tiintax

Now that I have finished my tax return (about which I will no doubt be writing more later) I have turned my attention to the consultation on “Making Urgent Care Work Better in Sheffield” which, coincidentally, also closes today.

As this is outside of my usual remit of tax consultations I have posted my response under a cut but click here if you’d like to read it nevertheless.

Making Urgent Care work better in Sheffield

Consultation response

From W Bradley

tiintax.com

Disclosure of interest: I am an elected public governor of the Sheffield Teaching Hospital Trust. Although I had the benefit of seeing a draft of the STH response to this consultation, the response below is a personal one and in no way connected with the Trust or its members. I am a retired civil servant and run a blog on government tax consultations, tiintax.com, where I will also be publishing this response. My relevant expertise is in the consultation process and the use of impact assessment to inform decision-making.

1. Policy objective. It is not clear from the consultation documents what the policy objective of the proposed changes actually is. The summary document suggest that it is led by feedback from service users while the main consultation document begins with the idea that services are “confusing and vary across the city”.
2. Variation in service is a “feature” of delegated service, not a “bug”. As I understand it, GPs have a wide latitude to organise their own service and some surgeries are better resourced, better organised and give better service to their patients than others. A proposal to standardise service should, surely, be predicated on standardising it at the best practice rather than some muddled middle?
3. Telephone triage. You are proposing a telephone triage before a patient is offered a same-day GP appointment. Again, if you were offering to reinstate the much-missed NHS Direct service I might agree there was some merit in the proposal, but in fact you are advocating what will, to me and others using the same GP practice I currently use, be a noticeably inferior service. You do not offer any alternative option to this proposal but surely sharing best practice ought to be considered first? There are practices which manage to offer a same day service: get them together with the ones which are unable to do this and find out what the differences are, and whether the best practices are replicable.
4. Workforce challenges. Your paragraph on “workforce challenges” suggests the real policy difficulty is the shortage of GPs and support staff but, again, there is no options appraisal in the document other than the “preferred solution”, not even the “do nothing” option. Rather than attempting to suppress demand by making it more difficult for patients to see a GP, might it not be more practical to increase supply? This could be done by offering trainee doctors bursaries to cover university fees and living expenses if they studied in Sheffield and took up a paid GP post for five years after qualifying. I would like to see an impact assessment of the costs and benefits of this and other options for increasing supply of GP services before we pursued any option designed to suppress demand.
5. National policy and best practice. You say that there is a national policy to create “urgent treatment centres”. You do not give any reasons why the Broad Lane drop in centre could not be upgraded to become an urgent treatment centre except to say that “a number of professional bodies” suggest these should be located next to A&E departments. If it is not mandatory to have an urgent treatment centre next to an A&E department, it seems to me the case of where to locate it in Sheffield requires more examination.
6. Sheffield-specific problems. A&E in Sheffield is located at the Northern General Hospital, but the NGH is poorly served by transport links. The supertram does not have a spur which goes near to it, bus services are confusing and long-winded, car parking is difficult to obtain and expensive, and the NGH campus itself is fully a mile from end to end, with no provision for disabled parking near to specific buildings or other intra-campus transport. Adding an urgent treatment centre to the NGH campus would increase traffic and there is no consideration in your consultation of how this is to be managed and resourced. There should in my view be no expansion of NGH service throughput without a commensurate provision for people actually to get to it. Otherwise you are simply triaging patients by distance from NGH and ability to pay for taxis.
7. Options appraisal. There is a legitimate expectation in a public consultation that the policy objective will be stated and that the competing options for achievement of that objective will be compared. You have not offered any option that is not closure of the Broad Lane Walk In Centre (your electronic response form is particularly poorly designed in this regard). If the policy objective is to overcome a shortage of GPs then why have supply side options not been considered? If it is to choose the best location for an Urgent Care Centre why has locating it at Broad Lane (or at the Hallamshire, or opening more than one) been considered? If the policy objective is to help patients choose the “correct” pathway to care, why have no options relating to decision making been put forward? Essentially I feel your consultation is lacking in the features one would expect of a major consultation and is little more than a request for endorsement of a take-it-or-leave-it package – without even the option of “leave it”!
8. I am against the proposals in their present form and would suggest that you think again with an open mind, generate a range of options, and appraise them even-handedly.