of travel, such as parking, taxis and tunnel fares. “A lot of cancer patients are quite elderly and cannot travel to Clatterbridge and cannot afford taxis.” Comments on cost were balanced by Liverpool postcode residents who considered it to be positive as they would save money on tunnel fares. ‘Yes’ voters believed that a better transport infrastructure would reduce the amount of taxi journeys required to the new site. Good Current Health Services Respondents acknowledged the benefits of the re-location and the establishment of a new cancer centre, linked to state of the art research and treatment facilities and the development of a world class health campus. Many respondents also spoke of excellent services and a preference to keep services in Clatterbridge.
“No problems with CCC so why change?” Ill Health Respondents who have had personal experience of cancer treatment reported on the difficulties of travelling when feeling unwell. “A new centre will provide easier access for patients at a time when they would prefer to be nearer to home. Travelling can be stressful especially when someone is ill.” Loss of Services
9 9
The loss of services was a concern for a particular minority of voters. In some cases people felt that the proposals might lead to the ultimate closure of services and loss of jobs at Clatterbridge. “Provided the service currently available at the existing Clatterbridge site is not diminished in any way then the new proposal is an excellent idea otherwise not so.”
We want to make sure that everyone in Cheshire and Merseyside can access the right cancer services, at the right time and in the right place. We plan to launch a formal twelve week consultation period in Summer 2014 which will enable us to explore the main themes identified in the pre consultation engagement work in more detail. We anticipate making a formal request to form a Joint Overview and Scrutiny Committee to be held in June 2014 to explore your views and take advice before we seek approval to proceed with a formal public consultation. This feedback will then be used as we develop our Outline Business Case which we anticipate will be completed in the Autumn of 2014. In the meantime if you would like us to attend a forthcoming meeting to provide an update on the project and present the findings of engagement work so far please Transforming Cancer Care Project office on 0151 552 1823.
Next steps
Agenda Item 6
47 Working Smarter for Better Health
Comprehensive Cancer Centre for Cheshire and Merseyside
Stakeholder Engagement Pre-Consultation Report
November 2011 to March 2013
Jacqueline Robinson Head of Patient & Public Voice
Statutory and Legal Context for Communications and Engagement Activity …... 10
Stakeholder Involvement 11 - 13
o Target Audiences
o Engagement Channels
o Key Messages
Range of Activity/Methodology …………………………………………….……… 14 - 17
Summary and Recommendations…………..………………..…………………… 18
Appendices
Appendix 1 Analysis of Patient and Public Feedback
Appendix 2 Stakeholder Engagement Matrix Model
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1. Background
Cancer incidence and mortality in Cheshire and Merseyside
1.1 Incidence (new cases) and mortality (death rates) represent a major challenge within Merseyside and Cheshire. For all cancers combined, the incidence of new cancers (Fig.1) and cancer mortality rates across the network are higher than the national average. Breast, lung, colorectal, prostate and upper gastro-intestinal (GI) cancers account for over 90% of all new cases of cancer and over 75% of cancer deaths, both nationally and across the NHS cluster area.
1.2 The incidence of new cases of breast cancer across the cluster is lower than the national average. Mortality rates for breast cancer across the cluster are lower than the national average except for in Liverpool. The incidence of new cases of lung cancer across the cluster is higher than the national average and almost twice the national rate in Liverpool and Knowsley. Similarly, lung cancer mortality rates across the cluster are higher than the national average and almost twice the national rate in Liverpool and Knowsley. 1.3 The incidence of new cases of colorectal cancer and colorectal cancer mortality rates are higher across the cluster than the national average. The incidence of new cases of prostate cancer across the cluster is lower than the national average except for Sefton. Prostate cancer mortality rates across the cluster are higher than the national average. The incidence of new cases of upper GI cancer across the cluster is higher than the national average (Fig.13). Similarly, upper GI cancer mortality rates across the cluster are higher than the national average. NB
• All incidence and mortality rates are per 100,000 population
• Incidence data is for 2006-8
• Mortality data is for 2007-9
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Fig.1 Incidence of new cancers (all cancers)
390.8
474.7 461.4416.7 421.4 402.3
354.8427.3
314.8
0.050.0
100.0150.0200.0250.0300.0350.0400.0450.0500.0
England Liverpool Know sley Sefton Halton & StHelens
WesternCheshire
Warrington Wirral Central &EasternCheshire
Current configuration of cancer services Hospital Cancer Services
Thirteen hospital trusts provide cancer services within the Merseyside and Cheshire Cancer Network. Ten of these 13 are designated to provide specific specialist (tertiary) cancer services. Table 1 shows which hospitals host specialist teams, most of which have been officially designated by commissioners through the cancer network in response to NICE improving outcomes guidance. The table also shows which hospitals provide non-specialist (secondary care level) diagnostic and treatment services for their local populations Table 1: The distribution of specialist cancer services in the network
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Aint
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services1
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Gynae
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Anal
Brain & CNS
Chemotherapy2 Clin
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Children’s
Head & neck
Liver
Lung surgery
Neuro-
endocrine3
Ocular
Oesophago-
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Pancreas
Radiotherapy.
Sarcoma
Specialist gynae
Specialist
haematology
Specialist skin4
Teenage &
young adult5
Testicular
Specialist
urology
1 ‘Local cancer services’ defined as diagnosing and treating most common cancers. 2 Clatterbridge provides out-reach clinics for daycase chemotherapy on several hospital sites. 3 A single neuro-endocrine specialist multidisciplinary team (MDT) is managed jointly by Aintree and the Royal. 4 Specialist skin MDT is hosted by St Helens & Knowsley. Associated unit is the Royal for T-cell lymphoma.
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Radiotherapy
The Clatterbridge Cancer Centre NHS Foundation Trust (CCC) is the sole provider of radiotherapy within the Merseyside and Cheshire Cancer Network (MCCN). The centre is based in Bebington on Wirral and treats around 5,500 patients with radiotherapy each year. A course of treatment for most patients will be made up of a series of appointments during which they will receive fractions of their overall dose of radiotherapy. CCC delivers approximately 83,000 fractions of radiotherapy each year. Ninety per cent of these treatments are for patients living within the Merseyside and Cheshire Cancer Network area.
Although 67% of the patients served by CCC live north of the River Mersey, CCC is located south of the river. Relative to the number of new cancers diagnosed, the PCTs on the south side of the river (Wirral and Western Cheshire) account for a larger number of the radiotherapy fractions delivered within the network, compared with patients elsewhere in the network, although it must be noted that the Sefton population appear to benefit from higher radiotherapy rates than other PCTs north of the Mersey, which might be explained by the higher numbers of older residents.
It would appear that the patients who live closest to the radiotherapy centre benefit from greatest access to treatment. The effect of distance upon access may be most apparent in the frailest of patients.
To improve access for patients, CCC opened a satellite radiotherapy unit adjacent to the Walton Centre in early 2011. This provides services for patients requiring radical (curative) radiotherapy for breast, prostate and lung cancer as well as stereotactic radio-surgery. This benefits around 900 patients a year (a little over a third of the total number of patients living north of the River Mersey who need radiotherapy). Patients needing more complex radiotherapy or who have other medical needs cannot be treated at a satellite unit as they require the full medical support only available in a cancer centre. Thus many Cheshire and Merseyside residents continue to need access to the service at Clatterbridge.
Chemotherapy
Chemotherapy for haematological malignancies is delivered under the care of consultant haematologists in local hospitals operating within local multidisciplinary teams. Patients requiring specialist diagnosis and treatment are managed through the multidisciplinary team based at the Royal Liverpool and Broadgreen University Hospitals NHS Trust. Chemotherapy for solid tumours (i.e. non-haematological) is delivered under the care of oncologists employed by The Clatterbridge Cancer Centre. All inpatient chemotherapy is given at CCC’s base in Bebington on Wirral, but patients can access outpatient or day-case chemotherapy more locally through 11 weekly clinics operated by CCC oncologists on six hospital sites. Approximately 70% of chemotherapy patients are treated in these clinics and this is set to rise as nearly all new chemotherapy treatments expected to come into clinical practice will not require an inpatient stay.
