Agenda and minutes

(If any) – receive

Apologies were received and noted. 

The Chairman requested that named substitute/s should not attend Board meetings in place of a principal member/s. Items on the agenda due to be presented by members should not be introduced by non-members.

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 11 September 2013 and to authorise the Chairman to sign them.

The Board considered and agreed the minutes of the meeting held on 11 September 2013 which were signed by the Chairman. 

Following the presentation on Dementia received at the last Board meeting, it was agreed that the post of Dementia Programme Manager would be extended beyond the current six month tenure. Representatives of the Local Authority and the Clinical Commissioning Group confirmed that this would be funded by the Integrated Care budget and that the matter would be progressed.

Work on the formation of the Joint Assessment & Discharge Team was in progress and it was anticipated that the team would be in place by April 2014.

It was noted that 7 Day Working would be introduced by BHRUT at the hospital as of November 1 2013 together with the GP Weekend Scheme also scheduled to commence in November. Two GP surgeries are required to participate - one surgery would be within close proximity to Queens Hospital and one further away; expressions of interest are currently being sought from GP surgeries. The Board agreed that these measures were timely in relation to the onset of winter pressures. The Chairman offered the use of the Local Authority magazine and the website to publish the weekend service to ensure that patients are informed and aware of the services. NHS England stated that they had requested that all Public Health improvements should be advertised.

The Chairman had written to the local newspaper in response to an article on the future of the St George’s Hospital site.

The Board welcomed Margaret McGlynn, Care Quality Commission Compliance Manager to provide a briefing on the CQC revised inspection procedures for hospitals.  The Board noted the following:

·                    The CQC were changing the way they worked and had adopted new inspection processes. Future inspection reports would look different in that they would be talking about services and the leadership within those services. Inspection will be based upon 5 domains – safety, effectiveness, responsiveness, caring and well-led

·                    The inspection teams had increased in numbers (up to 36 members) and would include independent experts (e.g.; clinical consultants, directors of nursing, hospital chief executives and experts by experience).

·                    Areas to be inspected included: A&E, maternity, paediatrics, acute medical and surgical pathways, care for the frail elderly, end of life care and outpatients.

·                    Inspection teams would be on site between 5 – 7 days.  Each service would be reported on and this would form part of an overall executive summary.

In order to test the modifying process and obtain useful feedback, the final report would be subject to a Question and Answer session prior to publishing. A new rating system had also been introduced and would be applied following the inspection. This would not be based on stars/symbols but by a narrative driven by the 5 domains.

Members of the Board requested to know how the CQC evaluated interactions between staff and patients on assessing care, and whether they would be investigating cancelled appointments. The Board were advised that these areas would come under responsiveness and that the inspectors would look at how services are working for both the public and  ...  view the full minutes text for item 54.

i.          Urgent Care Centre

ii.         Queens/King Georges A&E

iii.        Planned closure of King Georges A&E

iv.        Progress on joint projects with Urgent Care Board and Integrated Care Board

Verbal Update by BHRUT

The Chairman welcomed Averil Dongworth, Chief Executive Officer of the Queens Hospital Trust. The Board noted the following updates:

Urgent Care Centre                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

The Urgent Care Centre utilisation rates were up to 32% and the CCGs were being provided with weekly reports. At the HWB Board meeting of 14 August 2013, there was a discussion about the contracted level of 45%-50%. These figures were based on a clinical audit that would agree a trajectory to increase utilisation. The audit was currently with the CCG. Original utilisation rates were very low and it had been a slow process to increase the figure to 32%. The figure had been benchmarked with other outer London Trusts where it was found to be below the average figure of 33-34%.

Members of the Board expressed their concern in that they considered 32% a low take up in usage of the Urgent Care Centre and asked what measures were being put in place to increase the figure. 

The Chief Executive of BHRUT advised that it was essential to put the right patients with the right treatment in the right place. A lot of work was done to stream patients or redirect them to GPs on arrival in A&E. The Trust would like to achieve a utilisation figure of 40 % and work was on-going in developing the NHS England UCC model and using it as a template. It was also the view of the Chief Executive of BHRUT that the CCG ought to pay the right tariffs for work done and that a clinical audit would help in addressing this issue. The CCG were billed for patient’s treatments, however if temporary staff were not recording treatments appropriately, then information could not be correctly coded which in turn affected the figures. It was therefore very important to have permanent staff and a modern IT system. 

