Your Views on Proposed Changes to Healthcare in Your Area

Your Views on Proposed
Changes to Healthcare
in Your Area
A consultation for Mid Essex Clinical Commissioning Group
Monday 2 November - Monday 28 December 2015
Contents
1 Introduction...................................................................................................................................3
2 Who is Mid Essex Clinical Commissioning Group?..............................................................3
3 What is this document about?..................................................................................................3
4 How the CCG spends NHS money.........................................................................................4
5 Why does anything need to change?.....................................................................................5
6 What is the CCG proposing to change?................................................................................6
7 Prescriptions for gluten-free food............................................................................................7
8 Hearing aids for mild hearing loss............................................................................................9
9 Vasectomy and female sterilisation........................................................................................11
10 GP-accessed physiotherapy....................................................................................................13
11 Your Views Count...................................................................................................................... 16
12 Timetable....................................................................................................................................17
Appendix 1 – Reference list..............................................................................................................18
Appendix 2 – Distribution list............................................................................................................18
2
1Introduction
Mid Essex Clinical Commissioning Group (CCG) has asked Enable East to run a
consultation on its behalf on proposals to change healthcare in the area.
Enable East is an independent NHS team that helps
health and social care organisations to deliver effective
projects. We are a not-for-profit organisation working for
and within the public sector.
Mid Essex CCG wants to demonstrate complete
transparency, openness and objectivity in relation to this
consultation and has, therefore, asked Enable East to run
the process on its behalf.
No decisions have been made. Mid Essex CCG is committed to hearing people’s views.
2. Who is Mid Essex Clinical
Commissioning Group?
Clinical Commissioning Groups (or CCGs) are responsible for buying
(commissioning) most healthcare for their local populations.
The 211 CCGs across England came into being in
2013 after an NHS reorganisation. CCGs are clinicallyled by GPs and other health professionals. They buy
NHS services such as emergency care, hospital care,
community and mental health services.
3 What is this document about?
Mid Essex CCG spends £424m a year to help the local
population stay well. However, the CCG has a financial
deficit and needs to make savings this year. The CCG
Board has had to think about how and where it can
reduce NHS spending. This document sets out areas
where proposed changes could happen. As part of this
process, the CCG wants to consult with you and gather
your ideas and views before making any decisions.
The four areas are:
Prescriptions
for glutenfree foods
Hearing
aids for mild
hearing loss
Vasectomy
& female
sterilisation
GP-accessed
physiotherapy
This document sets out:
• The current facts
• Why the CCG is proposing change
3
• What the proposed changes will be
• How you can have your say
4 How the CCG spends NHS money
£424m
Annual Budget
£1,090
Braintree
Maldon
389,000
Chelmsford
People in Maldon, Braintree
& Chelmsford localities
Average CCG
spend per person
in mid Essex
52%
Acute Hospital Care
13%
GP Prescribing
10%
Community Services
8%
Mental Health Services
3%
Ambulance Service
Other Health Services
4
5 Why does anything need to change?
Mid Essex is one of the 11 most financially challenged health economies in
the country. National funding considers that mid Essex has a lower level of
need and spend for health services.
£1
4m
Less to spend per
head than any other
Essex CCG
Historically underfunded
£15.7m Savings plan
this year
Mid Essex CCG needs to save £15.7m this year.
With an increasing demand for services, the NHS must
evaluate everything it provides.
NHS finance issues are well documented across Essex
and the country. Most NHS organisations are continually
looking at ways to provide high quality services yet make
savings where possible.
£
£
Need to balance
our budget and
repay £24.9 million
The CCG recognises that this is incredibly difficult and
that tough decisions need to be made.
With an increasing demand for services, the CCG must
consider the local needs and demands on products and
services yet still balance this with the money available.
What is the CCG already doing to reduce NHS spending?
• Transforming immediate care services – to make sure
people have access to the right urgent care at the
right time
• Transforming frailty services – to ensure people can
stay well at home for longer
• Streamlining the Continuing Healthcare process
5
• Working with NHS and social care partners to
improve flow and collaboration – to join services
where possible
• Restricting NHS funding for IVF
• Developing a new model of care to help take
pressure off A&E services
6 What is the CCG proposing to
change?
The CCG wants to begin a genuine conversation with people about the
proposed changes to services set out over the coming pages.
Prescriptions
for glutenfree foods
Hearing
aids for mild
hearing loss
Vasectomy
& female
sterilisation
We want to hear
from anyone who
may be affected
by the proposed
changes and listen
to their views.
