Agenda and minutes

The Chairman gave details of action to be taken in case of a fire or other event that may require the building’s evacuation.

Apologies were received from Councillor Gillian Ford with Councillor Darren Wise substituting.

There were no declarations of pecuniary interest.

To agree as a correct record he minutes of the meeting held on 6 November 2014 and to authorise the Chairman to sign them (attached).

Under minute 28, it was clarified that there were in fact forty-eight GP practices in Havering rather than fifty-eight as stated.  

Other than this correction, the minutes were of the meeting held on 6 November 2014 were agreed as a correct record and signed by the Chairman.

To receive a presentation from senior officers of Barking, Havering and Redbridge University Hospitals NHS Trust on the Trust’s Patient Advice and Liaison Service.

BHRUT officers explained that there were Patient Advice and Liaison Service (PALS) offices at Queen’ and King George Hospitals open 10 – 12 pm and 2 pm – 4 pm. There were also a number of PALS phone lines open 9 am to 5 pm daily. The PALS team comprised three full-time and one part-time officers with the support of several volunteers.

The main areas PALS dealt with included general advice & signposting to relatives, analysing and responding to patient comment cards and logging and responding to compliments about services. Translation and interpretation services were for the Trust were also managed by PALS.

A total of 6,432 cases had been logged by the service in 2014 of which 5,720 were concerns. The most common area of concern related to appointments with other main categories being admission issues and problems relating to treatment received.

PALS aimed to resolve concerns directly with services but it could be difficult to provide timely feedback to enquiries. Signposting to formal complaints processes could also be carried out of necessary. There were no set national or local timeframes for PALS responses.

The capacity of the PALS service was also a problem. The service standard of a response within 48 hours was now being audited. One option was to reduce the number of PALS phone lines in order to allow staff more time to respond to existing issues.

85% of cases referred were successfully resolved by PALS. PALS staff were now attending more support groups for e.g. diabetes sufferers and PALS awareness days had been held at both hospital sites in order to publicise the service. Next steps for the service would see a standard operating procedure drafted which would see escalation of unresolved issues to a general manager after five days and a clinical director after 10 days.

Another option being considered was to have a member of PALS staff working in the appointments call centre in order that queries relating to appointments could be dealt with more quickly. PALS officers could also be present in for example A & E or the children’s ward.

Officers accepted that calls to PALS needed to be answered in a more timely manner. Around 60% of reports to PALS related to Queen’s Hospital and 40% to King George.

Many of the appointments team at the Trust were quite junior and training was in progress with this team in order that they would go back to the consultant or service more with any queries that had arisen. The Trust Chief Executive added that the point of contact in the relevant service should resolve appointment concerns direct. He also wished to introduce alteration of appointments being undertaken on-line. There was a need to change the Trust’s culture to fix concerns at the point of contact. There was also a need to train consultants in the computer system in order that they could book appointments direct.

Some 93% of PALS calls were now answered which compared to 40-45% previously. At peak times such as  ...  view the full minutes text for item 26.

The BHRUT Chief Executive explained the period October – December 2014 had been very challenging in terms of patient flows. The benefits of the Trust’s new initiatives in this area were however now starting to be seen. The Trust’s winter resilience procedures had been planned for several months and had been drawn up with the Council, CCG, NELFT and the London Ambulance Service.

Flu jabs had been provided to reduce on both staff and public. There were now approximately 45% of front line staff who had received the vaccination although the Trust’s target was 75%.

A Majors Lite unit had been introduced into A&E to speed up dealing with patients who may not need admittance onto a ward. These patients were seen in a separate area. An increasing proportion of discharges (around 30%) now took place in the morning. The majority still occurred after 12 pm however.

The number of patient admissions to BHRUT was very consistent at 95-100 per day. Daily discharge numbers were however more variable. A bed manager was now based in A & E and a bed manager was present in the assessment units. It was important that the pace of work in A & E was matched in the rest of the hospital.

The Chief Executive emphasised that clinicians had not been told to discharge patients too quickly and had to give a good clinical case for doing so. Admissions and discharges should be decided by consultants rather than junior doctors and this was the position the Trust was aiming for across its wards.

It was confirmed that it was monitored which nursing homes sent patients to A & E most often. A pilot scheme was in progress whereby a senior geriatrician was based in A & E in order that decisions could be reached more quickly on whether patient from care homes needed admission into the hospital. It was also noted that most Havering care homes now had a GP aligned to them. By the GP visiting the home on a weekly basis, the number of residents needing to go at A & E could be reduced.

The Trust Chief Executive agreed that it was unacceptable for triage to be carried out in clear sight of people queuing at A & E reception and the environment was not conducive to confidentiality. The issue of privacy would be addressed in the forthcoming reconfiguration of the A & E department.

