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Informal Q&A - 25th September 2013

Informal Question and Answer Session at the end of the Governing Body Meeting - 25th September 2013

Below you will find the questions received by the Governing Body as part of the informal session after the Governing Body meeting. You can also download this document via the menu on the right hand side.

Below is not a transciption but a summary of the questions and answers where appropriate, further clarifying commentary has been added to the verbal answer given at the meeting.


Question: What is the CCG’s view on the discharge from hospital of vulnerable elderly patients who might not have somebody to support them?  

Answer from the CCG: The CCG agrees that the discharge process can be improved on, however the process itself implies there is a transfer of the patient from one organisation to another.  The Caring Together Programme is working towards achieving ‘patient centred’ care.  In the case of a patient with complex care needs who needs treatment in a hospital, a neighbourhood team would manage the patient’s journey into and out of the hospital.  The aim of the Caring Together Programme is to change the culture of individual healthcare organisations and to get the NHS and social care to stop seeing themselves as separate entities and to start thinking of themselves as one organisation supporting the care of patients. 

 In the meantime there are ‘patient journey coordinators’ at East Cheshire Trust who can be contacted ahead of discharge of patients.  Currently GPs use an electronic system called DATIX to report comments and concerns about their own, or their patients’, experiences of any aspects of local healthcare services.

Comment from a member of the public: Bed blocking can occur if different parts of the system are not working adequately. This is costing the NHS money as a bed is taken up whilst e.g. continuing healthcare arrangements are not progressed qucily enough.

Response from the CCG: It is agreed that the Continuing Healthcare team needs to be as much part of the Caring Together Programme as the hospital, or the CCG, so that all are working as part of one coordinated system.  Feedback from members of the public about services is invaluable, as is ‘soft intelligence’ about how good care homes are.  This all contributes to the opportunity to make improvements to services.


Question: We have heard about ‘ambulatory care’ – it is a good idea to be triaged and not necessarily admitted, but would patients still have to go to Macclesfield Hospital in the first instance?

Answer from the CCG: There are 49 conditions which are classed as ‘ambulatory sensitive’.  For some conditions patients would have to go to Macclesfield Hospital in the first instance to be assessed as sometimes diagnostic tests such as a CT scan would be required before treatment at home, or in the GP surgery.   For treatment of other conditions e.g. cellulitis where currently patients would be admitted to hospital for a course of antibiotic treatment, in the future  a team would come out to their home, give treatment and assess the patient.  Another very successful example is management of patients with Chronic Obstructive Pulmonary Disease in their own homes by the respiratory team.


Question:  There seems to be a general lack of understanding of the importance of a registered Power of Attorney.  Difficulty is experienced by those holding registered Power of Attorney in making it understood to healthcare that they must be included in decisions about the vulnerable person’s care. Recognising that people sometimes do still have the ability to make some of their own decisions, the Power of Attorney’s input must be considered.  Will the CCG ensure all documents for patients and staff include reference to this important legal point? 

Answer from the CCG: There is a need for the all healthcare professionals to be aware of their responsibilities with regard to Powers of Attorney, and also to be assured that the legal Power of Attorney is indeed held and a need to make sure systems reflect that the document has been seen, and its authenticity recorded.

 The CCG agreed to use its website to promote more information on Powers of Attorney and also prepare guidelines for its members and providers.


Question: HealthVoice is a useful forum for gathering information, but is there a more direct way to get information to the CCG on experience of carers and patients?

Answer from the CCG: The CCG welcomes feedback, and this can be sent via the website or directly contacting the CCG.  All comments and concerns are valued by the CCG as it works to monitor and improve the quality of local health services.


Question: North and South Wales has come up with a system whereby a doctor goes out in an ambulance to an incident with the paramedics and determines whether or not the patient needs to be admitted.  This reduces the cost of admissions. Is this something which might be looked at for adoption locally?

Answer from the CCG: A slightly different approach is already being piloted locally by North West Ambulance Service, with a change from the traditional ambulance ‘scoop and run’ service being changed to ‘hear and treat’.  Paramedics with advanced training go to the scene, treat the patient, and have access by phone to a doctor in the ambulance centre to discuss and get advice.  The ambulance will also have direct access to other local expertise – e.g. the patient could be taken home with a guaranteed visit from a respiratory nurse within the hour.


