To consider two reports that were approved by Shropshire CCG Governing Body on 10 August 2016, attached marked:  8

The Chairman referred to the 10 August 2016 Shropshire CCG Governing Body papers circulated with the agenda on Shropshire CCG Decommissioning and Disinvestment (copies attached to the signed minutes).  He reported that he had received a great many letters expressing concerns related to these and had asked for them to be circulated to Members of the Committee for discussion.  He said that whilst the financial challenges of the CCG were accepted, it was felt that some of the changes proposed might have unintended consequences.  Although the CCG Chair had stated that ‘it is clear that the patients’ care comes first’,  it was essential to see that the patient had ample chance to be consulted before a service was changed or taken away and to understand their options. 

He said that this should be done as openly as possible and reiterated that discussions needed to be held with providers of services within Shropshire, including the Community Health Trust, the local authority, private sector and voluntary sector, so that they could analyse the situation and feedback on any unintended consequences that were likely to impact on the local Health and Social Care economy. 

A Member referred to the need for actions to live up to the statements in the Decommissioning and Disinvestment Policy.  She also referred to a step in preparing for disinvestment or decommissioning the service involving assessment of ‘appropriate availability of patient choice’.  She emphasised that patient choice was not often available in a large rural county like Shropshire, especially when it came to rehabilitation beds.  She reported on a major problem finding rehabilitation beds in the part of Shropshire she represented which bordered another county. 

Another Member felt that the terms ‘disinvestment and decommissioning’ were not helpful or meaningful to the public and that clearer engagement was needed by explaining simply that some services were going to close and some would be delivered in a different way.  The Chairman agreed that the Committee would want to know how messages would be conveyed. 

A Member said she had received lots of questions from members of the public, and also people who ran services who did not understand the situation.  She was concerned that the changes could affect some of the most vulnerable people in society who may not have any idea about what was happening.   Other Members expressed concern around the apparent lack of a risk or impact assessment relating to individuals and other organisations, including the Council and that legal action might be a consequence if procedures were not followed correctly. There was no legal definition of the term ‘substantial variation’.

The Chairman said it was important to avoid simple budget shifting to stabilise just one part of an economy.  The Director of Adult Social Care agreed that it was necessary to take into account risk and position of services across the whole economy, and ensure any shortfalls in accuracy and consultation were addressed.   In the interim period before the next meeting, a formal response from Adult Social Care had been made to the CCG and he had met with the Accountable Officer regarding commissioning arrangements in future.   The enormous financial pressure facing the CCG was recognised but it was necessary to reduce costs in the system which would minimise the impact across the whole system.  This also related to management of the Better Care Fund, and Governance Arrangements for the Health and Wellbeing Board and the Sustainability and Transformation Plan. 

It was proposed and agreed that a Special Meeting be held on CCG Decommissioning and Disinvestment as soon as possible. 

RESOLVED:

That a special meeting of the Committee be held on CCG Decommissioning and Disinvestment as soon as possible.