Health and Wellbeing Strategic Scrutiny Select Committee
5 February 2013
HEALTH AND WELLBEING SCRUTINY COMMITTEE
5 February 2014
Meeting commenced:2.00 p.m.
“ ended:5.07 p.m.
PRESENT:Councillor Val Burgoyne - in the Chair
Councillors Adrian Brocklehurst, Jim King, Iain Lindley,Joe Murphy, Paul Wilson and Ronnie Wilson
CO-OPTED MEMBERS:
Marian Wilson-Healthwatch Salford
Harold Kershner-Healthwatch Salford
INVITEES:Alan Campbell-Salford Clinical Commissioning Group (CCG)
Hamish Stedman-Salford Clinical Commissioning Group (CCG)
Sue Lightup-Strategic Director for Community Health and Social Care
Judd Skelton-Integrated Commissioning Manager
(Mental Health)
Jayne Wright}Greater Manchester West
Penny Evans }Mental Health NHS Foundation Trust
Steve Colgan}
Paul Gerrard}Save Mental Health Services
Jill Royle}in Salford
Diane Cawood}
OFFICERS:Mike McHugh-Senior Democratic Services Advisor
- INTRODUCTIONS AND APOLOGIESFOR ABSENCE
The Chair welcomed committee members, invitees and members of the public to the meeting and invited those present to introduce themselves.
Apologies for absence were submitted on behalf of CouncillorsChristine Hudson and Joe Kean.
- DECLARATIONS OF INTEREST
There were no declarations of interest.
- MINUTES OF PROCEEDINGS
The minutes of the meeting held on 4 December2013 were approved as a correct record.
- MATTERS ARISING
There were no matters arising.
- QUESTIONS FROM MEMBERS OF THE PUBLIC
There were no questions from members of the public.
- DEVELOPING PRIMARY CARE IN SALFORD
Alan Campbell, Salford Clinical Commissioning Group, gave a presentation relating to the development of primary care in Salford which included details of -
i.Legacy
Primary Care is-
-Too small in Salford
-Too Fragmented 240,000 across 52 practices
-Poor estate – Some excellent
-Good IT
-Stable practices
-Variable quality
-Engaged with the CCG
ii.The Challenge
-Access – create wider opportunities
-Hospitals can’t continue to do low technology work
-Urgent Care – A&E numbers stable
-Urgent Care – Admissions sky high (40%!)
-Limited out of hospital services
-A great hospital
iii.Our Intentions
-Create bigger critical mass
-Improve Estate
-Capitalise on our IT
-Re-energise our GPs careers
-Help the public improve confidence in Primary care
iv.Outline Model
-Access increased
-Diagnostics (X-ray, Ultrasound and others)
-Elderly Medicine, Respiratory, Paediatric specialists in Primary Care
-Long Term Condition management on a stable basis
-Aligned Mental Health Services – Psychology
-Integrated Care Adult Social Care /Welfare support
v.How Structured
-Bigger points of delivery – 30/40k population
-Estate Options
-Existing LIFT centres
-Virtual Practices around good estate
-New Centres
-Workforce Growth
-Short Term secure capacity –Locum / salaried workforce (“The Salford Standard”)
-Locally sited Paediatricians/ Elderly care consultants
-Assured access (eg Children's appointments same day?)
-Information Management and Technology (IM&T)
-Shared Records
-Agree primary care - Practice specific > Locality generic
vi.Our Landscape
-C 8 Localities
-3 LiFT Centres
-2 Plans in Progress
-3 other solutions to work up
-GP Provider entity - SALIX Health
-Workforce agency
-Negotiated and contracted Out of Hosp Services
-Local Authority alignment
-Mental Health services
Discussion took place in respect of a number of issues, including -
-a request for details of a timescale for the implementation of the proposals for the development of primary care in Salford
-a request for information relating to the reasons for the perceived shortage in the number of GPs operating in the city
-a request for information on the role of SALIX Health in the new system
-details of the patients presenting at Accident and Emergency rather than at their GP
-details of the development of partnerships between GP practices
-the need to ensure the maintenance and development of standards in GP practices
-use of the NHS England website to access the dashboard showing performance data of GP practices
RESOLVED:(1) THAT the presentation be noted.
(2) THAT an update report be provided in respect of the progress relating to this matter in September 2014.
- CONSULTATION ON STRENGTHENING MENTAL HEALTH SERVICES AND THE ACUTE CARE PATHWAY REDESIGN
Jayne Wright, Penny Evans and Steve Colgan, Greater Manchester West Mental Health NHS Foundation Trust, gave a presentation relating to the consultation on strengthening mental health services and the acute care pathway redesign.
