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Frequently Asked Questions



click here to read our consultation document

Below are answers to common questions about the formal consultation.  You may be able to find answers to your own questions too.  If your question is not here, click this link to contact us.

These questions have been split into six categories:

 

 Post Consultation Questions

    Urgent Care

    Pc1. What is the 8-8 service and how does it work? What is the difference between Hessle and that being proposed at Driffield and Withernsea?

    These are bases for community services teams and will include a range of clinics to support planned and proactive care management.   

    • Planned care / Wound clinics – changing dressings, removal of stiches
    • Therapy services (podiatry, dietetics, speech and language, occupational therapy, reablement and rehabilitation, falls service
    • Community link workers / social prescribing (help reduce social isolation by sign posting people to non-clinical activities in their local community
    • Musculosketal services

    For Driffield and Withernsea, there will be a number of urgent appointments made available for people with low level minor injuries and common minor ailments (i.e. patient suffers minor injury could ring NHS 111 and be triaged if clinically appropriate to an 8 to 8).

    Hessle will be an 8-8 centre base for community services teams but will not have urgent appointments available for low level minor injuries due to its proximity to UCCs and A&E.

    Pc2. What exactly is low level minor injury and how does this differ from injuries dealt with by the minor injury units?

    • Insect and animal bites
    • Sprains and strains
    • Minor burns and scalds
    • Cuts and grazes
    • Minor bumps and bruises

    These will not deal with simple fractures.

    Pc3. How exactly will appointments for low level minor injury services/GP services be made via NHS111?

    Patients will contact NHS111 who will follow a ‘pathways tool’ to identify appropriate course of action.  The Directory of Service will identify the preferred option either directing to an Urgent Care Centre or the Care Co-ordination Centre which will book an urgent appointment at the 8-8 centre.

    Pc4. How will people be educated to call NHS111?

    There will be a detailed communications plan and marketing campaign advertising the new Urgent Care system.  This will include leaflets, social media and information to households, etc.

    Pc5. Seasonal visitors not registered with GPs, how will they know what to do? They may still present direct at the local hospital. What is the plan for signage for the community hospitals?

    In terms of seasonal variation, we have reviewed the total activity (STP plus non-STP area) per day at each of the six current Minor Injury Units (MIUs) over the 2015/16 financial year.  The biggest influx of ERYCCG registered and non-ERY CGG registered patients occurs in Bridlington in the summer months, an increase of 350 more attendances for non-ERYCCG patients in August than in April, May, June and September.  Bridlington will have an Urgent Care Centre for seasonal visitors to access 16 hours a day.

    As part of the planned marketing campaign, we will target holiday resorts and caravan parks so they are aware of the services that are available to them.  For those people who present direct at the local hospital, we will arrange for clear signposting information to be available.  We are also making transitional funding available to support navigation and signposting via GP practices.

    We will work with the local authority regarding any required changes to road signage.

    Pc6. If 8-8 service provided at Driffield and Withernsea, why not also at Hornsea?

    This decision is based on patient demand, clinical need and taking into consideration levels of deprivation. 

    Our data shows that there are low numbers of people attending the MIU in Hornsea – less than 10 a day.  Many of those could be seen within planned community services, such as repeat wound dressing (which would continue to be available in Hornsea) or advice and guidance which can be offered through NHS 111.

    Our community services provider will be using Hornsea as a base for community services and they are working with the local medical practice to look at how they can continue to meet the need of the local population in that area and maximise the use of Hornsea Cottage Hospital as a community asset.

    Pc7. What changes will happen at Goole - are they losing a doctor?

    Goole will have an Urgent Care Centre that is open 16 hours a day. This will include access to medical (doctor) input.

    Pc8. Has consideration be given to providing transport to people in Driffield, Hornsea and Withernsea to take them to a UCC?

    Yes, consideration has given to transport arrangements, including availability of public transport and car ownership.

    The CCG has a responsibility to ensure appropriate transportation for people who are in medical need of emergency and planned care and service provision for these areas is commissioned appropriately.

    The CCG does not have responsibility to commission transport for people with minor injuries/minor illness however, in listening to the population we have considered what we could do to minimise the impact on local people in those areas where MIU’s and Community Beds are recommended to close.  Where there is an urgent clinical need, we are specifically looking at a transport solution for Withernsea through the YorMed service because of low car ownership identified in Withernsea at 66.7% (average for ERY is 82.4%).  We are also working with Humberside Fire and Rescue Service regarding potential solutions for people with an urgent need.

    Community beds/Wrap around patient care

    Pb1. Will East Riding Community Hospital in Beverley have increased bed capacity when creating an integrated community and intensive rehabilitation centre?

    The modelling identifies a need for 29 beds to be available at East Riding Community Hospital in Beverley.  This allows for changes in demographic growth up to 2026.


    Pb2. What will happen to palliative care beds at Beverley, Withernsea and Bridlington - are these being replaced by Time to Think beds?

    Palliative care is when there is no longer a cure and the emphasis moves into achievement of the best quality of life for patients and their families for the time they have left.  Many palliative care patients are already supported at home, with through the door nursing care.

    Where appropriate, there will be access to palliative care beds at East Riding Community Hospital in Beverley.  In addition, there will be a number of nursing or residential home beds with palliative wrap-around care, including Macmillan and Marie Curie support.  We are looking to specifically introduce these in Holderness and Bridlington.

