MINUTES of a meeting of the STANDARDS FOR BETTER HEALTH TOPIC GROUPheld on TUESDAY, 1 APRIL 2008 AT 10.00AM
______
As amended on 15 April 2008
ATTENDANCE
Members
K Coleman, D W Hills, N A Hollinghurst (Chairman), B Lamb, R Mays,
D Miller, J Pearce
Other Members Present
None
Officers
County Council
Natalie Rotherham, Scrutiny Officer
E Shell, Democratic Services Officer
Health
Primary Care Trusts
Lynda Dent, Public Engagement Lead
Raymond Jankowski, Public Health Consultant
Heather Moulder, Chief Operating Officer
Pauline Pearce, Director of Public Involvement and Corporate Services
East and North Herts Hospitals NHS Trust
S Brierley, Deputy Director Strategic Development
Jacqui Evans, Clinical Governance Manager
West Herts Hospitals NHS Trust
Nicola Havutcu, Head of Clinical Governance and Risk
Mark Jarvis, Associate Director Integrated Governance
Hertfordshire Partnership Foundation Trust
Shari Payne, Head of Business Development and Strategic Planning
Sally Wilson, Lead Standards for Better Health
PALS Representatives from each of the Trusts
Marcelle Olson, Corporate Affairs Manager, Herts Primary Care Trusts
Naomi Davies, PALS Officer, Herts Primary Care Trusts
Jackie Martin, Legal Services and Complaints Manager, East and North Herts Hospitals NHS Trust
Anna Farrer, Risk Manager, Hertfordshire Partnership Foundation Trust
Lesley Lopez, Head of Patient Services, West Herts Hospitals NHS Trust
Apologies
Apologies were received from Graham Ramsay, Director of Patient Safety at West Herts Hospitals NHS Trust.
ACTION1. / APPOINTMENT OF CHAIRMAN AND VICE-CHAIRMAN
1.1
1.2 / The appointment of N A Hollinghurst as Chairman, as agreed by the Health Scrutiny Committee at their meeting on 18 March 2008, was noted and endorsed by the Topic Group.
The appointment of J Pearce as Vice-Chairman, as agreed by the Health Scrutiny Committee at their meeting on 18 March 2008, was noted and endorsed by the Topic Group.
2. / REMIT OF THE TOPIC GROUP
2.1 / The Topic Group noted their remit as set out in the scoping document.
3. / STANDARDS FOR BETTER HEALTH
3.1 / Last Year
3.1.1 / Last year the Authority provided a commentary to the Healthcare Commission on the Hertfordshire Health Trusts’ ‘annual declarations’ for 2006/07. The Authority 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 Authority had agreed that a commentary on the Health Trusts’ annual declarations for 2007/08 should be submitted to the Healthcare Commission and that the commentary should continue to concentrate on those core standards with a patient/public focus.
However, this year the Topic Group would be receiving evidence, in addition from that received from the Health Trusts, from patient groups and from the Authority’s relevant internal departments. Members, who endorsed this approach, hoped that itwould increase the evidence base for the commentary submitted by the Authority and that it would also help to inform the Health Scrutiny Committee’s future work programme.
The Healthcare Commission’s deadline for receipt of commentaries submitted by local authorities was 1 May 2008.
4. / PRESENTATIONS FROM HERTFORDSHIRE TRUSTS
4.1 / Primary Care Trusts
4.1.1
4.1.2 / The Group received a report from the lead directors assigned to each of the core standards identified by the Authority for inclusion in its 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 process employed for finalising it prior to its submission to the Healthcare Commission by the 30 April 2008 deadline.
Summary
Members noted and agreed the following summary given by Natalie Rotherham, Scrutiny Officer, at the meeting:-
- That the PCTs anticipate declaring compliance with all of the core standards identified by the Authority for inclusion in its commentary.
- Finalisation of the draft declaration will be influenced by commissioned trusts.
- C6: Joint commissioning with the County Council is proving effective; practiced based commissioning includes mental health; the Trusts are also working closely with the County Council with regard to issues associated with the County having higher than national average growth in its elderly population. Members were reassured that there are a number of responsibilities placed on individual members of staff to ensure patients remain treated as ‘individuals’.
- C13: The Trusts are learning from good experience. Guidance for sharing patient information with partners, including the County Council, is clearly understood and applied.
- C17: The Healthcare Commission has informally commended the PCTs practice, especially with regard to BME (black, minority and ethnic) communities. This was reflected in the DQHC (Delivering Quality Health Care) for Hertfordshire consultation and is further demonstrated in the principles underpinning the Concordat (between the Authority and Health Trusts).
