Agenda item

TVCCG - Update

Representatives from TVCCG will be in attendance to provide an update to the Committee in respect of the following:-


-       Learning Disabilities Respite Review

-       Breast Diagnostic Services


The Director of Commissioning and Strategy at TV CCG gave a presentation entitled Breast Diagnostic Services Current Position. The presentation highlighted background information, the work undertaken over the last year, how the public, service users and stakeholders had been involved in the engagement exercises, the themes that had emerged and the next steps in this journey.


It was noted that although the Covid-19 pandemic had halted some of the progress following the patient engagement exercise. Both North and South Tees Trusts had continued to collaborate to maintain the service for patients through very difficult times. Some themes identified from the engagement included;


       The Breast Diagnostic Service was evaluated well by survey respondents with 95% rating the service either good or very good.

       Positive comments had been made about the high standard of care received, the professionalism of staff, the excellent communication as well as the efficiency of the service.

       A number of respondents had expressed their frustration with the closure of the James Cook service

       Linked to the above it had been noted that some patients were unaware of the ‘one-stop-shop’ approach at North Tees and better communication of this would have supported reduced patient frustrations and uncertainty.


In terms of next steps the Tees Valley system partners had agreed to implement and expand the use of innovative ‘Free-Flap Surgery’ (where appropriate), as part of the Breast Cancer pathway to improve outcomes for patients. This surgery would be performed at James Cook Hospital and had commenced in October 2021.


In addition the Northern Cancer Alliance had established a Managed Clinical Network for Breast Cancer Services. The vision of the managed clinical network was to enhance the quality of breast cancer services including breast cancer screening, diagnostics and treatment services, thus enhancing care across organisations; jointly reducing inequality, improving outcomes and patient experience in alignment with the recommendations in the NHS Long Term Plan. Future plans for the service model would be progressed through this approach, with an initial focus on building capacity and resilience in the breast imaging workforce.


In the meantime the service would continue to be delivered from North Tees as it was the safest and most effective way of ensuring that those presenting with symptomatic breast conditions were able to access the treatment they required. It was advised that in terms of the national standard the target was currently that 93 per cent of patients presenting on this pathway should be seen within a clinic within two weeks. In the Tees Valley 94 per cent of patients were currently being seen within two weeks, which was significantly higher than the England average of around 84 to 85 per cent. The current pathway was effective and there were mitigations in place to assist with any transport issues.    


As part of the ensuing discussions the following points/questions were raised:


· Reference was made to the breast care facility available at the Friarage Hospital at Northallerton and whether further information could be provided on the type of care provided there. In response it was advised that a breast clinic continued to be delivered at the Friarage Hospital but that the service was delivered by colleagues from York and predominantly served patients from the North Yorkshire area. The majority of patients within the Tees Valley did now access the service via North Tees Hospital.

· A Member commented that it was great to hear that 94 per cent of patients within the Tees Valley were being seen within 2 weeks. However, it was queried whether for those that were not seen within that timeframe whether the longest wait times were know. It was advised that the waiting times were monitored and it was accepted nationally that there were inevitably a number of patients that would opt to defer their treatment for a variety of reasons. In addition proactive follow up work was undertaken where it was identified that patients were waiting longer than the national 2 week target.  

· The work was such that no matter how much money was invested mental health services the work would increase, potentially a 40 per cent increase owing to COVID but if as a system we were able to get this right in terms of a system approach with Primary Care, VSC, TEWV and substance misuse services and agree on a system approach in which the patient came first and services would approach patients rather than the patient have to visit a whole host of services then we would have a service for the future.

· In response to a query regarding how many men in the Tees Valley suffered from breast cancer it was advised that these figures were available and would be provided to the Committee.

· Reference was made to the number of non-attendees and it was queried whether data in respect of this issue could be provided to the Committee. In response it was advised that the percentage of non-attendees was extremely low but that this information would be provided.

· In response to a query regarding transport it was advised that a patient transport offer was always available subject to the necessary criteria being met.


The Chief Executive of Tees Valley CCG gave a presentation entitled Adult Learning Disability Respite Update. The presentation provided a timeline of events between January 2020 and December 2021 as follows:-


· January 2020: CQC inspection resulting in a ‘must do’ action relating to compliance with the Mixed Sex Accommodation (MSA) regulation

· March 2020: Temporary closure of day and respite services in response to initial outbreak of Coivd-19. Outreach service formed

· Sept 2020 – Sept 2021: The project group discussed all service options and it was agreed that a revised service would be delivered that offered up to a maximum of 6 beds across the two sites (11 to 6 beds respite) due to further covid waves and staffing constraints

· Current state: As agreed with the project group, both units were open and offering a combined 6 places at any one time which was a reduced service capacity but meant the service could meet both the Infection Prevention Control (IPC) and the Mixed Sex Accommodation (MSA) regulations. Workforce challenges continued in line with all other health and social care provision.

· Future state: The initial set of architect plans had been received exploring 4 options; remodel existing building, new build and use of two other TEWV estates.  Further actions required with the view to review January 2022.

· Family Carers: remained engaged through frequent project group meetings, direct contact and regular updates. Representatives were appointed on the project group.


As part of the ensuing discussions the following points/questions were raised:


· Reference was made to email correspondence received by the Chair from a parent/carer of a patient in receipt of the respite service. The email made reference to the fact that until the architect’s plans could be actioned patients were in receipt of a reduced service; 24 days respite in place of 33 days, as previously agreed. In response it was acknowledged that it had been extremely difficult for the families and they were very much involved in the project. Efforts were being made to move the project on as quickly as possible.


AGREED that the information contained in the presentation be noted and the additional details requested by Members be provided.