    We will also be reviewing palliative care service provision in Bridlington and Withernsea.
     

    Pb3. Why is the ward at Bridlington called the Macmillan Wolds Unit?

    The Macmillan Wolds Unit in Bridlington has this name because Macmillan Cancer Support contributed to funding the set-up of this community ward.  Macmillan Cancer Support works closely with the NHS and wards up and down the country have been funded or partly funded by the charity.  The Macmillan Wolds Unit in Bridlington is not, and never has been, a cancer ward or a cancer unit.  The community ward does offer some palliative care which is care for someone nearing the end of their life when there is no cure for their condition. This could be due to cancer or some other illness.
     

    Pb4. If people donate to the Macmillan Wolds Unit, does the money go to Macmillan Cancer Support

    No, until 1 April 2017, the Macmillan Wolds Unit in Bridlington was run by Humber NHS Foundation Trust (HFT).  Any money donated to the Unit before this time would have been held by HFT in a charitable trust fund. 

    From 1 April 2017, the community services provision transferred to City Health Care Partnership Community Interest Company (CHCP CIC). 

    The CCG does not hold, or have access to, any charitable trust fund accounts.
     

    Pb5. When is the ward likely to close?

    The changes to urgent care services, including community beds, are expected to be implemented over the next six to nine months, in a managed way to minimise impact to patient care.
     

    Pb6. What will happen to any equipment used on the ward that was purchased through charitable donations?

    Any equipment purchased through charitable donations becomes the property of the NHS organisation.  CHCP CIC and HFT are currently in the final stages of discussions regarding the future ownership of all relevant equipment as part of the community services contract transfer.  Where appropriate, it is expected that equipment will continue to be used to support patients in the East Riding.
     

    Pb7. What will happen to any money left in the charitable funds when the beds are closed?

    HFT charitable trust will transfer those ‘in-scope’ funds (those held for the purpose of supporting the community services) to CHCP’s charitable foundation.  This is in progress at the moment, with each individual element of the overall fund being checked as to the terms of the original donation (if any); once established, HFT will seek assurances from CHCP that the terms of any ‘ring fenced’ in-scope funds will be respected, following receipt of which, HFT’s trustee will be requested to authorise transfer of the relevant amount.
     

    Pb8. What will happen to the Macmillan Wolds Unit when the beds are closed?

    Bridlington Hospital, including the Macmillan Wolds Unit accommodation, is owned by York Teaching Hospital NHS Foundation Trust who would be responsible for determining its future use. 

     

     General Questions - Consultation 
    1. Have you already made a decision?
      We have not yet made a decision. Should any alternative viable option come up then, of course, we would consider it.  The aim of the public consultation is to gather all the information to make sure that our decision is properly informed.  It is not a negotiation.
       
    2. What is urgent care?
      Urgent care is for a sudden illness or injury that needs treating fast, but is not considered to be a life threatening emergency.  You do not need an appointment to access an urgent care service.

      Urgent care services should not be used to treat minor symptoms that could wait to be treated by your own GP, pharmacist or even yourself using over the counter medicines.
       
    3. What do you mean by urgent care services
      The following urgent care services are currently available in East Riding of Yorkshire:

      • Minor Injury Units – There are 6 throughout East Riding of Yorkshire: Beverley; Bridlington; Driffield; Goole; Hornsea and Withernsea.  Patients are seen by an experienced nurse who can provide assessment, advice and treatment for minor injuries such as cuts, sprains, minor burns and simple fractures.

      • NHS 111 – If it’s not an immediate emergency and people are unsure about what action to take then patients can ring ‘111’. The service is available 24 hours a day, seven days a week, and can provide assessment and medical advice. The service directs patients to the most appropriate local service for further advice and/or treatment if required.

      • GP Out of Hours - Outside normal surgery hours you can still phone your GP practice, but you'll usually be directed to an out-of-hours service. The out-of-hours period is from 6.00pm to 8.00am on weekdays and all day at weekends and on bank holidays. Services are delivered from Beverley, Bridlington, Goole and Hedon.

      • GP Walk-in Centre, Bridlington - The walk-in centre in Bridlington is open 8.00 am to 9.00 pm, 7 days a week and allows patients to access care from a GP or a nurse with no need to register or to pre-book an appointment.

    4. How do community beds fit into the urgent care system?
      Community beds play an important role in preventing hospital admission by providing a higher level of care for patients (known as step up care) and providing a lower level of care for patients discharged from an acute hospital that are not quite well enough to go home (known as step down care).

      Our beds are not used as much as they could be for this purpose, meaning, often, people remain in hospital longer.  This causes blockages in acute hospitals which then has a knock-on effect for people waiting in A&E who may need to be admitted into hospital.  We want to improve wrap around patient care so that people can be cared for at home, resulting in quicker recovery and greater independence.
       
    5. Why do we need to change urgent care services?
      There a number of reasons why it is important for us to review current urgent care services. Some of these are based on national evidence provided by organisations such as the Department of Health and the Royal Colleges, but others are based on what we know at a local level as health professionals working closely with patients in East Riding of Yorkshire.

    • At a national level there is a desire for the NHS to:​​​​

      • Develop a more joined-up urgent care system that ensures patients are treated in the most appropriate setting for their needs.

      • Simplify the structure of urgent care services to reduce confusion amongst patients and ensure they access the right service, first time.

      • Reduce pressure on accident and emergency (A&E) departments by treating patients with minor symptoms either in primary care or in the community.