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Surgical oncology
Most patients requiring surgery for cancer are able to have their operation at their local hospital, under the care of a local multidisciplinary team. This is the case for many common cancers, such as breast and bowel, where there are sufficient numbers of patients to maintain the surgical skills of local teams.
Patients with less common cancers, or those requiring more complex operations, will have their care managed by specialist multidisciplinary teams hosted in fewer, designated hospitals. Largely in response to national guidance from the National Institute for Health and Clinical Excellence (NICE), the centralisation of specialist surgery has quickened pace over the last decade.
Pathology
With the exception of The Clatterbridge Cancer Centre and Liverpool Heart and Chest Hospital, each trust in the network hosts a pathology department. These departments are not homogenous, and they operate as a network to ensure that all patients have access to clinically appropriate pathology tests and expertise irrespective of where they live and what their local hospital can provide. The pathology departments in each of the general acute trusts provide a broad range services which reflect the hospital services they provide. Where a trust hosts a specialist multidisciplinary team, the trust’s pathology department likewise develops specialist expertise.
Radiology and nuclear medicine
All trusts in the network have a radiology department that supports day to day clinical services. As with pathology departments, the radiology teams work as a network so that patients requiring more specialist imaging or interventional radiology procedures can be referred on to other trusts if their local trust does not provide the service.
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2. Introduction In 2008, MCCN commissioned an independent review of how cancer services are organised across the region which showed that benefits could be gained for patients and their families by expanding the services provided by The Clatterbridge Cancer Centre NHS Foundation Trust.
The review recommended that The Clatterbridge Cancer Centre to build a new centre in Liverpool adjacent to the redeveloped Royal Hospital and The University of Liverpool, to provide all oncology inpatient services and associated radiotherapy, chemotherapy and outpatient services that the Trust is responsible for.
The Trust’s Wirral site would be retained and continue to provide outpatient radiotherapy and chemotherapy treatments for Wirral and West Cheshire patients. CCC will also retain the satellite radiotherapy facility on the Aintree Hospital site and will continue to provide existing clinics in hospitals across the region.
A comprehensive pre-consultation plan was developed to inform and engage with key stakeholders regarding the proposals to develop a new Clatterbridge Cancer Centre. The pre-consultation was undertaken within the spirit and guiding principle that in everything we do we should be cognisant of the Governments commitment introduced in 2011 and within the 2012 Health and Social Care Act, of: “No decision about me without me” which puts patients, service users and their carers at the centre of the decision making process. The aims of the plan were to ensure that decisions/recommendations are informed and guided by the views of stakeholders and patients, carers, and the public, which should in turn lead to more responsive decision-making and developing services that are more appropriate to meet the needs of patients now and in the future. The Plan also sought to:-
o Outline the objectives for communications and engagement within the project; o Define the communications and stakeholder engagement strategic approach; o Define the development of communications and key messages; o Identify the stakeholder groups (key target audiences); o Identify the channels of communications for these stakeholders; o Plan communications and engagement activities; o Systematically record all engagement aligned to the requirements set out in 2012
Health and Social Care Act, encompass Real Accountability standards in regard to “duty to consult”; and also the Cabinet Office Code of Conduct for public consultations.
o To ensure that all phases of the consultation will be composite, and will be compliant with the requirements set out in the Service Reconfiguration Assurance Framework 2011.
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o Define the means of monitoring feedback and evaluating the success of communications and engagement.
The plan has adopted a management approach that identifies stakeholder communications and engagement as a key support function. As with any programme of work, clear, effective communications should be a fundamental consideration from the outset to ensure all key stakeholders are informed and engaged. The Plan underpinned and contributed to the achievement of the above aims by using the following two key principles:
Communications as a core competency: It was agreed that we must meet the formal expectations for full, on-going and meaningful engagement with all stakeholders. We wished to go further than simply what is required of us to ensure that this engagement is genuinely comprehensive and adds value to the proposals to be detailed in the Outline Business Care, and thereby contributing to the best possible outcomes.
Excellence in planning, managing and evaluating communication: We will ensure we provide feedback to those we engage regarding the outcome of what has been said, where the feedback has made an influence, and if it has not been possible to respond to it, why not.
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3. Statutory and Legal Context for Communications & Engagement Activity
The plan was supported by the Strategic Overview Board comprising senior executive officers from The Clatterbridge Cancer Centre NHS Foundation Trust, The Royal Liverpool and Broadgreen University Hospital Trust and NHS Cheshire and Merseyside (PCT) Clusters, in delivering its communications and engagement responsibilities. There are a number of key specific documents that informed and shaped the plan.
• Service Reconfiguration Assurance Framework, April 2011
• Framework for Collaborative Agreement in Managing Service Change at Regional Level, NHS North of England
• Major Service Change Briefing Checklist, NHS North of England
• DH Operating Framework for the NHS in England 2012/13
With specific relevance to Improve Services for Patients, in one of the four key themes for all NHS organisations during 2012/13: “putting patients at the centre of decision making in preparing for an outcomes approach to service delivery, whilst improving dignity and service to patients and meeting essential standards of care;
• New rules on service reconfiguration Indicative evidence requirements against the
“Four Tests’ Test 1 – support from GP commissioners Test 2 – strengthened public and patient engagement Test 3 – clarity on the clinical evidence base Test 4 – consistency with current and prospective patient choice
• 2012 Health and Social Care Act With specific relevance to “The Case for Change” in regard to “Need for improvement.” At its best, the NHS is world‐leading, but there are important areas where the NHS falls behind those of other major European countries. If we had cancer survival rates at the average in Europe, we would save 5,000 lives a year”. There was an absolute commitment from all partners to carry out the work with full engagement from all stakeholders, particularly local patients, carers, providers and staff and it was planned and agreed to take an integrated approach to programme of work
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4. Stakeholder involvement
It is vital to involve a wide range of stakeholders in the debate for change. It is advised that reconfiguration plans and the real and continuing benefits for patients that these plans are designed to bring, are shared with a wide range of stakeholders. This ensures that people are informed about the reasons for the proposed changes and that they have an opportunity to comment on and influence these plans. NHS Merseyside, who transitioned into the Merseyside Commissioning Support Unit during this period, acted as the lead organisation with the Head of Engagement and Head of Corporate Affairs working closely with the Director of Communications and the Head of Patient Experience from NHS Cheshire, Warrington, and Wirral (which also became a Commissioning Support Unit) in having one consistent communication and engagement plan in place, which was inclusive of key stakeholders in the North and South Mersey regions. The feedback from this activity would be used to begin to inform the Outline Business Case. Assuming a positive response to the Outline Business Case, the plan will then be built upon and will inform the next stage of the process which is an extensive formal consultation programme expected to run for a minimum of 12 weeks beginning autumn 2013. The 3 phases of consultation envisaged are:-
• Pre-consultation as part of the development of recommendations • Formal consultation on the actual recommendations for change • Post-consultation feedback detailing how the decision is being implemented
As an early involvement strategy, Cheshire and Merseyside LINks (which has now transitioned into Healthwatch) were brought together in October 2011 to be informed about the proposals and to seek their support and collaboration in ensuring local people are involved in the pre-consultation activity. Representatives acknowledged and valued this early indicative plan and responded positively to our request for developing a collaborative approach to engage patients and the public in the pre-consultation process. Target Audiences The approach to communication and engagement aims to be comprehensive and robust. Our aim was to work closely with key organisations that can easily communicate with a range of audiences in the area, as follows:
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o Local residents o Patients and Carers o Third sector providers o Voluntary Patient Groups o Hospital Trust Members o Hospital Trust Volunteers o Local Involvement Networks (LINks/Healthwatch) o Local Council for Volunteer Service networks o Cheshire and Merseyside NHS Cluster Boards o Chairs and Chief Officers of Clinical Commissioning Governing Bodies o GPs members across Cheshire and Merseyside o Chairs of Local Medical Committees (LMCs) o Cluster Medical Directors o Primary and Secondary Care Trust Communication and Engagement Leads o Hospital Trust Chief Executive Officers o Hospital Senior Operational Managers o Senior Consultant Cancer Clinicians o Associated Operational Clinicians and staff o Cheshire and Merseyside Cancer Networks o The University of Liverpool o Local Authority Health Overview and Scrutiny Committees o Members of Parliament for constituent localities; o NHS North of England o Year of Action on Cancer leadership and operational group o Local media
Engagement Channels Stakeholder engagement used a range of channels to promote and explain the purpose and progress of the review, including:
o Senior officer meetings o Attendance at Scrutiny panels o Launch events o Community based roadshows covering constituent PCT areas across Cheshire
and Merseyside o Local Activity Programme for 3rd sector o Local Activity at GP practices o Local Activity at Hospital Trusts o Targeted letters and emails o Newsletters information within Hospital Trust membership publications o Web based consultation information o Web based questionnaire
A matrix demonstrating reach to respective groups is detailed Appendix 2
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Key Messages A consistent set of key messages ran through all communications. These messages are segmented into the following themes:
a) Continue to focus on making sure patients and service users receive high quality
care that treats illness and supports people to stay healthy.
