The Forest of Dean District Health Forum
General Meeting Tuesday 8th January 2013
Minutes
Present:
Jan BaynhamChairCoalway
Frank BaynhamSecretaryFoDDC Health Champion, Coalway
Doug BattersbyTreasurerCrossroads Care FoD + Herefordshire
Hilary BowenCommitteeBoughspring
Jenny GreenCommitteeForest Sensory Services
Albert WeagerCommitteeCoalway
Lee AbbottOrchard Trust
Clive ElsmoreFoDDC/Coleford TC
Eileen ElsmoreCAB/Coleford TC
Margy FowlerGloucestershire Care Services
Tim FretterFVAF
Alan GoreFVAF/Forest Seniors’ Network
Jo Hume Mears Safe at Home
Viv ShorneyAlzheimers Society
Brian ThomasLydney TC
Mary ThurstonFriends of LydneyHospital
John HalePublic Bream
Peggy JordanPublicBream
Apologies:Brian Edwards, Barbara Jenkins, Jane Lloyd, Di Martin, Dorothy Maskrey, Caroline Smith.
Speakers:Fiona Woodroffe, Development Officer for Forest Care Matters speaking on Personal Budgets in Social Care assisted by Dawn Rooke, a Carer with personal experience of the process.
Welcome: the Chair, Jan Baynham (JB)welcomed everyone to the meetingand wished those present a Happy New Year.She then welcomed Fiona and Dawn to the meeting.
Minutes of the meeting held on Tuesday 4thDecember 2012: JB said that Jo Hume had been missed from the apologies in the originally circulated minutes. The minutes on the Website and available to the meeting had been amended to reflect this. The minutes as amended were accepted without dissent.
Matters arising: JB had the reports on and feedback from the Carers’ Rights Day held at the Main Place, Coleford in December. These were tabled for members to peruse at their leisure.
Chair’s report: JBsaid that Dr Helen Miller had sent an email informing us that the NHS Commissioning Board had authorised the Gloucestershire Clinical Commissioning Group (CCG) to take on its formal responsibilities in April 2013.
Tim Fretter (TF) asked what the legal status of the CCG would be.
JB said that their constitution had been published and was available on their Website but as it was a rather lengthy document we hadn’t printed it out. We would try and get a hard copy for a future meeting but it was assumed that the status would be similar to that of an NHS Trust.Margy Fowler (MF) agreed that this was the case.
JB said a Press Release had also been received from Gloucestershire County Council (GCC) saying that the GCC Cabinet had selected Gloucestershire Rural Community Council (GRCC) toset up and manage Healthwatch Gloucestershire. SEAP (Support, Empower, Advocate, and Promote) has been selected to provide independent advocacy to people who want to make a complaint about health services.. She said that Healthwatch would be replacing LINKs from 1st April 2013 and SEAP replacing the Independent Complaints and Advocacy Service (ICAS).
SEAP is a national voluntary sector organisation whose aim is tosupportpeople to express their views and wishes, especially those who are vulnerable, isolated or marginalised. To empowerpeople to have their voice heard so that they can access their rights and take a central role in decisions that are made about their lives. To advocateon behalf of their clients to ensure that their views influence the planning, delivery and development of services that affect their lives and to promotethe value of advocacy by sharing their knowledge, experience and values with others and championing the involvement of service-users in the design and delivery of health and social care services.GUIDE and PALS would continue in their present roles although GUIDE would become part of Healthwatch.
A Press Release had been received from the National Association of Links Members (NALM) on the newregulations published by the Government in relation to Healthwatch. This claimed that the regulations effectively banned Local Healthwatch (LHW) “from leading campaigns to change poor services and amend legislation, even if such changes would improve the safety and care received by patients or social care users”. It went on to say that the regulations “also discourage the promotion of, or opposition to, changes in policy adopted by any governmental or public authority in relation to any matter”. The Chair of NALM, Malcolm Alexander, was quoted as saying: “The government’s decision to further water down the powers of LHW is shocking, coming just before publication of the Frances Report on the disasters at Mid Staffordshire Hospital. LHW Regulations further undermine the effectiveness of LHW as the people’s watchdog in health and social care. They disempower and muzzle local people who were looking forward to a powerful local body to defend and promote local services.”
Albert Weager (AW), a member of the current LINKs Board, disputed these claims and said that LHW would carry on from where LINKs left off and would have the power to enter and view Health and Social Care premises. AW explained that LHW would continue to investigate and take up public concerns and forward its findings to Health and Social Care Service providers and to the Care Quality Commission (CQC). LHW would be different in that it would no longer be led by volunteers but managed by a body set up by GRCC which would indicate areas for investigation for local hospitals.