Details were provided in respect of -
i.Why Change?
-Improve access to care and treatment close to people’s homes in line with Salford’s Integrated Care Strategy
-Realign home base treatment services to offer a true alternative to hospital admission
-Benchmarking data shows
-Higher number of beds for both adult and older adult services compared to England average
-High number of admissions
-Lower than average use of Mental Health Act admissions to hospital
-Slightly higher Average Length of Stay (ALOS) in adults than national average
-Required to meet financial savings of £2.2 million each year across district services
ii.What are the proposals?
-All three district community services in Bolton, Salford and Trafford to be redesigned, streamlined and where required supported by additional investment.
-All three district CRHT services to be redesigned and refocused to achieve an Intensive HBT model. No longer offering crisis assessment to the Acute Hospital as RAID services develop. Supported by reinvestment.
-All three district service refocus current model of inpatient services with reduced Adult bed numbers in Salford and Bolton.
-Develop Woodlands Hospital as the centre for Older People’s Inpatient services for Bolton, Salford and Trafford with a reduced bed base of 65 beds for all three districts.
-Refining and clarifying access points to primary and secondary care mental health provision (GMW) across all three districts.
iii.What does this mean for Salford Service Provision over the next two years?
(a)Access
-Current access point to remain as agreed with Salford CCG
-Full RAID service operational in SRFT – May 2014
(b)Community
-Additional investment in community services of £52k
-Care Coordinator to play key role as navigator through care pathway to ensure continuity of care.
-Provision of extended working hours (9am-8pm) Monday – Friday and weekend working (9am-5pm).
-Continue to extend the step down model with rapid re-access to service if required.
-Proactive advice and support to GPs.
-Re-establish specialist older people community teams for those with functional and organic mental health need. For functional older people services will be primarily but not exclusively age 70 depending on presenting need.
-Continued strong integrated working with the local authority and other service providers.
(c)Treatment at Home
-Investment in HBT of £445k to ensure home treatment as a real alternative to admission and facilitation of early discharge.
-Capacity of the team to visit up to three time’s daily if clinically indicated.
-High intensity pathway to be implemented for Older People to provide treatment at home (including to those older adults in residential/nursing home facilities).
(d) Inpatients
-Daily MDT review to promote early discharge, with support of HBT & Community Services.
-Consistent use/implementation of revised pathways.
-Robust bed management/discharge co-ordination within the local district but also across the wider GMW district service network.
-Reduction of in-patient beds as follows:-
-Reduction of 14 Adult beds – reducing from 59 to 45 via the closure of Riley Ward and the extension of Eagleton Ward by July 2014.
-Moss Ward at Woodlands (20 Organic beds) and Greenway at Trafford (21 beds) to become a shared facility across Bolton, Salford and Trafford (November 2014).
-Commence planning in 2014/15 to centralise all inpatient provision for older people at Woodlands Hospital by November 2015. The total number of beds will be 65 and will offer a service to older people living in Bolton, Salford and Trafford.
-Commence planning in 2014/15 to explore the feasibility of a centralised adult inpatient base to serve all three districts in the future. If this initiative was to progress it is unlikely that this would be commissioned until 2018.
iv.Service Offer
-What can Service Users expect?
-Straightforward, timely access to service
-Strengthened community services with extended hours of access
-(M-F 9-8, weekends 9-5)
-Intensive Home Based Treatment to avoid admissions and facilitate early discharge (24/7)
-Shorter focused inpatient stays in environments that promote privacy and dignity
-Care Coordinator vital navigator of care / continuity of care role
-Focus on specific needs of older people
-Support, advice and information for their carers.
v.Impact of the Proposal
-Anticipated public concerns
-Travel distance for service users and carers from Bolton and Trafford to Woodlands, however no change for Salford residents.
-Overall bed availability.
-Length of contact with patients by community services.
-Finance
GMW Investment is -
1.£1.15 million to strengthen community and intensive home based treatment services (Salford = £497k reinvestment)
2.Investing capital monies of £5.87 million for Woodlands development.
3.The proposal enables the savings target of £4.4 million across district services during the financial years 2014/15 and 2015/16 to be achieved.
vi.Consultation Framework
-Consultation document distributed to all statutory bodies, and key stakeholders including MPs.
-Consultation document displayed on CCG and GMW website with interactive email response.
-Consultation document distributed to all local patient and carer groups with presentations arranged with identified forums. Further presentations will be available to voluntary forums on request.
