Presented by Caroline O’Donnell
Minutes:
Officers from North East London NHS Foundation Trust (NELFT) explained that they wished to continue to widen the service portfolio of NELFT by moving into areas such as community nursing.
NELFT owned many buildings and estate in different stages of repair and wished to divest from properties where they had no control over infrastructure. There had also been investment into new properties such as the London Road Child Development Centre.
The Chairman felt that there were too many wasted facilities within Havering and that NELFT should talk more to organisations such as NHS England and NHS Property Services who were responsible for many local health buildings. There was currently no list of all health and social care properties within Havering although the CCG confirmed that this was being compiled.
NELFT officers felt that the London Road development was a good example of the different agencies working together. The building would be handed over to NELFT in December 2014. Services in the building would be based on engagement sessions that had taken place with stakeholders and the building would serve as a single access point for children’s mental health services. The CCG and Social Care were looking at ways to avoid duplication of work by voluntary groups.
There were a total of 120 extra health visitors recruited for the Outer North East London area. NELFT had programmes in place to support new health visitors and had also looked at its retention model. A ministerial visit had taken place to showcase the work done and a second visit was planned.
The Council chief executive explained that attempts were in progress to reach agreement across London on the transfer of early years commissioning which was due next year. Specific health visiting elements had been written into a much larger contract and the suggestion of the transfer of health visiting services to the Council without any funding for overheads was not acceptable. The Department of Health was therefore being lobbied to give Havering £432,000 for health visitor overheads and, while this had been agreed a figure by the Department’s area team, a meeting was due to be held with the Department of Health later that week in order to discuss the issue further.
It was also felt that some boroughs did not have sufficient health visitors for their 0-5 population. The caseload for health visitors also varied widely across London and was very heavy in Havering. NELFT officers agreed that it was difficult to recruit health visitors to Havering due to the high number of cases per health visitor. The Chief Executive added that the matter could be escalated to Members at London Councils if necessary.
The three local boroughs were underfunded for health visiting compared to Inner London boroughs and local CCGs were also under capitation generally. It was necessary to try to use political levers to get funding for the Outer London boroughs. The Board Chairman suggested this matter could be discussed at a planned meeting with the Health and Wellbeing Board Chairmen from Barking & Dagenham and Redbridge. It was suggested that an agenda be drafted and the meeting hosted by Havering.
The NELFT Community Health and Social Care Service had been remodelled into multi-disciplinary reams. This had allowed teams to be co-located and engagement had also taken place with GP practices.
The Access and Assessment teams were now more responsive and meeting their improvement plan targets. There were also improved flows into the Community Recovery team. More people were also entering treatment via the Improving Access to Psychological Therapies (IAPT) service which had reduced waiting times and maintained high recovery rates. A recruitment programme for IAPT trainees had been developed in partnership with UCL.
Havering had been selected as a pilot area for Open Dialogue – a new treatment option. A cohort of staff had been trained in Open Dialogue techniques which focussed on recovery. The Open Dialogue technique had been used successfully in Scandinavia and the USA and was also felt to be more cost effective.
As regards services for older adults, the intermediate care service had been redesigned and the Community Treatment Team put in which had achieved very good patient satisfaction rates. The team had seen almost double the projected number of patients with Havering using approximately 55% of the service. The Board agreed that the Community Treatment Team had been very successful and well received in the community.
The Intensive Rehabilitation Service had also achieved good scores on the Friends and Family test. A total of 535 Havering patients had been seen thus far, representing 46% of the service.
Memory services had improved their diagnosis times and rates and service productivity and improved 100% leading to the award of MSNAP Excellent accreditation in October 2014. Going forward, NELFT wished to integrate physical and mental health services for older adults and was discussing this with the Council and CCG. NELFT officers would confirm the proportion of people scanned for dementia on entering the memory service.
The Chairman felt that there was still a lot of work to do on dementia services in Havering. NELFT officers accepted that the Victoria Hospital was not suitable in the longer term but improvements had been made to increase the clinical space available. It was confirmed that the disabled toilet at the site was now working. It was confirmed that the St Bernards Day Centre building was owned by London & Quadrant rather than NELFT.
The Chairman felt that a corporate policy was needed on dementia and the Group Director would bring a paper on dementia to the next meeting of the Board.
While 800 patients had been assessed at the memory service in the last 12 months, this did not equal expected figures for dementia prevalence. NELFT officers explained that GPs and the Older Adults team could both access the service. The dementia diagnosis rate had increased but the CCG wished to increase this further in order to meet the national target of 67%. A number of diagnoses of dementia were also made in hospital.
A scheme had recently started to combine the Community Treatment Team with the London Ambulance Service. In the first two weeks of operation, this had allowed around 60% of patients seen by the combined staff teams to stay at home rather than go to hospital. The Chairman pointed out however that attendance figures at A & E were still not reducing. The Council Chief Executive felt that there was now more confidence in the BHRUT team and that work could start to tie in the BHRUT and Council improvement plans. This would however require a lot of work.
It was necessary to improve efficiency flows through the hospital and the Council was supporting the hospital to recruit more good clinicians. This could be discussed further at a private meeting with the BHRUT chief executive scheduled for 15 December. Better use was now being made of data to track problems in the system.
While the Board had made frailty the first priority to reduce the numbers of people going into hospital, it was felt it may now be necessary to look at other types of hospital attendees. The Healthwatch representative added that she was now more confident that community teams could deliver.
The system of dressings used by District Nurses was being addressed and an update on this would be brought to the next meeting of the Board.
The Board NOTED the update from NELFT and thanked the officers for their attendance.