MINUTES of a meeting of the STANDARDS FOR BETTER HEALTH 2008/09 TOPIC GROUP held on WEDNESDAY, 4 FEBRUARY 2009
AT 10.00AM
______
ATTENDANCE
Members
K Coleman, D W Hills, N A Hollinghurst (Chairman), J Pearce (Vice-Chairman), E T Roach, W A Storey
Other Members Present
None
Officers
Commissioning
J Fisher, Head of Provider and Placement Services, Children, Schools and Families Department
M Jordan, Head ofJoint Commissioning
M Lobban, Assistant Director Community Commissioning
R Jankowski, Deputy Director of Public Health
County Council
N Rotherham, Scrutiny Officer
E Shell, Democratic Services Officer
Representatives From User & Carer Organisations
R MillsCarers Involvement Manager, Carers in Herts
M RichardsCarer, Carers in Herts
D EdwardsProject Manager, Herts Viewpoint
C TreaceyCo-ordinator, Hertfordshire LINk
A PriestRepresentative, PohWER/ICAS
L BillyRepresentative, Guideposts
Trusts’ PALS Representatives
J MartinLegal Services, Complaint & PALS Manager, East and North Herts Hospitals NHS Trust
L LopezHead of Patient Services, West Herts Hospitals NHS Trust
M OlsonCorporate Affairs Manager, East and North Herts and West Herts Primary Care Trusts
R CornishPALS Officer, East and North Herts and West Herts Primary Care Trusts
Kate GolderCommissioning Complaints Manager, East and North Herts and West Herts Primary Care Trusts
M StephensonPALS and Complaints Manager, Hertfordshire Partnership Foundation Trust
H EdmondsonAssociate Director of Corporate Affairs, East of England Ambulance Trust
Other Health Trust Officers in Attendance
J ArcherDeputy Director of Governance, East and North Herts Hospitals NHS Trust
Natalie SmithPartnership and Involvement Manager, East and North Herts Hospitals NHS Trust
Lynda DentHead of Public Engagement, East and North Herts and West Herts Primary Care Trusts
A Khan Assistant Director for Integrated Governance, East and North Herts and West Herts Primary Care Trusts
S WilsonPerformance Improvement Manager, Hertfordshire Partnership Foundation Trust
G PryorParamedic, East of England Ambulance Trust
APOLOGIES
Members
Apologies for absence were received from B J Lamb.
Officers
Apologies for absence were received from:-
J Halpin, Director of Public Health
L Love, East of England Ambulance Trust
A Domeney, Deputy Director Social Care
K Shepherd, Head of Strategic Partnerships Unit
Public Attendance
Members of the public were reminded that meetings of the Topic Group were open for them to attend, that they may observe proceedings but that they may not participate in the meeting unless invited to do so by the Chairman.
ACTION1. / APPOINTMENT OF CHAIRMAN AND VICE-CHAIRMAN
1.1
1.2 / The appointment of N A Hollinghurst as Chairman of the Topic Group, agreed by the Health Scrutiny Committee at their meeting on 21 October 2008, was noted and endorsed by members.
The appointment of J Pearce as Vice-Chairman of the Topic Group, agreed by the Chairman and Vice-Chairman of the Health Scrutiny in accordance with paragraph 3.3, Annex 9A of the Constitution, was noted and endorsed by members.
CHAIRMAN’S WELCOME
1.3 / The Chairman welcomed members, officers and user/carer representatives to the first meeting of the Standards for Better Health 2008/09 Topic Group.
2. / INTRODUCTION AND BACKGROUND
2.1
2.2 / Members were reminded of the previous year’s scrutiny of standards for better health and of their briefing with a representative of the Healthcare Commission held in November 2008.
The information contained within the background papers provided was noted.
3. / REMIT OF THE TOPIC GROUP
3.1
3.2 / The Topic Group noted and endorsed the scoping document for their scrutiny as approved by the Health Scrutiny Committee at their October 2008 meeting.
It was agreed that the Group’s work should be undertaken within a short timeframe; in 2-3 longer, very focussed meetings and that the Group’s final report should be presented to the Health Scrutiny Committee at their meeting in March 2009.
4.
4.1 / EVIDENCE
Commissioners
4.1(a)
4.1.1 / Joint Commissioning Team (JCT) and Adult Care Services (ACS)
Community Commissioning and ACS
Mark Lobban, Assistant Director Community Commissioning,addressed members on the various aspects of commissioning being undertaken by Adult Care Services (ACS) in partnership with health. Key points noted by the Group included:-
- His post was a joint appointment between the County Council and health
- Health and well-being: the ‘Health and Well Being Strategy’, which pulled together the key parts of existing strategies of the County Council and health, was formulated following the Well-Being of the Over 50s Topic Group, to which health had contributed significantly. The joint appointment of a programme manager, with responsibility for the health and well-being of older people, had subsequently been made. The programme manager would be monitoring the common/joint targets as part of their role.