Question: In South Cheshire there is funding for a Specialist Investigation Domestic Abuse worker at Leighton Hospital.  There is confusion over where the funding came from.  Apparently the same is not available at Macclesfield Hospital.  Will the CCG consider equalising that kind of support in Eastern Cheshire?

Answer from the CCG: Central and Eastern Cheshire PCT was part of collective work looking at domestic violence and a centre was established at Leighton Hospital.   The CCG is not directly funding a Domestic Abuse worker at Macclesfield Hospital although this may be part of a role of somebody who works there.  As regards domestic abuse more generally, the CCG has a duty to oversee safeguarding, and GP practices contribute to domestic abuse investigations.  There will be a workshop on Safeguarding on Friday 27th September, looking at case studies to identify any gaps in current arrangements and processes, and domestic abuse will be raised at this workshop.

 The CCG will look to obtain information on the Domestic Abuse role at Leighton Hospital confirm whether somebody is fulfilling the same role at Macclesfield Hospital.  



Question: Stepping Hill Hospital is nearer to some residents of Eastern Cheshire than Macclesfield hospital and therefore it is bound to be a more attractive option.

Answer from the CCG: There is locally agreed criteria for which hospital to go to in the event of an emergency or for some specialist care (eg for major trauma), but in most cases it is the patient’s choice. 

Question: Several points have been raised at the meeting today looking for the CCG to encourage and support Macclesfield Hospital as a provider of services but it is understood why it is not correct for the CCG to promote one provider over another and that it is for the patient to make the choice.  It is helpful to have a list of providers and activity – is it possible to have this down further i.e. to show activity at Manchester Eye Hospital, Manchester Children’s Hospital rather than grouped as results for Central Manchester.  Experience has shown that when a large modern hospital has been on television, people choose to go there even although the service is available more locally.

Answer from the CCG: The NHS Constitution gives a legal commitment to offer choice in where patients have their care. It is therefore not possible or desirable for the CCG to explicitly recommend one hospital verses another. However, the CCG does have a responsibility to make it clear when referral to specific hospitals may be necessary due to clinical expertise eg specialist paediatric care (e.g. anaesthesia) which means patients have to go Manchester Children’s hospital.

Comment from Member of the Public: The South Manchester Healthier Together Strategy is backed and initiated by providers, some of whom have been set up via Private Funding Initiative.  Their aim is to keep their services fully loaded ‘to pay the mortgage’.   If successful this will lead to a limited number of providers left providing services.  The NHS does not consider the issue of availability of transport to patients and centralisation is happening in primary care.  The CCG should be wary of this strategy.

Response from the CCG: There is a provider group looking at standards of care in South Manchester, e.g. are there enough consultants to provide 24-hour care.  This group will make recommendations to a ‘Committee in Common’ comprising CCGs in Greater Manchester and Cheshire. NHS Eastern Cheshire CCG has been invited to take part in the Committee in Common decisions around Manchester Hospitals, although final decisions affecting Eastern Cheshire communities will require approval of the Governing Body. 



Question: Now that there is a Cheshire East Health and Wellbeing Board, what is the role of the Overview and Scrutiny Committee?

Answer: The Health and Wellbeing Board sets the strategy for the local population, including fostering and improving integration of health and social care.  The Scrutiny Committee has a more direct role to call in health bodies to ask questions on any aspect of the service.



Question: Carers are encouraged to state on forms that they are carers.  What happens to these forms?

Answer from the CCG: GP practices lodge this information on their records.  The information should appear when the carer is looking to make an appointment.  Some practices will give a card with contact details for the Carer’s Association which can signpost carers to assistance if required.

It is acknowledged that there is a lot of information available for carers, but it is available from a lot of different sources. 

Community Volunteer Services (CVS) Cheshire East

Crossroads Carers, now called the Carers Trust, has produced a report on research into what support carers need.  They also provide a service where if a carer has a medical emergency themselves, support to the person you they care for can be provided for 24 hours.