Third party commentary: Hertfordshire County Council Health Scrutiny Committee (12 March)
TRUST NAME: Hertfordshire Primary Care Trusts (PCTs)
C6: Health care organisations co-operate with each other and social care organisations to ensure that patients’ individual needs are properly managed and met
Based on evidence received 4 & 25 February 2009, unless otherwise stated in the text.
The relationship between Adult Care Services (ACS) and health has improved dramatically in the last two years with real progress in joined up working being achieved. This is due, in part, to the re-configuration of the PCTs (from eight to two PCTs with a single management structure). It has provided greater opportunities for joint working. Members commended the joint appointments which have been made by Hertfordshire County Council (HCC) and the PCTs (Assistant Director, Community Commissioning; Director of Public Health; and the Programme Manager for Health and Well Being).
Joint Strategic Needs Assessment (JSNA) is a statutory requirement. The steering group leading on this work comprises officers from ACS and the PCTs. Health and social care have assessed the JSNA and established that the voice of local residents needs to be incorporated into the JSNA to inform commissioning plans. This will be built into the next JSNA.
ACS are engaged with the implementation of the Delivering Quality Healthcare in Hertfordshire (DQHC) changes. A good example of joint working includes the review of intermediate care services. This work is being jointly led by ACS and the PCTs and the vision is to establish a new tier of care. The potential for an integrated county council and health team will also be explored. Whilst it is in the early stages of development, it is anticipated that this level of co-operation will improve operational efficiency and patient care. Information and advice for service users/carers is a crucial element of this work; an engagement and communications strategy is being developed, into which the views of users/carers are being fed.
The Assistant Director, Community Commissioning is a joint appointment between the County Council and health. It provides benefit for users in the development of services and a bridge between health and social care (also at C22). For example, the Health and Well Being Strategy, which pulls together the key parts of existing strategies of both the County Council and health. This was formulated following the Well-Being of the Over 50s scrutiny (October 2008), to which health had contributed significantly. The joint appointment of a programme manager, with responsibility for the health and well-being of older people, has subsequently been made. The programme manager is monitoring the common/joint targets (i.e. health and social care) as part of their role.
Alongside the joint appointments there are examples of joint working to improve patient outcomes. Falls prevention is a key area for the PCTs; a county wide multi-agency group (including ACS) was established in October 2008 to take forward work to reduce the number of falls. This has links to potential developments in intermediate care.
Mental health users expressed concern around the availability of long term funding and that some of the new initiatives and service developments implemented using the new finance would be unsustainable when these funds expired; however, during the recent scrutiny of mental health services demonstrated a commitment by JCT to embed mental health services into primary care. Evidence provided by ACS and JCT highlighted that joint working for older people with mental health problems needs to be further developed.
Hertfordshire has a well-established a multi-agency carers’ group, involving the County Council, Hertfordshire Partnership Foundation Trust (HPFT) and the PCTs. It is proposed that ACS (which has 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.
There is a considerable amount of co-operation between Childrens, Schools & Families (CSF) and health and this works better in some areas than others; however, it is recognised by both CSF and health that work underway would lead to further improvements. Examples of where this is improving outcomes follow; work has been 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 is also evidenced by health and local authorities participating in the County’s Public Health (Obesity) Topic Group (the report due late March 2009).
There is 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 has a good relationship with the PCTs. The PCTs, in partnership with CSF, also work to meet the needs of individual children who have additional needs. To do this a set of panel arrangements are in place which, as part of the process, ask for the parents’ views on the needs being presented to complex care panel. This allows the decision makers to have insight into the impact a disability will have on the child and the family. The PCTs are working jointly with CSF on meeting the needs of disabled children. In 2008/09, they worked with Carers in Herts to seek the views of parents to help shape plans to improve services. Plans are in place to meet the Aiming High strategy and this will include parent participation as a key work strand. Carers in Herts (CIH) are working with the PCTs on improving participation and funds have been used to support additional staff in CIH. PCT staff have attended parent participation groups to improve understanding of the needs of families with disabled children. The views of parents are also included in all applications to the joint complex care panel.
