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Agenda item

Adult Dysfluency and Cleft Lip and Palate Service Update and Draft Consultation Plan - NHS Sheffield Clinical Commissioning Group

Report of the NHS Sheffield Clinical Commissioning Group



The Committee received a report from the NHS Sheffield Clinical Commissioning Group giving an update on the Adult Dysfluency and Cleft Lip and Palate Service and the request for a review of the consultation plan for potential changes to the provision of dysfluency and cleft, lip and palate services for adults in Sheffield.




Present for this item were Kate Gleave, Deputy Director, Commissioning, NHS Sheffield Clinical Commissioning Group (CCG) and Lucy Ettridge, Deputy Director, Communications, Engagement and Equality NHS Sheffield CCG.




Kate Gleave apologised to the Committee, stating that representatives of Sheffield Children’s Hospital were unable to attend the meeting.  She then referred to the report and said that she had met with NHS England as part of the Major Service Change Assurance Process on 17th September and it was anticipated that NHS England would advise the CCG could self-assure itself regarding this proposed change.




Members made various comments and asked a number of questions, to which responses were provided as follows:-




·                The decision to make the changes to and serve notice of such changes to the Adult Dysfluency and Cleft Lip and Palate Service had been taken by the Sheffield Children’s NHS Foundation Trust (SCNHSFT) and not the CCG.  It was stated that the changes were in no way connected to the changes to be made to the Integrated Care System (ICS) in April, 2022.




·                The options available were for the CCG and the NHS Trust to work together to develop the options and it was anticipated that there would be an option to provide the Service within Sheffield as well as outside the city.  There was also a “no service change” option as well as a “no change” option.




·                The CCG had worked with the Sheffield Children’s Hospital in developing the consultation plan. The CCG has a legal duty to bring any substantial change of its services to this Committee and it had been unanimously agreed at a previous meeting that a formal public consultation process be carried out.




·                To date, there had been no formal consultation, but part of the process would be to engage with staff.  An Equalities Impact Assessment (EIA) has been undertaken around some of the options, but it should be noted that the CCG was still working through all of the options available.




·                It was largely men of white backgrounds that were affected by dysfluency.  As this was a relatively small service, some of the information gathered could look skewed and the CCG was mindful of that and would be monitoring data gathered to determine who they were engaging with.




·                With regard to concerns raised about the Service being taken outside Sheffield, consideration was being given to determine what options were viable and to look at what was available both locally and nationally.  A number of services have been carried out around the country via video-links, webchats or telephone calls rather than face-to-face and favourable feedback had been received on this and it was felt it would be wrong to rule these options out.  The CCG and Trust were aware of general issues and specifically the potential impact of travel on patients should they be asked to attend face to face appointments outside Sheffield. 




·                Feedback from this Scrutiny Committee would be fed into the consultation process and it was anticipated that further feedback from this Scrutiny Committee would form part of a formal written response from the Council.




·                In response to the question “what was the point of the consultation”.  The SCNHSFT felt that it was no longer viable to offer the Service to those over 16 years of age and had to decide on how best to meet the needs of children if the Service as it stands, was no longer viable.




·                Consideration had been given to options that were viable, and so far, the best options and best outcomes for the public, were unknown.




·                Workforce challenges and wider pressures were similar to those faced in other areas around the country, as children developing speech and language difficulties was on the increase which in turn had an impact on the demand for speech and language services.




·                Not all CCG’s around the country commission a service for adults with dysfluency, and there were some areas where an “as and when” service should a patient present with exceptional needs, was commissioned.  The range of age groups in other areas was very mixed, some areas only having one hospital that could provide services for adults and children combined, others have adult specific and children specific services.




·                “No change” will remain an option in the consultation process although it was not considered to be viable.  An all-age approach would be part of the consultation as the transition from child to adult would be key to the options available to determine how their needs might change and be managed through transition.  There was a need to test the views of patients.




·                Based on the fact that the Service had informed the CCG that it could not continue to provide the service as it stood, the CCG had a responsibility to work out the best way forward, following a standard matrix of quality of service, value for money and the wider impact on children’s paediatric services.  The CCG have had a conversation with the Children’s Hospital, and it was felt that there was a case for change, and this would be set out when the proposals go out to wider consultation.




·                In terms of whether a Service Level Agreements (SLA) would be a viable option, the CCG have contractual arrangements for this Service and it doesn’t use SLAs.  The CCG is the commissioning service for adult provision as well as children and the Service in Sheffield was comparatively well funded against national benchmark with more investment per service users than other providers across the country.




·                The CCG and the SCNHSFT were working on a speech and language review, taking account of wider issues and consulting with those in education, schools and the voluntary sector.  With regard to face-to-face consultations, it was anticipated that one of the options would be for a mixed service which provided telehealth appointments as well as face-to-face appointments to determine the needs of service users.




·                In layman’s terms, someone with a cleft palate would be diagnosed pre-birth and the majority of patients were usually discharged at around 20 years of age. Dysfluency in adults could continue for some patients well into their 50s, with some being re-referred into the service, for differing health reasons, sometimes these could be life-changing. Dysfluency patients transfer from the age of 16, whilst those with cleft palates would be retained until the age of 20, unless they still required some type of intervention. 




Whilst it was noted that representatives from the Children’s Hospital did want to attend the meeting, but unfortunately no-one was available, Members felt there was a need for representatives to attend a further meeting, so that the questions asked at this meeting could be answered and when more information was known, but this would have to take place before the scheduled meeting of 24th November, due to the commencement of consultation period.




RESOLVED: That the Committee:-




(a)      thanks Kate Gleave and Lucy Ettridge for attending the meeting;




(b)      notes the contents of the report and responses to questions raised; and




(c)      expresses its deep regret that representatives from the Sheffield Children’s Hospital NHS Foundation Trust were unable to attend the meeting and requests that a further meeting be arranged as soon as possible when they are available to attend.




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