To receive an update on the Diagnostic Centre in Wisbech.
Minutes:
Greg Lane from the NHS gave an update on the Wisbech Diagnostic Centre.
Members made comments, asked questions and received responses as follows:
· Councillor Foice-Beard asked what data was collected and how and could the committee have access to it as to better understand the conclusion in more detail? Greg Lane confirmed data has been sent through to the committee which is focused on local GP’s as this is the accessible data plus what non-hospital referrals are coming through for patients that are registered to those practices, which will paint a picture of the current needs and demands for those services and that is what is going to formulate those strategic discussions about delivery now and further down the line.
· Councillor Foice-Beard stated that on paragraph 7 of the presentation it stated, ‘that it is not technically possible to integrate’ and asked if not now is there a timescale of when they will be working towards this? Greg Lane stated that when it comes to the NHS app this is led nationally with no local influence, but is it known this is one of the ambitions with the NHS app. Councillor Foice-Beard asked how he can guarantee this will be at the forefront of the plans and will there be regular updates? Greg Lane responded when it comes to direct booking through the NHS app, local solutions will be considered if there is not a national solution in place and there will be regular updates in terms of what the thinking will be around the NHS app.
· Councillor Foice-Beard asked what efforts are being made to ensure that staff and patients are aware of the facilities at Wisbech as due to a recent telephone discussion to discuss an appointment there seemed to be a lack of awareness of what is in existence, the staff member in the department was very adamant that there was not a facility and the facility that was referred to in the letter was for Kings Lynn and not Wisbech. Greg Lane responded in terms of ongoing discussions that are happening around current and future delivery, all stakeholders are being included, general practice is pivotal in terms of that voice ensuring that the patient is kept aware and up to date and there are also regular updates given to Healthwatch and patient participation groups. Councillor Foice-Beard asked how this communication was being given out? Greg Lane confirmed the communication was happening through conversations and updates with bulletins and in writing within health groups. Councillor Foice-Beard reiterated that all staff need to be fully updated. Greg Lane stated that it is a minimum expectation that employees within a stakeholder position would know what their organisation does and when but he will take that information away from the meeting today.
· Councillor Sennitt Clough asked who the stakeholders are? Greg Lane responded in terms of the ongoing strategic discussions around the Clinical Diagnostic Centre (CDC) and why the North Cambridgeshire Hospital site, those stakeholders would include local GP practices from Wisbech and Fenland, colleagues from Queen Elizabeth Hospital and updates are also sent to colleagues from Norfolk and Waveney ICB including their integrated neighbourhood West Place, North West Anglia Hospital Foundation Trust, Cambridge University Hospitals and there are also Health Works representation.
· Councillor Sennitt Clough stated that a catchment area has been discussed and she would like to understand what the catchment area is and how far beyond Fenland as an administrative District does the catchment reach? Greg Lane stated that currently the catchment area is very much focused on Wisbech, Fenland and West Norfolk, with the ambition being that the catchment will be further than this in the spirit of patient choice, for the patients that sit just on the outside of Wisbech, Fenland and West Norfolk so they are given the option to access services at North Cambridgeshire Hospital and any other CBC or facility across that District.
· Councillor Hicks stated that he sits on the board of GP’s, and it has been mentioned that around 70% of appointments with the GP’s are with elderly and he would like some assurance that when the app is launched there will still be measures in place for the elderly patients that do not use computers or mobile phones and that still want to ring in to make appointments. Greg Lane responded as much as the NHS needs to keep up to speed with modern technology, in terms of the ability to book appointments online, there is a recognition that this will need to run alongside what is already in place so that appointments are bookable for all patients and feels it would be unrealistic to expect that all patients would swap to the app device.
· Councillor Hay stated that it was mentioned in the report that one of the main areas is Wisbech mainly because it has its own CDC but would like to understand why the portable MRI scanner was removed from the Hospital as this was valued within the town of Wisbech being as it is a very deprived area for health outcomes and what would warrant recommissioning it back into the town again? Greg Lane stated that in terms of the scanner move that was an operational decision lead by NHS England to move the scanner from Wisbech to Ely to enable the functional MRI scanner to open at Ely before the static MRI was in situ. He continued the activity levels seen at Wisbech and the demands did not make it financially viable to stay at Wisbech which is what led NHS England to make its decision to move it to Ely. Councillor Hay expressed her disappointment at this decision and asked for Greg Lane to push for a portable MRI scanner to be returned to Wisbech.
