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YORKSHIRE AND THE HUMBER SPECIALISED COMMISSIONING GROUP Meeting held on Friday, 24 June 2011 at Sandal Rugby Club, Sandal, Wakefield Decision Summary for PCT Boards 1

STRATEGY AND DIRECTION

SCG 46/11

Review of Children’s Congenital Cardiac Services in England At the previous meeting it had been agreed that there would be a comprehensive debate about the national review of childrens congenital heart services at the June SCG meeting. The debate focused on: Consultation process and activities Service planning issues and assumptions Additional national workstreams which would feed into the final decision making process Next steps and key milestones Cathy Edwards presented a report which summarised all the key activities and milestones during the consultation period and for the six months. Matt Day presented a paper which covered a range of service planning issues relevant to meeting the health needs of the Yorkshire and the Humber population. It was agreed: (a)

to prepare a briefing note for the July cycle of PCT Board meetings. The briefing note would summarise the issues which had been considered by the SCG and the issues which would be fed back to the JCPCT; and

(b)

that here would be a further discussion at the July SCG meeting. (This minute needs to be read in conjunction with the attached PCT Board briefing paper).

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POLICY

SCG 52/11

Commissioning Policies Romiplostim for thrombocytopenic purpura It was agreed: (a) that Romiplostim for thrombocytopenic purpura be routinely funded in accordance with NICE TA 221;

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(b) that the information for commissioners (Romiplostim is excluded from PbR tariff. Manufacturer will make available at discount. PCTs should ensure that this discount is available from local provider Trusts) be noted; (c)

that PCTs should ensure appropriate implementation and monitoring of the policy; and (d) that the agreed general policies are available to the public in accordance with the directives from the Secretary of State. 3

GOVERNANCE

SCG 57/11

Draft SCG Annual Report 2010-11

Paul McManus

It was agreed:

Cathy Edwards/ Paul Crompton

that the draft SCG Annual Report 2010-11 be approved subject to indicated amendments, together with the proposed timeline. The final report would be presented to PCT Boards in August/September 2011.

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YORKSHIRE AND THE HUMBER SPECIALISED COMMISSIONING GROUP Meeting held on Friday, 24 June 2011 at Sandal Rugby Club, Sandal, Wakefield Present: Ailsa Claire Andy Buck Steve Wainwright

Steve Hackett Jackie Pederson

Ann Ballarini Ian Atkinson Jayne Brown Matt Neligan Nigel Gray Jane Hawkard Caroline Briggs

Director of Commissioning NHS Yorkshire and Humber - (Chair) Development Chief Executive South Yorkshire & Bassetlaw Cluster Chief Operating Officer NHS Barnsley also representing NHS Rotherham and NHS Doncaster (from minute SCG 47/11) Director of Finance South Yorkshire & Bassetlaw Cluster Associate Director, NHS Doncaster Commissioning and Strategic Development Director of Strategy NHS Wakefield also representing NHS Kirklees and NHS Calderdale Chief Operating Officer NHS Sheffield Chief Executive NHS North Yorkshire & York Cluster Director of Strategy NHS Bradford & Airedale Cluster Director of Development & NHS Leeds Cluster Commissioning (Adult Services) Director of Strategy & Market NHS East Riding also representing NHS Hull Development Director of Strategy NHS North Lincolnshire also representing Commissioning and North East Lincolnshire CTP Development

In Attendance Cathy Edwards Kevin Smith Paul McManus Frances Carey Lisa Marriott Ged McCann Neil Hales Anthony Prudhoe Matthew Day Ruth Lund Paul Crompton Shirley Brook SCG 42/11

Director Medical Advisor Lead Pharmacy Advisor Deputy Director of Finance Assistant Director of Commissioning Associate Director Secure & Specialist Mental Health Assistant Director of Contracting & Performance Assistant Director of Contracting & Performance Speciality Registrar Y&H Congenital Cardiac Network Manager Business Manager Commissioning Manager

Y&H SCG Y&H SCG Y&H SCG Y&H SCG Y&H SCG Y&H SCG – from minute SCG 47/11 Y&H SCG Y&H SCG Y&H SCG Y&H SCG – up to minute SCG 47/11 Y&H SCG Y&H SCG

Apologies There were no apologies.

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SCG 43/11

Declarations of Interest There were no declarations of interest.

SCG 44/11

Minutes of the meeting held on Friday, 27 May 2011 It was agreed that the minutes of the meeting held on 27 May 2011 be approved as a true and accurate record.