Locating a nurse in acute services, to assess the patient’s fitness for discharge and to ensure that services are in place to prevent re-admission, has provided beneficial outcomes. Daily conferences ensure timely discharge of patients. This is underpinned by putting in place equipment needs and the creation of a robust single assessment.
PALS work with PohWER has been particularly helpful in establishing the PALS at The Mount Prison (also at C17).
Joint working between health and local authorities in Hertfordshire is considered to be further advanced than in many other parts of the Country.
For example, evidence provided by mental health user groups (Guideposts and Viewpoint) strongly affirm that partnership working with statutory organisations has improved year-on-year. They confirmed that the good relationship between user groups and the Joint Commissioning Team (JCT), PCTs and HPFT has enabled the JCT to take a more innovative approach in service provision and development. The current situation is one that needs to continue for the best interests of both providers, commissioners and users.
A lot of evidence had been received in relation to this core standard. Members were clear that the examples in the reports were not exhaustive. Members were assured of the Trust’s compliance with this core standard.
C13: Health care organisations have systems in place to ensure that:-
a)staff treat patients, their relatives and carers with dignity and respect
b)appropriate consent is obtained when required for all contacts with patients and for the use of any patient confidential information
c)staff treat patient information confidentiality, except where authorised by legislation to the contrary
Based on evidence received 4 & 25 February 2009, unless otherwise stated in the text.
The PCTs have an integrated Patient Experience Strategy to ensure they promote and actively implement service user privacy and dignity. This is reviewed and developed on an ongoing basis.
The PCTs’ ‘Complaints Audit and Patient Experience Committee’ has membership from all NHS providers in Hertfordshire including the PCTs’ own provider services. The Committee aims to analyse information from patient experience collected through complaints, incidents, privacy and dignity audits, GP surveys, performance targets etc to inform how the organisations in Hertfordshire are delivering services that ensure the privacy and dignity of services users and carers. Regular ‘Patient Experience’ reports are received by the PCTs’ governance committees for consideration by the executive team.
Relocation of the PALS office, to allow greater privacy, has helped to improve the dignity and respect given to patients and carers. Appropriate consent is always sought and received prior to action being taken. Members heard from two patient groups and both endorsed the view that trusts are listening to and acting upon information given to them in relation to this core standard.
Members were assured of the Trust’s compliance with this core standard.
C17: The views of patients, their carers and others are sought and taken into account in designing, planning, delivering and improving health care services
Based on evidence received 4 & 25 February 2009, unless otherwise stated in the text.
The PCTs are partners in the ‘Public Engagement Partnership’ with the County and District Councils, the Police Authority and Constabulary. They have collaborated with the councils in the PLACE survey and in developing new terms of reference to work more closely on engagement with users and carers. As partners, they have commissioned Opinion Research Services – the partnership’s social research organisation to obtain public views on GP-led health centres; Mount Vernon Cancer Centre services, dental services and the public’s knowledge of symptoms of stroke. A countywide Stakeholder Forum of local authority partners, voluntary sector organisations and the university with an independent chairman has been established.
In essence the role of the forum is to advise the Programme Implementation Board of stakeholder views on the implementation of health service changes in Hertfordshire. Patient involvement is being used to identify what is important to specific target groups in order that appropriate health messages can be delivered. Evidence received by members highlights the PCTs’ activity where patients, users, carers and public are involved in services and redesign. Members were pleased to note that a report commissioned from the Watford Council for Voluntary Service (CVS) will influence action planning.
As part of this work there has been ongoing training for staff to ensure respect and dignity for service users and carers, the development of a carers pack, greater involvement of carers in developing care plans, regular review of care plans, reviewing feedback from users and carers, impact assessment of carers situation, provision of the right information at the right place, review of the number of commissioned beds, review of inpatient environment, and providing a range of psychological therapies and improving waiting times for these.
With its increased operational capacity, the PALS has improved promotion of the service it provides and has seen significant improvements in gathering enquiries and in successfully resolving them; the majority of enquiries are resolved within 24 hours of receipt. A database of enquiries/complaints is being established to identify themes and trends; results will be available for the Health Scrutiny Committee’s scrutiny of standards for better health 2009/10.
Community involvement has increased, for example PALS attendance at Carer in Herts meetings, and at meetings of the Dentistry Panel (also at C18).
