Agenda and minutes

To consider whether the public should now be excluded from the remainder of the meeting on the grounds that it is likely that, in view of the nature of the business to be transacted or the nature of the proceedings, if members of the public were present during those items there would be disclosure to them of exempt information within the meaning of paragraph 1 of Schedule 12A to the Local Government Act 1972; and, if it is decided to exclude the public on those grounds, the Committee to resolve accordingly on the motion of the Chairman.

The Chairman requested that all visitors leave the meeting room prior to Item 47 on the Agenda

(If any) – receive

Apologies were noted and no substitute members were received.

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

None disclosed.

To approve as a correct record the minutes of the Committee held on 14 August 2013 and to authorise the Chairman to sign them.

The Board considered and agreed the minutes of the meeting held on 14 August 2013 which were signed by the Chairman. 

To consider the Board’s Action Log.

Health and Wellbeing Board Meeting 14 August 2013

Members of the Board briefly discussed the concerns and issues raised during the last Board meeting following the presentation from the Queens Hospital Trust representatives. It was agreed that a further meeting would be arranged where Trust representatives would be invited back for the Board to conduct a strategic review.

Proposed Closure of King Georges Hospital Night Time A&E  

The representative from BHRUT announced to the Board the findings of the Clinical Review into the A & E departments at Queens Hospital and King George’s Hospital. The review had found that both A and E departments would continue to remain open during the day and night, however, the eventual phased closure of King Georges A & E would proceed as planned.

It was announced that Dr Mary E Black, as Director of Public Health, had been invited to attend the BHRUT planning meeting for the CQC Review in October. The Board were advised that it would be an open process and that feedback would be provided.  It was noted that Dr Black would attend as Director of Public Health and not on behalf of the Health and Wellbeing Board.

Review of Action Log

A further meeting with Queens Hospital representatives would be organised.

The Chairman would discuss further the formation of an Operations/Working Group linked to the Health and Wellbeing Board.

The Chairman confirmed that the Four Seasons Garden Project had been completed.

The Well Man Scans project had not been progressed.

The Chairman, Director of Public Health and the Chair of Health Watch would meet to discuss the Sexual Health Contract.

The HWB strategy for 2014 would be discussed at the next meeting and the Chairman recommended that the current 8 key priorities should remain the same, however, members of the Board were invited to forward any suggestions or changes.

Priority 2: Improved identification and support for people with Dementia

Verbal Report by Debbie Mayor, Dementia Programme Manager

Priority2: Improved identification and support for people with Dementia                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

Members of the Board received a tabled report that provided an overview on progress of delivery of the National and local Dementia Strategy.

Dementia remained a key national and local priority, as set out in the Havering Health and Wellbeing Strategy 2012-14 (Theme A: Prevention, keeping people healthy, early identification, early intervention and improving wellbeing). The National Dementia Strategy published by the Government in 2009 contained seventeen objectives, fourteen being relevant at local level which were:

Objective One: Improving public and professional awareness and understanding of dementia

Objective Two: Good quality early diagnosis and intervention for all

Objective Three: Good quality information for those diagnosed with dementia and their carers

Objective Four: Enabling early access to care, support and advice following diagnosis

Objective Five: Development of structured peer support and learning networks

Objective Six: Improved community personal support services

Objective Seven: Implementing the Carers Strategy

Objective Eight: Improving quality of care for people with dementia in general hospitals

Objective Nine: Improved intermediate care for people with dementia

Objective Ten: Considering the potential for housing support, housing-related services and telecare to support people with dementia and their carers

Objective Eleven: Living well with dementia in care homes

Objective Twelve: Improved end of life care for people with dementia

Objective Thirteen: An informed and effective workforce for people with dementia

Objective Fourteen: A joint commissioning strategy for dementia

The fourteen objectives were mapped to locally agreed pathways as agreed by the Dementia Partnership Board.  It was the intention of the Board to undertake a detailed self- assessment against progress in delivering and implementing the National Dementia Strategy. In further developing the work of the Board, two sub-groups were in the process of being established:

·                    Training and Education Sub-group: this group would be charged with achieving Objective 13 of the National Dementia Strategy, which was to have an informed and effective workforce for people with dementia.

·                    User Engagement Sub-group: this group would ensure that the voices and views of people with dementia and their carers were  heard and used to inform the on-going development of a range of quality services and initiatives

The key purpose of the Training and Education sub-group would be to develop and oversee the delivery of the Havering Dementia and Training Programme, and to ensure that all staff working with older people in the health, social care and voluntary sectors have access to dementia care training.