SCG 45/11

Paul Crompton

Matters Arising (a)

National Transition A verbal update was provided to the meeting in respect of the national transition workstreams. The Y&H SCG Transition Executive Group were tracking progress in the various areas. The timescale for this was the end of July. Separation of specialised and core activity would be necessary for April 2012 contracts when there would be lead commissioning arrangements for SCGs. The national information algorithm was being tested by Leeds Teaching Hospitals Trust. It was felt that providers needed to be briefed on their responsibilities by a national communication process. Ailsa Claire agreed to raise this with Kate Caston. In terms of mental health contracts, requests were being sent to PCTs to identify what they commission for mental health that is not done via the SCG. The data would feed into the national contracting workstream.

(b)

Cathy Edwards

SCG Sub Groups A verbal update was provided to the meeting in respect of SCG Sub Groups. A report would be made to the SCG Board meeting in July 2011 with the revised terms of reference and membership.

(c)

Ailsa Claire

Cathy Edwards

Evidence Based Commissioning A verbal update report was provided to the meeting in respect of Evidence Based Commissioning (EBC). There had been some delays in progressing the wave 2 projects. Two policies had been referred to the Regional Policy Sub Group. Eight policies have been covered by NICE Technology Appraisals and a further 21 policies were being processed. The wave 3 policies were also being progressed. There were 38 policies and these would be divided into three segments. These would be brought to the SCG over the next three meetings.

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Andy Buck agreed to raise progress on the EBC work at the next Cluster Chief Executives meeting.

Andy Buck

It was agreed: that the verbal update reports in respect of the national transition, SCG sub groups and Evidence Based Commissioning be noted SCG 46/11

Cathy Edwards/ Paul McManus

Review of Children’s Congenital Cardiac At the previous meeting it had been agreed that there would be a comprehensive debate about the national review of childrens congenital heart services at the June SCG meeting. The debate focussed on: Consultation process and activities Service planning issues and assumptions Additional national workstreams which would feed into the final decision making process Next steps and key milestones Cathy Edwards presented a report which summarised all the key activities and milestones during the consultation period and for the six months. Matt Day presented a paper which covered a range of service planning issues relevant to meeting the health needs of the Yorkshire and the Humber population. It was agreed : (a) to prepare a briefing note for the July cycle of PCT Board meetings. The briefing note would summarise the issues which had been considered by the SCG and the issues which would be fed back to the JCPCT; and (b) that here would be a further discussion at the July SCG meeting. (This minute needs to be read in conjunction with the attached PCT Board briefing paper).

SCG 47/11

Neonatal Services – Gestation Thresholds A report was presented to the meeting on Neonatal Services – Gestation Thresholds which set out the impact of increasing the gestational cut off in the North Trent Neonatal Network area, in response to the national Neonatal Taskforce principles. The Yorkshire Neonatal Network were not yet in a position to move to this gestational threshold, but a capacity stocktake had commenced. A discussion followed and it was noted that it was two years since the Neonatal Taskforce recommendations were published and the proposals on the report only covered partial implementation.

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It was felt that the whole regional position needed to be available before any decisions could be made. It was agreed:

SCG 48/11

(a)

that a further report be made to the July SCG Board meeting, clarifying the Yorkshire Network and Bradford position and setting out the entire regional position.

(b)

that the impact of the ’48 hours issue’ be clarified in the report; and

(c)

that the decision in principle to implement the recommendations of the national Neonatal Taskforce be reaffirmed.

Cathy Edwards/ Joanne Poole

2009 Mortality Review – North Trent Neonatal Network A report was presented to the meeting which noted that an audit of the 2009 mortality data within the North Trent Neonatal Network tertiary centre had been completed. An executive summary of the audit had been reported to the Network Board in June 2011 and an action plan had been agreed. It was agreed: that the report on the 2009 Mortality Review – North Trent Neonatal Network be noted.

SCG 49/11

Joanne Poole

Vascular Services Review A verbal update report on the vascular services review was made to the meeting. The SCG project manager had been appointed. An agreed process for receiving and assuring the 4 sub regional action plans had been agreed with the SHA. A report including an analysis of the plans would be made to the next SCG meeting in July and time would be required to discuss this in some detail. It was agreed:that the verbal update report on the vascular services review be noted.

