Your Health, Your Voice
Thursday 21 September2017, 6:00pm – 8:00pm
The Boardroom, Kempthorne House,
St Martin’s Hospital, Clara Cross Lane, Bath, BA2 5RP
Attendees
Name / Initials / Organisation / Job roleBath and North East Somerset CCGand guests
Suzannah Power (Chair) / SP / Lay Member for Patient and Public Involvement
Julie-Anne Wales / JAW / Head of Corporate Governance and Planning
Lucie Owens / LO / Commissioning Manager for Planned Care (RSS & Health Optimisation)
Daisy Picking / Engagement Manager
Dr Chris Lewis / CL / Lead GP, Referral Support Service (RSS)
Members
Richard Blunden / RB / Retired Practice Manager
Roger Driver / RD / Rector at St Michaels Without, former Lay Member for PPI at South Sefton CCG
Ann Harding / AH / Healthwatch volunteer, Community Champion
Clare Hector / CH / Bath resident
Jeremy Ince / JeI / Midsomer Norton resident
Maureen Ince / MI / Midsomer Norton resident
Jean Lowe / JL / Protect Our NHS B&NES
Mark O’Sullivan / MO / Federation of Bath Residents’ Associations
Andy Morley / AM / Community Champion (Technology)
Ian Perkins / IP / The Abbey Residents Association, Bath
Cllr Vic Pritchard / VP / Cabinet Member for Adult Social Care & Health
Deborah Jane / DJ / Number 18 Surgery PPG, Bath
Julie Hockey / JH / The Pulteney Street Practice PPG
1. Welcome and Introductions / AP
SP welcomed everyone to the meeting. The minutes of the previous meeting (22/06/2017) were approved as a true record with the following updates:
Jean Lowe has stood down from Healthwatch.
Improving access to primary care – Members discussed how practices are working independently to change the way patients can access appointments. One practice has introduced a system where patients phone up and are called back by a GP within an hour, but that this can be difficult for those who work or need to go out. If was raised that speaking on the phone may present difficulties for some sectors of the community who may prefer to use an advocate.
MI would like the opportunity to see her GP face-to-face.
MIraised that theyhad not received hard copies of the recent ‘Booking appointments with your GP’ CCG survey. DP to share summary of all engagement done to date on improving access to primary care (including YHYV members feedback at last meeting). DP to make sure that all YHYV members receive future information in appropriate formats.
Action Points
All other action points complete. / AP1 DP
2. Mental health pathway review
DP updated the members on progress of the mental health pathway review. Phase one of the review involved consultation with people who use services, carers, service providers and primary care professionals, to find out how people are accessing community mental health services, how services are working together, what is working well, examples of best practice, what people think needs to change or improve, and any capacity/resource issues or gaps that need addressing. This engagement has built on the process and findings of Your Care, Your Way.
Engagement (for phase one) has been carried out via 62+ face-to-face interviews and focus groups, and surveys (188 responses received). A summary report has been written and will be shared on our website shortly:
Next steps are for commissioners and the mental health review team to do some detailed work on service options, and the Community Champions will be involved in this process. Phase two of public engagement will begin towards the end of the year.
YHYV members raised the importance of involving the police and Business Improvement District (BID) patrollers in the Review, as they have regular contact with people who have mental health problems. Members noted that there is resentment between services, as police don’t feel supported by mental health services.
Members raised that people on the autistic spectrumand young people need specific consideration as part of the Review.
CL shared that the referral process used by GPs is inconsistent and they would value a more consistent response, to avoid patients being referred back and forth. He also raised that access to services varies and that there aren’t enough services outside of Bath.
JL suggested that services outside of the health sector could be well placed to support people, but need to know what information and support is available so they can signpost people e.g. foodbanks.
JH suggested it would be useful if there was a health directorate that could be kept at the one stop shop for people to use. IP raised the issue of services becoming swamped and unable to cope if we just focus on signposting.
Members requested opportunities to share their feedback directly with commissioners. DP to arrange a meeting as part of phase two of engagement.
Members requested that young people involved in the Review come along to future YHYV meetings to share experiences. DP will build relationships with young people and see if this is possible in the future. / AP2 - DP
3. YHYV membership
RB offered to step down as a Core Member, as he lives outside of B&NES and isn’t able to attend meetings regularly. He will be an Associate Member and attend meetings when he’d like to in the future.
IP raised that members are a very engaged, self-selecting group and that it’s more important to focus on the best ways to feed in views that aren’t represented). JL added that some people may intimidated or uncomfortable attending meetings. The group agreed that outreach is important for engaging with certain groups.
DJ suggested approaching Robyn Pound, who is a practitioner researcher at Make a Move (a music and movement mental health and wellbeing charity). Robyn is a retired health visitor and led the Moving on Up! Therapeutic movement for postnatal anxiety and depression. DP to ask Robyn if she’d be interested in becoming a YHYV member.
JH shared that she is part of the KS2 Bath (carers) group - and offered to provide outreach support to add to YHYV discussions. IP shared that he is the Chairman of a Residents Association and could feedback views of those who have housing problems. It was suggested that YHYV members could bring back ideas/feedback from other groups or communities they are involved with.