- C22: Joint departments are working well in terms of developing services and information sharing (eg. Targeting of smoking cessation particularly in deprived wards (in recognition of the relationship between social deprivation and inequality of care)). Informal complaints and comments were of concern to members, however, reassurance was given by the PCTs (the role of the modern matron). Surveys have reinforced patient satisfaction. Discharge co-ordinators are employed to oversee joint working arrangements (between health, the local authority and the voluntary sector) for more complex cases.
4.2 / East and North Herts Hospitals NHS Trust
4.2.1
4.2.2 / 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 by the 30 April 2008 deadline.
Summary
Members noted and agreed the following summary given by Natalie Rotherham, Scrutiny Officer, at the meeting:-
- The Trust has enhanced ownership of ‘standards for better care’ at director level and has further developed its audit trail for supporting evidence.
- That the Trust anticipates declaring compliance with most of the core standards identified by the Authority for inclusion in its commentary. The exception may be C18 for which the draft currently indicates ‘insufficient assurance’. The uncertainty concerns the extent of the Trust’s understanding of the ethnicity of its population. A final decision on whether to declare compliance will be made by the Trust following a report due back from the Healthcare Commission.
- C6: The Trust places great value on partnership working (eg. the ‘Child Protection Suite’ involving health, the County Council and the Police Service).
- C13: Diversity training is undertaken by all staff. Feedback from all surveys etc informs service delivery and development.
- C17: Obtaining feedback is undertaken widely (via groups and individuals) and is being collated and fed into the patient experience strategy. The patient experience strategy acknowledges the need to understand and meet the needs of specific communities.
- C18: See 2. above.
- C22: In addition to the other evidence supplied, the Trust has also recently established an equality and diversity committee.
- Members were concerned about the results of the recent national survey on maternity services and care; the Trust did not perform well. Members noted that a new head of midwifery was due to be appointed and that the PCTs had a dedicated midwifery team to gain assurance on commissioning services (the team is monitoring the action plans of both acute trusts).
- Patient confidentiality was also a concern, particularly in areas where patients are separated from one another by a curtain. Some areas, such as A&E, present particular difficulties. Individual needs and requirements for privacy may not be consistently understood by staff at all levels.
- Members were reassured by measures outlined by the PCTs to provide homecare packages at times of ‘red alert’ to ease discharge from an acute bed (this applies to bothacute trusts).
- Additional information will be provided by the Trust on ‘end of life’ services/care. (There is a national strategy on this; a lot of work has been undertaken by the PCTs and the acute trusts). The Group may wish to recommend that the Health Scrutiny Committee consider this issue as part of their future work programme.
4.3 / West Herts Hospitals NHS Trust
4.3.1
4.3.2 / 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 by the 30 April 2008 deadline.
Summary
Members noted and agreed the following summary given by Natalie Rotherham, Scrutiny Officer, at the meeting:-
- The Trust has strengthened the process for ‘standards for better care’ through the appointment of ‘core standard’ leads, and through the increased involvement of non-executive directors and more frequent reports to the Trust Board.
- The Trust anticipates declaring compliance with all of the core standards identified by the Authority for inclusion in its commentary by the ‘end of the year’.
- C6: Members noted particularly the Trust’s work with the charity ‘Turning Point’ (who work with alcohol and drug abuse patients), which has helped to reduce the readmission rates of these patients. The Trust ispreparing a business case to introduce this system to other sites. Members considered that the Trust’s presentation concentrated on ‘inward facing’ co-operation; they would have liked a greater focus on the Trust’s relationships and work with other health and social care organisations. The Trust’s involvement with the County Council on child protection issues and in relation to vulnerable adults was noted (including the use of ‘policy matching’ between organisations).
- C13: Trust initiatives indicate a high level of patient satisfaction. The Trust ensures that lessons learned from consent policy and monitoring is applied. A ‘Bereavement Steering Group’ has been established to look at the needs of the dying patient.
- C17: Patient Involvement and Experience Strategy – this is currently being implemented; the Trust has a very active ‘Patient Panel’.
- C18: The Trust is working with The Mount Prison as a way of facilitating prisoner patient dignity. It is seeking ways of strengthening input from patients.
- C22: The Trust is working more effectively with its partners, especially at district/borough level.
- Members noted that the Trust had a system in place to monitor the ethnicity of the population served.
