Minutes:
The Chairman agreed that the following issue could be raised with the Committee and invited Peter Moore, Regional Director - North East Stroke Association to speak to Members. He circulated information relating to the Stroke Association (for copy see file of Minutes).
Mr Moore advised that after 9 years of funding from Durham Dales, Easington and Sedgefield CCG and North Durham CCG the Stroke Association had been serviced with a de-commissioning notice. He advised that this was a well-respected service dealing with a number of complex disabilities. He advised that clinical executives had made the decision to decommission the service.
The CCG had made a decision to extend the small community based stroke team, currently based in Easington. Mr Moore was concerned that this would not cover the long term needs of the service user.
He asked the Committee to consider the following questions:-
Was Durham Council aware of the decommissioning notice served by the Durham CCGs to the Stroke Association.? We provide long term support which cannot be offered by extending the role of the current CST, therefore stroke survivors living in County Durham will be disadvantaged even more than they are present due to the lack of funding Durham CCGs give to stroke services. With this in mind will the council work with us to ensure the quality of care for stroke survivors is not deprioritise?
Will the health scrutiny Committee support our Campaign to save this service, and request the CCG to withdraw the decommissioning notice until a full review takes place that involves the views of User, carers, and professionals?
The Chairman invited Sarah Burns, Director of Commissioning to respond.
She advised that a number of commissioning staff from North Durham, DDES and Darlington CCGs had been involved in a review of stroke services, and a decision on how to support these services had to be taken. She informed Members that only 5% of people currently had access to early discharge services and as no additional resources were available, the CCG needed to ensure that any re-focusing of investment should maximise clinical outcomes. Discussions had taken place with partners and the “Teams around the Practice” model currently being developed was thought to be the best option that could provide additional clinical support and strengthen the community service. The Director of Commissioning went on to explain that work was ongoing with the County Council and the Stroke Association around the exit and transition arrangements. She was confident that the alternative services would be in place and investment would be available for discharge from hospital.
The Interim Director of Public Health added that it was important that everyone in County Durham had an equity of provision of stroke services. The Strategic Manager, Planning and Partnerships advised that officers from Durham County Council had been made aware of the changes but had not had sight of the full report from the CCGs.
Councillor Brookes asked why the Stroke Association could not continue to provide this equitable service, and why there was a need to change the service.
The Director of Commissioning replied that the performance against the stroke indicator of people having to access the discharge team was 5% in County Durham compared to 35% nationally. The service was good in the Easington area but this was not carried across the whole of the County. She added that the Stroke Association did not provide a clinical service and that there would be a re-investment into clinical services for the whole County. The Teams around the Practice would bring all teams together including the voluntary sector.
Councillor Brookes further asked if there would be any new form of funding available to the Stroke Association and was advised that there would be no additional funding at this moment in time.
Councillor Armstrong expressed his disappointment that as a statutory consultee, no evidence had been brought forward about why the service needed to change. He asked that this together with the Impact Assessment be presented to the Committee.
The Chairman agreed that he felt that this was a substantial change and therefore the Scrutiny Committee should have been consulted about the changes. The Director of Commissioning explained that they had not viewed this as a material change and that was the reason why there had been no formal consultation. However, she agreed that this would now be addressed.
Councillor Hopper said she would be interested to see the numbers of people recovering from strokes and whether this was declining or rising. She was advised that the numbers would be included in the report that comes back to Members for consideration.
Councillor Huntington asked if there were contractual terms set out for the private sector in terms of supervision requirements and was advised that there was a robust performance metric in place.
The Director of Commissioning advised that they would not commission a less effective service. They did not have the budget to fund all services and as the clinical services were failing this was the area that would be addressed.
Councillor Savory commented that the Stroke Association were vitally important in providing support services to those people living alone.
Mr Moore commented that not all of the relevant people had been involved in the impact assessment. He was aware that there was no new money but pointed out that the costs of expanding the Easington community based team would be high. He suggested that this team could not provide the level of support currently provided by the Stroke Association.
Councillor Armstrong suggested that the Committee receive the verbal presentations made today and that the CCG come back with a further, more detailed report which should include details of service user and carer engagement undertaken as part of the decommissioning process, the rationale behind the proposed change in service model including evidence from Stroke service practitioners and the impact assessment undertaken as part of the decommissioning process.
The Principal Overview and Scrutiny Officer asked about the timeline around the service change and was advised that this would now be extended to take into account the Committee’s request for further information.
Resolved:
(i) That the report be received.
(ii) That a further, more detailed report be brought back to the Committee which includes details of service user and carer engagement undertaken as part of the decommissioning process, the rationale behind the proposed change in service model including evidence from Stroke service practitioners and the impact assessment undertaken as part of the decommissioning process