PALS worked with PohWER, who had been particularly helpful in establishing the PALS at The Mount Prison (also at C6).
The mental health users groups (Guideposts and Viewpoint) are confident that user views are taken into account when designing, planning and delivering and improving health services. Members noted that the results of the new service user questionnaire would be available later in 2009. With reference to the mental health scrutiny (Jan 2009) members were pleased to note that:-
- Viewpoint’s involvement in the independent review of mental health services
- Viewpoint’s membership of the ‘Implementation Group’, which is responsible for implementing the recommendations in the report prepared by the independent consultants conducting the review
- Viewpoint’s enhanced role in helping to design and to develop mental health services from the beginning
- Viewpoint’s work and relationship with the JCT, Hertfordshire Partnership Foundation Trust, Primary Care Trusts, and the County Council, which is now well-established
- Viewpoint’s representation on the Joint Commissioning Partnership Board; this is considered a positive step forward
- Viewpoint is now hoping to be able to gather the views of older people.
Members commended the appointment of an officer dedicated to ‘public engagement’. The PCTs’ report highlighted PCT activity where patients, users, carers and the public were involved in service redesign. A report due from Watford CVS (Council for Voluntary Service) would influence action planning. It should also be noted that a user group is represented on the Joint Commissioning Board and is, therefore, able to directly feed into the commissioning process. Members were assured of the Trust’s compliance with this core standard.
C18: Healthcare organisations enable all members of the population to access services equally and offer choice in access to services and treatment equitably.
Based on evidence received 4 & 25 February 2009, unless otherwise stated in the text.
The framework for improving inequalities across Hertfordshire includes a five year strategy, a health and inequalities action plan, Local Area Agreements, and Local Strategic Partnerships (LSPs). The Director of Public Health is represented on each of these (also at C22). The County is on target for reducing the number of teenage pregnancies and this could not have been achieved without partnership working between health, local authorities and voluntary sector agencies.
The PCTs consult widely and regularly with the local communities on the services commissioned and provided. The consultation documents are available in different languages. Members were pleased to note that the PCTs monitor uptake of the consultation documents to ensure better representation from all sections of the community.
The PCTs work in partnership with voluntary groups and have commissioned research regarding hard to reach communities. There are ongoing projects to engage with hard to reach communities, for example the BME (black and minority ethnic) community. This work is linked into activity being undertaken by the Implementation Group (responsible for implementing the recommendations arising from the review of mental health services) and will also inform the work of the HPFT’s ‘Delivering Race Equality Board’ and ‘Service User Council’.
Community involvement has increased, for example PALS attendance at Carer in Herts meetings, and at meetings of the Dentistry Panel (also at C17).
Members were assured of the Trust’s compliance with this core standard.
C22: Health care organisations promote, protect and demonstrably improve the health of the community served, and narrow health inequalities by:-
(a) co-operating with each other and with local authorities and other organisations
(c) making an appropriate and effective contribution to local partnership arrangements including Local Strategic Partnerships and Crime and Disorder Reduction Partnerships
Based on evidence received 4 & 25 February 2009, unless otherwise stated.
Members received a report from the PCTs’ operational leads for standards for each of the core standards identified by the Health Scrutiny Committee. The reports set out in detail the process adopted by the PCTs in preparing their draft declaration, key evidence to support it and the timetable and processes employed for finalising it prior to their submission to the Healthcare Commission.
Members were pleased to hear that the PCTs are undertaking work to baseline services to enable future monitoring of their impact. Reducing tobacco usage is being addressed through increased group work. Partners involved include Trading Standards, CSF, the PCTs, and environmental health departments.
Public health issues are complex and cannot be solved quickly. It is estimated that the NHS alone can contribute only 10% to improving inequalities in health care, the reminder has to be achieved through joint effort with partner organisations. Some partnerships are led by health, others by partner agencies. Members were reassured to hear that all Hertfordshire district/borough LSPs are considering public health measures/schemes with local PCTs involved (also at C18). Financial rewards made as a result of meeting LAA targets could lead to each LSP in Hertfordshire receiving £800,000 to spend on priorities within its Community Strategy. Each district/borough has a strand relating to public health within its Community Strategy.