b) Support staff to have the skills and knowledge needed to provide modern, responsive and consistently high quality care.
c) Make sure organisations, and contractual arrangements between commissioner and
providers, are focused on supporting this.
It is vital that we were absolutely clear why these changes are important, what they are about, what the projected outcome are and that we are consistent in communicating this in all programme activity as well as any formal communications outputs and consultation activities.
The following key messages will be covered in all communications to all key stakeholders:
• The need for change • Why is this a local priority • Who will it affect • What are the benefits • What are the risks • What does this means to local people and services • How it will be implemented • What are the timescales • What can you influence • What are your views on this proposal
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5. Range of Activity and Methodology
A range of opportunities and methods were undertaken to elicit the views of key stakeholders. Each NHS partner agreed a reporting schedule to relevant Trust, Cluster, and Clinical Commissioning Group Boards throughout the year. The dialogue began with an update on the communication and engagement approach and asked for feedback on areas for improvement. Information updates were provided at the Strategic Overview Group meetings which had provider, commissioner and cancer network senior representatives in attendance. The meetings were jointly chaired on a rotating system by the Chairperson from The Clatterbridge Cancer Centre NHS Foundation Trust and the Royal Liverpool and Broadgreen University Hospital Trust. The pre-consultation communication and engagement plan was also shared with NHS North West Strategic Health Authority lead for service reconfigurations. The respective Commissioning Support Unit staff attended relevant patient/stakeholder meetings to share plans and ask for feedback. In order to affect a broader engagement model, communication and marketing collateral was developed to support the programme which partners, staff and volunteers had full use of to assist their support and consistency of message:-
• A cancer centre summary document was developed using lay terms outlining the health of the population, current service provision, and the proposal for change, the benefits to patients, and how to make comment on the plans.
• The booklet was complimented with response cards which could be returned via freepost, by visiting the roadshows, or visiting the many venues where response boxes were placed and is detailed later in the report. Alternative language, fonts, and audio options were made available upon request.
• A customised cancer trailer vehicle was used to run the community roadshows.
• An on-line survey was created to enable virtual feedback.
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• A website address to learn more and also feedback was used in partnership with the Action on Cancer initiative and the Cheshire and Merseyside Cancer Network website also displayed this as a link www.actiononcancer.org
• A dedicated phoneline (standard charge) was made available to receive comments and answer any questions rising from the information booklet.
• A frequently asked questions sheet was uploaded onto websites and provided at roadshows for staff and volunteers to use where necessary.
• Post boxes were places in GP practices, hospitals, carers centres, support groups,
Charities and hospices. Marketing Collateral Images
Volunteer and Staff Identity materials also advertises website to find out more and feedback comments.
Two launch events were held, the first at The Clatterbridge Cancer Centre site and the second at the Liverpool Medical Institute. NHS Merseyside and NHS Cheshire, Warrington and Wirral Cluster commissioners opened the events to share the proposals. Leading clinicians from both Trusts (Dr. Nicky Thorpe and Dr. Chris Holcombe) presented the plans for change along with a screening of a patient experience DVD which was produced to share the patient perspective of having excellent care and what the benefits of the proposed change would mean in terms of improving patient experience and creating greater positive patient health outcomes. Key stakeholder organisations were invited to attend the launch events and make recommendations on how to create an inclusive and wide reaching engagement model, along with requesting their commitment to work in collaboration to help raise awareness of the proposal. Invited stakeholders ranged from constituent local authorities, clinical commissioning groups, Hospital Trust Governors and members, locality based cancer support groups, carers groups, hospices, charities, , LINKs, Liverpool University. Two volunteer engagement events followed also held in the North and South of the Mersey to support local uptake. The aim was to ask local groups andorganisations to be partners in the engagement. Over 40 local residents, many of whom were representatives of local support groups, LINKs, Clatterbridge Cancer Centre Governors, and carers groups, were volunteers at numerous road shows. Their commitment in extremely challenging weather conditions was magnificent and testament to their on-going support to improve cancer services for local people. Joining in such a high profile engagement activity gave opportunities for volunteers to promote the groups and organisations they were affiliated to gain new members or raise awareness of what support is available in communities without the incurring the expenses associated with promotion and advertising. The customised cancer trailer vehicle was used to facilitate 38 x 3 day long roadshows across Cheshire and Merseyside covering Liverpool, Halton, St. Helens, Sefton, Knowsley, Warrington, Wirral, Chester and East and West Cheshire. High footfall areas such as shopping centres, town centres, city centre areas were used to site the vehicle for three days per visit. Over 84,000 people passed the vehicle, with 14,500 people stopping to speak to engagement staff and local volunteers to find out more about the proposal.
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The first day of the roadshow was in September 2012 in Liverpool City centre and a prominent Radio Station (Radio City) presenter on seeing the trailer invited the lead officer from the commissioning support unit to share the information live on air that evening to raise awareness of the proposals and invite people to participate and share their views. This programme is aired across the North West and Wales and reaches 100’s of thousands of listeners and was an excellent springboard to begin the process. Radio City displayed contact details on behalf of the project on their website and have offered a further slot to feedback on the plans and would continue to help raise awareness by displaying the contact details on their website which has 1000’s of daily hits. Other local press titles also ran information regarding the roadshows. Hospitals across both regions were sent information and booklets, comment cards, freepost returns, voting boxes, namely those who displayed materials were: The Clatterbridge Cancer Centre NHS Foundation Trust as well as The Clatterbridge Cancer Centre clinic sites across Merseyside and The Royal Liverpool & Broadgreen University Hospital Trust,. District general hospitals also supported awareness at Whiston Hospital and, Southport and Ormskirk Hospital Trusts. Trusts were also offered use of pop up display materials to use where space permitted. Every GP practice across Cheshire and Merseyside was sent poster information and booklets, and where possible displayed post boxes for comments on site. Freepost materials and website access were also advertised and made available. Formal links with the Action on Cancer (AoC) campaign were made which enabled our work to be highlighted at alongside AoC specific events. AoC team members were provided with the marketing and information material as additional activity to use at events across region, for example a men’s health event held at Liverpool Football Club. Throughout Cheshire and Merseyside the Macmillan Centres provided support, the John Holt Foundation, Cancer Research centres, Faith organisations, the Healthy Communities Collaborative and the Brain Tumour Support Group all helped raise awareness of the proposals and displayed the marketing collateral and had post boxes on site. Local cancer support groups, carers groups, young carers, local involvement networks (LINks) hospices and charities across Cheshire and Merseyside all supported and engaged with the process and were invaluable in getting the message across to local people and patients in their respective settings. Similar use of marketing collateral was used and the commissioning support unit staff delivered and collected all the collateral across both Cheshire and Merseyside. The pre-consultation programme yielded 4,164 responses made on-line or through postal returns which were uploaded by NHS Merseyside and NHS Wirral staff. The analysis of the feedback was conducted by John Moores University and can be found in Appendix 1.
