MINUTES of a meeting of the STANDARDS FOR BETTER HEALTH 2008/09 TOPIC GROUPheld on WEDNESDAY, 25FEBRUARY 2009 AT 10.00AM
______
ATTENDANCE
Members
K Coleman, D W Hills, N A Hollinghurst (Chairman), B J Lamb, J Pearce (Vice-Chairman),E T Roach, W A Storey
Other Members Present
None
Officers
County Council
N Rotherham, Scrutiny Officer
A Service, Democratic Services Officer
B Wood, Strategic Partnerships Unit
Health
Primary Care Trusts
A Khan, Assistant Director of Integrated Governance
H Aylward, Communications & Patient Involvement
J Linskill,Assistant Director of Children’s Services
K Hall, Director of Development
C Hill, Director of Adult Care
East of England Ambulance Trust
J Moseley, Associate Director for Governance and Stakeholder Involvement
J Martin, Clinical Specialist (Development & Delivery)
East and North Herts Hospitals NHS Trust
B Jenkins, Head of Clinical Planning
K Broughton, Data Quality Improvement Manager
N Smith, Partnerships& Involvement Manager
West Herts Hospitals NHS Trust
Professor GRamsay, Medical Director
GEtheridge, Director of Nursing
M Jarvis, Associate Director, Integrated Governance
J Barlow, Assistant Director, Clinical Governance and Risk
L Lopez, Head of Patient Services
Hertfordshire Partnership Foundation Trust
K Moullin, Joint Deputy Director of Operations
S Wilson, Lead Standards for Better Health
B Suggitt, Company Secretary
E Bisset, Standards for Better Health Manager
Apologies
Apologies were received from L Dent, Public Engagement Lead, Hertfordshire PCTsand K Shephard, Head of the Strategic Partnerships Unit.
ACTION1. / MINUTES
1.1 / Subject to the amendment of the second bullet pointof paragraph 4.3.1 (page 9)to read” “Viewpoint hoped that they would soon be in a position to gather the views of older people,” the Minutes of the meeting of the Topic Group held on 4 February 2009 were agreed as a correct record. / Elaine Shell
2. / EVIDENCE: HERTFORDSHIRE STRATEGIC PARTNERSHIPS UNIT
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9 / Ben Wood, in the absence of Keith Shephard, advised on the progress being made with partners to develop strategies to deal with an ageing population and to promote health and well being. He also outlined the resources that would be achieved by meeting targets set within the Council’s Local Area Agreement (LAA) for the period 2008 to 2011.
He advised thattheHCOP Executive Group had consolidated its role in the County by leading on LAA1 health targets, negotiating LAA2 targets and that it was now in the process of producing a health and wellbeing strategy. However, district/boroughlocal strategic partnerships (LSPs) felt slightly disjointed from this countywide group and unsure as to how they fitted in to its agenda.
Financial rewards made as a result of meeting LAA targets could lead to each LSP in Hertfordshire receiving £800,000 to spend onpriorities within its Community Strategy. Each district/borough had a strand relating to public health within its Community Strategy. (The formula for allocating these rewards was agreed by the County Council‘s Cabinet. Decisions regarding the spending of monies allocated to each district/borough LSP was, in turn, signed off by each of district/borough council cabinets respectively).
Evidence which informed priority setting with the countywide Community Strategy in 2007/8 indicated that the greatest need for action was in the boroughs of Stevenage, Broxbourne and Watford.
Ken Coleman advised that he had attended a meeting of the Public Health (Obesity) Topic Group, held at a Stevenage school, at which both pupils and parents had informed members that, whilst they were aware of the need to take exercise and to eat sensibly, some parents struggled to afford the healthier types of food it had been suggested be put in children’s lunch boxes.
It was noted that, whilst local authorities had a responsibility for promoting healthier diets and the taking of exercise, individuals also had a responsibility to themselves.
It was noted that the Three Rivers District had the highest level of overweight girls in the County.
The Group agreed that, whilst the figures highlighted pockets of deprivation,consideration should also be given to other areas, such as lowly populated rural or more affluent areas.