RD suggested we work more closely with Julian House, B&NES Third Sector Group (3SG) and the Boater/Traveller community.
VP identified that the membership does not have enough representatives from peripheral areas of B&NES.
MO asked how the group can engage with people who live in remote, rural areas (e.g. Chew Valley and Harptree). SP suggested we could use the Village Agents system. DP to look into this.
CL suggested that YHYV uses a ‘cluster’ approach to membership, to make sure that there are patient and public representatives from all areas. Members liked this idea. VP suggested advertising for new members at Area Forums and via Village Agents. DP to draw up a list of areas not currently represented, and start planning for recruitment of new members in 2018.
SP explained that she will be writing to Core Members who have not attended meetings for some time, asking them to step down and become Associate Members (making room for new members who are keen to be involved). / AP3 - DP
AP4 -DP
AP5 - DP
AP6 –SP/DP
4. Helping people get fit for surgery
The CCG now has a plan to introduce health optimisation in three stages:
Stage one: from October 2017, patients who smoke or have a body mass index (BMI) of 30 or above, will have their hip or knee operation delayed by up to three months while they are supported to try and stop smoking and/or lose weight.
JA shared that evidence shows 40% of people who go through the Hip & Knee programme decide that they don’t want to pursue surgery, as they feel active and mobile enough.
Stage two: from January 2018, patients who smoke will have other types of non-urgent surgery delayed by up to six monthswhile they are supported to try and stop smoking.
Stage three: from March/April 2018, patients who have a BMI of 30 or abovewill be encouraged to undertake a period of weight management beforenon-urgent surgery.
CL explained there was a recent British Medical Journal (BMJ) article titled ‘Prehabilitation’, which explained that major surgery is like running a marathon (both put a huge strain on the body and require training). Getting people fit for surgery is not just about surgical outcomes, but the longer-term health outcomes too. From a public health perspective, supporting people to lose weight and stop smoking, and helping them to keep doing this, prevents long-term problems.
CL explained that it’s better to delay people’s surgery for these (right) reasons, rather than rush and end up with patients staying longer in hospital due to complications. It’s important for patients, clinicians and surgeons to work together to make this scheme as successful as possible.
LO talked YHYV members through the new (enhanced) hip and knee pathway:-
- GP initial assessment
If it’s a routine referral, they use the Oxford Hip/Knee Scoreto assess if the patient qualifies for the Hip & Knee programme.
Before the GP makes the referral, they must check the patient’s BMI and smoking status and, if necessary, explain that they will have to try and stop smoking and/or lose weight during a three month period, before joining the Hip & Knee programme. It’s very important that this discussion happens with the GP, not with the RSS. They must give all patients the new Hip & Knee Programme leaflet and discuss this with them.
- RSS review
- Hip & Knee team
If patients have a BMI of 30 or above or smoke, they will be referred onto lifestyle services to begin their three month period of trying to lose weight/stop smoking. Patients with a BMI lower than 30 or who don’t smoke, will follow the standard route through the Hip & Knee programme. Patients may opt for surgery (if needed) or prefer self-care.
VP shared that Health & Wellbeing Board members are supportive and had confidence in the intentions of this scheme. He shared statistic that a smoker is 38% more likely to die after surgery than someone who has never smoked.
Members were reassured that this is a ‘process of persuasion’ and that people who do not try to lose weight or stop smoking will not be denied surgery.
IP said there is a risk in assuming GPs all have the diagnostic ability to make the right judgement for patients, and x-rays are not always an adequate tool.CL reassured that no test is 100% accurate, but x-rays are a pretty good diagnostic tool for osteoarthritis. Not a common problem for referrals to Hip & Knee team to go back to GP (due to diagnostic error).
AH asked why the BMI criteria is as low as 30, as the evidence is elusive. It’s stronger for smoking and BMIs of 40+, for safety/anaesthetic purposes. CL explained that BMIs of 30+ tend to be the point at which other issues occur. This is about supporting as many people as possible and preventing longer-term health issues. Members suggested the wider benefits point should be made clearer by communicating it as getting fit ‘after’ (as well as ‘for’) surgery and being ‘fit for life’.
JL fed back that the language in the patient leaflet is quite corporate and could benefit from patients’ comments. RB fed back that the leaflet is too long/wordy and has some grammatical errors. RB to share feedback directly with Tamsin May (Head of Communications) by Monday 25 September.
MI asked if the smoking cessation/weight management programmes are compulsory. JAW explained that it’s compulsory for patients to engage and to try to lose weight and stop smoking. If patients won’t try, they’ll have to wait the three months before they are referred to the Hip & Knee Programme.
RD asked if smoking cessation services are easy to access. CL explained that some services are based in GP surgeries, but there are also weekend groups for people who work. / AP7 - RB
6. General comments
IP shared that the RUH is consulting on their new strategy and it’s worth people getting involved to share their views. DP to share details with YHYV members.
Members would like an STP update from NHS England at the next meeting. DP to invite representative from NHSE along. VP shared that BSW STP came second in recent STP assessment. / AP8 – DP
AP9 - DP
6. Next meeting
Next YHYV meeting is from 4-6pm on Thursday 23 November 2017in the Boardroom, Kempthorne House, St Martins Hospital.
Page 1 of 6