6
GP- accessed
physiotherapy
£2
6.
8m
A
£1
00
,0
00
Ye
ar
7 Prescriptions for gluten-free foods
Total NHS spend on
gluten-free foods
Total mid Essex spend
on gluten-free foods
Online availability of
gluten-free foods =
In-store availability:
All major supermarkets
including ‘express’ sites
Tesco, Asda, Sainsbury’s,
Morrisons, Waitrose, Ocado etc.
Price examples:
Average
7
£1.50
£2.90
£3.41
£1
Supermarket own-brand –
sliced bread gluten-free
(550g white or brown)
Supermarket –
Genius white sliced
gluten-free 535g loaf
Cost to the NHS of
Genius white sliced
gluten-free 535g
The average price of a
loaf of bread
Background
For more than 30 years, the NHS has prescribed glutenfree foods like bread, flour, cereal and pasta to help
people with coeliac disease follow a gluten-free diet.
years, the range and availability of gluten-free products
has increased dramatically, with most supermarkets now
stocking a wide range.
Currently, people who have been prescribed glutenfree foods because of gluten intolerance are issued
with an FP10 prescription form which they take to their
community pharmacy (or GP dispensary).
In January 2014, the CCG restricted prescribing of
gluten-free foods to bread and flour and also reduced
the number of units from 16 to 8 per month. The costs of
prescribing reduced as a result of this policy, but over the
last 12 months the CCG has still spent over £100,000 on
gluten-free food prescriptions.
This policy was created at a time when gluten-free foods
were not as readily available as they are today. In recent
What the CCG is proposing
The CCGs proposal is to not routinely fund gluten-free
foods on a prescription basis because:
• Other naturally gluten-free foods are widely available
– potatoes, rice, corn (maize)
• Funding them is an inequitable policy, as many
people who have special dietary needs, such as
lactose-intolerance or diabetes, are not able to
access food on prescription
• Improved food labelling means people can see what
to avoid in products
• It costs more for the NHS to supply gluten-free
products on prescription than to buy from a
supermarket
• Many people prefer to buy their own gluten-free
foods, due to the wider choice available in shops
than on prescription
Who might be affected by the proposals?
• Everyone who currently receives gluten-free foods on
prescription
Who would remain unaffected by the proposals?
• People who do not have gluten intolerance.
Proposed saving to the CCG
•
8
£100,000 a year
8 Hearing aids for mild hearing loss
4,203
Number of single or
double hearing aids
fitted in 2014/15 in
mid Essex for all levels
of hearing loss
£1.16m
One ear
How much does it cost
per hearing aid?
£289
Annual
CCG spend
Two ears
£388
In society generally:
Braintree
Maldon
10M+
Chelmsford
People in the UK who suffer some form of hearing loss.
That’s:
of the
population
3.7m
Are of working age (16 – 64)
6.3m
Are of retirement age (65+)
Braintree
Maldon
2M
Chelmsford
£500 to
£2,800
9
People in the UK have
hearing aids, but only:
1.4M
Chelmsford
Price of buying a hearing aid:
(e.g. Specsavers digital range)
Use them
regularly
Background
Mild hearing loss is usually defined as a minimum
audible sound of between 25-40 decibels. It may result in
having some difficulties keeping up with conversations,
especially in noisy surroundings. Soft noises are not
heard and understanding speech may be difficult in a
loud environment.
Currently, people who suspect they may have hearing
loss will be referred by their GP to an audiologist for a
hearing test. If the test shows they have hearing loss
greater than 25 decibels (the lower limit for ‘mild’ hearing
loss) they will be asked if they want a hearing aid or aids
fitted. This will be done at a later appointment.
What the CCG is proposing
Mid Essex CCG is proposing to not routinely fund NHS
hearing aids for people with mild hearing loss. This
represents a reduction of 30%. The CCG is proposing
this because :
Audiology tests for hearing loss will not be affected. If you
are referred for an audiology test, it will be delivered free
on the NHS.
• Many people are prescribed hearing aids for hearing
loss but do not wear them
• Hearing aids are widely available on the high street
Who might be affected by the proposals?
• Those with mild hearing loss (between 25 and 40
decibels) following an audiogram conducted by an
audiologist
Who would remain unaffected by the proposals?
Audiology tests for hearing loss will not be affected.
If you are referred for an audiology test, it will be
delivered free on the NHS.