Members noted and agreed the following summary given by Natalie Rotherham, Scrutiny Officer, at the meeting:-
a)The Strategic Partnerships Unit had outlined how the ‘healthier Communities and older people’ partnershipwas being developed and that it was going from strength to strength; the framework of the partnership demonstrated how it intended to work and how priority issues were being tackled,
b)All Hertfordshire district/borough LSPs were considering public health measures/schemes with their local primary care trust.
c)The Strategic Partnerships Unit was not responsible for monitoring the spending of funds allocated to district/borough LSPs
d)There was a need to encourage schemes that promoted healthy eating and the taking of exercise by school pupils. / Natalie Rotherham to note all
3. / STANDARDS FOR BETTER HEALTH
3.1 / Last Year
3.1.1 / The Chairman reminded members that last year the Health Scrutiny Committee (HSC)provided a commentary to the Healthcare Commission on the Hertfordshire Health Trusts’ annual declarations for 2007/08. That commentary had concentrated on those core standards with a patient/public focus.
3.2 / This Year
3.2.1
3.2.2
3.2.3 / The Chairman reminded members that the HSChad agreed that a commentary on the Health Trusts’ annual declarations for 2008/09 should be submitted to the Healthcare Commission and that it should continue to concentrate on those core standards with a patient/public focus.
This year the Topic Group would be receivingevidence, in addition from that received from the Health Trusts, from the East of England Ambulance Service and from the Council’s relevant internal departments. Members, who endorsed this approach, hoped that itwould increase the evidence base for the commentary submitted by the Committee and that it would also help to inform their future work programme.
The Healthcare Commission’s deadline for receipt of commentaries from third parties was 31 April2009.
4. / PRESENTATIONS FROM HERTFORDSHIRE TRUSTS
4.1
4.1.1
4.1.2
4.1.3
4.1.4
4.1.5
4.1.6
4.1.7
4.1.8
4.2
4.2.1
4.2.2
4.3
4.3.1
4.3.2 / East of England Ambulance Service
The Group received a presentation from Jill Moseley and John Martin setting out the performance of the Ambulance Service in 2007/2008. The presentation detailed the reasons behind the Service receiving weak ratings from the Healthcare Commission for ‘quality’ and ‘use of resources’ in 2007/08, outlined the action taken subsequently to introduce improvements, including the appointment of two senior directors (including a finance director), and set out the Service’s ‘Performance Improvement Plan’.
It was noted that 1 in 5 calls to the ambulance service in Hertfordshire involved people falling; funds were being allocated to assessing and implementing initiatives to reduce this.
Members noted that KLoEs stood for Key Line of Enquiries.
In response to a question, John Martin explained that the target times for getting to incidents started when telephone began ringing in the ambulance dispatch centre to the time a paramedic/ambulance arrived (8 minute target) and the time taken to get the patient(s) into hospital (19 minute target).
The Service’s prompt response to the Potters Bar rail disaster was complimented. Topic Group members stated that many of their constituents had commented that they were happy with the service provided to them by the Ambulance Service.
In response to a request for statistics relating to the number of patients dying in transit, John Martin stated that the figure was low [2%] and had not increased with the relocation and reconfiguration of acute hospitals in Hertfordshire and North London.
In response to a question concerning partnership working with Adult Care Services and follow up care, John Martin felt that adequate arrangements for follow up care by the County Council were in place and stated that it was possible to identify if there were repeat calls to the Ambulance Service to persons having falls etc. He stated that it might be possible to undertake a project to demonstrate this.
Members noted and agreed the following summary given by Natalie Rotherham, Scrutiny Officer, at the meeting:-
a)The Ambulance Trust had not been assisted by the absence of a financial director during the past year
b)Members considered that lessons had been learnt through their weak rating; this had subsequently led to the implementation of increased performance management measures
c)The Ambulance Service response level (73.8%) in 2007/08 had not met the response target of 75%; the more stringent target for next year (a 90 second reduction in response time) would make achieving the 75% target more difficult
d)The proactive nature of the Service and its reaction to crisissituations was noted
e)The Clinical Specialist (Development & Delivery) post covered the Eastern Region;all PCTs aided partnership working
f)The Trust had been proactive in undertaking local schemes e.g. working with the Falls Prevention Group(a regional groupseeking to decrease the number of falls and improve responses). The Trust emphasised that care arrangementsneededto be in place when (a) patient(s) left hospital
g)Regionalisation of the Service had brought new challenges.