    • Locally, there are a number of reasons why we need to change:

      • To improve the experience for patients - When we need care it’s only natural that we want to receive it as quickly and conveniently as possible. The last thing we want is to either wait for hours in a waiting room or be passed between different people and services before getting what we need.

        Due to the volume of patients accessing emergency services with minor symptoms, this does inevitably cause delays and results in long waiting times in A&E departments.

      • Create a simple and consistent system for urgent care - We know there are issues with patients knowing what services are available and what types of health needs they are designed to treat. For example x-ray facilities are only available in Withernsea on a Tuesday, Wednesday and Friday in the morning. If people had a simple fracture outside of these times patients would have to go to another MIU or A&E.

      • The need to reduce pressure on emergency services – The ambulance service will have more options than just simply taking people to emergency departments, leading to quicker patient handovers.

        FACT: latest figures show that your local NHS spent over £2.5 million transporting 8,611 East Riding patients to accident and emergency departments only to find out these patients only needed advice and guidance; they refused treatment or left before they were seen.This is £2.5 million that could have been better spent on other health services.

      • Responding to an ageing population - the fact that people are living longer is something to be celebrated. By 2021 we expect the number of people aged 80 and over to have increased by around 30 per cent.

        However, considering that one of the main users of urgent care services are people aged 80 and over, this will create more demand for services. It is therefore essential that we design services to be able to cope with this increase in demand and that it’s clear to patients which service they should access.

    1. What services are being consulted on?
    • Introducing Integrated Urgent Care Centres in place of Minor Injury Units:
      • Providing a range of advice, treatment and diagnostics (including x-ray) with no variation between centres.
      • Which are fully joined up with the wider urgent and emergency care system.
         
    • Improving wrap-around patient care
      • Having the right type of beds and services in the community to better meet the needs of people.
      • Helping to prevent unnecessary hospital admissions.
      • Earlier discharge home from hospital through strengthened support in the community at or close to home, delivering quicker return to independence.
      • Helping to ease the pressure on Accident and Emergency departments by caring for more people closer to or in their own homes where rehabilitation, reablement and active therapy enables greater independence.
      •  With consistent opening times, 16 hours a day, 7 days a week, 365 days a year.
    1. What services are not being consulted on?
      • GP out of hours
      • Accident and Emergency
      • GP Walk-in Services
      • Buildings/estates
         
    2. Do local doctors support the changes?
      Our local doctors are an important part of our decision making process and will be encouraged to have their say during the consultation.  We have also continuously involved our Council of Members (which includes representatives from every GP practice in the East Riding) in our pre-consultation discussions.  Our Council of Members helped develop and weight the criteria which have been used to test the long list of potential scenarios. 

      Local doctors have been directly involved in identifying the clinical benefits of change and we have also received external clinical assurance from the Yorkshire and Humber Clinical Senate.
       
    3. Are you doing this to save money? Is this a cost saving measure?
      As a CCG, we have a budget and we spend every penny of it on local healthcare for the whole of the East Riding.  With regards to community beds, our options include the ability to release money that is tied up in paying for hospital beds that are not used to capacity and don’t have the necessary rehabilitation focus to meet the demand and invest in better community services, such as intensive rehabilitation.  For Urgent Care Centres, we will invest what we need in order to create a better and wider range of advice, treatment and diagnostics services that are more consistent and that offer value for money.
       
    4. How much will you save
      This is not about saving money but our proposals mean that we could invest more money where it is needed to reduce duplication, make services less confusing and better used.
       
    5. Is there a financial trade off between beds and UCCs?
      No.
      As a CCG, we have a budget and we spend every penny of it on local healthcare for the whole of the East Riding.  With regards to community beds, our options include the ability to release money that is tied up in paying for hospital beds that are not used to capacity and don’t have the necessary rehabilitation focus to meet the demand and invest in better community services, such as intensive rehabilitation.  For Urgent Care Centres, we will invest what we need in order to create a better and wider range of advice, treatment and diagnostics services that are more consistent and that offer value for money.
       
    6. How will I access urgent care if I need it?
      There will be no change to how you will access urgent care services in the future, although we anticipate that NHS 111 will be far more geared up to offer help, treatment advice and referrals over the telephone.
       
    7. You say that people are not aware of the current MIUs, what have you done to advertise these?
      Over the last year, we have tailored our marketing of Minor Injury Services in direct response to people’s feedback seeking clarity on what the opening times are and what services are available at each of our MIUs.  Our campaign was widely publicised through GP practices, posters, leaflets, social media, radio adverts, local media, newsletters and Your East Riding articles as well as on-line: http://www.eastridingofyorkshireccg.nhs.uk/choose-well/minor-injuries-unit-miu/  

      Articles were specifically shared with Parish Councils and the voluntary & community sector for inclusion in their regular communications with local communities.  We also continue to publicise minor injury services as an alternative to accident and emergency at every possible opportunity, especially during the winter period.

    8. What questions have been asked by the East Riding of Yorkshire Council Health, Care and Welbeing Overview and Scrutiny Committee (HOSC)?
      The HOSC asked a number of questions at their meeting on 15 November 2016 and the CCG's response can be found here.
      The HOSC asked a number of follow up questions and the CCG's response dated 2 December 2016 can be found here. 
      The following questions where asked by the Health Care and Wellbeing Overview and Scrutiny Sub-Committee on the 6 January 2017.
      The following questions were asked by the Health Care and Wellbeing Overview and Scrutiny Sub-Committee on the 4 April 2017.
      All documents referred to in the above responses can be found on our supporting document pages.