The User Engagement sub-group would ensure that service users and their carers are fully engaged in the development, implementation and progress to delivery of the local Strategy. Finally, in order to enhance capacity, and drive progress, LBH and Havering CCG have recently appointed a Dementia Programme Manager to support the work of the Board and its Sub-groups.

There had been a number of local public awareness campaigns about dementia and priority was currently being placed on establishing the true level of prevalence of dementia, and to understand the ‘gap’ in people receiving a diagnosis.  ...  view the full minutes text for item 46.

Consideration of a report containing exempt information.

Written report by Joy Hollister

The Group Director of Children’s, Adults and Housing introduced the exempt draft report (previously circulated to all Board members) for consideration and comment.

The Integrated Care Commission, which is committed to improving the services offered to the local population, had proposed the concept of a Joint Assessment and Discharge Service which would be responsible for the safe and timely discharge of patients from acute settings, (primarily Queens Hospital and King George’s Hospital), and would serve all three boroughs. It was hoped that the service would be implemented by April 2014.

Teams would be placed in wards and they would be able to discharge to any borough thus improving the patient experience as well as increasing hospital efficiency and effectiveness.  Barking and Dagenham had led on the project with the engagement of NELFT and BHRUT. 

Coalition members agreed the Design Principles at the workshop in April 2013 which were clarified by the Project Steering Group and translated into the following aims:

·                To facilitate safe return home through collaborative working;

·                To provide the integrated health and social care support required to discharge patients with social and/or complex medical needs;

·                To identify end of life patients who wish to be looked after at home and ensure that they receive expedited discharge with the right health and social care support;

·                To minimise delays arising from problems with inter-agency liaison;

·                To focus decision making with the service user at the centre of processes;

·                To analyse trends e.g. frequent attenders, borough trends, reduction in bed use, increase in community care packages.

The potential benefits identified:

·                Improved patient experience - supporting patients to be discharged to the most appropriate location first time;

·                Increase in numbers of people returning home and reducing the number of people going into residential and nursing home placements;

·                Single patient centred screening and assessment process;

·                Decline in complaints

·                Reducing length of stay and delays in discharge;

·                Potential release of capacity based on cross cover and shared resources across health and social care;

·                Reduction in number of voided section 2s and increase in the section 2 to section 5 conversion rate;

·                System talking with one voice;

·                Change in culture and reduction in organisational boundaries;

·                Cross service cohesion and joint decision making;

It was noted that the draft report would also be considered by Barking & Dagenham and Redbridge Health and Wellbeing Boards before being presented to the appropriate decision makers.

The Board Members noted the report and commented as follows:

a.         There was no mention of enablement within the “Discharge and Returning home”.

b.         It was noted that a manual information system would operate before the move to a shared electronic system, and Board members requested that a Risk Assessment and Audit should be carried out on the whole procedure.

c.         There were currently five other authorities/organisations involved in the proposed JAD and there was a need to build trust between the organisations.

d.         The Board requested further reassurance around costing and suggested that more work was required in this area, and also on population  ...  view the full minutes text for item 47.

Verbal update to report given on 8 May 2013 by Joy Hollister

The Board agreed to defer this item to a later meeting. 

Verbal Update by Alan Steward

The Board were advised that there was now a focus on the business case which had been forwarded to the Clinical Director. There were to be further discussions around ambulatory care/primary care and the possibility of moving four or five GP practices onto the site.

The original service model was to have included diagnostic clinics on site but there was a need to avoid duplication. PropCo were now the developers and would be looking at the business case as it was now a commercial model. NHS England had agreed funding on the basis of the business case, however, the risk would be transferred to Clinical Commissioning Group and therefore the plans must be viable.

Members of the Board were concerned that the business model would not include 24/7 care and that this would be a retrograde step.  The Board requested that the Clinical Commissioning Group look at the placement of additional urgent care facilities on the site in order to support A & E.

The CCG stated they were looking at opening some GP practices at weekends so as to provide access to urgent care however there were issues to resolve with NHS England.  A member of the Board suggested that it would be a useful exercise to question users as to why they chose Queens Hospital for their primary care rather than GPs, and also cited a shortage of GPs in Havering. 

The CCG confirmed that the business case for the redevelopment of St Georges would be finalised in January 2014 and that the current model offered enhanced and extended services during the day and, where possible, at night. 

The CCG were also currently carrying out detailed reviews with regards to 2014 on services, hospitals and primary care.   

Members of the Board are asked to note the date of the next meeting on 9^th October 2013 at 1.30 pm.

Members of the Board were asked to note that the next meeting would be held on 9 October 2013 at 1.30 pm.