-Planned public meetings.
-Consultation document and briefings cascaded to all affected staff.
-Bi-weekly staff briefings and regular question and answer logs already established.
vii.Consultation Timescale
viii.Recommendations
The Health and Wellbeing Strategic Scrutiny Select Committee is asked to:-
1.Support the consultation framework approach and advise of any additional forums.
2.Comment on the proposal as part of the consultation exercise ()
Discussion took place in respect of a number of issues, including -
-details of the principle of the change and the associated need to ensure that the treatment of patients in their own home could be achieved safely.
-the process forthe safe delivery of specialist medications to assist with complex mental health issues in a person’s home.
-the balance between making the changes to address need or whether cuts in resources were the main driver.
-staffing issues relating to the proposals. It was noted that the proposals should involve no compulsory redundancies
-concerns relating to the distance of travel to the Woodlands centre for residents from Salford and Trafford
-issues relating to status of the Trafford Clinical Commissioning Group in the consultation process
-issues relating to ‘risk’ from the implementation of any proposals.
-the need to ensure publicity and ease of access for members of the public to future meetings within the consultation process.
The Chair welcomed Paul Gerrard, Jill Royle and Diane Cawood from the Save Mental Health Services In Salford Group. She noted that they had been invited to express a public viewpoint of the proposals.
Paul Gerrard addressed the Committee. He provided comments in respect of a number of issues, which included -
-confirmation that the presentation had given more detail than the consultation document which was included on the Greater Manchester West Mental Health NHS Foundation Trust; and requested that the presentation be included alongside the consultation document
-data contained on the Alzheimer’s Society website which suggested that the number of cases of dementia would double from 3m to 6m over the next 20 years. He raised concerns on the impact of these numbers on the provision of mental health services.
-he noted the numbers of patients from Greater Manchester that had been treated in ‘out of area’ facilities owing to space in Meadowbrook not being available.
-he raised concerns relating to the provision, under the proposals, which noted three visits to a person’s home per day. He noted that this may leave people vulnerable for the time a medical professional was not present in their home.
-he raised concerns that the Trafford Clinical Commissioning Group had withdrawn from the consultation process.
-he noted with concern that in many previous changes to NHS provision that ‘free transport’ which was delivered as part of the process did not last owing to issues of sustainability from the operators.
Jill Royle addressed the Committee. She provided comments in respect of a number of issues, which included -
-she provided details of her experiences of the mental health services in Salford
-she re-iterated a point made by Paul Gerrard that the proposals for three visits to a person’s home per day would leave people vulnerable for the time a medical professional was not present in their home
-she also raised concerns relating to the impact that the proposals may have on the families of patients being treated at home
-she noted that the consultation was not widely publicised and that people suffering from mental health issues may not be in a position to respond to the consultation themselves and that the use of advocates should be examined.
Diane Cawood addressed the Committee. She provided comments in respect of a number of issues, which included -
-issues relating to the staff consultation during the process
-safeguarding issues which may arise owing to the need to use mixed-sex accommodation
-questions relating to the number of people from Salford making use of the mental health services, suggesting that the need may be greater than elsewhere
-the use of sectioning under the Mental Health Act.
-general concerns that the proposals for change should be better thought out.
The Chair thanked Paul Gerrard, Jill Royle and Diane Cawood for attending the meeting, indicating that she hoped that they had been given adequate time to present their views.
Paul Gerrard thanked the Chair for the opportunity to attend the meeting. He also provided details of further work being undertaken by the group in support of mental health services in Salford. He noted in particular the involvement of the actress, Beverley Callard, who was supporting the work of the group.
RESOLVED:(1) THAT the presentations be noted.
(2) THAT the Committee’s response to the consultation be presented in due course.
- WORK PROGRAMME FOR FUTURE MEETINGS
The Chair outlined proposed items to be included in the work programme for future meetings.
Discussion took place relating to the items to be included on the agenda for the meeting of this Committee to be held on 5 March 2014.
RESOLVED:THAT the Work Programme be noted.
- FORWARD PLAN OF KEY DECISIONS
The Chair outlined the issues on the forward plan, relevant to this scrutiny committee.
RESOLVED:THAT the matter be noted.
- ANY OTHER BUSINESS
There were no items of any other business.
- DATE AND TIME OF NEXT MEETING
RESOLVED:THAT the next meeting be held on Wednesday 5 March2014, in a Committee Room at the Salford Civic Centre, Chorley Road, Swinton, at 2.00p.m.