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6. Summary and Recommendations
The methodology used for this pre-consultation phase was wide ranging. Using a network approach enabled local ownership, andwider reach into communities both in terms of communities geographically and communities of interest.
The additional benefit this model achieved was the inclusion of hard to reach members of the population affected by cancer, whose only contact can often be community support services such as support networks, clinicians in communities or faith network groups.
Using a matrix model of engagement such as roadshows, events, networks, and meetings created extensive opportunities of reach and yielded a high volume response rate which has rich, insightful soft and hard data results. This collective model of insight has culminated in key thematic areas being identified which The Clatterbridge Cancer Centre can consider in regard to mitigating issues of concern raised during the process and learning what works well and should be built upon.
Using the stakeholder database developed for this programme of work creates strong foundations to feedback and demonstrates how The Clatterbridge Cancer Centre has listened to patients, public and key stakeholders and creates further opportunities for on-going dialogue during the formal consultation and indeed the potential implementation period. This will effect a model of continuous engagement for the life of the new build project and after.
Clearly, concerted efforts to hold north and south Mersey activity is essential to ensure patients and potential users of services can comment as the plans become clearer and the timelines for the new build are realised, particularly following the announcement that the new Royal Liverpool Hospital has received Treasury support to proceed with its new build and the benefits which the adjacency and connectivity to the planned new bio-campus offers to residents of Merseyside and Cheshire.
The three developments create an exciting campus of health care and research, which until now,. The formal consultation process needs to reflect the synergy of its co-location to other capital developments as the public views are “we are one NHS” not separate entities and therefore the benefits of a campus model of care could be viewed positively both in terms of the health economy working in partnership, but also the local economic regeneration such developments will bring.
The Clatterbridge Cancer Centre NHS Foundation Trust is strongly advised to focus its next stage of consultation using the insightful feedback from stakeholders to share what can be mitigated in the short, medium and long term. It needs to be transparent in its communication in relation to what cannot be mitigated and why, and the Trust can also
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use the formal process to consider areas where there is a information/knowledge gap from a patient perspective, which did not get covered in stage one, but which the Trust would value having clarity and understanding of at this next stage of the process.
Overall this pre-consultation stage provides the Trust the opportunity to reflect on the feedback and plan for the future in a timely manner.
Comprehensive Cancer Centre Pre-Consultation: Qualitative
2. Extant Literature .................................................................................................................................... 6
3.1. Data ................................................................................................................................................. 6
4.2 Themes per area ................................................................................................................................. 14
4.3 Themes per vote ................................................................................................................................. 17
4.4.3 Good Current Health Services..................................................................................................... 21
4.4.4 Ill Health ...................................................................................................................................... 21
4.4.5 Loss of Services ........................................................................................................................... 21
Several reports have been produced in order to understand the technical and costing
implications of reconfiguration. These include the Baker-Cannon report[1] and the Ellison-
Cottier report[2]. Equality issues, such as whether the reconfiguration would positively or
negatively impact on a group with characteristics protected by law, have also been
considered[3]. These reports recognise that reconfiguration will have travel implications for
those currently living near to the current and proposed sites. The reports conclude that
there will be some people who will experience reduced travel as a result of the proposal and
some for whom journey time will increase. Overall, the reports find that a majority of future
patients will experience reduced travel time based on where the burden of disease lies
within the MCCN population. The reports also find that a relatively small population
experience direct travel benefits from the current service location and these benefits are no
longer realised once the public transport journey time exceeds about 15-30 minutes.
3. Methodology
3.1. Data
This analysis is drawn from survey data taken from a survey sample of 4,164 respondents.
Cleaned data revealed that 3,755 (90%) respondents left comments to an open question
within the survey. The data presented was predominantly qualitative requiring an
epistemological approach and a method based on critical realism.
In order to provide quantitative and qualitative analyse of the data by location, respondents
had the opportunity to record their postcode along with their responses. There was a
variety of responses gathered with some respondents providing a full postcode, and some
only a partial postcode. In a few cases no postcode was given (n=23). In view of this data
inconsistency a number of geographies have been prepared to enable analysis to take place
(Table 1)
7
Table 1: Postcode Geography Definitions
Geography
Name
Geography Definition
1 Liverpool
Postcodes
Contains all postcodes beginning “L” (Liverpool postal district). It does not including “LL” which is a N Wales
postcode district
2 Cheshire
Postcodes
Contains all postcodes beginning “CH” (Chester postal district). The CH postcode is the most coterminous
postcode for the Local Authority Footprints of Wirral, and Cheshire West and Chester. The classification of
‘Cheshire’ used here is purely for ease of presentation and does not include postcodes relating to the Cheshire
East Local Authority (“CW” or Crewe postcodes)
3 Manchester
Postcodes
Contains all postcodes beginning “M”
4 Warrington
Postcodes
Contains all postcodes beginning “WA”
5 Wigan Postcodes Contains all postcodes beginning “WN”
6 Miscellaneous
Postcodes
Contains all postcodes not allocated to geography 1-5 above (Liverpool – Wigan). Examples include “CW” “LL”,
“PR”, “SY”, “ST”, “SK”, “NG” and “VH”
7 Other Area
Postcodes
This grouping includes all non-Liverpool postal district (L) or Chester postal district (CH) postcodes
11 Not Known Either no postcode was provided or location based on classifications above could not be determined
3.2 Methods
A combination of content analysis and initial evaluation using Computer Assisted Qualitative
Data Analysis Software (CAQDAS) package Nvivo 10 was applied to the data. CAQDAS assists
in the identification of emerging themes using textual analysis. The data analysed included
no missing responses in respect of the overall ‘yes, no or not sure’ consultation question.
However, the optional follow up question responses contained some missing or textual
errors. This qualitative analysis is broadly based upon Grounded Theory and uses a process
of open coding and axial coding to extract and distil themes from the free text responsese.
Grounded Theory in its purest form is entirely data directed and presupposes no specific
themes from the data. In this scenario, it is clear that there are some constraints on being
able to follow a pure Grounded Theory methodology. The pre-consultation builds on the
extant literature and is structured on a premise that the reconfiguration will cause a
difference of opinion between local groups, most likely with differences observed between
groups who live near to the current or proposed sites. In this respect the analysis should be
considered semi-inductive, that is to say that the analyst will investigate some expected
themes in relation to location.
e Grounded Theory involves taking raw data and systematically distilling it to form a theory. Key points in the data are coded and then these codes are combined to form themes and concepts which can be developed into a theory.
8
4. Key Findings
Analysis of the PCQ shows that significantly more people voted in support of the proposed
changes and also that there is a significant difference in the PCQ responses of different
locations. Figure 1 illustrates that the number of people who support the proposed
reconfiguration is greatest from locations with a Liverpool postcode.
Figure 1: Distribution of Votes by Postcode Area
Source: Engagement survey 2013
Figure 2 shows the percentage of votes cast in the PCQ by each postcode area. Cheshire
postoces dominated the No vote with Liverpool Postcodes recording the highest percentage
of Yes vote. Warrington and Cheshire postcodes make up the majority of undecided voters.
Number
of Votes
Postcode Area
9
Figure 2: Percentage of No, Yes and Not Sure votes by Postcode Area
Source: Engagement survey 2013
A Tree Map (Figure 3) can be used to illustrate the responses at a lower geography,
displaying what proportion of votes came from each postcode. As Figure 3 shows ‘No’ votes
were predominant in CH postcodes with CH64, CH43, CH62, CH45 and CH63 being ‘No
Hotspots’. Warrington Postcodes made up a substantial proportion of the votes from people
who were undecided. ‘Yes Hotspots’ included L36, WA7, L32, L35 and L33. This report will
go on to consider the responses from these postcodes, designated ‘Yes’ and ‘No’ Hotspots,
in more detail (Section 4.4).
Figure 3: Distribution of Postcodes by Vote
Source: Engagement survey 2013
Figures 4 and 5 show how Yes and No votes were distributed across the MCCN footprint.