- Healthier Communities and Older People block ensured delivery against the Local Area Agreement (LAA)). This group was led jointly by Mark (county council) and Carol Hill (primary care trusts) and the Executive was chaired by the Deputy Director of Public Health
- Joint Strategic Needs Assessment (JSNA): a statutory requirement existed to produce a JSNA. The steering group leading on this work comprised officers from Adult Care Services (ACS) and the Primary Care Trusts (PCTs). The voice of local residents needed to be incorporated into the JSNA, which would inform the resulting commissioning plans
- Implementation of ‘Delivering Quality Healthcare in Hertfordshire’ (DQHC): ACS was engaged with the implementation of the DQHC changes. A good example of joint working included the review of intermediate care services. This work was being jointly led by ACS and the PCTs and the vision was to establish a new ‘tier’ of care. The potential for an integrated county council and health team will also be explored. Whilst it was in the early stages of development, it was anticipated that this level of co-operation would improve operational efficiency and patient care. Information and advice for service users/carers was a crucial element of this work; an engagement and communications strategy was currently being developed, into which the views of users/carers were being fed
- Equipment Service:The Department of Health (DoH) was proposing the adoption of a new ‘retail’ model for the equipment service. The County Council and health were undertaking a joint feasibility study on this and would be exploring how it might also be linked into the handyperson and the wheelchair schemes. Members were reassured that this was a good example of services being driven by the individual needs of the whole person
- ‘Carers Break’ Monies:Hertfordshire had a well-established a multi-agency carers’ group, involving the County Council, Hertfordshire Partnerships Foundation Trust, and the Primary Care Trusts. It was proposed that ACS (which had the infrastructure and expertise already in place) manage, on behalf of the PCTs, the PCTs’ ‘carers break’ budget. Members welcomed and commended this ‘bottom up’ approach
- Individual/Self-Directed Budgets: Health and the County Council were working together to investigate how best to take these budgets forward and would be developing possible pilot schemes for the management of individual health plans
- Mark Lobban was meeting quarterly with representatives of the Hertfordshire LINk. Whilst LINk were still setting their agenda, it was hoped that in time they would be feeding in the views of the wider community
- Mental Health: the recent scrutiny of mental health services by the Mental Health Topic Group demonstrated further examples of joint working between ACS and health,although it was noted that joint working for older people with mental health problems could be further developed.
- The relationship between ACS and health had improved dramatically in the last two years with real progress in ‘joined up’ working being achieved. This was due, in part, to the re-configuration of the PCTs (from 8 to 2 PCTswith a single management structure) which had provided greater opportunities for joint working.
- Joint working between health and local authorities in Hertfordshire was considered to be further advanced than in many other parts of the Country.
- Engagement with users and carers was not always as joined up as it could be; the Group would explore this further at their next meeting.
4.1.2 / Joint Commissioning Team (JCT)
Mark Jordan, Head of Joint Commissioning, addressed members on the various aspects of commissioning being undertaken by Adult Care Services (ACS) in partnership with health. Key points noted by the Group included:-
- In relation to C6:The recent scrutiny conducted by the Mental Health Topic Group provided evidence of the significant joint work undertaken between the County Council, Health Trusts, and user/carer groups
- In Hertfordshire, formal integrated partnerships between health and the County Council had been in place since 2002. The County was believed to have the most integrated joint commissioning arrangements in the Country, with a budget of £250 million currently being overseen by the Joint Commissioning Partnership Board (JCPB)
- Little distinction had needed to be made between health and social care budgets when contracting forintegrated mental health services
- In relation to C13:National government standards were in place and providers performed well against these. Formal user/carer input into commissioning was more advanced for mental health services (for which ‘Viewpoint’ was commissioned to provide user input, and for which ‘Carers in Herts’ provided carers’ input) than for learning disability services; Commissioners recognised the need to improve user/carer input into learning disability service provision. Confidentiality was often expressed as an issue of concern for carers and this was recognised and being addressed
- In relation to C17: There were a number of forums and voluntary sector networks through which users and carers could inform commissioning decisions around mental health services. The JCPB also held its quarterly meetings in public and had briefing meetings in advance of formal meetings to which the public were invited. Hertfordshire Partnership Foundation Trust (HPFT) was contractually bound to routinely collect evidence of service user and carer experience and to feed this information through to the JCT and JCPB. The outcome of new projects and initiatives undertaken with monies from the ‘innovation fund’ would be evaluated over the next couple of years and would help inform the Standards for Better Health 2009/10 Topic Group’s deliberations.
