Primary Care Trust’s response in full

PRINTED below is the complete response from North Yorkshire and York Primary Care Trust to the questions posed by Whitby Hospital Action Group.

An initial response was included in the Friday 14 October 2011 edition of the Gazette.

This included a reaction from WHAG to the answers given by chief executive Jayne Brown.

Thank you for your letter of 18 August 2011.

The following responds to the specific questions in your letter.

Question 1

1) What was the money used for?

During the financial year 2010/11 the PCT invested £1,000,282 in capital works to maintain Whitby Hospital.

Repairs to the roof cost £477,750, the windows were replaced, which cost £403,472 and other items of work were undertaken to comply with current legislation.

2) Why did the PCT need to go to NHS Central Funding for money when there is a budget of £1.265 billion for NYYPCT?

Capital which pays for building work and maintenance of the NHS estate is a separate allocation from the Department of Health to the revenue allocation which NHS North Yorkshire and York (PCT) receives.

Question 2

Why do the PCT continue to put patients and staff in a mixed ward environment when this is clearly not an accepted practice?

The following is the current guidance on when single sex accommodation can be provided:

Single-sex accommodation can be provided in:

(i) single-sex wards (i.e. the whole ward is occupied by men or women but not both).

(ii) single rooms with adjacent single-sex toilet and washing facilities (preferably en-suite).

(iii) single-sex accommodation within mixed wards (i.e. bays or rooms which accommodate either men or women, not both; with designated single-sex toilet and washing facilities preferably within or adjacent to the bay or room).

In addition, patients should not need to pass through opposite-sex areas to access their own facilities.

The ward accommodation at Whitby is organised as single sex accommodation within a mixed ward and the current arrangements are consistent with iii) above and therefore they meet the required standards.

[WHAG explained to the Gazette that this question was not intended to relate to single sex wards, but related to mixed ailments and treatments of patients]

Question 3

Explain the legal justification for the people in Whitby who feel that they were a significant part of the minority that had to accept a ‘lesser’ health and medical service.

The PCT has a statutory responsibility to balance its books and break even.

This is a legal requirement which is not negotiable and in an increasingly difficult financial climate all PCTs have to consider how they can achieve this and difficult decisions have to be made.

The areas of spending where the PCT has the discretion to reduce costs quickly to respond to the increased costs of clinical services are few, particularly as most services require a legal contract between the PCT and the provider of the service to be in place so change cannot be made quickly.

This affords some protection to the majority of clinical services.

The letter of 10 October 2010 outlined proposed changes to expenditure in 2010 where there was some discretion.

The most significant savings were achieved by reducing the number of commissioning staff in the PCT; we reduced our overheads and so on.

We also considered reducing services that are not routinely provided by the NHS or where the benefits to a small number of individuals was outweighed by the need to keep services maintained for the majority.

The minority that is mentioned in the letter are individuals and small groups of people rather than a whole community such as the people using services in Whitby and the letter makes it clear that GPs could still refer patients as normal and we reviewed exceptional cases through our normal processes.

Question 4

1) How did this come about and who made the decision that the cornerstone of the PCT’s argument for closing the theatres last year and closing the MIU overnight has just vanished?

The arrangements for the future ownership and management of estate in the NHS are being considered at a national level during the Government’s current reform programme and we are waiting for further guidance from the Department of Health.

Decisions will have to be made about the future management of all NHS premises following the abolition of the SHA and PCTs in 2013.

I am not aware that ground rent was discussed at the Health and Scrutiny Committee and at the time of writing this letter the minutes of the meeting are not available.

As far as the PCT is aware there are no plans to remove the requirement to pay depreciation, rent and rates on NHS buildings and no funds are being released and for the time being the PCT continues to own the building and it is rented by Scarborough and North East Healthcare NHS Trust (SNEY) who now provide both acute and community services in Scarborough, Bridlington and Whitby

2) Is that £900,000 now available for investment in patient care in Whitby?

My response to Question 1.1 explains how the resources were used.

Question 5

1) When and by whom were the tests done that yielded this emergency action?

SNEY made the decision to cease operations at Whitby because of the reports they received on the ventilation systems at both Whitby and Malton.

This was a clinical decision not a strategic one and based on the advice of senior engineers, consultant micro biologists, PCT public health physicians and surgeons.

2) Mr North operated in the theatres at Whitby on June 16 2011 – was he informed that the theatre was not safe but that he should continue?

16 June 2011, was the date the decision to cease operating was made.

SNEY then had to put in place plans to reschedule patients and inform all staff etc.

This took a couple of days to sort out and surgery was allowed to be completed for patients who were already scheduled that week where alternatives could not be put in place.

3) Were the patients informed that the environment that they were being operated upon were not safe?

The arrangements for managing the closure of the theatres considered the alternatives available and the risks of continuing in the short term.

It would be usual to discuss the risk of surgery with patients prior to the patient is asked to consent to treatment.

Question 6

1) Who is going to make sure that the figures are changed and corrected?

The information on the pathfinder website reflects the registered list size of practices that became GP Commissioning pathfinders and the position before the Whitby GPs joined the Hambleton and Richmondshire consortia pathfinder.