10
Figure 4: Map of the Distribution of Yes Votes across the MCCN
Source: Engagement survey 2013
Figure 5: Map of the Distribution of No Votes across the MCCN
Source: Engagement survey 2013
11
In order to place these responses in some context the current geographical distribution of
people attending for in-patient treatment at CCC is shown in Figure 6. Comparing the maps
it can be seen that the No Hotspots correspond with the areas on the map with high
representation in the in-patient treatment population.
Figure 6: Distribution Map of Clatterbridge Inpatients
Source: CCC data 2013
4.1 Emerging Themes
A basic word frequency query was used to identify the words that were most commonly
used in people’s free text responses (e.g. detailing why they said yes, no or not sure to the
PCQ). These words can be visually presented in a tag cloud where the size of the word is
proportionate to the number of times it appearsf. Figure 6 shows the tag cloud for all the
responses.
f The more often a word appears the bigger it is in the tag cloud
12
Figure 7: Word Frequency Tag Cloud for All Responses
Source: Engagement survey 2013
This word frequency investigation formed the basisof the open coding. A coding model
(Figure 8) shows how themes were distilled from the datatset. In this first round of coding
33 common themes were identified. These included themes (in no particular order) like
Idea, Stress, Travel, Links, Distance, Visits, Treatment, Travel, Support and Time.
Figure 8: Research Coding Model
Source: Engagement survey 2013
13
The context of each theme was explored using word trees to understand more about the
context that each word was used in. For example, the word “stress” was used 102 times
across all the responses. Figure 4 shows the context surrounding the word.
Figure 9: Word Tree of Responses that Include the Word “Stress”
Source: Engagement survey 2013
From this it is possible to see that the word ‘stress’ is most commonly used in the context of
travelling to receive treatment. A typical response is provided below:
Reference 39 Having Cancer is a stress in the first place. Having to travel further for a treatment only adds to the stress.
Appendix 1 contains more word trees for some of the other ambiguous themes
14
The 33 initial themes were axially coded or distilled using these methods into 7 main themes
emerging from this engagement exercise. These are:
Accessibility
Cost
Good Current Services
Ill Health
Loss of Service
Travel
Visits.
Having obtained these key themes, it is possible to repeat this exercise for smaller
populations than the overall survey sample, such as groups from the same postcode area or
those who voted either Yes, No or Not Sure
4.2 Themes per area
The overall PCQ analysis showed that respondents from Cheshire Postcodes and those from
Liverpool Postcodes tended to demonstrate different voting behaviours. Analysing and
comparing the word frequency of these two groups makes the reasons for their different
positions clearer.
Figure 10a and 10b show the word frequencies for the two postcode areas. While many of
the words are similar, suggesting that they have a similar understanding of the proposition
and share some of the same views, there are notable differences.
For example, the words Costs, Parking and Tunnel have a greater prominence in responses
from Cheshire. The word Tunnel is mentioned 10 times across Liverpool responses but 29
times in Cheshire responses (Table 2).
15
Figure 10a Word Frequency Tag Cloud for Cheshire Postcode Responses
Source: Engagement survey 2013
Figure 10b Word Frequency Tag Cloud for Liverpool Postcode Responses
Source: Engagement survey 2013
16
Table 2: Number and percentage of responses that include the word “Tunnel”
Not
Known
Warrington Cheshire Liverpool Manchester Miscellaneous Wigan
Number of responses containing "Tunnel" 2 5 29 10 0 0 1
Total number of responses 19 1,008 792 1,776 5 117 38
Percentage of responses which contain "Tunnel" 10.53 0.50 3.66 0.56 0.00 0.00 2.63
Source: Engagement survey 2013
Another theme that emerged with a greater prominence from Cheshire responses was
satisfaction with current services – the prominence of words like ‘excellent’ and ‘stay’ drew
attention to the comments about the ‘excellent’ quality of current services and the request
to let things ‘stay’ as they are. The following comments were typical of this theme.
Reference 38 I am a patient who has had an excellent series of treatments at Clatterbridge Oncology Centre. It is a well organised and pleasant convienent hospital to attend.
Reference 96 There is already an excellent system at clatterbridge which should be further invested in
Reference 105 As long as the new centre does not replace Clatterbridge, where my father received excellent treatment
Reference 12 Because have used services at Clatterbridge and would like it to stay as it is
Reference 18 Services need to stay on the Wirral
Reference 24 Clatterbridge has such a good reputatuon and should stay as it is
Reference 40 Having been treated at Countess and Clatterbridge would prefer services to stay nearby
Liverpool postcode responses tended to record that a service that ‘closer’ to home was one
reason why respondents had voted the way they had. The number of comments about
‘travel’ as evidenced by its relative size in the tag cloud reinforces this point. The idea that
services should be based near to where the greatest need was echoed in responses from
Non Cheshire-Liverpool postcodes (see Appendix 1 for ‘closer’ word tree)
Figure 11 shows a cross tabulation of the key thematic content by Postcode Area. From this
analysis it is clear that the notion of travel and accessibility whilst potentially feeling unwell
and issues related to visiting are a common themes for Liverpool postcode respondents and
a large majority of respondents overall. Cheshire respondents were raising concerns of cost
and pointing out their satisfaction with current services.
17
Figure 11: Number of Coded Responses by Key Theme and Postcode Area
Source: Engagement survey 2013
4.3 Themes per vote
It should be noted that not everyone in a particular area voted the same way. For example,
taking the two postcodes where the number of votes for and against were highest or most
polarised (CH64 – ‘No’ and L36 – ‘Yes’) it can be seen that voting was not unanimous.
Table 3: Percentage of Respondents from Selected Postcodes voting Yes, No and Not Sure
Source: Engagement survey 2013
In view of this it is appropriate to investigate the themes that emerged from those who
indicated support for the proposal and those who opposed it. Using similar analytical
methods it can be seen that ‘Yes’ voters were reporting travel, closeness of services and
meeting the needs of family. ‘No’ voters reported concerns about parking, travel,
inconvenience and commented on the excellent quality of current services (Figures 12a and
12b).
% Voting 'No' % Voting 'Yes' % Voting 'Not Sure'
Postcode = CH64 63.5 23.8 12.7
Postcode = L36 1.0 98.0 1.0
Number of
Coded
Responses
18
Figure 12a: Word Frequency Tag Cloud for Yes Responses
Source: Engagement survey 2013
Figure 12b: Word Frequency Tag Cloud for No Responses
Source: Engagement survey 2013
19
The different perspective of the two groups is also observed in the analysis of the key
themes. Figure 13 shows the number of comments made in respect of each theme by the
two groups and it is striking that the number of comments relating to accessibility made by
the Yes group outnumber all the comments relating to key themes made by the No group.
However it is important to ensure that the total number of respondents in each group does
not distort the picture – there were many more yes vote responses than no vote responses.
For example, the number of ‘cost’ comments from the ‘no’ voter group is quite similar to
the number made by the ‘Yes’ group but as Figure 14, which is a presentation of themes as
a percentage of comments made by each group, shows there is a greater proportion of
‘cost’ comments coming from the ‘no’ voter group. In this respect it is easy to compare
which themes were particularly pertinent to each group.
Figure 13: Number of Coded References of Key Theme By Yes/No Vote
0 500 1000 1500 2000 2500 3000 3500
No Vote Content
Yes Vote Content
A : Accessibility
B : Cost
C : Good Current Services
D : Ill Health
E : Loss of Services
F : Travel
G : Visits
Source: Engagement survey 2013
20
Figure 14: Key Themes Expressed as a Percentage of the Yes and No Votes
Source: Engagement survey 2013
4.4 Key Postcode Analysis
Having identified that there are different perspectives across groups of voters and that
these voters were generally split by location (Cheshire/Liverpool), it is worth considering in a
little more detail what respondents are actually saying about the key themes. In order to do
this, analysis has been focussed on the responses of those areas with the most polarised
views. i.e. postcodes that could be described as being ‘Yes’ or ‘No’ vote Hotspots.