- Members were reassured by measures being taken by the Trust to tackle hospital acquired infections.
- Maternity services/care: The Trust did not perform well in a recent national survey on maternity services/care. Members noted that the Trust has since drawn up a detailed action plan which is monitored by the Chief Executive on a weekly basis. The Trust is also considering funding a post to oversee the improvement of its maternity services. (See also 4.2.2 (8) above).
4.4 / Hertfordshire Partnership Foundation Trust
4.4.1
4.4.2 / The Group received a presentation from lead trust 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 by the 30 April 2008 deadline.
Summary
Members noted and agreed the following summary given by Natalie Rotherham, Scrutiny Officer, at the meeting:-
- The Trust has assigned an executive director and management leads for each core standard, improving ‘ownership’. The Trust has received ‘substantial assurance’ on the process used by internal auditors.
- The Foundation Trust anticipates being able to declare compliance with all of the core standards identified by the Authority for inclusion in its commentary with the exception of C13a; compliance is currently being held in abeyance pending the outcome of an investigation into allegations made at one of its establishments.
- C6: Partnership meetings are held with key agencies that the Trust works with to ensure a joint agenda is delivered; policies are developed in collaboration with the County Council’s Adult Care Services (ACS) Department. The Foundation Trust support ACS is achieving specific social care performance targets which are jointly delivered. There are many joint policies.
- C13: Key evidence includes the role of service users in developing themes for user-led audits, and the recent introduction of a single equality scheme. The Trust is also currently recruiting a permanent chaplain. There are shared protocols with ACS and the Council’s Children, Schools and Families (CSF) Department on the use of information with mandatory training for all staff. It was recognised that managing the needs of service users may conflict with carer views. Work with carers regarding issues of confidentiality is ongoing.
- C17: The Trust are piloting a ‘patient tracker’ which, if successful, will be introduced more widely. There are well established service user and newly established carer councils.
- C18: In the last year the Trust has established a health inequalities group with representation from the PCTs. There is ongoing work with the acute trusts to improve access to acute care for people with learning disabilities.
- C22: Examples of evidence include the partnership agreements with ACS in mental health and learning disabilities services, and the public health strategy and action plan in place with PCT input.
- Members requested additional information regarding homecare for Alzheimer patients; mixed skills, adequacy of suitably qualified carers, finance, training etc. The Group will also explore this issue further at their next meeting with officers from the ACS department.
- Multi-sited services can make it difficult when trying to gather patient views and complaints; traditionally users of mental health services do not complain. The Trust isaware of its need to be more proactive and is exploring ways of encouraging feedback.
- HPFT will ensure that its policies comply with the requirements of the Mental Capacity Act; staff training will be mandatory.
5. / EVIDENCE RECEIVED FROM PATIENT REPRESENTATIVES AND ORGANISATIONS
5.1
5.1.1 / Patient Advice and Liaison Service (PALS)
Trust officers with responsibility for PALS attended from each of the Health Trusts. Key points raised by each of them are listed below:-
Primary Care Trusts
- The service has been largely reactive as a result of staffing issues which followed the restructuring of the County’s PCTs (from 8 to 2). The PALS team, which is located centrally at PCT headquarters, is now fully staffed and will be looking to develop a more proactive approach in the near future (which will involve visiting GP surgeries etc). PALS officers have structured meetings and the lead officer for the service meets with the Chief Executive bi-monthly to discuss progress and service developments.
- 90% of PALS work (enquiries and complaints) comes via telephone contact. Queries/concerns cover a wide range of services (eg. Dentists, Opticians, GPs, social services etc), with some calls involving several providers. Most calls are not complaints (the PCTs have a separate complaints department) and frequently concern communication issues. Issues referred to PALS officers may be resolved in a matter of minutes, whilst others may take several weeks. Members noted that many of those in deprived areas do not have access to a phone and were assured by Trust officers that visiting areas of social deprivation will be a priority once the newly recruited PALS officers are trained and able to go out into the community (anticipated to be June/July 2008).
- A new leaflet explaining the service has been produced and, together with a business card, is now being sent out.
East and North Herts Hospitals NHS Trust
- The PALS service was recently amalgamated with the legal and complaints department.
- The PALS team is a mix of full and part-time staff and volunteers, who are specifically recruited and trained to work alongside PALS staff.
- The PALS team’s work is considered invaluable in preventing concerns being complaints. Most concerns can be resolved quickly and at a local level. Complaints are graded on receipt; the more serious ones (eg. concerning clinical care) are referred straight to the complaints department.