SCG 50/11

Cathy Edwards

Spinal Cord Injury – Ventilated Beds at Sheffield Teaching Hospitals A report was presented to the meeting which set out Sheffield Teaching Hospitals proposal to convert four existing spinal beds into two spinal ventilated beds and two respiratory support beds. A discussion followed and it was felt essential that there was further detailed work undertaken on the proposals to understand the activity implications for individual PCTs, the costs and the charging arrangements. It was recognised that the proposal would not be fully cash releasing, on the assumption that the beds in STH and other provider ICU’s, would be filled with other appropriate patients.

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It was noted that if the Sheffield Teaching Hospitals proposals set out in the report were supported then Mid Yorkshire Hospitals would not need to consider developing their services to provide ventilated beds. However this assumption would be tested by a piece of national work on patient pathways and service capacity which would ultimately determine which hospitals would be designated as a Spinal Cord Injury Centre. It was agreed: that approval, in principle be given for the development of the additional spinal cord injury ventilated beds at Sheffield Teaching Hospitals subject to:

SCG 51/11

(a)

a detailed costing plan, showing the marginal increase in cost, related to the changes in the use of the beds;

(b)

an agreed contracting mechanism, based on the cost per night for all eight beds, and an agreed bed rate charge for the six level three beds and the two level two beds.

Cathy Edwards/ Jackie Parr/ Alan Browne

Commissioning a Peri Natal Mental Health Pathway A report was presented to the meeting which set out proposals for developing the commissioning of a Peri Natal Mental Health pathway. Work on the proposals had stalled due to the transitional arrangements. This meant that the current inconsistent arrangements for the service were still in place. There was insufficient capacity in the region in terms of beds and staffing teams. Several areas in the region were completely reliant on out of area provision for in-patient services and had no access to community services. There were significant clinical risks with the existing system, and the SHA senior management team had highlighted this as a priority for action. A discussion followed and it was felt that at this stage it would not be appropriate to establish a clinical network. The work should progress on a task and finish basis. It was recognised that a network may be required to sustain ongoing clinical linkages. However it was noted that NHS Sheffield did not feel the report represented their experience with regard to this issue and their comments would be forwarded to the SCT and the Y&H SHA. It was agreed: (a) that priority work be undertaken to understand the existing peri natal activity and associated costs across all 14 PCTs, both block and out of area; and (b) that a collaborative development of a Yorkshire and Humber pathway protocol be undertaken with existing providers and service users.

SCG 52/11

Cathy Edwards/ Ged McCann

Commissioning Policies A report was presented to the meeting in respect of Romiplostim for

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thrombocytopenic purpura and recommended that this be routinely funded in accordance with NICE TA 221. It was agreed:

SCG 53/11

(a)

that Romiplostim for thrombocytopenic purpura be routinely funded in accordance with NICE TA 221;

(b)

that the information for commissioners (Romiplostim is excluded from PbR tariff. Manufacturer will make available at discount. PCTs should ensure that this discount is available from local provider Trusts) be noted;

(c)

that PCTs should ensure appropriate implementation and monitoring of the policy; and

(d)

that the agreed general policies are available to the public in accordance with the directives from the Secretary of State.

Paul McManus

Exceptions Performance Report (to 31 March 2011) The Exceptions Performance report covering the twelve month period ending 31 March 2011 (audited position) was presented to the meeting. The report showed a £2.1m overspend, which was 0.35% of the Budget. It was anticipated that the final year end position would be less than this figure. It was agreed: that the Exceptions Performance report for the period up to the 31 March 2011 be noted.

SCG 54/11

Frances Carey/ Neil Hales

SCG Acute CQUINs 2010-11 - Quarter 4 A report was presented to the meeting which set out the performance for the Acute CQUINs scheme 2010-11 – Quarter 4. The Clinical Standards Sub Group recommended that payments be agreed for all providers in respect of all the indicators. It was agreed: that the recommendations for the payment of CQUINs made by the SCG Clinical Standards Sub Group be approved.

SCG 55/11

Neil Hales

SCG Acute CQUIN Scheme 2011-12 A report was presented to the meeting setting out how the agreed SCG Acute CQUIN scheme 2011-12 would be applied within local contracts. The scheme represented a potential additional 1.5% of contract value (0.3% relates to national indicators and 1.2% is apportioned across specialised services weighted on individual component contract values – this means that the payment payable to each provider for each indicator is variable).