Figure 15: Number of Coded References by Theme and Vote Hotspot
A : No Hotspot B : Yes Hotspot
1 : Accessibility 84 217
2 : Cost 84 45
3 : Good Current Services 38 27
4 : Ill Health 8 40
5 : Loss of Services 5 -
6 : Travel 104 425
7 : Visits 35 112
Source: Engagement survey 2013
The themes are considered in detail below:
4.4.1 Accessibility
The accessibility theme is defined by issues of transport and travel, but more specifically this
theme includes references to the availability of public and private transport, parking and
congestion. In general, ‘No’ Hotspot responses recorded that a move would reduce
accessibility for them and ‘Yes’ Hotspot respondents reported that accessibility would be
improved because of the transport infrastructure in Liverpool. A detailed analysis of Hotspot
21
responses showed that ‘No’ vote responses considered Clatterbridge to be accessible as it
was close to the motorway and that Liverpool was inaccessible due to parking and
congestion. ‘Yes’ vote responses focussed on what they believed to be better public
transport network to Liverpool.
4.4.2 Cost
Although cost was mentioned in several different contexts, the majority of the cost
references were in respect of the additional costs of travel, such as parking, taxis and tunnel
fares. ‘No Hotspot’ respondents tended to report that the tunnel costs would be additional
to them if the service moved whereas ‘Yes Hotspot’ respondents reported that taxi fees
were currently additional for them.
4.4.3 Good Current Health Services
Comments relating to this theme were made in qualification of a preference to keep
services in Clatterbridge. Many respondents spoke of excellent services and the notion of ‘if
it ain’t broke don’t fix it’ was expressed.
4.4.4 Ill Health
Respondents who have had personal experience of cancer treatment (either themselves, a
friend or relative) reported on the difficulties of travelling when feeling unwell. Respondents
from ‘Yes Hotspot’ postcode areas in particular commented on this issue with 40 ‘ill health’
references being reported against 8 from the ‘No Hotspot’.
4.4.5 Loss of Services
The loss of services was a concern for a particular minority of voters. This theme was
especially linked with those who reported personal experience of current service provision
in ‘No Hotspot’ postcodes. In some of these cases it was clear that the respondent felt that
this might be the thin end of a wedge, resulting in the ultimate closure of services and loss
of jobs at Clatterbridge. For example:
Reference 2 A devious way of closing the oncology unit at Clatterbridge, which is highly regarded for people in Wirral, Cheshire and N.
Wales
Two respondents made specific reference to the relocation of other health services away
from the Wirral.
4.4.6 Travel
Travel is by far the most commented on theme to emerge from the responses. Travel
comments are predominantly related to distance. Issues of general transport availability
have been collected under the accessibility theme. However, reference to transport ‘links’
have been recorded within this theme. The majority of those comments relating to travel
come from respondents with Liverpool postcodes and reflect the opinion that current
provision is ‘too far’. Many made reference to the difficulties of travelling when ill. A typical
response is recorded below:
22
Reference 1 Family have been affected by cancer and the travel to Clatterbridge took alot out of them when they were unwell. It was too far.
4.4.7 Visits
Many respondents were clearly able to draw on personal experience of cancer treatment
services. Analysis shows that some 75 references were made to parents who had cancer and
had used services. Many of these comments were surrounded by reflections on travel and
accessibility for the individuals who were receiving treatment but many also commented
about the importance of the patient’s support network and therefore the need to make it
easy to visit. Analysing hotspot responses in respect of this theme, it is clear that the No
Hotspot respondents valued the proximity of current services to them and their family,
whereas Yes Hotspot respondents reported the difficulty families had travelling to
Clatterbridge.
Appendix 3 includes examples of these responses.
5. Summary
The qualitative analysis identifies and evidences the following emerging themes (in
alphabetical order):
Accessibility
Cost
Good Current Services
Ill Health
Loss of Service
Travel
Visits
These themes were generally observed across the whole dataset but it is clear that different
perspectives exist between those who voted ‘Yes’ and those who voted ‘No’. There was also
a geographical dimension to the responses but as Figure 16 shows this was not as strong an
association as voting behaviour.
The Cluster Analysis (Figure 16) uses statistical methods to chart the similarity of the words
used by the groups selected and the spatial relationship between objects in the chart shows
how similar they are. The closer together a group the more similar the content of the
responses. From this chart it is possible to see that ‘No’ votes are the ones most closely
23
associated with some of the themes like Ill health, Loss of Services , Cost and Good Current
Services.
Figure 16: Cluster Analysis of Themes, Votes and Postcode Area by Word Similarity
Source: Engagement survey 2013
Based on the analysis within this report, it is recommended that:
the business case records and reflects the benefits that the majority of respondents
reported, namely reduced travel for the majority of patients and their families and a
view that general accessibility using public transport will be improved by locating the
service in Liverpool.
the business case includes a strategy for informing and reassuring those who oppose
the proposals that the quality of service will not reduce as a result of reconfiguration.
the business case makes provision to comment, as far as possible, on the possibility
of further service reconfiguration in response to concerns that this may be the start
of a programme of service withdrawal.
consideration is given to how best to further communicate which patients will need
to receive their care in Liverpool following reconfiguration and which will continue to
be treated at the Wirral site.
24
6. References
1. Baker, M.R. and Cannon, R.C. (2008) The organisation and delivery of no-surgical oncology services in the Merseyside and Cheshire Cancer Network: A feasibility study into the potential for the relocation of non-surgical oncology services from Clatterbridge to Liverpool, Cancer Taskforce.
2. Ellison, T. and Cottier, B. (2009) An Analysis of Radiotherapy Services in the Merseyside and Cheshire Cancer Network, The National Cancer Services Analysis Team.
3. Hennessey, M., McHale, P. and Perkins, C. (2013) Equality Considerations in the Development of a Comprehensive Cancer Centre, 2013, Centre for Public Health: Liverpool John Moores University.
25
7. Appendix 1: Word Trees
Word Tree of Responses That Include the Word “Support”
26
Word Tree of Responses That Include the Word “Links”
Word Tree of Responses That Include the Word “Idea”
27
Word Tree of Responses That Include the Word “Closer”
28
8. Appendix 2: Cluster Analyses
Cluster Analysis: Postcodes Clustered by Word Similarity
Yes Cluster
No Cluster
29
Cluster Analysis: Dendrogram of Postcodes, Vote and Themes by Word Similarity
The closer together items are in the tree above, the more similar their word content: For example, the responses the mention
‘accessibility’ were most similar to responses from WA7 and WA postcodes
30
9. Appendix 3: Theme Report
Theme Report: “Travel” Theme
Appendix_Travel report (excerpt)
Name Description Number Of Coding References
Coded Text Percent Coverage Of Source
Travel Report 0
Travel Report Key Theme. Distilled from references relating to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey
1,733 A centre for the care of cancer patient and for research in to finding cures would be one of the most useful establishments one could hope for. Especially now that so many advancements have been made. Things will get better.
0.02 %
Travel Report Key Theme. Distilled from references relating to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey
1,733 A centre of excellence seems a good idea, as long as it does not take money and resources from local services.
0.02 %
Travel Report Key Theme. Distilled from references relating to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey
1,733 A city like Liverpool should have its own centre to ease the burden of travelling to clatterbridge
0.02 %
Travel Report Key Theme. Distilled from references relating to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey
1,733 A devious way of closing the oncology unit at Clatterbridge, which is highly regarded for people in Wirral, Cheshire and N. Wales
0.02 %
Travel Report Key Theme. Distilled from references relating to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey
1,733 a good place to go good bus service and train
0.02 %
Travel Report Key Theme. Distilled from references relating to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey
1,733 A layman's view. Provided the service currently available at the existing Clatterbridge site is not diminished in any way then the new proposal is an excellent idea otherwise not so. To avoid confusion the Liverpool site should have a separate name
0.02 %
Travel Report Key Theme. Distilled from references relating to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey
1,733 A long way from home. 0.02 %
31
Travel Report Key Theme. Distilled from references relating to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey
1,733 A long way to travel when visiting Clatterbridge, so the Royal will be good.