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     The Consultation Process
    1. What is the timescale for this consultation?
      The formal consultation period runs for 12 weeks, starting on 25 October 2016 and ending on 17 January 2017.
       
    2. How can I find out more?
    3. How can I have my say?
      Once you have read our consultation document and understand our proposals, click here to take our survey.
       
    4. How did you decide on your final options for consultation?
      We involved local patients, clinicians and social care professionals in developing ideas for how future services might look.  We developed five tests (our review criteria) to check which scenarios might work best.  Everyone involved had a say in which tests were most important to them.  All scenarios were then tested and scored using the first four tests.
      Those that proved to be realistic potential options had their finances analysed. This then helped us to identify the best options for formal consultation that delivered quality, safety and value for money.
       
    5. How have you engaged the public in the development of your proposals?
      Planning services across a large, varied population and geography is a complex process.  We are always listening to local people and involving them in decision making.  Information gathered from surveys and focus groups between 2013 and 2015 helped to shape our urgent care strategy. 

      We established a stakeholder forum in May 2016 to help us develop and weight our tests and consider potential scenarios.  The stakeholder forum includes representation from patient groups, partner organisations, voluntary and community sector, care homes, Healthwatch and the Health, Care and Wellbeing Overview and Scrutiny Committee.

      We also involved patients in the detailed scoring of all our potential scenarios.

    6. How have you engaged staff in the development of your proposals?
      Staff from provider organisations are always involved in discussions about service change.  Such discussions occur at all levels of the organisation; Chief Executive to Service Managers.  Representatives from Humber NHS Foundation Trust, Northern Lincolnshire and Goole NHS Foundation Trust, Hull and East Yorkshire Hospitals NHS Trust, York NHS Foundation Trust, Yorkshire Ambulance Service, East Riding of Yorkshire Council and Care Homes are members of the Stakeholder Forum which helped develop our tests and scenarios.  

      Staff views will be proactively encouraged throughout the consultation period.

    7. How have you engaged GPs in the development of your proposals?
      Clinical engagement is key to discussions about service change and our CCG is led by GPs.  Our GPs have been engaged through Council of Members (representatives of every GP member practice) and locality commissioning forums.  GP representatives are members of our Stakeholder Forum and have been actively involved in the detailed scoring of all our potential scenarios.  The GPs on our Governing Body form part of the decision-making process to approve the options for public consultation (October 2016) and the final decision (March 2017).

    8. Can I make alternative suggestions for you to consider?
      Yes. We have already considered a long list of potential scenarios but we will carefully consider any new ideas that are put forward as part of this consultation.   We encourage people who are making a comment about their local area to bear in mind the knock-on effects that might result from their suggestions.
       
    9. Have you already made up your mind?
      No. We have duty to propose options that we believe are viable, sustainable and offer the high quality service we would like to see.  We have worked with the public to identify these and we are now seeking the wider views of patients, public and clinicians.  We will make our final decision based on the evidence presented and this includes the views of patients and the public.
       
    10. How will you reach a decision once the consultation has ended?
      We will carefully consider all the views that we receive before making a final decision.  We will need to balance the views of patients and the public with the clinical case for change and the financial considerations.
       
    11. When will the changes take place?
      When the consultation closes in January 2017, we will carefully consider all the feedback we have received.  A final decision will be made by our Governing Body at their meeting in public on 21 March 2017.

      This will be followed by mobilisation discussions with the provider regarding implementation which could take 3-6 months.

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     Urgent Care Centres
    1. What is an Urgent Care Centre?
      Urgent Care Centres will provide a wide range of services, for all age groups, open seven days a week, for 16 hours a day, 365 days a year for the treatment of a sudden illness or injury that isn’t life or limb threatening. These will offer the same treatment and care whichever centre you visit, reducing the need for multiple visits or visits to alternative sites.
       
    2. What will the Urgent Care Centres offer?
      Please see page 14 of the ‘Have your say’ consultation document.
       
    3. When should I go to an Urgent Care Centre?
      You should visit an Urgent Care Centre if you have a sudden illness or injury that needs treating fast, but is not considered to be a life or limb threatening emergency.
       
    4. Why is it better to use an Urgent Care Centre than A&E?
      If you have a sudden illness or injury that isn’t life or limb threatening and cannot wait to be treated by your GP or pharmacy it is better for you to use an Urgent Care Centre. Here you will be seen and treated a lot quicker by a qualified clinician.

      Urgent Care centres will be open 16 hours a day, it is a one stop shop for you to go with a number of urgent injuries or illnesses and because they are joined up to the wider health care system you will be referred onwards for further treatment if needed.

      You should only use A&E for potentially life threatening conditions. A&E departments are staffed by specialist emergency teams who are there to care for people with life or limb threatening conditions.
       
    5. What is the difference between what an MIU and a UCC offer?
      Urgent Care Centres will have consistent opening times, 16 hours a day, 7 days a week and will provide a consistent range of advice, treatment and diagnostics (including x-ray) with no variation between centres. This is something that Minor Injury Units do not do, they are inconsistent in opening times and inconsistent on the service available.

      By providing a reliable service Urgent Care Centres will be fully joined up with the wider urgent care system which will offer clinical supervision with emergency departments and information can be shared easily. This means if you go to a UCC your doctor will know you’ve been. If you’re known to a social worker then they will be aware you’ve had an injury or illness. 