- Ways of further improving user and carer involvement in relation to learning disability services were being taken forward. The Group agreed that this may be an area for inclusion in the Health Scrutiny Committee’s future work programme
- In relation to C22; examples included the development, in conjunction with district and borough councils, of the Mental Health Housing Strategy; the multi-agency work being undertaken on the mental health needs of offenders; and work with practice based commissioning groups.
- There was clear evidence of multi-agency co-operation
Tom Hawkyard/Natalie Rotherham/Elaine Shell
4.1(b)
4.1.3
4.1.4 / Children, Schools and Families
Jonathan Fisher, Head of Provider and Placement Services,addressed members on the work being carried out in partnership with the Hertfordshire Health Trusts and other partnership organisations. Key points noted by the Group included:-
- The over-arching structure for working with partner organisations; the Children’s Trust; the Safeguarding Board (with multi-agency representation both on the Board and on its working groups with responsibility for developing services for children and young people e.g. the Disability Working Group)
- There was a lot of ongoing work to meet statutory requirements and changes in legislation, for example the provision of a dedicated doctor and nursing staff for children in care; CSF had a good relationship with the Primary Care Trusts
- Delivery of integrated services was complex; integrated services were divided into ‘universal‘and ‘specialist’ services
- The Common Assessment Framework (the structure, staff training etc) was in place, although delivery of effective integrated services was a long way off. Health was fully involved with CSF in taking this work forward
- Children with disabilities (‘Aiming High’): This was a major area of partnership work between education, social care and health, particularly on transition from child to adult social care services
- Children with behavioural difficulties (e.g. ADHD): Some significant work was required in this area; different services applied different thresholdsand this was problematic for both service users and carers
- Confidentiality: On going tension existed around confidentiality between CSF and health. The issue of confidentiality was one of the more difficult areas of joint working. Both health and social care services worked to ensure confidentiality, however, the practical focus of their services did have different confidentiality requirements. Information sharing was an essential part of safeguarding children; the level of appropriate information sharing waspart of an ongoing debate between partners. It was anticipated that the establishment of multi-disciplinary teams would help overcome some of these problems
- Child Protection: Access to paediatricians was good although where delays in access were experienced there were also delays in assessments. Obtaining a quorum at initial child protection conferences was an issue, with health professional attendance not always as good as it might be. It was noted that the Children’s Trust Partnership Board would be subject to scrutiny by the County Council’s Overview and Scrutiny Committee on 23 March 2009.
- There was a considerable amount of co-operation between CSF and health; this worked better in some areas than others. This was recognised by both CSF and health and work was underway to make improvements.
Tom Hawkyard/Natalie Rotherham/Elaine Shell
4.2
4.2.1
4.2.2
4.2.3
4.2.4 / Director of Public Health
Raymond Jankowski, Deputy Director of Public Health provided members with a presentation on the partnership work being undertaken to help address public health priorities, particularly in relation to C22.
A copy of the presentation is attached.
A paper listing the 30 wards experiencing the greatest public health inequalities was tabled (copy attached).
Key points noted by the Group included:-
- Public health issues were complex and could not be solved quickly
- It was estimated that the NHS alone could contribute only 10% to improving inequalities in healthcare, the rest would need to be achieved through joint effort with partner organisations. Some partnerships were led by health, others by partner agencies
- The partnership arrangements noted in the addresses given by ACS and CSF officers were endorsed
- The framework for improving inequalities across Hertfordshire included a 5 year strategy, a health and inequalities action plan, Local Area Agreements, and Local Strategic Partnerships (LSPs). The Director of Public Health was represented on each of these
- Work was being undertaken to baseline services to enable future monitoring of their impact
- Work was ongoing with GP practices to address the ‘top 30 wards’ with health inequalities
- Patient involvement was being used to identify what was important to specific target groups in order that appropriate health messages could be delivered
- Reducing tobacco usage: This was being addressed through increased group work. Partners involved included trading standards, CSF, the PCTs, and environmental health departments
- The Director of Public Health worked with the Crime and Disorder Partnership
- In relation to reducing obesity: Work was undertaken jointly with the CSF department to collect data on childhood obesity levels (with 85% of schools participating), and with the district and borough councils’ environment departments to make parks and public areas feel safer. Partnership working was also evidenced by health and local authorities participating in the County’s Public Health (Obesity) Topic Group(the report for which was due to be presented to the Health Scrutiny Committee in March 2009)
- The County was on target for reducing the number of teenage pregnancies; this could not have been achieved without partnership working between health, local authorities and voluntary sector agencies
- Falls prevention was a key area for the PCTs; acounty wide multi-agency group had been established in October 2008 to take forward work to reduce the number of falls. This was linked to potential developments in intermediate care
- Hertfordshire was recognised as being above average within the Eastern Region for its partnership working; co-operation and partnership working led to service improvement and also provided financial savings