Agenda and draft minutes

Venue: Havering Town Hall

Contact: Anthony Clements 01708 433065  Email: anthony.clements@oneSource.co.uk

Items
No. Item

46.

WELCOME AND INTRODUCTIONS

Details of the arrangements in case of fire or other events that might require the meeting room or building’s evacuation will be announced.

Minutes:

 

The Chairman reminded Members of action to be taken in the event of fire or other event requiring the evacuation of the meeting room.

47.

APOLOGIES FOR ABSENCE AND ANNOUNCEMENT OF SUBSTITUTE MEMBERS

(if any) – receive.

Minutes:

Apologies for absence were received from Councillor Linda Hawthorn (Councillor Alex Donald substituting) and Councillor Carole Smith (Councillor Garry Pain substituting).

48.

CHANGES TO MEMBERSHIP

The Sub-Committee is asked to:

 

1.    Note that Councillor Ford is no longer a member of the Sub-Committee and that Councillor Van den Hende has joined the Sub-Committee.

2.    Select a Member to replace Councillor Ford on the Outer North East London Joint Health Overview and Scrutiny Committee.

Minutes:

It was noted that Councillor Gillian Ford had recently left the Sub-Committee. Councillor Linda Van den Hende was welcomed by the Sub-Committee to her first meeting as a member.

 

It was also agreed unanimously that Councillor Van den Hende should take the vacant position on the Outer North East London Joint Health Overview and Scrutiny Committee.

49.

DISCLOSURE OF INTERESTS

Members are invited to disclose any interests in any of the items on the agenda at this point of the meeting. Members may still declare an interest in an item at any time prior to the consideration of the matter.

Minutes:

There were no disclosures of interest.

50.

MINUTES pdf icon PDF 204 KB

To agree as a correct record the minutes of the meeting held on 12 January 2016 (attached) and to authorise the Chairman to sign them.

Minutes:

The minutes of the meeting of the Sub-Committee held on 12 January 2016 were agreed as a correct record and signed by the Chairman.

51.

NORTH EAST LONDON NHS FOUNDATION TRUST (NELFT)

Officers from NELFT will update the Sub-Committee on the following issues:

 

·         Mental health support in the community

·         Intermediate care

·         The Acorns Centre

 

 

Minutes:

Mental Health Liaison Service

 

Officers from NELFT explained that, while acute hospitals had always had some mental health liaison services, this was generally patchy and people with mental health issues often fared badly in acute settings, leading to longer lengths of stay etc.

 

NELFT favoured a model based on rapid access, intervention and discharge (RAID). This was very expensive and funding had been allocated for an enhanced service available 24:7 on site in A & E for over 18s. This had allowed the introduction of parallel assessment whereby BHRUT and NELFT mental health liaison staff assessed patients together. Staff also went into A&E seeking to identify cases with a mental health element.

 

The target of seeing all patients referred in 60 minutes was met by mental health liaison staff on 94% of occasions. On-ward targets were being met at 100% and the service could have up to 120 referrals per week. Patient satisfaction with the service was high with comments indicating the team was caring and engaged with family members.

 

Work was also in progress regarding high intensity users – those who attended A & E more than 10 times per year. NELFT wished to reduce this by setting up complex care plans in order that these patients could be better supported in the community. 

 

The new service also sought to ensure people with dementia received appropriate care in hospital. Delirium could often be misdiagnosed as dementia and mental health liaison staff trained A & E colleagues in how to identify this. This had led to fewer breaches of targets at BHRUT. Other training offered to BHRUT staff included case discussions and more specific courses such as working with people with dementia.

 

Future initiatives planned included a street triage service to reduce the need for the Police to pick up people from the street under s. 136 powers. An under 18 service could also be introduced into A & E, albeit this would involve fewer patients and better IT systems would allow mental health records to be fully accessed from the A & E department.

 

It was emphasised that the mental health team worked closely with partners such as the Police and London Ambulance Service although more work needed to be undertaken with the Police. If the project was supported going forwards then work on mental health issues could also potentially be undertaken with Police Community Support Officers.

 

It was confirmed that there were now two s. 136 suites at Goodmayes Hospital which reduced the need for people with mental health issues to be held in police cells. Officers felt there should be parity in A & E between responses for physical and mental health issues.

 

Patients with mental health issues would still attend the main triage in A & E but mental health liaison service staff would seek to proactively identify these patients and try to offer other community-based routes of crisis support where appropriate.  

 

The Police were able to notify NELFT and the Council of people they had dealt with who had exhibited mental  ...  view the full minutes text for item 51.

52.

PRIMARY CARE STRATEGY (PMS REVIEW)

Update from health officers.

Minutes:

Officers explained that the Primary Medical Services (PMS) was one of several contracts used for GPs and this was now under review nationally. Fifteen Havering GP practices used the PMS contract which carried a total premium of £1.1 million and equated to additional funding of £10-12 per patient.

 

The London PMS offer had now been confirmed by NHS England and this included mandatory Key Performance Indicators (KPIs) such as influenza services and cervical screening as well as optional KPIs covering areas such as breast screening and walk-in centres. In addition, premium service specifications in the London offer covered better use of on-line technology for patients, Saturday morning GP openings (as seen at the two hubs in Havering which could now access patients’ GP records) and allowing additional hours and appointments capacity at practices. The total premium for Havering practices for these services equated to £11.18 per patient.

 

In view of these targets, PMS practices would be asked over the next year to increase patient uptake of on-line services. The Local Medical Committee had been receptive to overall commissioning intentions although individual negotiations with practices had not taken place as yet.    