JB said that the tender process for a new Service Level Agreement (SLA) for Gloucestershire’s Community Hospitals had been completed. This was to provide GP cover and locally the Blakeney practice, which had previously been providing cover at the Dilke, had won the contract for both Dilke and Lydney hospitals. As reported previously, this would be to cover five hours per day during the week and two hours each on Saturday and Sunday.
MF confirmed that weekday cover was now in place but weekend cover had yet to be finalised due to a delay in identifying GPs who would be available at that time. It was expected that this would be in place by the end of March 2013, until that time, cover would be provided by the GP Out of Hours Service.
We had also received notification of a two hour 1st Aid Training session to be held at the DeanAcademy, Lydney on 17th January 2013. This was being offered by the British Red Cross and open to anyone at a cost of £15 per person. Places could be booked by ringing Tina Tibbs on 01452 726661. “The course covers common first aid scenarios, including what to do if someone is choking, unconscious or bleeding, and how to treat a burn or fracture. It will also help participants spot the warning signs of a heart attach or stroke, and give them the tools to step in and act.”
JB reported that the contract to run the Gloucestershire Out of Hours GP Service was due to expire in September 2013 and was being put out to tender. This service was currently being run by the Great Western Ambulance Service (GWAS) and Gloucestershire Care Services (GCS) and Dr Jeremy Welch, clinical commissioning lead for the service said the contract had to go out to tender. He said that they had “taken some legal advice and because the contract has come to an end, we are unable legally to just keep extending the contract... It’s not about price; it’s about quality of service. That may well be the current provider, that may well be a new provider that offers that service...We have a very good out-of-hours service in Gloucestershire and we absolutely want to maintain that service.”
AW said that he understood that the current contract with GWAS was being extended until the results of the tender were known.
JB said that notification had been received that Monitor had agreed that Gloucestershire Hospitals NHS Foundation Trust (The Trust) was meeting its targets for the Emergency Department waiting times. It was said that “The Trust”, which runs Gloucestershire Royal and CheltenhamGeneralHospitals, had been failing to consistently see, treat and admit or discharge 95% of patients in its Emergency Departments within four hours.” An Emergency Care Programme under the leadership of Nursing Director Maggie Arnold had taken a number of actions to tackle the problem including building new consultation and treatment cubicles in the Emergency Departments at both Gloucester and Cheltenham Hospitals; Recruiting more Emergency Nurse Practitioners in the Emergency Department; Changing the way people are discharged from hospital including earlier and more frequent ward rounds, so that beds are available for emergency patients earlier in the day when they are needed; Developing live online information to help patients to choose the best place for treatment, including Minor Injuries Units. The link for this is now available on the Health Forum Website.
Notification had been received of a joint 2gether and Children and Young People Service (CYPS) Stakeholder Event to take place on Tuesday 22nd January 2013. NHS Gloucestershire, GCC and partners had commissioned 2gether to provide a specialist emotional wellbeing and mental health service for all children and young people in Gloucestershire.This event would be an opportunity for stakeholders to hear about progress with these developments and give feedback on their recent experience of the serviceor that of their clients. We were hoping to have a representative at the event and would feed back to the next meeting.
A course for the support of patients with cancer was being arranged by the Penny Brohn Cancer Care group. This was to be held at the Great Oaks Hospice. Further information was to follow but anyone needing further information should contact Caroline Seguro at Penny Brohn Cancer Care by email at: or telephone 07415 526794 Tues/Wed/Fri.
Treasurer’s report: Doug Battersby (DB) said that the balance remained at £937.79 as reported to the December 2012 meeting. He was disappointed to have to announce that a request for funding to Tibberton Parish Council had not been successful.
Members’ Reports:Albert Weager (AW) said that the new 111 telephone helpline service was online for rollout on March 21st. The 10th version was due to be ratified by the NHS. AW is a member of the 111 governance board and he said that patients with Welsh postcodes would not be able to access the service even if they lived in England. Anyone in this situation who dialled the 111 number would be transferred to the Welsh equivalent.
Jo Hume (JH) expressed her concern at this and said that this could lead to delays in getting the right treatment. She asked if patients would be triaged under the new system and referred to the appropriate service.
JB explained the triage system to members and said the 111 Service would be fully explained to the Health Forum meeting on 5th March.
AW said that there was to be a Healthwatch Network event on 23rd January which he would be attending. He said that Gloucestershire Care Services would be an NHS Trust from March but it was not known if they would be taking over the CommunityHospital buildings.
