The consultation on Sheffield's urgent care services is now closed. Thank you to all those who responded to my petition and survey about the plans, and I can confirm I've now submitted my response on behalf of constituents.

I share concerns about the relocation of the Minor Injuries Unit to the Northern General, which include transport time, cost of travel, the lack of a direct bus or parking on site and the impact that this move would have on the most vulnerable and with poorest mobility.

I was concerned, though sadly not surprised, to hear from so many constituents of their difficulty in accessing a GP appointment – and do not believe that our GP practices have the capacity to replicate the service provided by the Broad Lane walk in centre when they are already so overstretched. In some cases, residents told me about their experiences of waiting outside GP practices from 7:30am to get an appointment.

Please find my full response copied in below. I will keep you updated when we hear further news, and if you have any further questions please don't hesitate to get in touch.


Dear Dr Moorhead,

 

I am writing in my capacity as the Member of Parliament for Sheffield Heeley in response to the Clinical Commissioning Group’s proposals for urgent care in our city. I have enclosed correspondence from other organisations that have been sent to me, and which I am sure the CCG will have received directly.

 

First, I appreciate that the NHS is under ever-increasing pressure in both demand and in tackling the challenges of limited funding and staffing levels, I cannot support the proposals which would see the re-location of the Minor Injuries Unit (MIU) to the Northern General Hospital (NGH), the closure of the Broad Lane walk in centre (BLWIC) and the delivery of urgent eye appointments from locations other than the Royal Hallamshire Hospital (RHH).  In recent years, we have seen in Sheffield significantly reduced services, particularly in mental health, and the proposals by the CCG appear to form part of an ever-shrinking NHS estate in Sheffield.

 

I share the frustration expressed to me by residents that the options presented by the CCG for adults are not varied, and that the only options appear to be between where children’s services will be delivered. I remain concerned that there is no city-centre option, nor does the CCG appear to be giving any consideration to better working or to smaller adjustments within the current model.  

 

I also remain worried, based on the conversations I have had with my constituents, that awareness of the CCG’s proposals remains low. I would be grateful to know how many consultation responses the CCG has received directly, how many of these were favourable to the proposals and which option, if any, was most popular. I would also be grateful if the CCG could confirm what analysis has been done of postcodes to ensure that the response represents a cross-section of the city and its demographics.

 

Over the last three months I have communicated with thousands of people living in my constituency, who have shared with me their own experiences of using Sheffield’s hospitals. Overwhelmingly, residents have expressed deep concern and dismay about all three strands of the CCG’s proposals and I enclose with this response a copy of a petition exemplifying this. As you know, I also wrote to a number of constituents and have received hundreds of survey responses; I attach an overview of their responses and some key anecdotes and experiences are shared in the below.  Many respondents expressed dismay at the focusing of urgent and emergency health services on the North side of the city, not only in their difficulty in accessing them, but also in terms of a feeling of abandonment. I was also interested to read that many residents, particularly in the S8 area, would find it easier and quicker to travel to Chesterfield Hospital than the NGH, and I have written separately to the Chesterfield Trust to make them aware of the potential increase in demand to their own service.

 

The proposals

 

As discussed when we met in November, I remain deeply concerned that the proposals rely very heavily on a significant culture shift in the way that Sheffield patients seek to access appropriate care, and also on services that are not yet in place or require serious improvement. I understand that the CCG’s position is that doing nothing is not an option, but I do not believe that a fundamental shift in health services in the city, without a transitional period, and well-functioning, established alternatives in place, is realistic.  It is clear to me from my conversations with constituents, and from the survey responses received, that a third of patients unable to go to the walk-in centre or the MIU will simply go to A&E, an already over-stretched service. Less than 13% of respondents indicated that they would phone 111 for guidance and those I have spoken to have advised me that their experiences of 111 have been poor. In situations such as those we saw on the 19th January this year, with more than 100 people attending A&E after slipping on black ice and sustaining fractures and breaks, I am extremely concerned that any additional pressure on A&E may push it beyond breaking point.

 

I am concerned that areas of Sheffield Heeley particularly affected by the proposals including Batemoor and Blackstock Road and also Jordanthorpe and Gleadless Road are in the bottom and second deciles of Multiple Deprivation respectively.  Areas in the constituency with the highest proportion of use by 18-29 year olds, namely Lowedges, are in the 10% of most deprived neighbourhoods nationwide.  As you will appreciate car ownership is low, and additional pressures such as time and cost in accessing appropriate medical treatment will present very real barriers.