      After assessing a patient’s condition ambulances can transport patients to a UCC instead of an emergency department. UCCs can then treat and diagnose more patients and refer them for further treatment alleviating patients having to go to A&E, being admitted into hospital and waiting days for assessment. 

      Minor Injury Units operate in isolation, do not share information and as such cannot offer the additional benefits UCCs can.
       
    6. Will Minor Injury Units still be open?
      To make the urgent care system better for everyone across the East Riding, the new Urgent Care Centres will replace the current Minor Injury Units.
       
    7. How often are MIUs closed?
      Figures show that during 2015/16:

      •    Bridlington X-ray closed 1 day
      •    Hornsea MIU was closed 18 days, X-ray closed 12 days
      •    Withernsea MIU was closed 10 days, X-ray closed 14 days

      For 2016/17 (to date)
      •    Hornsea MIU was closed 1 day, X-ray closed 84 days
      •    Withernsea MIU was closed 5 days, X-ray closed 61 days

    8. How many people were treated through MIUs in 2015/16?
      • Beverley – 13,063 attendances per annum
      • Bridlington – 19,051 attendances per annum
      • Driffield – 7,466 attendances per annum
      • Goole – 16,112 attendances per annum
      • Hornsea – 3,140 attendances per annum
      • Withernsea – 2,813 attendances per annum
         
    9. How many people with minor injuries are treated through A&E?
      In 2015/16 8,774 people attended A&E who had no investigation carried out and no significant treatment.
       
    10. How much is currently spent on MIUs?
      We currently spend around £3.2 million per annum on the provision of 6 Minor Injury Units. This activity is purchased through a mixture of cost per case (under the national tariff) and block contract arrangements.
       
    11. How many people visit the Goole MIU during the 8 hours the CCG is proposing to close?
      During the 2015/16 financial year (01/04/2015 to 31/03/2016) there were 729 attendances at Goole MIU between the hours of 00:00 and 07:59. An average of 2 per day.
       
    12. Can I use an Urgent Care Centre, even if I don't live near it?
      Yes. The Urgent Care Centres will be able to treat anyone with an injury or illness that needs immediate care, but is not serious enough to require an A&E visit.  This includes all people living in, and visitors to, the East Riding area.
       
    13. How much will it cost the CCG if an East Riding resident attends Bransholme MIU or Hull Royal Infirmary A&E with a minor injury? Have these costs been factored into your decision making process?
      The recharge rate for the use of Bransholme MIU is £57 per individual.

      There are national prices for A&E services and MIUs, based on 11 Health Resource Groups.  However, costs vary depending on the type of contract agreed locally.  Therefore, to assess the value for money of shortlisted scenarios, the tariff has been calculated at an average cost of £70 (Emergency Medicine, No Investigation, With No Significant Treatment @ £57) and (Emergency Medicine, category 1 investigation with category 1-2 treatment @ £83).

      Information is from this document, Annex A

      T​​​​hese have been costed in the evaluation of scenarios.
       
    14. I don't have my own transport, how will I get to the new Centre?

      In East Riding of Yorkshire 82.4% of residents have access to one or more vehicles (source local transport plan, ERYC). This is higher than the Yorkshire & Humberside average (72.4% and 74.2% respectively). For those who don’t, public and community transport is available:

    • Public transport

      A number of bus services operate between urban and rural areas

      • Beverley to Hull – Daily until 11:30pm
      • Bridlington to Scarborough – Daily until 6:40pm / Hospital Shuttle Bus – Daily until 6:00pm
      • Driffield to Beverley – Daily until 11.02pm / Sunday until 7:09pm (winter)
      • Driffield to Bridlington – Monday to Saturday until 11:57pm / Sunday 10:36pm
      • Goole to Hull – Monday to Saturday until 4:48pm
      • Goole to Scunthorpe – Monday to Saturday until 5:35pm / Sunday 5:10pm
      • Hornsea to Beverley – Monday to Saturday until 7:15pm / Sunday until 5.30pm
      • Hornsea to Bridlington – Daily until 4:00pm
      • Withernsea to Hull Royal Infirmary – Daily until 9:45pm
         
    • Community Transport
      MediBus provides a door-to-door, dial-a-ride service to towns throughout the East Riding for pre-arranged trip to medical appointments, 24 hours in advance. They will offer ‘on the day’ bookings if a vehicle and capacity is available.

      Arranged through Passenger Services on 03456 445 959
       
    • Help with Healthcare Travel Costs
      Under the NHS Healthcare Travel Costs Scheme (HTCS), there is an opportunity for patients on a low income/benefits to claim help with travel costs and for carers/escorts (if it is medically necessary). More information is available on the NHS website, click here.
    1. Why can't we upgrade all 6 MIUs to Urgent Care Centres?
      The possibility of upgrading all 6 of our Minor Injury Units to Urgent Care Centres has been considered using the 5 tests (review criteria) that were agreed with the involvement of clinicians, partners and the public. Before any financial modelling was considered, this scenario ranked 42. Clinically, there would not be enough patient demand at each Centre to allow staff to maintain their valuable range of skills and we wouldn’t have enough staff to provide consistent care, 16 hours a day, 365 days a year, at 6 Urgent Care Centres.
       