The following groups will still be eligible for a hearing aid:
• Those with a learning disability
• Those with auditory processing disorder
• Children up to the age of 17
• Those with severe multiple sensory disability
(definition available)
• Those with a moderate hearing loss (41-55 decibels)
and which is affecting their everyday life (functional
impact)
• Those with multiple severe physical disabilities
(definition available)
• Those with severe or profound hearing loss (above
56 decibels)
• People with clinically exceptional circumstances
Proposed saving to the CCG
•
10
• Those with a confirmed diagnosis of dementia
£335,000
• This policy does not include occupational hearing
loss nor its related legal processes
9 Vasectomy and female sterilisation
average number
of men
416
per year having a
vasectomy on the
NHS in mid Essex
£256,600
Average number of
women
36
per year having
sterilisation
Cost to the CCG
In society generally:
2000
40,000 vasectomies a year on the NHS in 2000
2010
13% of British men had
a vasectomy in 2010
2012
at least
3
Braintree
Maldon
Chelmsford
11
Aged
16-29
= 1%
Aged
40-44
Chelmsford
= 21%
increasing gradually to:
Aged
65-69
Chelmsford
= 32%
15,000 vasectomies a year on the NHS, due to a decrease
in the availability of vasectomies on the NHS as well as
more couples opting for female long acting contraception
Number of
private providers
in Mid Essex
£295 to
£1,167
Cost of having a
vasectomy privately
Background
Vasectomy, or male sterilisation, is an effective and
permanent form of contraception that involves a minor
operation (usually carried out under local anaesthetic)
to cut, seal or block the tubes that carry sperm from a
man’s testicles to the penis.
Female sterilisation is done by cutting, sealing or
blocking the fallopian tubes which carry an egg from the
ovary to the uterus (womb).
What the CCG is proposing
The proposal is to not routinely fund vasectomies and
female sterilisation because:
• Vasectomies can be accessed privately relatively
cheaply
• Effective low-risk alternative methods of NHS
funded contraception is available for women
Who might be affected by the proposals?
• Anyone seeking NHS-funded vasectomies
• Women seeking sterilisation
What would remain unaffected by the proposals?
Free NHS contraception services for women, including:
• Contraceptive implant
• Contraceptive injection
• Intrauterine system (IUS), such as the Mirena coil
• Intrauterine device (IUD)
Proposed saving to the CCG
•
12
£256,000 a year
Men can access free condoms (‘C’ card scheme) and
sexual health services are available from family planning
clinics and some community pharmacies.
10 GP-accessed physiotherapy
30,366
Average number per year
of all first and follow-up
physiotherapy appointments
in mid Essex
Annual spend
on GP-accessed
physiotherapy
in mid Essex
£1m
6 -12
WEEKS
Average first appointment
waiting time for
GP-accessed physiotherapy
services in mid Essex
Approximate costs of private physiotherapy:
£40
Initial consultation
(45 minutes)
13
£40
Follow-on treatment
(30 - 45 minutes)
Background
Currently when someone has a musculoskeletal (MSK)
pain or injury, such as a painful shoulder or knee, they
visit their GP. If the GP believes a routine physiotherapy
assessment and diagnosis is needed, the individual will
be referred to the community physiotherapy team.
At the moment patients wait, on average, between 6 and
12 weeks for a first appointment, where they will receive
an assessment, exercises to do at home and information
on how best to self-manage their condition. Up to four
further treatment sessions are available if necessary.
The current service works as follows:
Patient visits GP with musculoskeletal pain or injury
Referred to physiotherapist for diagnosis
Assessment and/or diagnosis by a physiotherapist and appropriate advice on
self-management
Up to four appointments / treatment sessions as appropriate
Discharged or further investigation
14
What the CCG is proposing
Option
What does this mean?
Proposed saving
Option 1: Stop all
direct GP-accessed
physiotherapy
Patients would have to self-fund physiotherapy treatment.
£1million
Option 2:
Telephone advice only
People would have access to a prompt telephone service to give
early advice and guidance on self-management and a programme of
exercises.
Approx £825,000
Option 3:
Limit service to one
assessment and one
follow-up
Following advice and guidance, patients would be given exercises to
complete and advice about how to self-manage their condition. One
follow up appointment may be offered if required.
£600,000
The CCG believes that by changing to option 2 or 3:
• Waiting times for advice and possible treatment
would be less
• Medical evidence shows that early advice on
self-management is an effective intervention
• Patients will receive advice and information more
quickly from a physiotherapist, without a 6-12 week
average wait for an appointment
• Medical evidence and patient evaluation shows that
not all patients/conditions benefit from physiotherapy
• Fewer unnecessary follow-up appointments
Who might be affected by the proposals?
