The campaign for an urgent treatment centre to serve the East Bristol area, in which Week In readers have played a key part, is gathering pace.
A cross-party group of councillors on South Gloucestershire Council has now published its report after reviewing urgent care – including minor injuries provision – within the district.
One of their findings is that the views of the 5,000 people who signed the petition calling for the opening of the long-promised minor injury unit (MIU) at Cossham Hospital in Kingswood were not properly taken into account by health chiefs.
More than 2,000 of those who signed were our readers who got behind the campaign that was started by local nurse Josh Ditte. But the governing body of the local Clinical Commissioning Group (CCG) rejected the request in April of last year without debate, saying it wasn’t part of their urgent care strategy.
The report by South Gloucestershire councillors was prompted by the rejection of that petition which had flagged up how an alternative minor injuries treatment service in GPs surgery had been ditched at the end of a two-year trial because it had failed to reduce attendances at A&E departments, and that funding had instead been put into Yate MIU. However, people heading there may find it shut as it closes early at times of significant demand.
Nationally, there is now a move away from minor injury units, walk-in centres and urgent care centres to urgent treatment centres (UTCs) instead. These are GP-led, open at least 12 hours every day, offer appointments that can be booked through 111 or through a GP referral, and are equipped to diagnose and deal with many of the ailments that people attend A&E for.
Last Tuesday, it was agreed to send the report to Shane Devlin, chief executive of the NHS Bristol, North Somerset & South Gloucestershire Integrated Care Board (ICB). The board replaced the CCG as part of a health management shake-up last year.
Cllr Ian Scott, who chairs the council’s Health Scrutiny Committee, told the meeting: “If you are a resident in South Bristol, you can access the South Bristol Hospital and the urgent treatment centre over there. If you are a resident in West Bristol, you can access the Bristol Royal Infirmary. If you are a resident in North Bristol, you can access Southmead Hospital.
“But if you are in East Bristol or Greater Kingswood, you then have to go much further to access either Yate Minor Injury Unit or Southmead or the BRI.
“Residents over the last 15 years, since the closure of Frenchay Hospital, feel that they are not getting the same level of service. In fact they feel they are getting a second-class service. And I also think that while there have been improvements at Yate, it’s not as good as South Bristol.”
Cllr Scott said that back in 2008, Frenchay was recognised as needing an MIU as well as Cossham. He recognised that things had moved on, saying: “My understanding is that great things are going on at Cossham. There is further expansion at Cossham so in terms of where this urgent treatment centre ends up in the future – if we are to get one – it might not necessarily be at Cossham. It could be at Frenchay or there might be another site that can serve East Bristol and South Gloucestershire.”
Cossham is already a base for Severnside Integrated Urgent Care which combines NHS 111 and the out-of-hours GP service, see below.
The report was produced by a sub-committee following evidence taken earlier this year from the ICB, members of the public and relevant stakeholders.
It found a lack of data in the evidence that was given by the ICB, including that the views of the 5,000 people who signed the petition were not properly taken into account.
The report also highlights a history of not delivering on earlier plans and that no detailed consideration had been given to assessing whether the distance patients may have to travel to access healthcare – and the associated costs – was a barrier leading to greater health inequality.
Although sub-committee members understood that remote assessment would benefit some patients, they voiced concern about the impact on older and more vulnerable people and those who may be ‘digitally excluded’.
The report’s recommendations, which have been sent to Shane Devlin, include that an assessment of current service provision in South Gloucestershire is undertaken and compared to forecast need, with data to identify both the type and location of future healthcare provision.
In particular the councillors want to know:
- Current population needs and the people not able to access urgent care.
- Inequalities in access to, and use of, services, as well as outcomes.
- The criteria for determining urgent care services, including the size of population needed for a UTC.
- The budget and workforce available for urgent care provision.
Another recommendation is that work carried out by the independent Healthwatch group is actively considered and assessed by the ICB. It was highlighted in the report that Healthwatch was delivering valuable work, but a “lack of action” followed.
Mr Devlin, who was at Tuesday’s meeting, said he would respond fully to the report and recommendations within 28 days and gave a commitment to work with the council to “really understand” what need looks like now.
The chief executive said the report refers to urgent care and population need, “which is obviously very important”, but added. “We should look at the population need in the totality for health and social care.”
Health inequalities in the Kingswood area
The Kingswood area has a lower life expectancy than both the South Gloucestershire and England averages, and rates of death from preventable diseases are higher than average.
In Kingswood 19.9% of people are disabled, higher than the South Gloucestershire average of 15.6%.
Kingswood has the second highest proportion of people in South Gloucestershire who state their ‘day-to-day activities are limited a lot’ (10.2%).
A significant percentage of the Kingswood population is aged over 65 – and the percentage aged over 75 is significantly higher than the South Gloucestershire average.
There was anger when the Cossham petition was rejected by the Clinical Commissioning Group’s governing body last April without debate and without the competition of a health inequalities impact assessment or an equalities impact assessment.
The group said such assessments weren’t required when receiving a petition.