Ill-conceived, ill-judged and ill-prepared

That is our verdict on the first of two ‘Information & Discussion Events’ held at St Peter’s Hospital on Wednesday 9th August. Bearing in mind the atrocious weather the turn out for a midweek evening was good with over 30 patients present. The format for the evening was to be a series of presentations from the service providers - Ashford & St Peter’s Hospitals NHS Trust (ASPH) and Central & North West London Trust (CNWL) , and from the service commissioners - Surrey County Council and NHS England. Unfortunately we only heard from ASPH and CNWL because of the number of questions that anxious patients wanted to raise. However, contributions were made by the commissioners in response to a number of the questions, particularly around the 33% cut in funding that led to only one bid being submitted for the integrated sexual health & HIV services contract for Surrey. What did we learn? That the commissioners’ preparation of the tender for the integrated service was ILL-CONCEIVED in that it completely failed to scope the Blanche Heriot Unit service adequately. ASPH Chief Executive Suzanne Rankin identified BHU patients as falling into 3 groups – sexual health, HIV and complicated GUM - on the basis that the first two groups came within the new contract (and thus would go to Buryfields) but the third group did not and would probably stay at St Peter’s. But, as was pointed out at the meeting by patients whose first attendance may have been for sexual health screening which then identified other issues, there is considerable overlap and, indeed, other categories of patient - hence the efficiency of the BHU model which integrates and manages patients seamlessly. A figure of 700 was put on the 3rd group of patents who fall outside the remit of the contract and whose continuing care must now be organised, with separate funding, by ASPH. We don’t know how that figure has been calculated but Ms Rankin indicated that services for these patients will be retained at St Peter’s - beyond that there is no information or, as yet engagement, with these patients. It was also ill-conceived in that there is a group of BHU HIV patients - again we don't have a confirmed figure but we think it is a high number - who cannot reasonably be expected to go to Buryfields Cllinic on the outskirts of Guildford for their continuing care. These patients have serious co-morbidities (eg wheelchair users, mental health issues, frailty). We believe that these vulnerable patients will have to continue to be treated at BHU otherwise their future health will be put at significant risk. NHS England fund the HIV services and their representatives at the meeting were at pains to point out that they had not cut the funding - so services for these patients should continue to be provided at St Peter’s. It was ILL-JUDGED because the CNWL team completely misread the mood and purpose of the meeting. They clearly viewed it as an opportunity to "sell" the service model they had decided - without consultation - to impose on Surrey. For CNWL, as we had been previously informed, Chertsey and Guildford may not look far apart on a map of Surrey so it was ok to expect BHU patients to go to Buryfields. That simply shows the folly of awarding a contract to a Central London provider who has no understanding of the geography of Surrey or the inadequacy of public transport in the County – you can’t jump on the tube to get from Chertsey to Guildford. Because we had to sit through the CNWL sales pitch we didn't really have much opportunity to question them about the detail of their service model. There was a great deal of self-congratulatory assertion about how modern and efficient their services are but little by way of evidence. Repeated questions about whether Buryfields had the capacity to take 15,000+ attendances were dodged. We were told about the virtues of the on-line appointment booking service that CNWL would expect patients to use. A number of people in the audience had already tested it with dismal results. At BHU patients phone up, discuss the appointment they need, book it or simply just walk in – that is what we call an efficient, patient-focused service. The co-Chair of the Surrey Coalition of Disabled People was vocal about the lack of attention to the needs of disabled patients and, as a school governor, he cast doubts on some of the assertions about on-line testing being the way to get young people to take responsibility for their sexual health. Added to which, CNWL’s latest Board papers tell a worrying story - they are currently struggling financially as a Trust and missing their NHSI performance indicators for sexual health services in May. CNWL appear to have a policy to add to their portfolio of sexual health service contracts - they have just won a tri-borough contract in London. Our concern – and it is a concern that should be shared by the commissioners - is that they will over reach themselves and subject these contracts to further costs savings. Finally there is no doubt that CNWL and ASPH are ILL-PREPARED. They are not ready for the service to transfer from ASPH to CNWL on 1st October. The work has not been done to identify, let alone plan for, the patients who do not fit the service model that is being imposed by CNWL. That is why legal action is being pursued to halt the transfer and extend the existing BHU contract by six months to allow a full review of, and planning for, BHU patient needs to take place, engaging both with the Patient Group and patients individually as well as GPs and other stakeholders. As a GP representative at the meeting pointed out, there has been no effective engagement with local GPs about the service model that is being transposed from Central London to Surrey. A couple of clinic sessions in Runnymede and Spelthorne, as yet to be confirmed, does not begin to replace the accessibility and expertise of BHU for patients from North Surrey. The responsible decision for all the parties now to take is to allow BHU to continue to operate for a further six months whilst all these complex service and funding issues are properly addressed and patients’ needs are taken fully into account.