Patient & Public Involvement Committee Meeting
Thursday 24th April 2014 5.30pm – 7.30pm
St Joseph’s Hospice, Education Centre Lecture theatre, Mare Street, E8 4SA
Meeting Notes and Action Points
Chair: Jaime Bishop
Members attending:
Jaime Bishop Chair
Rosemary Jawara Programme Board LTC Representative
Roger Till Chair, Lawson PPG
Shirley Murgraff Co-Chair of Well St Consortia, Hackney Pensioners’ Network
Cynthia White Chair, Neaman Practice PPG, Older People’s Reference Group
Liz Hughes Hackney Healthwatch
Laurie Sutton-Teague Programme Support Officer, CCG (Minutes)
Siobhan Harper Programme Director CCG PPI
Anu Kumar PPI Clinical Lead
Margaret Howat Homerton University Hospital, Patient Experience
Ida Scoullos Programme Board LTC Representative
Melanie Telford Alzheimer’s Society, Hackney
Meena Krishnamurthy Integrated Care Clinical Lead
Mark Scott Programme Director Integrated Care and Urgent Care, CCG
Michael Vidal Hackney Healthwatch
Chris McCabe Chair, Lower Clapton Practice
Deborah Colven CHUHSE, GP Federation
Leigh Bell People’s Network
Tony People’s Network
Daniel Johnson People’s Network
Lucitta Wells Carer, Hackney, People’s Network
Brian Fisher Save Lewisham Hospital Campaign
Apologies:
TBC
Action tracker
CCG and Healthwatch to work jointly on the next steps following on from the Healthwatch Homerton Report / CCG, Healthwatch / On-goingCCG and Healthwatch to present the report together at Homerton / CCG, Healthwatch / Date TBC
Lack of representation from Bart’s Hospital / CCG to look into this / On-going
Personal Health Budget related questions to be sent to Eilis Kilfeather / PPI team to collate and forward / On-going
Full medical check-up available for those over 75? / CCG to look into this / NHS Health Check (CVD, diabetes) for those aged 40-75
Those over 75 can request the above tests at their GP but GP won’t be able to calculate CVD risk score.
Any additional tests?
Paula Lloyd-Knight to come and speak to the PPI committee / SH to find out / On-going
Meeting Notes:
1. Welcome, Introductions and matters arising
· Jaime Bishop welcomed everyone and members introduced themselves.
· As the meeting was late starting and there were guest members attending, it was decided to focus the meeting around items 4, 5, 6, 7, and 8, addressing remaining items at the end of the meeting if there was time.
2. PPG Developments
This item was referred to the next meeting.
3. Updates from Programme Board Representatives
This item was referred to the next meeting.
4. Update from Programme Board Leads: Integrated Care – Mark Scott and;
5. Integrated Care Pilot – Meena Krishnamurthy
· Mark Scott introduced himself and gave an overview of the Integrated Care Programme Board plans.
o Plans focus very much on collaborative work and better supporting patients at home or in the community.
o The focus will be on frail older patients, particularly those with mental health problems.
o Crisis plans will be developed for each patient so that there is a clear plan in place in case of emergency.
o There will be a training package for GPs around having conversations if health is deteriorating and if there are any plans they would wish to put into place – end of life care.
o Patients will be asked if they have any specific relatives or friends who they would want to be involved in their care.
o All parties involved should have contact details of other parties involved to allow full coordinated care.
o One of the primary aims is to develop a more coordinated approach to patient care and prevent unplanned admissions to hospital.
· Meena Krishnamurthy introduced herself to the group and outlined the Integrated Care Pilot plans.
o The pilot aims to enable all parties involved in a patients care work together to provide collaborative care.
o Each group of patients will have slightly different needs from a care plan.
o The care plan is developed in collaboration with the patient, then discussed at a multidisciplinary meeting, before being taken back to the patient to be signed off.
o Care plans broadly speaking are developed in 9 sections. The final version of the plan will include sections also relevant to patients with mental health problems – the current plan only focuses on physical problems.
· Shirley Murgraff questioned where the resources come from to put this plan into action, and how will issues around consent and information governance be dealt with when implementing the new IT system?
o All practices involved will receive information governance training and have IG rules and regulations in place.
o There will also be a separate IG and IT group overseeing the pilot.
o Anu Kumar explained that whilst money to practices from NHS England is going down, the money for this project will come from the CCG. The plan will be beneficial in the long term as will be cost-effective and will lead to better care. She stated that this really will be the beginning of an integrated care system.
· Meena stated to the group that it was important to explain that the type of information sharing mentioned in the plan is not outside of the normal realms of information sharing used between those involved in a patients care in hospitals, for example – this will just be in the community. The key difference is that patients will be involved in decisions around their care.
· Sharing care plans using IT will be a long term project and it will be a number of years till there is a full working way of sharing data. It was stated that this is a national issue that we will have to wait for national guidance on.
· Daniel Johnson stated that he believed individuals should be taught to help themselves more, and that people can sometimes be intimidated by GPs. Patients should be empowered.
o Jamie Bishop stated that if this model works then communication will be all ways, and patients will be able to have more input into their care.
· Lucitta Wells expressed concerns about how the plan will work when it comes to the care of those with mental health problems. She stated that GPs are not always fully trained to deal with mental health issues, and that it can take a lot of time, compassion and effort to deal with these patients and their carers.
o Meena stated that one of the main aims of the plan is to involve carers a lot more and ensure they are named in the care plan, so long as the patient agrees.
o This will lead to better communication and in turn better care.
o Meena acknowledged that mental health is a challenging area, and noted that there will be education and training for GPs around this.
