Patient & Public Involvement Sub- Committee Meeting

Thursday 26th June2014 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 BishopChair

Rosemary JawaraProgramme Board LTC Representative

Roger TillLawson Practice PPG

Shirley MurgraffWell Street Practice PPG, Hackney Pensioners’ Network

Cynthia White Neaman Practice PPG, Chair of Older People’s Reference Group

Liz HughesHealthwatch Hackney

Eeva HuovialaProject Officer, CCG PPI (Minutes)

Siobhan HarperProgramme Board Director CCG PPI

Margaret HowatHomerton University Hospital, Patient Experience

Ida ScoullosProgramme Board LTC Representative

Sarah WeissInterlink, Programme Board Maternity Representative

Steve StephensonCity Healthwatch

David MaherProgramme Board Director CCG Mental Health

Chris McCabeLower Clapton PPG

John BaileyHoxton Practice PPG

Michael VidalHealthwatch Hackney

Gabrielle FairClinical Director for Mental Health services for Older People, ELFT

John Wilkinson ELFT

Anu Kumar PPI Clinical Lead

Greta HarperWork Experience

Sarah McilwaineSenior Consultant, NELCSU

Rozalia EntiAssistant Director, Medicines Management, CCG

Nick MannGP

Apologies:

Sandra CaterCCG Social Prescribing Project Officer

Heather FinlayProgramme Board Urgent Care Representative

Stuart MaxwellGovernor Homerton Hospital

Jackie BrettHSCF

Paul MunimCEO, Hackney Carers

Action Tracker:

Lack of representation from Bart’s Hospital / CCG to look into this / On-going
Sarah Weiss’ comments relating to HUH
  • Prediction that birth rate due to go down at Homerton over the next year
  • Issues identified with entry to maternity ward
/ Margaret Howat to follow up / TBC
CCG’s lack of involvement in Transforming Services, Changing Lives / Siobhan Harper to find out / TBC
Well St PPG constitution to be shared with the committee / Shirley Murgraff to share / Circulated with meeting papers
Newham declining the FOA proposal / David Maher to find out more information more the trust. / TBC
Address the FOA issues raised by the committee / ELFT to provide clarification / ELFT have responded to the concerns raised by the committee and the response will be discussed at the CCG Board meeting on 25 July 2014.
Why was Picker chosen at HUH as the method for measuring patient satisfaction / Margaret Howat to find out more / Margaret Howat provided clarification – see below.
1 million pounds to be invested in community mental health services / PPI Committee to discuss with David Maher / TBC
A regular agenda item to be added on the agenda for Homerton Updates and addressing the issues identified in the Healthwatch report. / PPI Team to add item on the agenda for every other month / Item added on July agenda.
-A list of groups for brown bag reviews
-What people want from their community pharmacists / EH to collate and feedback to Rozalia Enti / TBC
  1. Welcome, Introductions and matters arising
  • The members introduced themselves
  • Corrections to previous minutes and matters arising
  • Michael Vidal’s comments relating to the Monitor letter discussed at the May PPI meeting were about the effectiveness of the letter
  • Sarah Weiss’ comments about Homerton related to the entry to the maternity ward/antenatal ward only.
  • Liz Hughes emphasised that she would like to see regular updates from HUH on the PPI agenda once the HUH action plan has been signed off
  • Steve Stephenson requested an action tracker to be included at the beginning of the minutes
  • Margaret Howat clarified that Picker is routinely used (i.e.no choice) as the tool for collecting patient feedback. Picker are also currently the chosen provider for facilitating the admin process.
  • Jaime Bishop asked to be informed if/when the admin facilitator would be procured again
  • Sarah Mcilwaine told members that if needed staff from CSU can come and talk to the committee about Transforming Services, Changing Lives.
  1. Cancer and Cardiovascular Services Centralisation
  • Sarah Mcilwaine presented the summary of the business case for the proposed centralisation of cancer and cardiovascular services (see appendix 1) affecting North East London as well as part of Essex.
  • The proposal is based on a London wide review of the services and is currently undergoing the second phase of the engagement process
  • The proposal aims to create centres of excellence to treat some forms of cancer and cardiovascular services, which are currently spread across London.
  • People would receive their treatment and check-ups etc. at their local hospital but have any operations at these new centres
  • City and Hackney CCG as well as NHSE will be carrying out checks before the plan goes ahead.
  • Providers need to be delivering good standard of care on their current areas before any changes can take place
  • The plans are not immediate and would take place on a sliding timescale over the next 1-4 years.
  • Video and slides explaining the proposal are available to public and have been sent around to the committee
  • Cynthia White asked about the proposal being already confirmed and wanted to know how much influence people can have on the outcome
  • Sarah Mcilwaine said that this is not the case
  • Steve Stephenson raised concerns about the standard of admin at Bart’s Hospital, which would become the centre for cardiovascular services if the proposal goes ahead.
  • Cynthia White also raised concerns about the fact that Tower Hamlets are the commissioners for Bart’s and UCLH and that this will have an impact on decisions and reiterated that people need reassurance that current services will be delivered to a good standard before any changes take place.
  • Jaime Bishop asked about the building already being built and what happens to this if the proposal does not go ahead.
  • Sarah Mcilwaine emphasised that the case for change is clinical
  • Roger Till wanted to find out where the funding for this proposal would come from
  • Sarah Mcilwaine clarified that the CCG pays for people’s treatment and the money follows patient to wherever they are being cared for
  • Shirley Murgraff said that changes itself costs money and requested that any papers in the future would be sent well beforehand so that people will have a chance to familiarise themselves with the issues before the meeting
  • Shirley Murgraff also wanted some clarification regarding Bart’s financial situation and the use of potential profits
  • David Maher asked why there was no need to have a formal consultation around this issue?
  • Ida Scoullos also requested a formal consultation
  • Michael Vidal stated that the reason for not consulting is that the proposed change is not classified as substantial