0.02 %
Travel Report Key Theme. Distilled from references relating to Travel. Includes Stemmed words and synonyms for...Distance, Far, Near, Journey
1,733 A lot more research and treatment is needed to help people with cancer and also to help families come to terms with their diagnosis.
0.02 %
Reports\\Appendix_Travel Report (excerpt) Page 1 of 185
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Authors: Matthew Hennessey
Centre for Public Health Research Directorate Faculty of Health and Applied Social Sciences Liverpool John Moores University 2nd Floor, Henry Cotton Campus 15-21 Webster Street Liverpool L3 2ET Tel: +44 (0)151 231 4535 Fax: +44 (0)151 231 4552 Email: [email protected]
TITLE OF REPORT: Work Programme 2013/14 and Monitoring of
Actions/Recommendations 2012/13 - 2013/14 1. PURPOSE 1.1 The purpose of the report is for the Committee to consider its work
programme for the remainder of the municipal year and to monitor the actions and recommendations agreed by the Committee or any of its Working Groups.
2. CONFIDENTIAL OR EXEMPT 2.1 Not applicable 3. INTRODUCTION AND BACKGROUND 3.1 The Committee agreed it substantive Work Programme for 2013/14 at
its meeting on 20 March 2013. This is a ‘living document’ and a copy of the latest version is attached as Appendix 1. This report details the progress made regarding the implementation of the work programme.
3.2 The schedule at Appendix 2 provides an update as to progress on any
actions proposed or recommendations made by the Committee, referrals received, and Working Group recommendations.
4. WORKING GROUP ACTIVITY
4.1 The Committee has not established any Working Groups to date. 5. FINANCIAL CONSIDERATIONS 5.1 When carrying out scrutiny activity Members are reminded of the
general financial climate and the Council’s Values, which include a commitment to “living within our means.”
Agenda Item 9
106
6. RISK ASSESSMENT 6.1 The following potential risks have been identified: recommendations not
accepted by Executive Board, or not acted upon; partners unwilling to engage; insufficient capacity within Directorates to support scrutiny activity in the light of efficiency savings; selection of inappropriate topics, which have minimal impact or are undeliverable; insufficient capacity within the work programme to deal with matters arising.
6.2 Risks are regularly monitored and managed by the Chairman with the
advice and support of relevant officers. Links with the Partnerships and Performance Team and the Policy Committees are maintained and the delivery of the Work Programme is routinely monitored.
7. EQUALITY AND DIVERSITY/EQUALITY IMPACT ASSESSMENT 7.1 Democratic and Member Services has an up to date Equality Impact
Assessment for its policies and services. 7.2 Equalities issues relating to policies, services and other topics under
scrutiny are the responsibility of the individual Directorates concerned. However, the committee will monitor the compliance by Directorates on equality and diversity issues when carrying out its functions.
8. CONSULTATION 8.1 Consultation with relevant stakeholders is undertaken on a regular
basis. 9. RECOMMENDATION 9.1 To approve the Work Programme for the remainder of the municipal
year 2013/14 at Appendix 1 9.2 To note the progress on actions, recommendations and referrals at
REPORT DEADLINE – FRIDAY 17 JANUARY 2014 Issue Methodology, Details, Purpose Lead
Officer(s) Progress Further
Action(s) Scrutiny of the Medium Term Financial Plan and Council’s Budget
Rationale: To respond to the annual consultation on the MTFP and draft Council Budget Anticipated Outcome: To support the Executive Board and Council to develop a robust Budget which is aligned to Corporate priorities and to be a voice for comments and concerns expressed by the public and other stakeholders.
L Green and Portfolio Holder for Corporate Resources & Assignments
OFSTED Inspection of Fostering and Children’s Homes
Rationale: To consider the anticipated report of the Inspectorate in respect of vulnerable children. Anticipated Outcome: To provide assurance to the public that procedures are in place to learn from the findings of inspections to improve educational provision in Warrington.
F Waddington
Agenda Item 9 – Appendix 1
Progress Legend Completed Progressing to target Early progress / just started Not started (lower priority)
19 March 2014 REPORT DEADLINE – MONDAY 10 MARCH 2014
Issue Methodology, Details, Purpose Lead Officer(s)
Progress Further Action(s)
CQC Updates Rationale: To consider on a quarterly basis a summary of CQC inspection reports in relation to care provided in Warrington. To be local watchdog for any good and poor standards involving providers, so as to provide a conduit for intelligence from service users and other stakeholders to be fed back CQC. Anticipated Outcome: To hold local providers of care to account and to engage with the public about their experiences of care provision.
S Reddy An appropriate reporting system needs to be developed to capture CQC information and WBC support
State of Warrington Report - Snapshot of Wellbeing Outcomes
Rationale: To receive a biannual high level monitoring report, also provided to the Health and Wellbeing Board, which includes overarching outcome measures for performance in the five thematic priority areas of the Warrington Strategy for Wellbeing (JHWS) Anticipated Outcome: To provide critical challenge to the Health and Wellbeing Board and an assurance to the public that health and wellbeing priorities are being met.
Rita Robertson This report will
follow monitoring information reported to the Health and Wellbeing Board
Healthwatch Monitoring
Rationale: To consider biannual update report from Healthwatch, including its findings in relation to the customer or patient experience of healthcare or adult social care in Warrington. To deal with any statutory referrals from Healthwatch. Anticipated Outcome: To gather intelligence from service users about the standards of health care and adult social care in Warrington and to make reports or recommendations to providers, as necessary.
Local Healthwatch
Agenda Item 9 – Appendix 1
Progress Legend Completed Progressing to target Early progress / just started Not started (lower priority)
Rationale: To receive any presentations from NHS providers about their annual Quality Accounts. Draft Quality Accounts will usually be circulated outside of the formal meetings for Members’ comments. Anticipated Outcome: To respond NHS bodies carrying out their statutory duty to consult Scrutiny, by holding NHS bodies to account for past performance and providing a conduit for the public to comment on future priorities.
WHHT, 5BPT, Bridgewater NHS Trust, Clatterbridge Cancer Trust, NWAS
Draft Quality Accounts should be available from March 2014. Replies are usually delegated to officers in consultation with the Chairman
Educational Achievement – Annual Report
Rationale: To receive a report on the educational achievement of pupils in Warrington and the performance of Warrington schools, including Academies and Free Schools. Anticipated Outcome: To hold to account providers of publicly funded education in Warrington so as to help drive up educational attainment by Warrington pupils.
S Callaghan
Youth Strategy Forum Annual Report
Rationale: To receive an update report from the Youth Strategy Forum on its partnership activity in respect of young people in Warrington Anticipated Outcome: To provide critical challenge to partnership bodies about the delivery of multi-agency plans across Warrington.
F Waddington
Annual Report on Children’s Safeguarding
Rationale: To consider an annual report on Children’s Safeguarding and the Safeguarding Board’s Business Plan. Anticipated Outcome: To hold to account the executive and partners regarding arrangements for the protection of a specific vulnerable group and to provide an assurance to service users and their families about safeguarding issues
F Waddington Also submitted to Health and Wellbeing Board on 17 October 2013
Agenda Item 9 – Appendix 1
Progress Legend Completed Progressing to target Early progress / just started Not started (lower priority)
Rationale: To consider an annual report on Adult Safeguarding and the Safeguarding Board’s Business Plan. Anticipated Outcome: To hold to account the executive and partners regarding arrangements for the protection of a specific vulnerable group and to provide an assurance to service users and their families about safeguarding issues.
S Reddy Also submitted to Health and Wellbeing Board on 17 October 2013
Homelessness Review (project with CfPS)
Rationale: To consider a report on New Homeless produced following a project with the Centre for Public Scrutiny looking at health scrutiny with a Return on Investment approach. Anticipated Outcome: To make a report and recommendations to the Executive Board on potential improvements to housing advice services for working families who have been affected adversely by the economic downturn and are at risk of homelessness.
