1. Are the rate of unsafe discharges taken into account when assessing the services’ safety? Infection control was mentioned but what about MH patients in crisis being allowed to walk out of A&E?

A&E staff are trained to assess mental capacity and should be applying the same principles of safe, effective and reasonable clinical practise to all people in their care irrespective of whether they are presenting with a physical or mental health emergency.

As a city we have and continue to invest in services and training (termed mental health liaison) where predominantly physical health trained staff have rapid and timely access to specially trained mental health professionals. This liaison service helps to deliver the needed mental health element of service to people presenting at the A&E department, but also helps to appropriately train and skill A&E staff to deal with these issues.

2. Also, has 111/Health direct been abandoned? If so, was this because of public distrust? A false economy?

We can confirm that the 111 service is running and regularly deals with on average 3200 calls a day during the week and approximately 6000 calls at the weekend. The referral rate to A&E is one of the lowest in the country as is the 999 conveyance rate.

3. I’ve tried to return life expired drugs via my local pharmacy like it says in the instructions and they look at me as though I’d done something daft and then they tell me to take it back to my doctors

It is difficult to respond fully without knowing what type of date expired medicines is being referred to. However, pharmacies are obliged to accept back most medicines such as tablets, capsules, liquids, drops, inhalers, creams, etc. Unfortunately, they are not required to accept medicines that are contained in syringes fitted with needles. These are classed as ‘Sharps’.

Some outpatients are provided with medicines in syringes by Sheffield Teaching Hospital, who also give the patient a large sharps-bin to safely store used syringes for disposal. These bins should be returned to the hospital. Syringes prescribed by the GP should be returned to the surgery for disposal although some surgeries are now refusing to accept such returned waste.

We appreciate this is not a satisfactory state of affairs but NHS England is working with Sheffield City Council to find a suitable solution.

In addition, the CCG is working at the moment to re-issue a clause which formally allows GP practices to take these from patients, but we are awaiting written confirmation of this so we can issue to everyone to try to resolve that particular issue.

4. Can you focus on preventing alcohol addiction – it is a major cause of ill-health and yet it has not been discouraged in the way that smoking and obesity is

The alcohol strategy for Sheffield for 2016-2020 was approved by Sheffield City Council Cabinet in September and the Council is currently pulling together an implementation group to ensure the actions agreed are implemented.

The strategy has a focus on prevention, screening and early interventions in order to educate on the impact of alcohol misuse. It also focuses on asking the right questions, the right interventions to prevent alcohol misuse occurring, and to prevent it worsening where it is occurring already.

This will be available on the Council website shortly.

5. Do you, like local government organisations, have a contingency fund for Sheffield patients who need expensive drugs or procedures? If so, does this prevent a postcode lottery?

There isn’t a contingency fund as such. Any requirements for expensive drugs or treatment that is not included in the Sheffield CCG contracts or is not commissioned by Sheffield CCG are considered by the Individual Funding Request (IFR) Panel.

Requests via the IFR process are required to demonstrate exceptionality. A patient may be considered exceptional if both the following apply:

• He/she is different to the general population of patients who would normally be refused the healthcare intervention, and
• There are good grounds to believe that the patient is likely to gain significantly more benefit from the intervention than might be expected for the average patient with that particular condition.

All requests are considered on an individual basis.

6. Why can’t A&E be renamed so that its title more accurately reflects what its priority function eg ‘emergency treatment centre’?

A&E is for receiving accidents and emergencies - some of which will be treated in the department, some of which will need no treatment/ or advice on treatment at home (40%) and some of which will be treated by admitting to hospital (20-25%). A&E isn’t primarily for treatment, it is for the safe reception and appropriate triage - either treatment or redirection- of accidents and emergencies.

A&E is one of the strongest brands in the country, and one that in fact we should build upon. It is for accidents and emergencies so we don’t think it should be renamed, we need to educate people and remind them of its appropriate use. The CCG is currently developing an Urgent Care Strategy which we hope will simplify urgent care services in the city – as part of this we hope to educate people on best use of A&E.

7. With regard to mental health services: I used to take up much of my GP’s time with ‘feeling unwell’ when my problem was living with someone else’s excessive drinking. If I had been given the helpline for AL-Anon Family Group as an option I would have saved hours of futile visits to the GP. It took me 10 years to find this help myself.

We are always looking at ways of making information easily accessible for members of the public and for professionals.

With regard to alcohol services, professionals are aware that they can refer directly and in fact the public can also directly access these services without referral:

• http://shsc.nhs.uk/service/open-access-team/

Lots of information regarding a huge number of services can be found on the Sheffield Mental Health Guide or the Sheffield Directory:

• http://sheffieldmentalhealth.org.uk
• http://www.sheffielddirectory.org.uk/kb5/sheffield/directory/results.page?qt=alcohol&term=&sorttype=relevance

8. Because patients will still have the GP or A&E as their first port of call, what are you going to do to broadcast the broader services to patients, so they use the most appropriate service first time? They may not explain to the receptionist their reason

The CCG promotes the NHS ‘Choose well’ campaign which has been developed to give people information to help them make the right decision on which services they choose based on their symptoms. This will help people access the right treatment and professional advice when they need it. This winter the CCG will be including messages about appropriate use of services through the CCG website, social media, articles in the local papers, radio interviews, leaflets distributed across a variety of Sheffield’s public venues and the CCG’s free mobile phone app.

9. Is a discharge checklist used on ALL hospital wards? Is this checked again immediately prior to discharge? Patients may over-anticipate their recovery. Improving discharge planning might avoid re-admission.

Yes a discharge checklist is used on all hospital wards and is checked again immediately prior to discharge. Sheffield Teaching Hospitals aim to ensure that every inpatient is discharged in a safe and well-planned way; with appropriate support services in place to allow him or her to successfully return home or to be discharged to a more appropriate care environment. Discharge planning will commence at the earliest opportunity, following admission to hospital in the case of emergency patients, or at the pre-admission stage for elective cases. In the main, we don’t think that patients over anticipate their recovery and likely procedures, outcomes and length of stay are discussed with the patient and their carers. In an aim to avoid inappropriate re-admissions, when discharged, patients are also given any additional information which is specific to their case so for example they may be given contact telephone numbers for specialist services for help and advice, patient information leaflets, clinical advice and follow up appointments.