The information on the website reflects the pathfinder status of the consortia rather than the authorised body that will be the Clinical Commissioning Group.

Pathfinders were identified before the Government published its response to the Listening Exercise and the NHS Future Forum and the Government’s recommendations to change the constitution of Commissioning Consortia to broaden the membership.

The numbers are correct for Hambleton and Richmondshire as Whitby was not part of the Pathfinder.

2) Will the PCT and the GP commissioners get the numbers right for funding for patient care when the PCT ‘hands over’ to the GPs or will it be left as another cornerstone for excuses as to why Whitby and surrounding areas cannot access their rights to medical care?

No formal guidance on the constitution of Clinical Commissioning Groups has been published as the Health and Social Care Bill has still to go through Parliament before becoming legislation.

We are expecting this information in October 2011 and as the timescales are short most consortia are preparing themselves in readiness.

It seems likely that the boundary and population for a Clinical Commissioning Group will be determined by a combination of the practice list size, the number of people who usually reside in the area but are not registered with a practice and in relation to some specific services anyone who is present in the area.

Further guidance is expected and when we receive it the PCT will work with the GPs and specialists in public health to determine the correct figure.

3) Who will evaluate the efficiency of the GP commissioners given that their role on the Clinical Executive is stated at one day per week and the salary between £40,000 and £50,000 per year?

The NHS Commissioning Board will evaluate the application to become a Clinical Commissioning Group and ensure that they are fit for purpose and once established they will be held accountable by the NHS Commissioning Board and Health and Well Being Boards. The clinical executive function within the PCT does not provide a comparison for the role GPs will have in a commissioning group.

Question 7

The scheme was a pilot which ceased in March 2011, in response to the recommendations of the NCAT report and before the pilot was due to complete.

A cost analysis of the incomplete pilot is not available.

Question 8

1) Who decides on the temporary nature of medical and health care for patients in Whitby?

Temporary changes to services usually occur either in response to unexpected operational issues affecting the delivery of care and the decision is made by the provider of the service usually after consulting with the PCT.

2) Who monitors and evaluates these decision makers?

Decisions are monitored and evaluated through the governance arrangements required by current legislation, for example the executive of NHS organisations is separate to the Board which holds the executive to account.

The Strategic Health Authorities (SHA) also have a role in the performance management of PCTs.

3) Are the PCT/GP commissioners ready to take full stakeholder requirement in decision making and allowing the Governments NHS changes, ‘driven from the bottom upwards’ to take effect in Whitby?

If not, why not?

It is expected that following the passing of the Health and Social Care Bill that the roles and responsibilities of health and social care organisations for patient and public engagement will be made clearer by the NHS Commissioning Board and the state of readiness of NHS organisations and Health Watch will need to be assessed in the light of that additional information.

Previous guidance to the NHS around public engagement has focused on the formal consultation processes when significant service changes are made and we have followed the SHA guidance on service reconfiguration which is required in response to the Act.

The proposed NHS reforms place a greater emphasis on clinical engagement in decision making.

Clinical Commissioning Groups once established will have a role in promoting patient involvement in decisions about treatment and in involving patients and the public when they develop proposals that have a significant impact on service delivery or the range of health services available.

The latter is a new responsibility for GPs engaged in commissioning and while we have yet to see the detail of how commissioning groups will undertake this role their expectation is that they will engage the public at a much earlier stage in planning and place an emphasis on how the needs of the population can be met by services that are clinically safe and effective.

Question 9

1) Who monitors and endorses your evaluation criteria?

Evaluation criteria are usually developed by the clinicians and managers who are developing the proposal and reviewed by our integrated executive board which comprises a wider group of clinicians and the PCT Director Team.

Ultimately the PCT Board looks at the proposal in the form of a business case and decides if the criteria are appropriate and met by the proposal.

It is not clear to me which evaluation criteria you are referring to in the preamble to this question which relate to 2010 and the appendices to your letter do not reference any.

Concluding Statements

I cannot agree with the statement that the PCT has treated the people of Whitby and the Esk Valley with contempt.

The proposals put forward last year were intended to secure safe and local services for the people of Whitby and Esk Valley and those who use services in the area who come from further afield.

The National Patient Safety Agency (NPSA) do not undertake risk assessment for PCTs and we have not contravened any NPSA requirements.

The report prepared by Professor Hugo Mascie-Taylor was not commissioned by the PCT and we do not know what it cost.

The report is the outcome of an independent review commissioned by the SHA who will determine how the recommendations are to be implemented.

I hope this information has been helpful to you, however, if I can be of any further assistance please do not hesitate to contact me.

Yours sincerely

Jayne Brown OBE

Chief Executive

cc Sue Metcalfe, Deputy Chief Executive (Director of Localities) NHS NYY; Simon Cox, Associate Locality Director, NHS NYY; Mike Proctor, Chief Executive, Scarborough and North East Yorkshire Healthcare NHS Trust; Hilary Jones, Deputy Leader, Scarborough Council; Robert Goodwill, MP