 

Two practices in Havering now provided blood pressure and ECG checks and it was felt more effective to commission these types of services from GP practices. The new services would be monitored by Primary Care Commissioning officers as well as via the Council and Healthwatch.

 

In line with national trends, there was a shortage of GPs in Havering. Officers had sought to resolve this by working towards more place-based commissioning as well as considering new roles and career opportunities for GPs and other practice staff such as nurses.

 

It was confirmed that some practices allowed patients to register at the practice address in case of homelessness etc but thus did not apply to all Havering GPs. There were also plans to remodel the sexual health service to form a more attractive offer for women. Officers agreed that practice nurses could potentially be used to work on this service.

 

It was clarified that GPs owned patient records on behalf of the Secretary of State. Each time a patient visited a GP hub, they were required to give consent for their records to be shared.

 

As regards appointments where patients did not attend (DNAs) these constituted 9-13% of GP appointments in Havering and cost in the region of £1 million a year overall. It was hoped that work to extend access to GPs would result in less DNAs occurring. Officers would confirm which GPs offered phlebotomy services.

 

The Sub-Committee were pleased that work with NELFT such as the Community Treatment Team had won a number of awards and was seen as a best practice model. Staff morale in the service was felt to be very good.

The new GP practice was at Orchard Village as currently under procurement and was due to open in October 2016. The walk-centre for this area would remain at South Hornchurch Health Centre. The Kings Park surgery  ...  view the full minutes text for item 52.

53.

PUBLIC HEALTH EXPENDITURE pdf icon PDF 162 KB

The Director of Public Health will brief Members on the use of the Public Health Grant in Havering in 2016/17 (report attached).

Minutes:

The Interim Director of Public Health explained that when responsibility for public health transferred to the Council in April 2013, Havering had received one of the smallest grants in the UK. This had been based on the previous low expenditure on public health by the then Primary Care Trust. The Interim Director was required to account for how the Public Health Grant was spent and cuts to funding meant some services had been lost or reduced.

 

The total grant for public health services in Havering was £9.7 million but this had received a significant in-year cut of £688,000. A further cut of around £1 million was required in 2016/17 and an additional £300,000 in 2017/18. A paper had therefore been taken to Cabinet in February 2016 suggesting disinvestment in some public health services worth a total of £850,000. These cuts did not impact on the Council’s mandatory public health services nor on certain non-mandatory services such as school nursing, the drug and alcohol service and health champions.

 

Services that may be decommissioned included some sexual health and physical activity services as well as the stop smoking service. The final decision on whether to decommission these services was a matter for the relevant Cabinet Member.

 

The Council’s public health team had been cut by one third and offered a corporate support service to other Council departments and partner organisations such as the Clinical Commissioning Group. Services which received the most funding were health visiting, sexual health and drug & alcohol services.

 

The Interim Director accepted that the most controversial proposal was to decommission the stop smoking service. Some negative feedback on the proposal had been received but it was felt this constituted the ‘least worst’ option in order to make the required savings. Smoking cessation services for pregnant women would be retained and it was noted that people were making more use of electronic support and obtaining nicotine replacement products from their GP.

 

The prevalence of smoking had fallen and this had made the stop smoking service less cost effective. Other boroughs were also considering decommissioning of smoking cessation servicers and it was possible that a pan-London digital platform could be commissioned for this. It was emphasised that non-smoking was the norm in Havering although prevalence of smoking was higher in certain sub-groups that could be targeted via services such as the Healthy Schools programme.

 

The Interim Director wished to identify the added value provided by the service and there were therefore public health business partners for each area of the Council. The service was able to comment on section business plans and was looking to integrate an assessment of public health into decisions. There was also a target to raise the profile of the Healthy Workplace programme.

 

The current sexual health service operated on an open access basis whereby people referred themselves to clinics for e.g. sexually transmitted infections. The Council had to pay for all Havering residents who received these services (other than HIV services) even if they were  ...  view the full minutes text for item 53.

54.

HEALTHWATCH HAVERING

A director of Healthwatch Havering will update the Sub-Committee on recent Enter and View visits carried out by the organisation.

Minutes:

A director of Healthwatch Havering explained that the Care Quality Commission (CQC) had recently introduced an on-line map of care homes with links to their ratings and further details. The Healthwatch Havering website also now included links to the reports for facilities at which Healthwatch had conducted an Enter and View visit.

 

Healthwatch had received some complaints that patients registered at the North Street and Rosewood Medical Centres received inferior service compared to the GP hub surgeries at those sites. Healthwatch would be undertaking a review of the hubs in due course and would update the Sub-Committee on this work.

 

The three local Healthwatch organisations had been commissioned by the Clinical Commissioning Groups to consult the public on how they viewed Urgent Care Centres, Walk-in Centres and similar facilities. As such, a questionnaire on these and related issues had been distributed by Healthwatch. The results of this research project would be reported to the Clinical Commissioning Groups and an update given to the Sub-Committee.

 

 

 

55.

URGENT BUSINESS

To consider any other items of which the Chairman is of the opinion, by means of special circumstances which shall be specified in the minutes, that the item shall be considered as a matter of urgency.

Minutes:

The Clerk to the Committee advised that preparations were continuing for the topic group review of delays to treatment at the Hospitals’ Trust. The Director of Healthwatch Havering added that the Trust had been very supportive of the review thus far. It was noted that an initial briefing for the review would be held on 6 April and the Sub-Committee agreed some minor amendments to the scope of the review that had been suggested by Healthwatch Havering.

 

A Member reported staff from a local care home had complained that residents were at times being discharged from Queen’s Hospital with cannulas left in their hands and without discharge letters or medication being provided. The Director of Healthwatch Havering agreed that the organisation would investigate this.