Margy Fowler (MF) said that a new National NHS Property Services Agency had been established which would take over NHS buildings but that the Community Hospitals would not be part of this. These would be owned and managed by GCS.
Speakers: JB introducedFiona Woodroffe (FW),Group Development Officer working at FVAF on a Local Action Group funded project to investigate the potential for local groups in the Forest of Dean to benefit from the introduction of personal budgets. Accompanying FW was Dawn Rooke, a Carer who had been through the process of Personalised Budgets.
The title of the presentation was “Personalisation- A New Way to Manage your Care”.
FW began by quoting the following from the Department of Health (DoH: “Every person who receives support, whether provided by statutory services or funded by themselves, will have choice and control over the shape of that support in all care settings". She then gave a brief history of personalisation:
She said that there had been growing dissatisfaction amongst disabled people at the lack of flexibility and unreliability of welfare services and that since 1997 disabled people had been eligible for direct payments, a cash sum in lieu of directly provided services to give them more choice, control and independent living
“In Control” wasestablished in 2003 as a National social enterprise, independent from government, which developed the concept of personal budgets and supported local authorities to implement a new way of working called Self-Directed Support
In 2007 the Government announced “Putting People First; A shared vision and commitment to the transformation of adult social care”. This officially introduced the idea of a personalised adult care system where people would have maximum choice and control over the services they receive. This set a target of 100% of eligible service users on a Personal Budget by April 2013 (since been downsized to 70% Oct 2012).
JB asked what percentage were currently on personal budgets (PBs)and FW said that she wasn’t sure what the current position was but it had been estimated that 70% would be on PBs by April 2013.
As part of the “Every Child Matters” agenda, in 2007 The “Aiming High For Disabled Children”initiative piloted individual budgets for disabled children and their families which has since been rolled out nationally.
FW then went on to describe the Core Principles of Personalisation. These werechoice and control which was person centred. The upfront allocation of funding was a budget allocated via the Resource Allocation System (RAS), known as the Personal Budget. This gave the individual the choice of support for planning or brokerage (with access to good information); The choice of delivery e.g. direct payment, virtual budget -services commissioned by the Local Authority (LA) or a mixed packageThe idea was to enable services to fit round people’s lives the way they wanted it and not the other way round. Under this philosophy it would be outcomes for people which mattered and the development of independence and inclusion.
FW said that it was important that all the client’s needs were recognised at this stage to make sure these were included in the assessment.
JB asked if something that had been missed in the initial assessment could be added at a later date.FW said that it was possible but not easy but that the questions asked should prompt the client’s thoughts on actual needs.
JB was concerned that the majority of people might make light of their condition and became used to “coping”. This might mean that they did not really recognise what their actual needs were.FW said that the assessment and the Social Worker should extract such details from the individual and if needs change, a reassessment can happenShe then went on to describe the Process which began with:-
(Step 1) a Supported Assessment known as a FACE assessment. FACE stands for: Functional Assessment of Care Environments and the tools are based on a sound evidence and research base giving a standardised assessment of care needs.
Step 2 is about verifying the assessment usingFair Access to Care Services (FACS for short) which is a system for deciding how much support people with social care needs can expect, to help them cope and keep them fit and well. This applies to all the local authorities in England and its aim is to help social care workers make fair and consistent decisions about the level of support needed, and whether your local council should pay for this.On the basis of the results of this, a Resource Allocation system is applied.
Step 3 is to Identify a Personal Budget (indicative) followed by a financial assessment by the Financial Assessment and Benefits (FAB) team.
Step 4 is about Support planning which must clearly show how the individual will use the money from adult social care to meet the needs identified in their original assessment and must give details of the outcomes they plan to achieve.
Step 5 is the approval of the support planThe plan should say how the money will be used.
Step 6 is the implementing of the support plan. The Personal Budget can be given as a direct payment to the individual themselves who will buy services and manage their care package or it can be paid to an agenton behalf of the individual who will manage and buy the services needed.The individual can also ask theirLocal Authority to purchase and manage the service on their behalf .
Step 7 is a periodic review of the arrangements to make sure they are still meeting the individual’s needs.
AW said that he could see benefits in the new system but it had its limitations.
FW said that PBs could cover health care needs but accepted that transport costs had been an issue. She also said that it was recognised that elderly people could have difficulties with the new system but they could opt to continue to have services provide by the Local Authority.AW took exception to the term “elderly” and suggested that the 0ver 65s should not all be categorised as being the same.FW recognised that there was a vast difference in the capabilities of many older people but this was a term that was used in legislation and was recognised by the social care fraternity.
AW said that just because you were elderly didn’t mean you were vulnerable and there were many people who could be seen asvulnerable, not just those who were over 65.