    2. Is there any scope in the future to re-open an MIU as a UCC?
      Based on our current modelling, we feel confident that our proposed options offer the best solution for most people. These options were the highest scoring against the criteria method we set out.

      We did review the scenario for more than 3 MIUs however it wasn’t viable using the criteria method. Therefore we will not be looking to reopen an MIU as a UCC in the future.
       
    3. How many UCCs are affordable?
      This isn’t about how many UCCs are affordable. Our proposed options are primarily based on applying the first four tests (review criteria):

      •    Have a positive impact on improved health and wellbeing of the population.
      •    Improve patient experience and access to services.
      •    Meet or improve upon all clinical and quality standards.
      •    Be suitable for implementation during 2017/18.

      Once our top 9 scenarios were identified, these were then costed using the fifth and final test:

      •    Lead to better use of NHS money / staff and be more sustainable for the future.

      This resulted in the top 4 proposed scenarios being identified for consultation.
      Before any financial modelling was considered, the first scenario in which more than 3 MIUs would be upgraded ranked 32.

      Click here to see the costings for our top 9 scenarios
    1. Will these changes affect A&E services and access to these?
      No. These proposed changes will not affect A&E services or access to these. We are hopeful that people will use Urgent Care Centres as an alternative where possible, which will ease pressure on A&E and ensure that people in need of specialist emergency care receive it at the right time, by the right person delivering improved outcomes.
       
    2. Will Urgent Care Centres stop more people from going to A&E?
      If people use them appropriately, yes we beleive that it will stop more people going to A&E.
       
    3. How will these changes improve health services for me?
      Although there will be no MIUs, local residents will benefit from a wider range of services that are more consistent in two or three UCCs. This means you will be seen and treated first time, more often and not passed from service to service (potentially ending up in A&E) which is what currently happens at the moment when MIUs are closed or not able to treat your condition.

      Specialised A&E departments can focus their attention on specialist emergency care for life threatening and limb threatening conditions as more people attend UCCs for care and treatment.
       
    4. Do you have to stick to national criteria?
      No, we are not required to follow national criteria however, we are using this as a good practice guide
       
    5. If you relaxed the national criteria (i.e. open less hours), would we be able to have more Urgent Care Centres?
      No. We wouldn't have the additional clinical workforce required to deliver the full range of services UCCs require.
       
    6. Elderly people will become more ill if there is no UCC near them. How will this be better for them?
      Support will continue to be provided by primary (doctor) and community care services and the UCCs will work more closely with these services to ensure they provide improved wrap around patient care.

      A UCC can provide a wider range of care and treatment and offer enhanced support whereas MIUs only support people with a minor injury such as cuts, burns, bites, breaks and falls. They do not manage minor illness.
       
    7. Many children attend Minor Injury Units with teaching staff during term time. How will this impact on them?
      There are 39 school weeks per year.  Our data shows that only a small number of school age children use a minor injury unit on a school day in school hours.  We do not have any data to show whether these children were accompanied by teaching staff or parents/ guardians.  

      •    Beverley – 30 per school week
      •    Bridlington – 18 per school week
      •    Driffield – 11 per school week
      •    Goole – 17 per school week
      •    Hornsea – 5 per school week
      •    Withernsea – 7 per school week

      Most schools have a nurse/matron trained in first aid who can make an initial assessment. If that assessment is an emergency then a 999 call would be made immediately. If the child has an urgent care need then parents should be contacted and advised to take their child to a UCC.
       
    8. What will happen to the staff? Will staff lose there jobs?
      Urgent care and community staff do an amazing job and our aim is to improve the whole system so that we can retain a workforce in the East Riding with the right skills that are able to work where they are needed and can make the best impact.  We are not expecting staff to lose their jobs and we will work closely with our provider organisations to redeploy staff.
       
    9. Do you have the skills and workforce to deliver these services?
      We will be able to reallocate staff who already work in these roles and develop capacity where required. Working as part of an integrated care system we will be able to maintain and develop clinical competencies.
       
    10. NHS 111 does not send people to MIUs, how will an urgent care centre be any different?
      NHS 111 is unable to direct people to Minor Injury Units due to inconsistencies in their opening times and services offered. Urgent Care Centres will be consistent with their opening times and services offered which will enable NHS 111 to direct patients to them.
       
    11. Why can't ambulances drop people off at MIUs now?
      Ambulances cannot take patients to Minor Injury Units due to their inconsistent opening times and services offered. Urgent Care Centres will be consistent with their opening times and services offered which will enable ambulances to drop patients off there.
       
    12. I cannot get an appointment with my GP so I rely on MIU. Where will I go for treatment in the future?
      We are continuing to work with local GPs to improve access. It is important that you access your GP as they are able to look after your full health needs, not just your urgent need for care.
       
    13. What about the impact on GP practices?
      We have done some analysis of the potential impact on GP practices resulting from our proposed changes.  This shows that, whilst most practices are unlikely to be affected, some may see a potential increase of up to 3 patients per day requesting an appointment.  Where necessary, we will work with our GPs to consider ways to support patients and practices manage any increase in demand. 
       
    14. Why have rural and coastal areas been targeted?
      Rural and coastal areas have not been targeted. We have been through a rigorous process to develop and agree tests (review criteria) with the involvement of clinicians, patients and partner organisations.  These tests were then used to score a long list of potential scenarios to check which ones are realistic.
       