· Councillor Booth stated tha,t in a letter regarding the CT scanner, it states that the guidance from NHS England was that it should no longer be used. He asked what that guidance was, was it that it was too old or did it not meet the new modern standards required, why was there not a decision to replace the piece of equipment and was there any push back to this decision? Greg Lane stated the answer is along the same lines as the MRI conversation with the fact that the level of demand makes the mobile not financially viable and NHS England would not commission the mobile units. He continued that there was a national push to ensure that CDC’s were becoming permanent facilities as opposed to having mobile units within them and the CT scanner was lobbied in the same way as the MRI scanner to no avail with the NHS England but he insists that these two items will still be lobbied for but stressed the need for them to be financially viable to meet an agreement. Councillor Booth commented that it was his understanding that NHS England was going to be abolished and asked if Greg Lane had any idea what the replacement was going to look like and how it was going to work, and if there will be more decision making locally that would enable the facilities to be reinstated back into Wisbech? Greg Lane stated that having more local flexibility allows more opportunity to do the things that are needed, but again the finances will need to be looked at to make sure that none of the stakeholders are running at a cost pressure to deliver, which is part of the development work in place as shown in the slides. He added as a system there would need to be an injection of funding from somewhere to allow the opportunity to put the plans together and present to organisations like local councils to see what other help can be received within the system.
· Councillor Roy stated it was mentioned about keeping the services local, the feedback he gets from residents is that they are mostly referred to King Lynn and he would like to know if the message is getting out about the facilities at Wisbech CDC or if GP surgeries are just automatically referring patients to the bigger hospitals and not giving patients the choice. Greg Lane stated to give a wider context, the Queen Elizabeth Hospital has just opened its diagnostic assessment centre on the Kings Lynn site and the fact that they do offer a service at the North Cambridgeshire Hospital is now causing a capacity pressure for them in terms of running it across both sites which is where the strategic discussions become important because the service at North Cambridgeshire Hospital needs to be kept alive, so the group of stakeholders need to stay in sync in terms of strategic ambition. He continued a patient at Wisbech should always be offered the services at North Cambridgeshire Hospital if that service is available, with the wider context particularly within the CDC programme being that it is not going to double run on some services. Councillor Roy stated that Wisbech is one of the deprived areas that lacks the transport infrastructure to get people to Kings Lynn, and he constantly hears that people are struggling to afford standard living costs and extra travel expenses to Kings Lynn is not viable and feels this needs addressing to offer people information locally and what services are available at the Hospital. Greg Lane stated this links back to an earlier question around the catchment area for the site because the wider the catchment area becomes then the more beneficial it is to the local patients because the more financially viable the service delivery becomes. He continued that the object is to bring the North Cambridgeshire Hospital as a site alive into the wider CMP and Norfolk strategy because that then enhances the catchment area, which then increases the financial viability around running the services and, therefore, means more can be undertaken for the patients.
· Councillor Hicks asked how is the conclusion drawn to find if something is viable or not viable? Is it based on the cost of the individual patient and if so is that a Government guideline or is it the amount of patients using the equipment? Greg Lane replied that the costing will include the overhead of staffing cost with the offer of a certain amount of capacity, depending on how the payment is made on the CDC programme, each patient treated comes with a tariff so if they are not treating enough patients, they will not make enough tariff cost back to effectively cover the outlay. He continued this becomes a provider decision because if the income is not coming in based on the outlay then this is being run at a cost pressure and providers need to make sure they are not running at a loss as an organisation because if one service is being delivered at a loss then other services are compromised, which is where commissioning is a key part, particularly if it is an item of service fee which is effectively per patient. Greg Lane stated that in relation to the North Cambridgeshire Hospital the more activity there is within the site the more income is generated from the provider and the more financially viable that service becomes. Councillor Hicks asked how much below capacity were the machines that have been discussed at today’s meeting? Greg Lane stated from memory there was around 40% in terms of the capacity that was offered, for example a mobile MRI scanner would operate at 11 slots a day and the anticipation from the programme is that this would be run seven days per week, out of 77 slots per week the local demand was using between 30-40 per week so the extra activity would need to be found further afield to make that service viable at that site.