 

Furthermore, I am concerned about the impact of such a significant change on vulnerable people and for whom familiarity with the services provided is key, including those with mental health and learning difficulties. In their response, Nomad, a Sheffield charity offering advice, support and practical help to homeless or inadequate housed people, advised “we work with a large amount of people who are disabled and several have learning difficulties. Many suffer with substance misuse, PTSD, depression, anxiety and agoraphobia. Many are newly arrived refugees with very specific health needs and limited English language skills”

 

In addition, the issue of GP indemnity remains a real concern. I know that the CCG itself had concerns about the timeframe of any Government initiative in this regard and in November I asked the Secretary of State what progress he had made on the development of medical indemnity insurance for GPs. Philip Dunne MP, the then Minister of State in the Department of Health, responded “We recognise that the rising cost of indemnity cover is a source of concern for general practitioners (GPs). This is why on 12 October 2017 my Rt. hon. Friend the Secretary of State announced that the Government would develop a state-backed indemnity scheme for general practice in England. This complex piece of work is at an early stage, we are working with GP representatives and others to develop our plans. We expect the scheme will take 12-18 months to develop.”   With this response in mind, it seems clear that any state-backed indemnity scheme will simply not be in place in the timeframe that the CCG are considering introducing the changes to GP access.

 

I understand from our meeting in November that there are plans to improve the 111 service and for it to be more clinician-led. Once again I am concerned about the timeframe for such improvements. 

 

Further, on comparison with other cities’ provision, it would appear that any move to reduce the NHS estate and locations at which patients access urgent care is not in line with other areas of arguably similar demographic and need. Indeed, I understand that Leeds has 3 Urgent Treatment Centres and 5 A&E locations within 10 miles of the city, while Sheffield currently has 2 of each– including the A&E at Rotherham[1]. While I appreciate that some of this is due to the proximity of other towns and cities with large populations, the figures demonstrate we are underserved.

 

 

I have broken down my concerns below into the three key strands of the CCG’s proposals, but many of these cross-over and are interlinked – and that pressure on one area of the service will undoubtedly increase pressure on other areas also.

 

Minor Injuries Unit relocation to NGH

 

First, I have serious concerns about the concentration of any additional services at the Northern General Hospital.  Having visited a friend only last week there, it is clear to me that the hospital is already very busy, hard to access without a car and difficult to navigate once there.  Indeed, I have spoken to many constituents who have advised me that they got lost in the hospital, and expressed concern about how they’d have managed if they had reduced mobility. 

  

Although I understand that the CCG believe improving access to GP appointments will reduce the need to travel to an urgent treatment centre, clearly this does not apply to all patients – some of whom will require a visit to the UTC and some of whom will simply show up there anyway.

 

Sheffield’s transport system works, as you know, in a radial way – with it being much easier to get into the centre of the city than from one neighbourhood into the next. Residents of Sheffield Heeley have expressed deep worry about the difficulties that they will experience in accessing the Northern General Hospital; their options being taxis which would cost £20 each way, an hour journey by car, or that they would require at least two buses each way and to allow 1hour and half to travel in this way. Some constituents advised that they would have no alternative but to phone for an ambulance. 

 

Parking at the NGH has been raised with me time and again – with many feeling that it is “impossible to find a parking space”.  The costs of parking have been noted as prohibitive to some, and the congestion around NGH highlighted as a worrying concern. Others have expressed concern about the impact for those with poor mobility and advised that even if they are able to get to the NGH by bus, they would find it very difficult walk up the steep hill into the hospital itself and to move around the already vast estate.

 

Residents have spoken to me of their concerns in accessing the NGH due to finances, that the cost of the bus fare or a taxi would be prohibitive to them accessing appropriate medical care.  Indeed, this is echoed by the Student Unions, who commented that the cost of travel, distance and delay in accessing the appropriate health service would create a very real barrier for students to accessing medical treatment. Nomad had similar concerns, advising that: “all of our clients are on a very low income or in receipt of welfare benefits making travel on public transport unaffordable to them. Most of the housing we offer is located on the South-West of the city in S2, S7, S8 and S10. Having to travel to the other side of the city when they need urgent care and are therefore even more vulnerable is likely to deter many of our clients from accessing medical treatment”.