Additional resources had been brought in for the recent spell
of inclement weather (heavy snow and ice) in early February 2009
h)The number of patients dying in transit was low (2%)
Hertfordshire Partnership Foundation Trust
The Group received a presentation from Trust lead officers. The presentation covered the process adopted by the Foundation Trust in preparing their draft declaration, key evidence to support the declaration, and the timetable and process employed for finalising it prior to its submission to the Healthcare Commission.
Summary
Members noted and agreed the following summary given by Natalie Rotherham, Scrutiny Officer, at the meeting:-
a)C6: Partnership was the essence of Hertfordshire Partnership Foundation Trust working; Delivering social care was a joint responsibility of HPFT and Adult Care Services (ACS)
b)C13(a):The concerns raised last year about services provided in a learning and disability unit had been tackled by the Trust and the unit had subsequently been closed. Residents had been relocated and staff successfully re-deployed. Staff training included aspects of privacy and dignity. Generic job descriptions had been introduced to ensure the smooth movement of staff between units. The Trust was not complacent in its responsibilities and the lessons learnt would be applied across all relevant services.
c) C17: Questionnaire results from users were complimentary about Trust.
- d)C18: The difficulties of using a multi-service site were noted.
- Some of the 80 sites in operationwerein older buildings which were more difficult for people with physical disabilities to access. The Trust had contingency arrangements in place to address this.
Forty percent (40%) of the funding for the redesign of services would be drawn from secondary services: earlier identification and intervention at primary level was the aim of both the Trust and Commissioners to prevent more serious crisis’ developing due to lack of diagnosis or treatment. There had been full involvement of users and carers in planning services.
d) C22: A number of successes were outlined in this area; members were particularly pleased to hear about joint working with the acute trusts around learning disabilities.
Primary Care Trusts
The Group received a report from the PCTs’ operational leadsfor standards for each of the core standards identified by the Health Scrutiny Committee for inclusion in their commentary. The report set out in detail the process adopted by the PCTs in preparing their draft declaration, key evidence to support it and the timetable and processes employed for finalising it prior to its submission to the Healthcare Commission. Natalie Rotherham stated that whilst the East & North Herts and West Herts PCTs would submit separate declarations, the Topic Group would submit one commentary covering both primary care trusts.
Summary
Members noted and agreed the following summary given by Natalie Rotherham, Scrutiny Officer, at the meeting:-
a)The prime points made by the PCTs were contained in the written submissions (attached as Items 3.2 and 3.3 of the agenda papers)
b)C6: Members were clear that the examples in the reports were not exhaustive. (It was noted that the Trust had links to support patient discharge; a community nurse worked in the acute admissions unit at the QEIIHospital to assess the patient’s fitness for discharge. This helped reduce the number of re- admissions. The equipment contract had been changed to provide a more responsive service 6 days a week. Both had proved beneficial).
c)The involvement of users/carers was increasing e.g. work being undertaken to support patients with early dementia and depression.
The PCTs were working with acute providers on the management of patient falls.A falls audit had been completed.
‘24/7’ care and ‘falls’were issues requiring greater attention.
d)C13: The ‘Patient Experience Strategy’was reviewed and developed on an ongoing basis
e)C17: The PCTs’ report highlighted PCT activity where patients, users, carers and the public were involved in service redesign. A report due from Watford CVS (Council for Voluntary Service) would influence action planning.
f)C18: Access was covered under the standards discussed earlier (e.g. improvements to services for mental health patients, learning disability service users, homeless people, work with prisoners etc.) Access to information in different languages and formats was promoted by the PCTs. The Group noted the work being undertaken to improve access to GPs and NHS dentists.
g)Members commended quality of evidence and reports provided. / Natalie Rotherham to note all
Natalie Rotherham to note all
Natalie Rotherham to note all
4.4 / East and North Herts Hospitals NHS Trust
4.4.1
4.4.2 / The Group received a presentation from lead trust officers. The presentation encompassed the process adopted by the Trust in preparing their draft declaration, improvements made to the process during the past 12 months, key evidence to support the declaration, and the timetable and process employed for finalising it prior to its submission to the Healthcare Commission.