· Councillor Booth stated looking at the number given there are around 400 appointments per month, which sounds like they are operating seven days a week which works out around 20 appointments per day but going by what has been said the figures need to be around 60 appointments per day. Greg Lane responded if those services are operated within the CDC programme, which has the benefits because it is funded by NHS England, the guidance is seven days working meaning that is the capacity that needs to be offered. He continued if it was decided to use a more locally commissioned agreement then effectively those services could be run for the demands that exist locally, but the service would need to be amended to ensure it works out financially viable or a local decision made to run at a loss. Councillor Booth asked what the number would need be to be to have the CT scanner running per day at the North Cambridgeshire Hospital? Greg Lane did not have this information to hand and marked it as an action to send the figures after the meeting.
· Councillor Barber stated that originally it seemed there were going to be two CDC’s, one in Wisbech and one in Ely, with both having an MRI facility, the MRI facility was removed from Wisbech through lack of usage, which leaves one in Ely. She reiterated what Councillor Roy stated that she has had many residents not knowing this service was available in Wisbech and the GP practices seem to be sending patients to the bigger hospitals like Kings Lynn, and she feels there would have been a lot more patients using the facilities on offer had they been made aware of it. Greg Lane stated as things stand the unit at Ely hospital is still CDC owned and in terms of the MRI and CT scanner it does come back to the local demand because as stated previously if the demand was stretched out further than Wisbech this will eat into the catchment area for Ely so again it has to be financially viable to run both services at both sites. He continued with the way the programme is set up and the way NHS England commissioned it this did not make it possible for this to happen but there are options available to make it financially viable, but this will need to be worked through a local solution rather than one through the CDC programme currently.
· Councillor Sennitt Clough requested confirmation that Ely was not in the Fenland catchment area. Greg Lane confirmed that geographically no Ely is not in the catchment area because it is not in Fenland, but he referred back to the patient choice conversation, because if you are a patient who lives in Ely but work in Wisbech why cannot it be possible to use the Wisbech Hospital or vice versa and that is the ambition to give patient choice.
· Councillor Sennitt Clough stated that Ely is a much more affluent area and has a railway station whereas according to the 2021 census 26% of people in Wisbech do not own a vehicle and transport is limited, she felt that the answers given so far were driven by the stakeholders, the providers and financially rather than the facts and asked if this could be confirmed? Greg Lane stated that no one stakeholder wants to be driven by finances but the finances are a reality and that is the point of the strategic discussions to find out how to deliver these services and not leave someone sitting with a financial cost and that is the conundrum as a group which is being worked on together to solve and get the right pathways and strategies in place to make this possible. Councillor Sennitt Clough asked, of the information gathered particularly with the CT scanner that was decommissioned, how long was it active for and what did the data tell them? Greg Lane answered there is data available for a full year until March 2024, with Addenbrookes being the lead provider as a lot of patients were coming from the Addenbrookes case load because the referral pathways were not in place for local patients and this can muddy the waters in terms of where that demand was coming from, so yes there is data and yes it was used but he felt that the activities running through the MRI and CT scanners would have been uplifted from patients that were willing to travel from South Cambridgeshire up to the facility at Wisbech, so it was not all made up of the same population. Councillor Sennitt Clough asked if there was any scope for discussions around having another CT scanner and what are the processes involved in trying to get that facility back to the Fenland catchment area? Greg Lane stated that the options would be either having machines mobile or a permanent static in situ and there are the right pathways and access points in place to generate enough activity from across the county to make those modalities viable from within that site. He added that the other option is what Addenbrookes and the ICB explored was having pads, where the mobile is parked and plugged into the generator to make it operational, and there are pads strategically placed across the county and then these services are delivered on a rotational basis, which means there would not be an MRI or CT scanner at Wisbech Monday to Friday, but it may be there on a Wednesday because that is when most activity can be generated for that location, with these being the two most viable options at this present time. Councillor Sennitt Clough asked how the Council can lobby to make sure that this can become a reality for the patients of Fenland? Greg Lane stated that he felt it would come from the NHS, ICB and the stakeholder’s group in terms of putting that plan on a page to see what the different options would offer in practice and what would be needed to make it work which could also be something that can be shared with this committee to get a view on what could and could not be supported.
Members noted the information provided.