A report on the approval by NHS Berkshire West Clinical Commissioning Group on revised future arrangements for the commissioning of NHS Hydrotherapy Services in Berkshire West.

The Executive Director of Social Care and Health submitted a report informing the Committee that NHS Berkshire West Clinical Commissioning Group (CCG) had approved revised arrangements for the commissioning of NHS hydrotherapy services in Berkshire West.  This would mean that hydrotherapy would only be funded when exceptionality could be demonstrated via an individual request.  Given the operational challenges of providing this service currently due to stringent control policies, the CCG would be working with the Royal Berkshire Foundation Trust to determine the best way to provide this service.  The hydrotherapy facility at the Royal Berkshire Hospital had in fact been closed since March 2020 as part of the Trust’s Covid-19 Infection Control Policy.  A copy of a report by Shairoz Claridge, Director of Operations Planned Care and Long-Term Conditions, Newbury Locality, and Caroline Tack, Head of Planning and Transformation, entitled ‘Future Commissioning of NHS Hydrotherapy Services in Berkshire West’ that had been presented to the NHS Berkshire West CCG Governing Body on 8 December 2020 was attached to the report.  Copies of the Stage 1 and 2 Integrated Impact Assessment Tools were also appended to the report.

Shairoz Claridge and Dr Kajal Patel, Milman and Kennet Surgery and GP Locality Lead South Reading CCG, were present at the meeting and addressed the Committee on the revised arrangements for the commissioning of NHS hydrotherapy services in Berkshire West.  They informed the Committee that the CCG had a duty to ensure that limited NHS resources were spent prudently and that the services it commissioned were evidence based and they offered clinical benefit to the maximum number of people.  The CCG would regularly review procedures of limited clinical value, procedures where the clinical value was either absent or evidence showed week efficacy.  A consultation had taken place to understand the future provision of the service and was the first time a public consultation had taken place about this issue.  The scope of the consultation had related solely to hydrotherapy services for NHS funded patients and those referred by a physiotherapist or a consultant from the Royal Berkshire Foundation Trust using the NHS funding from the CCG.  The consultation had begun on 10 August 2020 and had concluded on 2 November 2020, around 498 individual responses had been received and nine written responses from organisations.  Of the responses received, 217 identified as having used the NHS service and 279 had not; only 59 were NHS patients who had been prescribed hydrotherapy.  The majority of the comments had been about the pool at the hospital rather than about hydrotherapy and it was clear that these comments were from people who used the pool in a private capacity.  Other views were that hydrotherapy did not have to be provided at a hospital site, a better pool was needed and that hydrotherapy was good at aiding pain relief.  There was a limited amount of good quality evidence on the effectiveness of hydrotherapy compared to land-based therapy and therefore considering the clinical effectiveness and analysis of responses to the public consultation the CCG Governing Body members approved an option to commission hydrotherapy services on an exceptionality basis via an individual funding request.  This option would allow consideration of the individual’s needs and an assessment of the benefits that hydrotherapy could deliver against a set list of clinical criteria and would ensure that those who needed the service the most would get it.  The criteria were being developed in partnership with the Chartered Society of Physiotherapy.

Councillor Hoskin, Lead Councillor for Health, Wellbeing and Sport, read out an email that had been sent to him during the meeting from Iain Croker, Organising Officer – South, Charter Society of Physiotherapy (CSP), who was unable to join the meeting at that point.  The email stated that although the pool might not be fit for purpose currently if the decision was made to close it then a suitable alternative would have to be found.  There was evidence that hydrotherapy was beneficial for a number of conditions, none of which were linked to National Institute for Health and Care Excellence (NICE) guidance except in the management of axial spondyloarthritis, which was why the CCG wanted to move hydrotherapy to a procedure of limited clinical benefit and to develop an individual funding request process.  Aquatic physiotherapy covered a wide rand of symptoms and conditions and by its nature created an improvement in function for some of the most disabled members or society as buoyancy counteracted the effects of gravity which allowed freedom of movement.  However, ceasing or restricting access to hydrotherapy might promote further health inequalities for these people as they would not be able to achieve the same or similar levels of function on dry land.  The process by its nature was about restricting access and referring clinicians would have to prove an individual patient had a clinical need over and above others who had a similar condition and with funding only being provided on an exceptional basis further inequality was promoted.  The CSP was working with the CCG to try to influence the development of the process to minimise the restriction of access but moving away from a referral/open access system had been decided by the CCG.  It was appreciated that this was as a result of the CCG having to make cost savings but consideration should be given to increasing activity in the pool in order to offset costs.  Access to hydrotherapy allowed individuals to self-manage their conditions thus saving costs in terms of hospital and GP appointments and was an effective treatment option for those with multiple conditions and for those recovering from Covid-19 as it promoted muscle power and stamina, while reducing pain levels and the need for pain medication.

The Committee discussed the report and made a number of points including the following:

·         The Council had agreed at its meeting on 20 October 2020 (Minute 9 refers) that the decision by the CCG to stop commissioning of hydrotherapy services was premature;

·         The decision by the CCG to stop commissioning services would very likely mean that the facility would be under threat of closure;

·         The lived experiences of many people who had benefited from the hydrotherapy had not been listened to and although this had been picked up in the consultation it had been less strongly reflected in the report by the CCG;

·         It was recognised that the CCG was in a difficult financial position, but this decision would impact on those people who were in most need and could lead to a bigger impact on finances in the future;

·         With the services only being provided on an exceptionality basis and not provided for all, this would promote inequality;

·         As all public services were under great financial pressure, there was a need for the Council to keep sight of the issue and to make sure that the resource was not lost.  In addition, having just heard about the redevelopment of the hospital, see minute 18 above, if a hydrotherapy pool was not going to be provided in the redevelopment then what was going to be provided in its place;

·         If the service was not available in the hospital then thought had to be given as to where else it could be provided, for example, by making use of private gyms, which had been piloted successfully by other authorities.

The Chair, on behalf of the Committee, thanked Shairoz Claridge, Dr Kajal Patel and Iain Croker for attending the meeeting.

Resolved –    That the decision regarding future commissioning of NHS hydrotherapy services in Berkshire West be noted.