Summary
Members noted and agreed the following summary given by Natalie Rotherham, Scrutiny Officer, at the meeting:-
a) C6: The multi-agency child protection unit, which was working well at the ListerHospital, was noted. It demonstrated good partnership working in a multi-agency environment, streamlining the process and creating a child-centred environment.
b)C13: A ‘Patient Experience Co-ordinator’ was to be appointed to take forward patients’ experiences with the view to improving them.
c)C17: Examples included feedback from patients and PALS on the redecoration of hospital wards and waiting areas,regular hospital involvement committee meetings, more prompt handling of patient complaints, and discharge arrangements (assisted by daily conference calls and weekly meetings). Concessionary/refunding arrangements for car parking fees for those patients requiring ongoing treatment at the hospital were welcomed. In response to a request from members, East and North Herts Trust officers agreed to provide additional information on this. / Natalie Rotherham to note all
Natalie Smith, ENHHT
4.5 / West Herts Hospitals NHS Trust
4.5.1
4.5.2 / The Group received a presentation from lead trust officers. The presentation encompassed the process adopted by the Trust in preparing their draft declaration, improvements made to the process during the past 12 months, key evidence to support the declaration, and the timetable and process employed for finalising it prior to its submission to the Healthcare Commission.
Members noted and agreed the following summary given by Natalie Rotherham, Scrutiny Officer, at the meeting:- / Natalie Rotherham to note all
a) C4(c) The Trust would be declaring non-compliance for 2008/09. However, members were assured that, it was the view of the Health Commission,a good service was being provided.
b) C6: Safeguarding Children – a review had been undertaken since the ‘Baby P’ case and the Director of Nursing currently sat on Safeguarding Board.
Work had been undertaken jointly with ‘Turning Point’ (dealing with substance misuse) to reduce the number of ‘revolving door’ patients; this had been extended over the last year to include the Hemel Hempstead site.
At the Eric Shepherd Unit, the Trust had reviewed patient pathways and adopted an approach better suited to unit users.
A coach has been provided for staff travelling between Hemel Hempstead and Watford to lessen the impact on parking at the WatfordGeneralHospitalsite.
c) C13a: The Trust had developed ninepledges with an evaluation framework. The re-training of front line staff had also included managers to ensure that patient’s dignity and privacy needs were met. End-of-Life and bereavement training was being provided. The Trust’s consent policy was reviewed annually.
d) C13c: Data security was more robust. The Trust reacted to incidents reported by patients and staff and changed procedures accordingly. From March 2009 all laptop computers would be encrypted to provide greater patient confidentiality
e) C17: A discharge pilot included arrangements for related services e.g. meals on wheels for patients returning home. This would be extended across the Trust.
WHHT used feedback from patients and PALS on the decoration of hospital wards and waiting areas.
f)C18: Translation/interpretation services were available; this service could be provided on a planned or short notice basis.
g)C22: A comprehensive public health strategy was now in place; the Trust was looking at how obesity could be addressed.
End-of-Life provision of hospices beds was limited as was the ability to access them at short notice. This was an area that the Trust’s Medical Director was currently exploring with the hospices.
h) Members welcomed this year’s presentation, which they considered tobe more informative and which reflected on the needs and objectives of the Topic Group.
5.
5.1 / DRAFT COMMENTARY AND WORK PROGRAMME FOR THE NEXT MEETING
A draft commentary for each trust would be prepared and issued to members for consideration and finalisation at their next meeting. / Natalie Rotherham to note
6. / DATE OF NEXT MEETING
The next meeting of the Topic Group will be held on Monday 9 March 2009 at 2.00pm in Committee Room C, County Hall, Hertford. / All to note
Adrian Service