ACTION: Sarah Mcilwaine to check and provide information about formal consultation

  • Anu Kumar wanted to know how groups such as PPI committee can have a say and influence decisions and changes at Bart’s.
  • Sarah Mcilwaine suggested that a representative from Transforming Services, Changing Lives could come along to the committee meeting
  • Michael Vidal said that all the shortlisted options for this proposal had included at least one of the services being delivered at Bart’s. He also requested assurance that despite financial pressures private and NHS patients were treated equally
  • Michael Vidal requested information about any concerns raised by clinicians
  • Sarah Mcilwaine said that the way services are changed around is based on hospitals having done a certain level of training.
  • Jaime Bishop said that people need to be consulted from the beginning.
  1. Functional Older Adults Proposal – Update
  • Gabrielle Faire and John Wilkins from ELFT introduced themselves
  • Jaime Bishop suggested going through the list of concerns
  • Reliance on community model
  • Gabrielle Faire said that the basic community services are in place and staffed and that there will also be a new intermediate service which will support people during transition
  • Jaime Bishop wanted to know if there is enough capacity to support people
  • Gabrielle Faire replied that she wants to support people with more staff but that it is difficult to give specifics because other services are also changing
  • Jaime Bishop requested that this should be discussed together.
  • Gabrielle Faire said that pathways are more streamlined and people are working in teams.
  • John Wilkins said that existing teams have done a lot of work and that the capacity is there already
  • Success relies on reducing bed numbers by reducing length of stay and this will create more beds and more space
  • Jaime Bishop wanted to know how this would be done in practice
  • Gabrielle Faire said that in NELFT 33 beds will go down to 25 and that elsewhere there are 20 beds shared between two boroughs. In this light the FOA proposal is fairly normal. She also said that the similar proposal carried out for dementia patients has shown good results.
  • Steve Stephenson mentioned that the number of older people is rising and in particular City the number is up drastically with large numbers of older single people who sometimes need to be cared for in hospital settings rather than community and that people don’t always have the networks in place to support them with recovery in the community.
  • Anu Kumar stated that Mental Health services in City and Hackney had got a lot better under David Maher and Rhiannon England but that there was still work to be done.
  • David Maher said that the CCG were investing 1 million pounds to help caring people closer to home and asked if PPI committee wanted to take the lead on identifying where the gaps are