· Jamie Bishop suggested that carers be involved and present when the care plan is being devised.
· Rosemary Jawara expressed concern about commissioners’ confidence in these plans, and also stated that she does not feel that carers are being respected as equal players in the pilot presented.
o Mark Scott informed the group that the model that is being used has been based on existing projects that have already been rolled out and proved successful, including one in North-West London. He stated that he has full confidence in these plans for also marking the start of better integrated care in City & Hackney.
· Ida Scoullos expressed concern that the plan has been produced without consultation. She is concerned that money is being spent on IT and not the actual care packages. She also noted an unease that there is a great focus on the medical model, without acknowledging the importance of social input.
o Meena stated that it will not just be GPs implementing the care plans, but will be coordinating with other people providing care.
o Anu stated that this is the beginning phase of trying to network together everyone involved in a patients care.
· Cynthia White also expressed concern about the predominance of the medical model and mentioned that it is very difficult to change a culture of the way care is provided – ideally we would want to blend the medical and social model.
o Anu Kumar quoted the phrase “Culture is not inherited. It is learnt”. She said she has always been interested in multidisciplinary care and noted that in Hackney she believes GPs have historically worked well together.
o Deborah Colven noted that the main agenda of the plan is about trying to avoid people having to go to hospital. GPs are trying to move away from the medical model.
· Cynthia White stated that she does not like the use of the word ‘elderly’. She also noted a concern that older adults sometimes to not want to bother people, and so if they are told to ‘only go to A&E if….’, they may not seek help when they really need it.
· Chris McCabe mentioned an approach called Clean Talking, and said that a greater focus on talking therapies could be used.
· Mark Scott thanked the group for all of their comments and feedback. He noted that he would take these back to the CCG and think about how to incorporate them into the plan – particularly the comments about carer involvement. The aim will be to launch the pilot in the autumn.
6. Federation / CHUHSE – Deborah Colven
· Deborah Colven introduced herself and explained to the group what the Federation is.
o It is a community interest company whose members are the 44 practices of City and Hackney.
o It is a Shareholder company as they want to have pensions.
o Shares will only be £1 – it has not been set up to make money.
· Deborah explained that the Federation had been started because the Local Authority said each service would have to go to tender. CCGs say they can’t give individual practices enhanced services anymore. Work load has gone up while income is going down.
· Deborah said that they are still in the early stages of setting up the Federation, and hope to finalise the constitution on May 1st.
· There are plans to have a lay person who will look at patient experience and quality, and a lay person for finance.
· Jamie Bishop stated that the Federation will:
o Offer 100% coverage to services across City & Hackney;
o Provide access to ‘the list’;
o Be the key building block to enabling the continuation of the good services we have seen provided across City and Hackney.
· Deborah explained that in cases where practices are unable to provide certain services, the Federation will be able to step in.
· Lucitta Wells expressed concern that patients will not want to go and see other GPs.
· Deborah explained that the Federation will support practices to provide services within their own site, and if they can’t the Federation will come in and give the service at that practice. There may be some cases where it might not be possible to provide a service at that practice, in which case GPs will have to say to patients that another named practice is the best place to receive this particular care/service.
· Deborah informed the group that there is a very successful Federation in Leicester.
· Deborah noted that all but 4 practices have currently signed up.
· Rosemary Jawara stated that she would like to have more information about how the Federation will work. Rosemary wanted to know what the Federation will do to improve access to information pertaining to health inequalities, and how the Federation will create a more inclusive service.
· Jamie Bishop suggested that member practices are encouraged to speak to patient involvement groups.
· Siobhan Harper suggested that when the Federation recruit a lay member, the group could meet with them.
· Liz Hughes would like to find out whether the Federation will have any role in terms of increasing availability to appointments. She said that there seems to be a greater disparity between patient experience – some groups say appointment availability is getting much better, whilst others say it is not.
· It was asked whether there is a relationship between the Federation and CHUHSE.
o Deborah informed the group that CHUHSE will be the 45th member of the Federation.
· Due to time restraints and the number of questions the committee had, it was suggested that Deborah, or another member of the Federation return to a later meeting to discuss in more detail.
7. Monitor Letter – Brian Fisher
· Brian Fisher introduced himself to the group and explained that he was attending the meeting as part of the Save Lewisham Hospital campaign.
o As part of this process he has been worried about the privatisation of the NHS and has noticed that there are a number of pressures within the system that are forcing CCGs to go to tender.
o Brian stated that this is causing more and more parts of the NHS to be outsourced, causing the NHS to become a fragmented service.
o Brian argued that this is a dangerous process.
o Brian explained that the letter he has brought to the meeting could be an opportunity for individuals or the CCG to counter this drift.
· The group accepted the position outlined by Brian.
· Brian presented to the group the letter that had been used as part of a petition in Lewisham to fight against this process.
o Brian noted that two thirds of the letter has been written by lawyers.
o Brian explained that the rhetoric of the letter is that CCGs are allowed NOT to go to market if it is in the interest of the patients’ best needs.
o Brian stated that his campaign group believe if enough people sign the letter, the CCG would have a strong enough base to say to Monitor they will use the NHS preferred provider rather than going to tender.
o In Lewisham they have collected in the region of 2500 signatures.
o Brian noted that Lewisham CCG have been moderately supportive of this campaign but not overwhelmingly. Brian stated that he believed if other areas of London take up the campaign, it will gain more power.