A member representing the CCG advised that the CCGs had not been very proactive in the past but would be leading now as they had a better understanding of the position. A&E admissions had decreased slightly whilst attendances had increased marginally and there was still a lot of work to do. UCC utilisation rates were only 23% 2 years ago and the CCG would be investigating how the service is commissioned.

It was noted that Queens A&E was being redeveloped. There would be separate doors to A&E and the UCC which would make it easier to staff. 

It was confirmed that both UCCs at Harold Wood and Queens Hospital were operated by the same provider. The Chairman questioned why the Harold Wood centre was not being run according to the original plan of closing at 8.00pm and closed its doors to new patients at 6.00 pm. The centre should support 6 GPs and provide a 24 hour service. The representative from NHS England said that he would raise this issue in a meeting with primary care colleagues. The Chairman offered to forward the original plans if required. 

The  ...  view the full minutes text for item 55.

Priority 5: Better integrated care for the ‘frail elderly’ population

Presentation by Alan Steward

Priority 5:  Better integrated care for the “frail elderly” population

It was agreed to defer this item to a later meeting.

Discussion item.

It was noted by the Board that CCG and LBH officers were in the process of reconfirming priorities and that discussions would follow receipt of the JSNA. It was anticipated that a strategy would be available by November 2013. 

Verbal Update by Dr Mary Black

It was agreed to defer this item to a later meeting.

Written report presented by Kathy Bundred

Children

The Board received the Havering Local Safeguarding Children Board’s Annual Report 2012-2013 together with a further report highlighting aspects of the LSCB Annual Report.

Havering Multi Agency Safeguarding Hub (MASH)

A review had recently been carried out to benchmark the Havering Multi Agency Safeguarding Hub (MASH) operation with others and that a report would be released in November 2013. MASH continued to receive a high level of referrals of which a number were attributable to police MERLIN[1] notifications made to Children’s Services when a child comes to the notice of the police.  This was being addressed by the police who were looking into how they screen their work and reduce unnecessary information sharing with different agencies.

Child Protection Processes

The Havering Local Safeguarding Children Board (LSCB) Quality and Effectiveness working group continued to scrutinise the whole area of child protection. Thus far, the quality of the work has been good however Children’s Social Care have identified cases that remain on a child protection plan for only three months whilst others remain on a plan for 2 years.  An audit will be carried out and findings reported to the Quality and Effectiveness working group.

Looked After Children

Looked After Children had not been performing well however significant progress had been made following the implementation of an improvement plan. It was noted that there had been no serious case reviews during the last financial year. A priority for the partner agencies was to secure long term stability for Havering’s most vulnerable children with permanent and adoptive placements. 

Early Help

The LSCB agreed an approach to Early Help in July 2013. A report by the LSCB Quality and Effectiveness Group will be passed to the LSCB in January 2014 on whether the early offer of help strategy has resulted in improved measurable outcomes.

Havering LSCB

A LSCB Development Day is being planned for the LSCB Quality and Effectiveness group to explore how each partner agency quality assures its work and the methodology of reporting this information back to the Group.    

Havering LSCB had a new independent chair, Brian Boxall, who would be chairing both the Children and Adults Safeguarding Boards. Havering LSCB has a responsibility to ensure that thresholds are set appropriately and fully understood.  The current threshold document was developed by Children Social Care and ratified by Havering LSCB with inspection finding that practitioners understood thresholds and were confident in its application. 

In response to Working Together 2013, the London Safeguarding Board is developing a threshold document in consultation with all London Boroughs with the expectation that the threshold document will be adopted by Havering LSCB in early 2014.  Havering LSCB is in the process of undertaking an audit of section 11 compliance across LSCB partners. The LSCB will receive a report on agency compliance in January 2014

The Board noted the report. 

Adults

The Board received a tabled report on the Safeguarding of Adults and noted the following:

The introduction of the Care and Support Bill will place  ...  view the full minutes text for item 59.

(a)        St Georges Hospital site

None.

Members of the Board are asked to note the date of the next Health and Wellbeing Board meeting is on 13 November 2013.

Members of the Board were asked to note that the next meeting would be held on 12 November 2013 at 1.30 pm.