ACTION: PPI Committee to discuss with David Maher

  • Liz Hughes wanted to know what the current feedback from service users says
  • John Wilkins replied and said that due to the nature of the service people mostly only have one stay in the hospital so are asked about their experience then and the majority of the feedback is that people would rather be cared for in the community
  • Cynthia White said that she feels cynical about the proposal and is concerned that changes are dressed up as clinical improvements. She requested evidence to demonstrate what the current need is and how flexible the service is in terms of responding to changes in the population.
  • John Wilkins said that closing wards will result in staff no longer being needed at those locations and there are plans to relocate some of these members of staff to support community services. He emphasised that the trust had to make 4% efficiency savings as part of national savings programme and that under use of beds is not good use of money.
  • Cynthia White wanted to know the reason behind the under use of the beds and if this was due to people being under the radar and not receiving the care they would need.
  • Gabrielle Faire said that this was possible the case but that these people were not in need of hospital care and that community support and access to day care services should address their needs better.
  • Jaime Bishop wanted to know how we can make sure that the community services are protected.
  • Gabrielle Faire said that Health and Wellbeing Board needed to address this
  • Jaime Bishop said any consultation would need to happen in an integrated way.
  • John Bailey said that IAPT should also be seeing older people
  • Jaime Bishop pointed out that the Bankcroft Road site was isolated and that it was important to guarantee that people had access to transport support, taxis etc.
  • John Wilkins said that Dr Foster has done a detailed study of the transport service and although the journey may be complex for some, for majority the Mile End site was the best. Those referred to the service would have a comprehensive assessment of their transport needs.
  • Jaime Bishop wanted to find out about views from clinicians
  • Gabrielle Faire said that initial feedback from clinicians suggests that the concerns presented by the clinicians mirror those from the public
  • Jaime Bishop asked people for their views following on from the meeting and said that he felt at least some of the concerns had been addressed today
  • Liz Hughes said that she would like to see the PPE part strengthened
  • John Bailey said that he would like the proposal to go through formal consultation
  • Siobhan said that there was need for more feedback from the current service users
  • Jaime Bishop asked about internal involvement/PPI at ELFT
  • Shirley Murgraff said she had been encouraged by the discussion today
  • Ida Scoullos said it was important to consult a wide range of groups
  • Jaime Bishop recommended moving forward to consultation as long as the issues raised by the committee are being taken into consideration.
  • David Maher said that the next steps would include taking the proposal to the board, then consultation followed by a report which would be reviewed by the PPI committee and the CCG board. He agreed that there was a need to make the consultation as wide as possible and have a clear idea of what is out there in terms of services and gaps, formal and informal, which could take part in the consultation.
  • Timeline following from the meeting
  • Sept: Overview and scrutiny committee
  • Oct: Consultation
  • John Wilkins agreed to the PPI Committee reviewing the consultation strategy.
  1. Programme Board Update: Prescribing
  • Rozalia Enti introduced herself and did a presentation on the Prescribing Board and what they do (please see appendix 2)
  • Rozalia Enti said that in addition to medicine adherence and reduction of waste the Prescribing Board is encouraging the good use of community pharmacists.
  • The total spend on prescribing in Primary Care is 27-78 million a year
  • Jaime Bishop asked about the conflict regarding funding requests i.e. “postcode lottery”, and how these situations are resolved
  • Applications for individual funding requests are discussed in line with the Ethical Framework and NICE guidance. When NICE guidance changes the CCG have three months to respond and implement.
  • There are variations between different practices
  • If a drug isn’t available at a hospital the formulary will try and use another one
  • David Maher added that the Prescribing Board are currently recruiting for a patient representative and wanted to know how to make the engagement meaningful.
  • Cynthia White said that the OPRG get a lot of feedback regarding medications and prescribing and that it would be good to share this. The feedback included the below suggestions.
  • Several medications make it difficult to keep track and order new lots in
  • Electronic prescribing to help avoid overlapping
  • Why do useful medications disappear from the market if there are no substitutes
  • Pharmacists to help with the leaflets that come with prescriptions
  • Role of the pharmacists to be promoted a lot more in the future
  • Rozalia said that if a particular medicine is not available people can ask the pharmacist for alternatives although due to health and safety the pharmacists can no longer produce their own medicines,
  • Jaime asked suggestions for the groups the Prescribing Board should engage with
  • Mental Health
  • HIV groups
  • Older People’s Reference Group
  • Patients Network
  • Rozalia asked for groups to take part in brown bag reviews as well as people’s feedback on what people need and want from their community pharmacists.

ACTION: EH to collate

5.AOB

  • It was agreed that a template would be produced for co-production and involvement
  • Shirley Murgraff mentioned that some practices are facing funding cuts due to the recent MPIG cuts resulting in money from deprived areas being withdrawn.
  • Jaime Bishop said that the Practice Managers are not allowed to highlight the issue to their patients.
  • Nick Mann asked Shirley to speak for the campaign as the feedback needs to come from the patients and said that the cuts could potentially force out some practices in favour of private sector providers.
  • Anu Kumar said that GP practices should have leaflets and that in Tower Hamlets some practices texted their patients about the cuts but that this was not seen as appropriate use of patient details by NHS England.

Appendices