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It was agreed: that the report relating to the SCG acute CQUIN scheme for 2011-12 be noted. SCG 56/11

Neil Hales

QIPP A verbal update was made to the meeting in respect of QIPP following the discussion at the last SCG Board meeting on the 27 May 2011. The SCT were currently reviewing the QIPP programme and service areas to identify potential ‘could do’, or ‘should do’ projects and those which should be discontinued. It was noted that it had been signalled that there would be a single SCG QIPP plan for 2012-13. It was agreed: that the verbal update report in respect of QIPP be noted.

SCG 57/11

Cathy Edwards

Draft SCG Annual Report 2010-11 A copy of the draft SCG Annual Report 2010-11 was presented to the meeting. The theme of the Annual Report was ‘Improving Quality – Adding Value’. It was the intention that the document would only be available in electronic format. Subject to approval of the draft report, this would be presented to the NHS Barnsley Board at their meeting in July 2011. The final version of the Annual Report incorporating the actual year end financial figures would be presented to the SCG Board meeting in July for approval and subsequent circulation to PCTs Boards.

It was agreed: that the draft SCG Annual Report 2010-11 be approved subject to indicated amendments, together with the proposed timeline. SCG 58/11

Cathy Edwards/ Paul Crompton

Audit Commission Review of SCG for 2010-11 A report was presented to the meeting which set out the Audit Commission review of the SCG 2010-11 which primarily related to the recommendations from the Audit Review of 2008-09 and 2009-10. The report indicated that no recommendations were outstanding. The report had been presented to the NHS Barnsley Audit Committee on the 6 June 2011 and had been circulated to Audit Managers of the constituent PCTs. It was agreed: that the report in respect of the Audit Commission Review of SCG for 2010-11 be noted.

SCG 59/11

Draft minutes of the Regional Policy Sub Group held on 10 May 2011 It was agreed:

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that the draft minutes of the Regional Policy Sub Group held on 10 May 2011 be received.

SCG 60/11

Minutes of the Performance Monitoring Sub Group held on 16 May 2011 It was agreed: that the minutes of the Performance Monitoring Sub Group held on 16 May 2011 be received.

SCG 61/11

Joanne Poole

Draft minutes of the Congenital Cardiac Network Board held on 11 May 2011 It was agreed: that the draft minutes of the Congenital Cardiac Network Board held on 11 May 2011 be received.

SCG 64/11

Cathy Edwards

Draft minutes of the Yorkshire Neonatal Network Board held on 5 May 2011 It was agreed: that the draft minutes of the Yorkshire Neonatal Network Board held on 5 May 2011 be received.

SCG 63/11

Frances Carey/ Neil Hales

Action notes of the Y&H SCG Transition Executive Group held on 27 May 2011 It was agreed: that the action notes of the Y&H SCG Transition Executive Group held on 27 May 2011 be received.

SCG 62/11

Paul McManus

Lisa Marriott

Any Other Business There were no items of other business.

SCG 65/11

Date and Time of Next Meeting 9.00am on Friday, 22 July 2011 in the Chevet Suite, Sandal Rugby Club, Wakefield

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All to note

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SAFE AND SUSTAINABLE: REVIEW OF CHILDREN’S CONGENITAL CARDIAC SERVICES IN ENGLAND BRIEFING PAPER FOR PCT BOARDS

1.

INTRODUCTION At the Yorkshire and the Humber SCG meeting on 24 June the Safe and Sustainable review was discussed in depth, including issues raised during the consultation. It was agreed at the meeting that each PCT representative would brief their PCT Board at PCT Board meetings during July about the Safe and Sustainable review. This briefing paper sets out: Key milestones for the decision-making; Consultation overview, including in Yorkshire and the Humber; The evidence to be considered by the Joint Committee of Primary Care Trusts (JCPCT) when making a decision; and Key issues raised during the consultation period.

2.

BACKGROUND On 16 February 2011 the JCPCT, a body overseeing the consultation, at its meeting in public agreed to consult on four areas: Standards of care Congenital heart networks Options for larger and fewer surgical centres New systems for the analysis and reporting of mortality and morbidity data The consultation started on 1 March 2011 and has run for four months (one month longer than the statutory consultation period) until 1 July 2011.

3.

KEY MILESTONES It is currently planned that the decision on the future configuration will be made by the JCPCT at the meeting in public, currently planned for November. This is subject to the outcome of a judicial review proceeding that has been instigated by the Board of the Royal Brompton & Harefield NHS Foundation Trust and may be delayed if the Judicial Review goes to a full hearing. The JCPCT will not make a final decision before the Judicial Review has concluded.