- Information about PALS is located around the Trust’s sites and is available in poster and leaflet form, as well as comment cards, which can be completed anonymously if preferred. The format used for the comment cards is changing and will more closely reflect the core standards in future. Results are collated into quarterly reports.
- PALS staff are respected by other staff within the organisation and issues referred to departments by PALS officers are addressed as requested.
West Herts Hospitals NHS Trust
- The Trust has a proactive PALS team which resolves many concerns before they become complaints. PALS officers ‘walk the wards’ on a daily basis but are not based on the wards; this gives them separation and independence. PALS officers work closely with a number of outside organisations, including MENCAP, PohWER (who provide the County’s ICAS (independent complaints and advisory service), and carer organisations etc.
- There is no ‘watering down’ of complaints. Where letters are received the letter is copied to the relevant department/staff in its original form for response. All letters of complaint receive formal written acknowledgment within 24 hours of receipt. The final response is formally signed off by the Chief Executive.
- Information about PALS is located around the Trust’s sites, and is available in poster and leaflet form. Comment cards are located around the sites and are collected weekly. Information is collated into a quarterly report. (The reports for the first 3 quarters of 2007 were tabled for members information [further copies are available from Elaine Shell, Democratic Services Officer, on telephone 01992 555565 or by emailing . The service is also advertised on the Trust’s website and folders, containing information on PALS, are being prepared and will be located by each hospital bedside.
- The ‘Dr Foster Patient Experience Tracker (PET) Project’ is to be launched imminently; 15 machines with ‘touch screen’ questionnaires will be situated around the three hospital sites and the results will be collected weekly.
- Information received from the PALS process will be used to develop action plans for ensuring the core standards are met and maintained.
Hertfordshire Partnership Foundation Trust
- The PALS posts had, until recently, been ‘frozen’. The Trust has now recruited 3 staff to the service which will cover the whole of Hertfordshire plus the units now run by HPFT in Norfolk. It is hoped that by providing evidence that PALS leads to service improvements the Trust Board will be willing to commit to increasing resources in the future.
- The Trust encourages all staff to be ‘PALS’ representatives.
- The service will be re-launched; it is intended that it be a proactive service.
- The categorisation of complaints will be redrawn to reflect the core standards for the standards for better health.
- The lead officer for PALS is confident that PALS officers will be well received by other staff within the organisation.
5.2 / PPIF
5.2.1 / It was agreed that this item of business be carried forward to the Topic Group’s meeting on 15 April 2008. / Elaine Shell
5.3 / Viewpoint
5.3.1
5.3.2 / A copy of Viewpoint’s submission and of their presentation was tabled. [Further copies are available from Elaine Shell, Democratic Services Officer, on telephone 01992 555565 or by emailing .
It was agreed that this item of business be carried forward to the Topic Group’s meeting on 15 April 2008. / Elaine Shell
5.4 / Carers In Herts
5.4.1
5.4.2 / Carers in Herts will be preparing a submission for the Topic Group to consider at their next meeting.
It was agreed that this item of business be carried forward to the Topic Group’s meeting on 15 April 2008. / Elaine Shell
6. / EVIDENCE RECEIVED FROM COUNTY COUNCIL DEPARTMENTS
6.1 / Adult Care Services
6.1.1
6.1.2 / Adult Care Services will be presenting evidence to the Topic Group at their next meeting.
It was agreed that this item of business be carried forward to the Topic Group’s meeting on 15 April 2008. / Elaine Shell to note all
6.2 / Children, Schools and Families
6.2.1
6.2.2 / Evidence from the Children, Schools and Families Department was tabled. [Further copies are available from Elaine Shell, Democratic Services Officer, on telephone 01992 555565 or by emailing .
It was agreed that this item of business be carried forward to the Topic Group’s meeting on 15 April 2008. / Elaine Shell to note all
7. / WORK PROGRAMME
The Topic Group agreed that, at their next meeting, consideration will be given to:
- Examples of good commentaries given by the Healthcare Commission
- Evidence deferred from the meeting on 1 April 2008
- Recommendations made by the Health Performance and Service Delivery Topic Group on their work on mental health (2007)
- Identifying the key points (and supporting evidence) for each Health Trust for inclusion in the commentary
8. / DATE OF NEXT MEETING
8.1 / The next meeting of the Topic Group will be held on Tuesday, 15 April 2008 at 10.00am in Room 246, County Hall, Hertford. / All to note
Elaine Shell