Homelessness Commission/ Dr R Robertson
Council’s Active Warrington Strategy and LiveWire Annual Report
Rationale: To receive a report on the delivery of the Council’s Active Warrington Strategy, including an annual report on the performance of LiveWire, which shows past performance and future priorities for the Trust. To be considered in conjunction with the Supporting the Local Economy Policy Committee. Anticipated Outcome: To hold to account the principal provider of leisure services in Warrington and to provide an assurance to the public about standards of service.
S Kenton Also submitted to Health and Wellbeing Board on 23 January 2014
Agenda Item 9 – Appendix 1
Progress Legend Completed Progressing to target Early progress / just started Not started (lower priority)
Cultural Strategy and Culture Warrington Annual Report
Rationale: To receive a report on the delivery of the Council’s Cultural Strategy, including an annual report on the performance of Culture Warrington, which shows past performance and future priorities for the Trust. To be considered in conjunction with the Supporting the Local Economy Policy Committee. Anticipated Outcome: To hold to account the principal provider of cultural services in Warrington and to provide an assurance to the public about standards of service.
S Kenton Also submitted to Health and Wellbeing Board on 23 January 2014
New Cut Heritage and Ecology Trail
Rationale: To receive a presentation on behalf of Poulton with Fearnhead and Woolston Parishes Councils and others, who are promoting the development of the New Cut Heritage and Ecology Trail and to listen to any concerns as to barriers to progress. Anticipated Outcome: To raise the profile of this valuable community project, to understand the challenges faced by the promoter, to consider the Council’s role in supporting the project and to make recommendations as to how the Council might work with the promoters to deliver shared objectives within agreed timescales and available resources.
Cllr I Johnson (Chair Poutlon with Fearnhead and Woolston Parishes)/ D Boyer
Potential for a site visit
Agenda Item 9 – Appendix 1
112
Work Programme Items (Not yet allocated to a meeting)
Issue Rationale Anticipated Timescale
NHS Substantial Variation/Development of Service – Consultations
Rationale: To deal with any health service matters which in the view of the Committee constitute a substantial variation or development of service. NB. Cancer Services review anticipated in June 2014, likely to be a Joint Committee with other authorities in the region. Anticipated Outcome: To engage the public and service users and to provide challenge to health service commissioners and providers about significant changes to services to ensure that outcomes are in the interests of local health services. (WCCG and other NHS bodies, as appropriate)
TBA
Later Life Memory Service – Consultation (5 BPT)
Rationale: To consider a specific substantial variation issue being developed by 5BPT, which is likely to be the subject of formal consultation in 2013/14 Anticipated Outcome: To engage the public and service users and to provide critical challenge to 5BPT about the proposed changes to services to ensure that outcomes are in the interests of local health services. (Julian Eyre and Therese Patten - 5BPT)
TBA
OFSTED Reports Rationale: To consider any OFSTED reports in relation the authority or its 8 children’s centres and any action plans arising from such reports. To consider any issues from OFSTED inspections of Warrington schools, where the Council may be able to provide advice or support. Anticipated Outcome: To provide assurance to the public that procedures are in place to learn from the findings of inspections to improve educational provision in Warrington. (A McCormack/ F Waddington)
TBA
Warrington Partnership Annual Update
Rationale: To receive an update report from Warrington Partnership as to progress on the delivery Partnership priorities. Anticipated Outcome: To provide critical challenge to partnership bodies about the delivery of multi-agency plans across Warrington and to provide assurance to the public that the Council is leading on ‘place shaping’. (K Griffiths)
TBA
Agenda Item 9 - Appendix 2
Progress Legend
Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed
Issues (exception)
113
Monitoring of Recommendations & Actions A. Committee Recommendations and Actions These are items that have come directly from an item on the Agenda of a meeting of this Committee Minute No & Date
Recommendation Referred to & Date
Action Progress
SC6 06/02/13
Work Programme 2012/13 (2) To ask the Solicitor to the Council, in consultation with the
Chair of the Committee, to look into the extent to which the Committee might scrutinise the matter of Arpley Landfill Site
T Date
A limited role for the Committee has been identified. The Committee will be updated by way of a briefing note (below) The Council has now responded to an appeal in respect of the 12 year extension planning application. A public inquiry is scheduled for 18th February 2014 and is expected to last 3 weeks at Orford Jubilee Hub.
Agenda Item 9 - Appendix 2
Progress Legend
Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed
Issues (exception)
114
The Council has employed a number of expert witnesses and a barrister to defend the Council’s reasons for refusal. All details are on the Council’s web site under planning appeal documents. The Council has also and separately received a planning application for a 5 year extension. This application was considered by DMC on 23 January 2014. Again the Council has employed a number of experts in respect of the 5 year application. The Committee’s decision, in accordance with the recommendation was to refuse planning permission.
Agenda Item 9 - Appendix 2
Progress Legend
Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed
Issues (exception)
115
SC11 20/03/13
State of Warrington Report (2) To agree to receive the report on a bi-annual basis to
facilitate the monitoring of performance against key local priorities for health and wellbeing.
R Robertson
Half Yearly monitoring reports will be provided (in colour)
SC18 24/06/13
Revenue Budget Monitoring 2012/13 – Quarter 4 (Draft Outturn) (4) To request that the Chief Finance Officer include a footnote in
the Statement of Accounts to explain the implications of the Department of Communities and Local Government not allowing the capitalisation of certain expenditure on redundancies and pensions.
L Green
This was actioned in the Statement of Accounts
SC20 24/06/13
The Francis Inquiry into Mid Staffordshire NHS Foundation Trust – Messages and Implications (2) To approve the Action Plan at Appendix 1;
T Date
Detailed work yet to commence
SC21 24/06/13
Health Scrutiny in Warrington – Legacy Report (3) To approve the Action Plan at Appendix 2 and to monitor
progress from time to time;
T Date
Detailed work yet to commence
Agenda Item 9 - Appendix 2
Progress Legend
Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed
Issues (exception)
116
SC22 24/06/13
Work Programme 2013/14 (1) To approve the Work Programme for 2013/14 at Appendix 1,
subject to the inclusion of the following additional topics:-
Regular overview of the Work Programmes of the Policy Committees; and
T Date
Noted. This will be carried out via desktop monitoring and involvement of the Chairman in the Chairs Forum
SC28 17/09/13
Children’s Social Work Complaints (2) That a copy of this report is shared with all managers, social
workers, social work assistants and other appropriate officers working within children in need, children in care and safeguarding and quality assurance divisions.
(3) That all managers within the Department reference the report
and its contents within staff at team meetings. (4) That, following the distribution of this report, the Assistant
Director, Targeted Services will send an e-mail to all social work staff to provide a reminder about the need to respond within timescales. The e-mail will note the achievement of 90% of complaints responded to in timescales this year as an improvement on last year but will also emphasize the need to need to continue with good performance and aim for 100%.
A McCormack A McCormack A McCormack
Confirmation of progress on actions has been sought
Agenda Item 9 - Appendix 2
Progress Legend
Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed
Issues (exception)
117
SC34 10/12/13
North West Ambulance Service (2) To request further information on the level and detail of
complaints made locally.
T Date
Information circulated by e-mail on 27 January 2014
Agenda Item 9 - Appendix 2
Progress Legend
Completed Progressing to target Early progress / just started Not started (lower priority) Complete – Immediate review programmed
Issues (exception)
118
B. Referrals to the Committee These are items that have been formally referred to the Committee by another body, such as Council, the Executive Board or another Committee Referred from and Date
Minute Details Response/Comments Progress
Nil C. Working Group Final Report Recommendations When a Working Group has submitted its final report and recommendations to the relevant body a summary will be recorded in the table below. Where interim recommendations are made prior to a final report, these are also recorded here. Recommendation Referred
to and Date
Action Review Date Progress
Nil D. Schedule of Future Meeting Dates Meeting Dates Where possible, draft documentation to
be provided no later than Final documentation to be provided no later than