    15. How much money will you save by consolidating services on fewer sites?
      We will invest what we need to invest to provide this proposed model of care. Every penny of funding received is spent on health care. Any funding released will be reinvested to enhance the provision of wrap around care so that more people can be cared for at home.
       
    16. Is there enough space within the existing hospital sites to create Urgent Care Centres?
      There is sufficient space available within the existing hospital site at Goole for an urgent care centre to be created.  Additional space within the building would be required to create an Urgent Care Centre at Beverley and Bridlington. Some improvements are needed to bring these up to the standard we would want to see (ie extra treatment rooms, storage, decoration, fittings, etc).
       
    17. How much would it cost to upgrade the existing sites to accomodate the space requirements of an Urgent Care Centre?
       
      Beverley: £67,433
      Bridlington: £28,053
      Driffield: £35,277
      Goole: £12,463
      Hornsea: £40,253
      Withernsea: £25,178

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     Transforming Community Beds
    1. How will these changes improve health services for me?
      There will be more consistency in accessing services, and the services provided will be more joined up with other parts of the urgent care system. This will enable the right care at the right time to be delivered by the right person in the right place, supporting better patient outcomes and experiences.
       
    2. How many beds do you currently have? How much do the beds cost?
      We currently commission 54 community hospital beds to support discharge from hospital.  We pay £6.5 million for these beds; this is approximately £350 per bed, per day.  Our data shows us that many patients don’t need the high level of medical or nursing input provided in a community hospital bed and would recover more quickly by being better supported in their own home.
       
    3. Are you reducing the number of community beds?
      Yes, we want to invest in our local workforce to improve intensive rehabilitation services so we can support more people back to independence sooner, in their own home.  For people aged 80 and over, 10 days in hospital equates to 10 years of muscle wasting.

      Last year we successfully piloted eight Time to Think Beds in local residential or care home settings at a cost of around £65 to £140 per day. Time to Think beds are more flexible and offer short term NHS care, rehabilitation, therapy and support to help people back to independence whilst care packages are set up in their own home.
       
    4. Why are you considering reducing the number of community hospital beds when Hull and East Yorkshire Hospitals Trust (HEYHT) is buying 10 more beds to help reduce winter pressures?
      Whilst we welcome the proactive approach HEYHT is taking to help the local NHS cope with this year’s winter pressures, this is a short-term measure. We want to look towards the longer term and invest in our local workforce to improve intensive rehabilitation services so we can support more people back to independence sooner, in their own home.
       
    5. How many beds will you have in the new options?
      • Option 1 - create an integrated community sub-acute and intensive rehabilitation centre in a single location, supported by Time to Think beds.
        This option will provide 12 community sub-acute beds and 17 intensive rehabilitation beds, supported by 15 Time to Think beds.  More care will be provided in the patient’s own home.
      • Option 2 - create a home first solution, supported by community rehabilitation and Time to Think beds.
        Community sub-acute care would be provided in an acute hospital.  The remainder of care will be provided in the patient’s own home, supported by 15+ Time to Think beds.
         
    6. Will you have enough beds in winter?
      We are confident that our plans will offer us more flexibility, especially during times of higher demand such as winter.
       
    7. What are Time to Think beds?
      Time to Think beds are based in local residential or care home settings.  They are more flexible and offer short term NHS care, rehabilitation, therapy and support to help people back to independence, whilst care packages are set up in their own home.  Feedback from the patients involved in our pilot has been really positive with everyone asked saying they felt safe while they were in a Time to Think bed.
       
    8. Where will the Time to Think beds be located?
      Time to Think beds will be in a number of geographic areas across the East Riding of Yorkshire. We would plan specifically to locate beds in our coastal areas of Withernsea and Bridlington if Option 1 is supported by the consultation.
       
    9. Is there enough capacity in the care home system to deliver this model?
      We have successfully piloted Time to Think beds and are confident that the capacity is available to deliver this model. We would be working closely with the care home market to develop and implement this new model.
       
    10. What about carers? Will you make any provisions to manage their transport?
      In East Riding of Yorkshire 82.4% of residents have access to one or more vehicles (source local transport plan, ERYC). This is higher than the Yorkshire & Humberside average (72.4% and 74.2% respectively). For those who don’t, public and community transport is available:

    • Public transport

      A number of bus services operate between urban and rural areas

      • Beverley to Hull – Daily until 11:30pm
      • Bridlington to Scarborough – Daily until 6:40pm / Hospital Shuttle Bus – Daily until 6:00pm
      • Driffield to Beverley – Daily until 11.02pm / Sunday until 7:09pm (winter)
      • Driffield to Bridlington – Monday to Saturday until 11:57pm / Sunday 10:36pm
      • Goole to Hull – Monday to Saturday until 4:48pm
      • Goole to Scunthorpe – Monday to Saturday until 5:35pm / Sunday 5:10pm
      • Hornsea to Beverley – Monday to Saturday until 7:15pm / Sunday until 5.30pm
      • Hornsea to Bridlington – Daily until 4:00pm
      • Withernsea to Hull Royal Infirmary – Daily until 9:45pm
         
    • Community Transport
      MediBus provides a door-to-door, dial-a-ride service to towns throughout the East Riding for pre-arranged trip to medical appointments, 24 hours in advance. They will offer ‘on the day’ bookings if a vehicle and capacity is available.

      Arranged through Passenger Services on 03456 445 959
    1. Why are Time to Think beds needed? Surely you are just paying for services that could be provided by social care?
      We are seeking to deliver a new model of care in partnership with social care where an integrated approach enables patients health and social care needs to be met through joint working.
       