 

Finally, I remain concerned that the already large and busy estate at NGH does not have the capacity within it for an urgent treatment centre to replace the MIU at the RHH. The feasibility assessment for this seems to rely heavily once again on an assumption that patients would both rather be seen at their local practice or a neighbouring practice, and that GP practices have capacity for this, which I will cover later.

 

Broad Lane Walk In Centre

 

I remain unconvinced that it will be possible for GP services to deliver the service currently provided by the WIC, who I understand currently deliver appointments between 8am and 10pm and see 60,000 patients per year, 5,000 appointments each month - even with weekend and evening appointments more readily available.  While some residents have responded that they have been able to see a GP the same day, more than 30% waited up to two weeks and 17% more than two weeks.

 

Although I understand that it is hoped GPs would be working within a ‘neighbourhood’ I have not seen anything which has convinced me that there are sufficient appointments available across practices, should the issue of indemnity be resolved.  Indeed, I was horrified to hear from numerous Jordanthorpe residents in their 70s and 80s that they are required to wait outside their GP surgery from 7:30am in the morning if they have any hope of getting an appointment the same day – I will of course be writing to you and to the practice about this under separate cover.  I understand that the CCG has undertaken a second audit of GP phone calls and would be most interested to see the results.

 

I am concerned that the neighbourhood models, on which these proposals so heavily rely, will not be established in sufficient time to deliver an effective and safe service, which meets demand.  I share concerns expressed to me by constituents that the time frame for change is too compressed with no clear evidence that devolving urgent care in this way will be effective.

 

Once again, I would raise here the issues of the 111 service. I do not believe that a sufficient number of patients seeking treatment will call the 111 service if unable to reach their own GP or secure an appointment at another neighbouring practice. Less than 13% of respondents to the survey advised that they would seek guidance in this way.  Further, I do not believe that the 111 service will address the issue of visitors to the city who, without the WIC, will undoubtedly present at A&E.  Although I accept that this in fact provides some justification for having an urgent treatment centre located alongside A&E, clearly the better option is in not closing the WIC. Your own figures advise that approximately 20% of the users of the WIC are visitors to the city – and it is unclear how these visitors would know to call the 111 service. Further, the OneMedical Group commented “There is a strong push to increase visitors to the City and to build Sheffield’s role as part of the Northern Powerhouse. Therefore the number of visitors to the City is likely to increase year on year”.

 

Furthermore, I am concerned that the Broad Lane WIC is a vital resource to our city in providing necessary healthcare to our homeless and inadequately housed residents. Concerns have been expressed to me by Nomad, who advised that the closure of the MIU at the RHH and of the BLWIC would make urgent care services inaccessible for the majority of their clients.  Nomad stated: “Our clients, especially those who are still homeless or who are struggling to transition out of homelessness, depend on the walk-in clinic at Broad Lane. The reality is that should these proposed changes take effect, many of those who us our services will not be able to access urgent health care and are likely to suffer disproportionately as a result”.

 

 

Urgent eye appointments

 

In general, there has been a lot of concern about the delivery of urgent eye appointments and what a change to the service provided at the RHH will mean for patients, particularly those who attend on a regular basis.

 

Constituents have told me of their concerns that the services they depend so heavily upon should not be privatised and reliant on external companies. They are also concerned, and I share their frustrations, that there has been no detailed information about who the CCG are proposing would provide urgent appointments in place of the RHH; whether that would be GPs or opticians, how far patients would be expected to travel or how long they would have to wait for appointments.

 

Further, it is unclear how patients are expected to make an assessment of whether their need is an emergency, which would be dealt with at the RHH, or an urgent matter to be addressed in their community. In your letter in November, you advised that around 50% of patients who currently use the Emergency Eye Clinic have an urgent, rather than a sight-threatening problem.  Is it the case that a patient presenting with an urgent matter at the RHH would be sent away to arrange an appointment closer to home?

 

Yours sincerely

 

 

 

Louise Haigh MP

[1] Information provided by the House of Commons Library, using the NHS Choices Urgent Care Finder