The JONAH system was still used in discharge work as this was a consistent predictor tool for discharge. The Trust as a whole needed to discharge 100 patients daily, seven days per week. The elders receiving unit had consultant presence seven days per week but there remained vacancies to fill before this could be achieved on the Medical Receiving Unit. The Trust has been pleased with the response of the medical teams during the peak winter period.

It was noted that the Joint Assessment and Discharge Team had been put together by the health economy and that this helped discharge by for  ...  view the full minutes text for item 27.

Officers from Havering Clinical Commissioning Group and NHS Property Services will update the Committee on plans for the former site of St George’s Hospital, Hornchurch.

The Chief Operating Officer of Havering Clinical Commissioning Group (CCG) explained that the CCGH wished to have a health and wellbeing centre site of the former St George’s Hospital. An outline business case for the proposal needed to be submitted by the end of March.

A workshop had been held to update the plans for the facilities to go on the site which included a number of potential areas. There may not be a full GP practice on the site but access to GPs (as well as nurses and opticians) was likely to be offered. This could be for registered or non-registered patients. Working patients would be able to see a ‘drop-in’ GP at the site.

It was emphasised that the CCG wished to have services on the site that people wished to use and that were viable for the medium term (5-10 years). Members were not involved on the St George’s steering group but had been invited to the recent workshop. The CCG was keen to engage with the Sub-Committee on the St George’s issue and would look at involving Member as well as he Council’s Group Director in relevant meetings.

Patients treated at St George’s would be mainly from Havering but could come from other areas depending on what services were available at the site. Other proposed facilities included space to be used by the voluntary & community sector, or by Council services, an education and training centre for local people and NHS staff, diagnostics such as potentially x-ray or phlebotomy and a short-stay, rapid access assessment and diagnostic unit. A rehabilitation therapy centre was considered but this had now been overtaken by the introduction of new rehabilitation services.

Services such as diagnostics and the day assessment unit needed further work to ensure that they would be fully used if they were to be introduced to the site.

The findings of the recent workshop had included that services should be co-located and that the site should have a focus on wellbeing. It was felt that some mental health services should be available on the site and that the sharing of care records within a multi-disciplinary approach would be the best way to address patients’ needs.

Specification and modelling for the facility was being developed prior to the submission of the outline business case. There had also been significant changes to the local health economy recently with the GP Federation being established and evening and weekend GP access being introduced. The complex care organisation – Health 1,000 was also now in operation.

An options appraisal of the proposed new services at St George’s was currently underway. Funding for the new facilities would be separate from the rest of the health economy. Funds from the sale of the St George’s site went into national resources and the CCG could apply for capital to build the new centre at St George’s. It was also confirmed that NHS 111 would direct patients to any services on the St George’s site.

There was not  ...  view the full minutes text for item 28.

A director of Healthwatch Havering will update the Committee on the organisation’s programme of Enter & View visits.

A Director of Healthwatch Havering explained that Enter and View visits were an important part of the organisation’s work and formed part of the statutory powers of Healthwatch. Health and social care premises were visited by Healthwatch from the point of view of the service user. Healthwatch considered what patients and residents thought. Reports of visits were placed on the Healthwatch website and also sent to the Care Quality Commission, the Council and the CCG.

Healthwatch sought to make recommendations that made life easier for residents or patients such as e.g. the installation of a new sink and taps. Healthwatch always sought to make constructive criticism in its reports. It was possible to refuse admission for a visit but Healthwatch would report if this had happened.

Enter and View visits could be announced or unannounced. Healthwatch usually gave a time period within which they would be carrying out a visit not the exact date of when the visit would take place. Unannounced visits were also undertaken.

Healthwatch liaised with the Care Quality Commission and the Council’s Quality Assurance team. Healthwatch volunteers were trained in Enter and View, safeguarding and deprivation of liberty issues. Most Healthwatch Havering volunteers were retired health or social care professionals and were hence well informed. Healthwatch Havering strived to be a critical friend to organisations it scrutinised.

Enter and View visits had been carried out at care home for older people and for people with learning disabilities. The Healthwatch website showed reports and recommendations made relating to each visit and also gave a link to further details of each care home. An Enter and View visit had also been undertaken to the Queen’s Hospital maternity unit. A visit had also recently been undertaken to a ward at Goodmayes Hospital.

The Enter and View powers covered hospitals, GPs, dentists, pharmacies and opticians. A lot of different GPs had been found by Healthwatch to be seeing patients in care homes leading to more visits to A & E and work had been undertaken with the CQC to reduce the number of different GPs involved at each care home.  Enter and View powers allowed the identification and resolution of these types of problems.

The choice of location for Enter and View visits was discussed with the Care Quality Commission and Quality Assurance Team. Some ‘good’ rated homes had also been visited.

To consider any other items in respect 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 at the meeting as a matter of urgency.

There was no urgent business raised.