    2. How much will you save on beds?
      We will invest what we need to invest to provide this proposed model of care. Every penny of funding received is spent on health care. Any funding released will be reinvested to enhance the provision of wrap around care so that more people can be cared for at home.
       
    3. What are the plans for communitiy beds in Bridlington?
      We would like to improve access to intensive rehabilitation (e.g. physiotherapy, occupational therapy), community nursing and reablement to support patients in or close to their own homes.  Our data shows us that these ‘wrap-around’ style patient services would be more effective in supporting people back to independence as many patients don’t need the high level of medical or nursing input provided in a community hospital bed and would recover more quickly by being better supported in their own home.

      Because of this, last year we successfully piloted eight Time to Think Beds in local residential or care home settings.  Time to Think beds are more flexible and offer short term NHS care, rehabilitation, therapy and support to help people back to independence whilst care packages are set up in their own home.

      As part of our upcoming formal public consultation about improving urgent care services in the East Riding of Yorkshire, we are proposing to improve the wrap-around care we provide to patients in the community to better support them back to independence. Our proposals suggest freeing up resources by reducing the number of community beds and focusing more resources on wrap-around patient care by:
       
      • introducing Time to Think Beds; and 
      • improving availability of services in the home such as intensive rehabilitation, community nursing and reablement. 
         
    4. Are the plans to close beds in Bridlington tied in with plans to introduce Urgent Care Centres?
      They form part of our upcoming formal public consultation about improving urgent care services in the East Riding of Yorkshire.
       
    5. How might the proposals affect palliative care patients?
      We are confident that our proposals will improve these services for everyone that has need of care in a community setting as there will be much more scope to care for people at or close to their own home. This includes people in the late stages of their lives with diseases such as cancer, motor-neurone disease and long term conditions related to the ageing process that are receiving palliative care.  We will be reviewing palliative care services, in Bridlington, specifically focussing on improving ways to support people where there may be a greater need as a result of the consultation outcome.
       
    6. Why is the ward at Bridlington called the Macmillan Wolds Unit?
      The Macmillan Wolds Unit in Bridlington has this name because Macmillan Cancer Support contributed to funding the set-up of this community ward.  Macmillan Cancer Support works closely with the NHS and wards up and down the country have been funded or partly funded by the charity.
       
    7. What will happen to the staff?  Will staff lose their jobs?
      Urgent care and community staff do an amazing job and our aim is to improve the whole system so that we can retain a workforce in the East Riding with the right skills that are able to work where they are needed and can make the best impact.  We are not expecting staff to lose their jobs and we will work closely with our provider organisations to redeploy staff.
       
    8. Do you have the skills and workforce to deliver these services?
      We will be able to reallocate staff who already work in these roles and develop capacity where required. Working as part of an integrated care system we will be able to maintain and develop clinical competencies.
       
    9. Isn't it more expensive to put poorly people in nursing homes rather than community beds?
      No. The new model is designed so that people in need of health care receive the right care, in the right place at the right time by the right person and patients achieve the best outcome and experience. We believe that the proposed model provides the best value.

      Cost of different bed types:
      Community Beds: £350 per day
      Intesnsive Rehabilitation Beds: £147 per day
      Time to Think Beds: £65 - £140 per day
      Home First Beds: £65 - £140 per day

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     Future of Estates
    1. What will happen to the hospital where the Minor Injury Unit / community beds close?
      Our aim is to improve the range and quality of urgent care services that are available for people across the East Riding area. Our plans may result in some space within existing hospitals not being used or used for the provision of a different service in the future. We are also aware that some combinations of our proposals could result in decisions that leave no Minor Injuries services and no community inpatient provisions at Beverley, Bridlington or Withernsea. Any significant change to use of buildings would be subject to a separate consultation.

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     Additional questions raised since consultation started
    1. The dataset used for modelling the scenarios included data relating to ERY patients accessing the MIU services together with patients accessing MIU services in East Riding from other neighbouring CCGs within our Sustainable Transformation Planning (STP) area.

      The Sustainable Transformation Planning (STP) area includes the following CCGs:
    • Scarborough & Ryedale CCG
    • Vale of York CCG
    • North Lincs CCG
    • North East Lincs CCG
    • Hull CCG

      The dataset used in the CCG’s decision making was taken from the NHS Secondary Uses Service data warehouse which is the primary source of data for payment used in the NHS. This activity is the extent of that legally accessible by the CCG’s Business Intelligence team (eMBED) due to access restrictions on patient records. 

      Patients outside the STP area also access ERY Minor Injuries Services. This data is included in one of the reports included on this website.  This report uses data supplied by the Providers of the MIU services in East Riding i.e. Humber, Hull & East Yorkshire Hospitals Trust, North Lincolnshire and Goole Hospitals Foundation Trusts and City Health Care Partnership Trust.

      The costs of accessing MIU services to non East Riding Patients is chargeable back to the CCG of origin and Providers need to ‘right size’ units and services to meet the total demand.

      While total activity is important when Providers are sizing the totality of their service provision commissioners are responsible for their registered populations. For completeness the CCG has run the additional activity through the CCGs modelling tool which has reconfirmed the four top ranked options remain as the top four.

      A more detailed response, including adjusted scores, is available in our Mid Consultation Review document - click here to view this document.

     

     

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