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The consultation responses will be analysed by Ipsos MORI, an independent expert third party and the consultation report will be in the public domain in late August. Health Impact Assessment (HIA) reports will be produced in August (interim) and November (final) and will be available to the JCPCT at the at the same time as to the OSCs, patients and the public. Health Overview and Scrutiny Committees (HOSCs) will also have a further opportunity to consider the analysis of the consultation and the interim health impact assessment and supplement their original consultation responses by 5 October 2011. 4.

CONSULTATION AND ENGAGEMENT ACTIVITIES The consultation process has been significant in scope. 55 public events, focus groups and workshops have been held to date. At the time of writing, over 55,000 responses have been received (including text messages). Of the 37,000 hard copy and online response forms 2833 came from Yorkshire and the Humber. During the consultation period a number of events have been held in Yorkshire and the Humber: Two public consultation events held in Leeds on 10 May attended by about 500 people; A consultation event aimed at young people held on 14 May in York; A focus group (run by Ipsos MORI) for parents, carers and young people held on 31 May, in Leeds, to explore in depth the issues raised during the consultation events; Locally organised focus groups held in Hull on 6 June and on 22 June in Northern Lincolnshire; Meeting with the staff of Leeds Teaching Hospitals Trust, facilitated by the Specialised Commissioning Team (SCT), on 15 June and on 29 June; Health Impact Assessment focus group, organised by Mott MacDonald, in Leeds on 1 April to explore the impact of the proposed changes on the vulnerable populations, with 250 stakeholders invited, out of whom 17 attended; Given poor attendance of BAME groups at the HIA workshop, further groups were organised for this community: focus groups with Black and Minority Ethnic groups (BAME) on 28 June (run by Ipsos MORI) and on 29 June in Leeds (Mott MacDonald), with two more workshops planned in Bradford and Dewsbury to explore the impact of the proposed changes on the BAME community.

5. EVIDENCE TO BE CONSIDERED BY THE JCPCT WHEN MAKING A DECISION The JCPCT will consider a number of relevant evidence when making its decision on future configuration of services for children with congenital heart disease: (a)

Health Impact Assessment

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Phase 1, a scoping, was undertaken and a report produced. The scoping phase has analysed available clinical and equality evidence to understand which groups were more likely to require paediatric cardiac surgical services. The scoping report and further work undertaken since the scoping phase has revealed several patient groups which are, proportionally, more likely to be in greater demand for paediatric cardiac services than the wider population. However, the numbers are very small: Those who experience socio-economic deprivation; Black, Asian and Minority Ethnic (BAME) groups, particularly those related to Indian, Pakistani, Bangladeshi and other Indian subcontinent populations; Mothers who smoke during pregnancy; and Mothers who are obese during pregnancy. Phase 2 is in progress and has built on the initial findings through undertaking Health and Equality Impact forums, inviting almost 2,000 organisations and individuals across England and Wales. In addition to this, telephone interviews with vulnerable patients and their families from those areas most likely to be affected as a result of the proposals are being undertaken. (b)

Testing the Assumptions: Patient Flows and Network Configurations External management consultants have been appointed to test, objectively and independently, the referral flows which will inform the future configuration of networks. The Yorkshire and the Humber post codes included in this work are: S, DN, WF, LS, HU, BD, HX, HD. The information will be gathered via, interviews, surveys and focus groups with centre and referring clinicians; interviews and surveys with patients/families; focus groups covering the general public. The work will be finalised during the autumn with the final report going to the JCPCT meeting in November.

(c)

Capacity Planning All of the current surgical centres have been asked to submit further information about their plans and state of readiness regarding physical capacity to meet the activity anticipated in the options. The report is due to be finalised in September and will feed into the November JCPCT meeting.

(d)

Data Validation All of the current surgical centres have been asked to submit their 201/11 procedures data to the national Central Cardiac Audit Database (CCAD) database. The numbers went in at the end of May 2011 and the validation work will be completed by the end of July 2011.

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6.