• Any adult affected by musculoskeletal problems
Who would remain unaffected by the proposals?
• Children up to the age of 17
• Neurological physiotherapy
• Post-operative and rehabilitation physiotherapy
• Physiotherapy for people who are housebound
• Consultant-referred physiotherapy
15
11 Your views count
Enable East, on behalf of Mid Essex CCG, wants to hear from anyone affected
by this consultation and members of the local communities.
The CCG wants to listen to people’s views and take account of what people
have said during this consultation.
You are welcome to come along to one of our drop-in
events. Each event lasts approximately one hour and
will be attended by a CCG clinician. It is your chance
to understand more about this consultation and the
proposals. You will have the opportunity to ask questions.
Please let us know if you are interested:
By email: [email protected]
By phone: Linda Williams 01206 287501
Please tell us which drop-in event you would like to attend:
Date
Venue
Time
Wed 11 Nov 2015
Braintree Community Centre, Hollywood, 19-21 Bocking End,
Braintree, CM7 9AH
6pm-7pm
Mon 16 Nov 2015
Main Hall, Maltings Academy, Spinks Ln, Witham, Essex CM8 1EP
6pm-7pm
Thurs 19 Nov 2015
Springfield Parish Council, St Augustine’s Way, Chelmsford CM1 6GX
6pm-7pm
Mon 23 Nov 2015
Conference Room, Champions Manor Hall, Hullbridge Rd, South
Woodham Ferrers, Chelmsford, Essex CM3 5LJ
6.30pm-7.30pm
Mon 30 Nov 2015
Main Hall, Maldon Town Council, Market Hill, Maldon CM9 4PZ
6pm-7pm
Thurs 3rd Dec 2015
St Cedd’s Hall, Chapter House, Cathedral Walk, Chelmsford CM1 1NX
6pm-7pm
Survey
You can let us know your views by completing our
feedback questionnaire, via
www.surveymonkey.com/r/HXZYMJH
If you have problems accessing information online,
please call Linda Williams as below and we will be
pleased to talk you through the survey.
In writing or via email
You can send your views and comments as follows:
By email: [email protected]
By phone: Linda Williams on 01206 287501
By post: Your Views on Changes to Healthcare in your
Area, Enable East, The Laurels, Severalls Hospital,
Boxted Road, Colchester, CO4 5HG
Closing date for feedback is Monday 28 December 2015
16
12Timetable
For the consultation process
2 Nov
Consultation process begins
2 Nov - 28 Dec Drop-in events, group meetings and individual meetings where required
28 Dec
End of public consultation period
Post consultation
17
Jan 2016
Enable East to gather all feedback and draft an outcome report for Mid Essex CCG Governing Body meeting
28th Jan
Mid Essex CCG Board meeting: Outcome of the consultation presented and CCG decision.
End of Feb
Inform all stakeholders of decision
Appendix 1: Reference list
Further reading:
Hearing aids:
http://www.hearinglink.org/facts-about-deafness-and-hearing-loss
http://www.actiononhearingloss.org.uk/your-hearing/about-deafness-and-hearing-loss/statistics.aspx
Gluten-free Facts and figures:
https://www.coeliac.org.uk/about-us/news/coeliac-uk-letter-to-the-daily-mail-and-others-on-gluten-free/
Vasectomies:
The dramatic fall in numbers of vasectomies in Britain:
http://www.netdoctor.co.uk/sex_relationships/facts/sterilisation_men.htm#ixzz3o3skZrPh
Age profile of men who had undergone a vasectomy:
http://www.ons.gov.uk/ons/rel/lifestyles/contraception-and-sexual-health/2008-09/2008-09.pdf.
Appendix 2: Distribution list
This consultation was initially distributed to the following:
Relevant community and voluntary organisations
in Mid Essex
District, town and parish councils
Essex County Council
(including adult social care services)
Essex Health and Wellbeing Board
Essex Health Overview and Scrutiny Committee
HealthWatch Essex
18
Mid Essex CCG Patient Reference Group
NHS England (Essex and Midlands and East)
Mid Essex GPs
Essex Clinical Commissioning Groups
and Commercial Support Units
Press and media contacts
Relevant action groups and interest organisations
Libraries
Hospitals and relevant service providers
in Mid Essex
Essex Local Medical Committee (LMC)
Local MPs
Essex Local Pharmaceutical Committee (LPC)
Mid Essex contacts for groups representing older
people, mental health and people with disabilities
Voluntary and Community Sector (VCS)