KEY ISSUES RAISED DURING THE CONSULTATION During the consultation period a number of issues have been raised by stakeholders in Yorkshire and the Humber. The SCG at its meeting on 24th June considered the following issues: (a)

Consultation with Black and Minority Ethnic (BAME) groups Some stakeholders have raised the later availability of the consultation documentation in other languages as well as the level of engagement with the local BAME communities. The consultation documentation was originally translated into other languages on request. The consultation literature has been translated into ten languages and these versions were made available on 20 May. The national review team has publicised the consultation in a number of BAME newspapers. The question is what arrangements would normally be made to consult with BAME groups from a perspective of national best practice and relative to individual PCT practice. As soon as the request was made for consultation material in alternative languages action was taken to translate the documents. This action, taken alongside several focus groups and workshops for BAME communities, suggests that there has been significant engagement and consultation with BAME groups. These actions are consistent with both national and local best practice. In setting out options for consultation the JCPCT has been mindful of the particular issues relevant to Black and Ethnic Minority groups. A Health Impact Assessment is being undertaken that will advise the JCPCT on the potential impacts of the options to vulnerable groups, including the BME communities. This work is being undertaken by independent experts and the findings of the HIA will be used to help inform the JCPCT in making its decision.

(b)

Adult Congenital Heart Services The scope of the review excludes adult congenital heart services. Some stakeholders raised concerns about the need for the adult and children’s heart services to be reviewed at the same time as the children’s congenital heart services. When Safe and Sustainable was instigated in 2008 the professional associations advised that the most pressing concerns were around the children’s element of congenital heart services. The Safe and Sustainable standards include the need for links with adult services and the need for a good transition between the two. It has always been acknowledged that draft standards for adult congenital heart services would need to be reviewed. The process for the designation of services for adults with congenital heart disease will resume in July 2011. An advisory group to finalise the adult standards (after having taken account of public opinion via a public engagement exercise in the autumn) has been established under the chairmanship of Professor Sir Roger Boyle, the National Director for Heart Disease

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and Stroke. It is planned that public engagement on the draft standards will start in September. (c)

Health Impact Assessment Comments have been raised by the stakeholders about the timing of the HIA. The national team has considered this and determined that the HIA could only feasibly take place once the short list of options had been identified. The scope of the HIA was agreed by the JCPCT at the meeting in public on 16 February and published. The independent experts commissioned by the JCPCT are content that the proper process is being followed. A scoping report was published in February 2011, and initial findings from consultation were published in June 2011. The interim HIA report will be published in August 2011, with the final report – incorporating the findings from the public consultation – will be available in November.

(d)

Scotland The scope of Safe and Sustainable excludes the paediatric cardiac surgical services in Glasgow. It was agreed that the English and Scottish reviews will be kept separate. NHS Scotland has been involved throughout the process to identify the cross-border issues. A representative from Scotland is a member of the Safe and Sustainable Steering Group and an observer on the Health Impact Assessment Steering Group. The activity that flows to England from Scotland has been included in the centres’ activity.

At their meeting on 24 June the SCG were assured that all the concerns raised during the consultation have been or are being considered by the JCPCT.

7.

SERVICE PLANNING ISSUES At the June SCG meeting consideration was given to an impact assessment which looked at a range of service planning issues from the perspective of the health needs of the Yorkshire and Humber population. The impact assessment looked specifically at: Regional epidemiology including growth projections and ethnicity Multiple health needs and the benefits of co-location of services Patient flows in and out of Yorkshire and Humber Network configuration Travel and retrieval times Patient experience Fetal cardiology Adult congenital heart services Financial issues Staffing issues

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The debate about each area, taking into account the national work already in progress, identified a number of specific areas which would need to be addressed: How do the numbers of children with multiple health needs in Yorkshire and Humber compare to other areas of the country? How would patient choice and clinician choice operate in the new system? What level of outreach services would be provided by each surgical centre and how would this compare to the current level of outreach services? Is the proposed presence of a children’s cardiology centre in areas where there is no longer a surgical centre a viable and sustainable model? A robust piece of work should be undertaken to assess the potential impact on all retrieval services and any knock on effects for existing paediatric and neonatal transport networks. What are the implications for adult congenital heart services? It was agreed that these issues should be fed back into the JCPCT meeting on 30th June by the SCG chair. It was recognised that a Yorkshire and Humber view on the best national configuration and the preferable option for Yorkshire and the Humber population could only be determined in the light of: The local impact assessment (revised in the light of the June SCG discussion). The outcome of the consultation process The outcome of the national health impact assessment work The outcome of the work testing the assumptions about patient flows There will be a further substantial discussion at the SCG meeting on 22nd July. The views of the PCT Boards feed back into the September SCG meeting.

Cathy Edwards Director of Yorkshire & the Humber SCG 4 July 2011

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