Agenda and minutes

The Chairman gave details of action in the event of fire or other event that might require the evacuation of the meeting room.

Apologies were received from Councillor Syed Ahammad, Barking & Dagenham and from Jaime Walsh, Healthwatch Waltham Forest.

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

Councillor Richard Sweden disclosed an interest as he was employed by North East London NHS Foundation Trust.

To agree as a correct record the minutes of the meeting held on 13 March 2014 (attached) and to authorise the Chairman to sign them.

The minutes of the meeting held on 13 March 2014 were agreed as a correct record and signed by the Chairman.

To receive an update on patient experience work at BHRUT from the Trust Deputy Director of Nursing.

The head of PALS and complaints at BHRUT explained that there had been a large rise in the number of enquiries received by PALS. Many of these were due to issues relating to the new Trust computer system such as appointment letters being duplicated or not being received. IT solutions to address this had now been put in place. There were however still concerns about patients being able to amend appointments etc.

There had been an increase in compliments received compared to the previous quarter. The highest proportion of both compliments and complaints related to A&E. Information could also be provided anonymously on the NHS Choices website which for the first time had seen more positive than negative comments relating to the Trust. The positive comments related mainly to maternity and A&E. Negative comments related mainly to difficulties in telephoning the hospital and all comments were responded to by the BHRUT Interim Medical Director.

The overall number of complaints had risen in the last quarter although the Trust response rate to complaints had also improved in that period. It had been found that patient surveys by kiosk or hand held device had not received a large response so patient surveys were now completed on paper as this generated a larger response rate from patients.

As regards the Friends and Family test, BHRUT was achieving a score of 65 for adult inpatients and 42 for A&E. This was slightly below the target for adult inpatients and well below that for A&E. It was accepted that a lot of work was required to improve patient experience in A&E.

A lot of information for patients had been placed on the BHRUT website. A patient handbook and a bedside handbook of information were also being developed. Patients could also nominate individual staff members for recognition or pass messages and comments direct to the Matron.

Measures to improve patient experience included the appointment of two patient & staff experience facilitators who spoke direct to patients on each ward. Information was reported back to wards monthly and it was wished to increase this. Welcome boards were also being installed in each ward.

Future developments would include the introduction, as part of a national initiative, of patient headboards indicating if for example patients suffered from dementia or needed assistance at mealtimes. More easy read patient literature would also be introduced.

Following a pilot scheme, a bereavement questionnaire was being introduced which would be sent to next of kin eight weeks after a patient’s death. Departments were also asked to specify what they had learnt from complaints that had been reported. Patients were also beginning to relate their stories and experiences at staff induction and training and at Trust Board meetings.

A mystery shopper programme using real patients would commence shortly. Monthly patient experience reports were produced and the previous year’s survey responses were also analysed.

The BHRUT officer was aware that there continued to be complaints concerning the hospital telephone and computer systems.  ...  view the full minutes text for item 49.

Representatives of NHS England will present to the Committee on plans and strategies for GP services in the areas covered by the Committee.

It was explained by the Deputy Head of Primary Care (London) at NHS England that this was a national organisation that had commenced in April 2013 with a very broad role. NHS England was responsible for commissioning services directly and for assuring the work of Clinical Commissioning Groups (CCGs).

Core GP services i.e. those operating from 8 am – 6.30 pm were commissioned by NHS England which also commissioned community pharmacies, optometry and dental care. NHS England procured, monitored and performance managed contracts and sought to raise the quality of primary care and poorly performing GPs. NHS England was also responsible for GP premises.

CCGs commissioned secondary care such as hospital care as well as non-core primary care e.g. special GP services. The NHS 111 service was also commissioned by CCGs.

There were however a number of overlaps between the two roles such as the estate strategy which was likely to see more services located on the same sites. NHS England and the CCGs also had to agree the primary care strategy together. The primary care strategy had a number of priorities including empowering patients and the public, publishing clear quality outcomes, and developing the workforce, GP premises and IT.

NHS England expected to see GP practices working together on a bigger scale in order to achieve economies of scale. This would see more extended opening hours and the officer felt that some GP surgeries would be open until 10 pm very shortly. GP practices would also make more use of text messaging and virtual consultations. More hospital-based services would move into the community although the position would be different in each borough.

It was explained that there were a lot of part-time GPs in the sector. As more practice nurses etc were introduced, the size of a practice list normally went up. Appointments at GPs were organised by the individual practice rather than NHS England and there were no targets for numbers of appointments in the current GP contracts. Patients should make complaints initially to the GP practice. NHS England received information annually concerning the number of GP complaints but not on specific issues.

Population information was held by the public health team in each borough and was also contained in the Joint Strategic Needs Assessment for each borough. This was the same for Essex and Epping Forest and it was agreed that the clerk to the Committee should ask NHS England for the GP statistics for the Essex area.

It was explained that NHS England arranged premises development but that NHS Property Services managed the buildings themselves and associated phone and IT systems. Many GPs had currently bought their own buildings. NHS England’s view was that many GPs could not give a full service to patients due to poor premises and it was therefore better to have groups of clinicians working together. The issue should be the quality of care and health outcomes rather than the number of practices. Comments on NHS Choices and reports from Healthwatch were  ...  view the full minutes text for item 50.

To receive a presentation from officers of North East London NHS Foundation Trust on mental health issues and services in this sector.

The NELFT representatives explained that access to hospital mental health in-patient services was normally via the NELFT home treatment teams. The establishment of teams had led to a reduction in the number of admissions to hospital. With effect from May 2014, NELFT would also be responsible for adult duty emergency services. There was a rising demand for referral into mental health services.

Mental health assessment opening hours were being extended in Waltham Forest and it was hoped do the same in the other NELFT boroughs. Psychiatric liaison services were accessible from the three local acute hospitals and it was aimed to direct mental health service users away from A&E.

Outpatient clinics were no longer used but community multi-disciplinary teams were used to offer short-term interventions. For older adults, the memory service was in place across the four boroughs. There were also strong links with the Alzheimer’s Society and other groups. Work was also in progress with Admiral Nurses in three boroughs and with the third sector with initiatives such as the Alzheimer’s Café.

It was explained that the work of the home treatment teams had led to only needing a low bed base in acute wards. There were two female 20-bed wards and three male 20-beds wards as well as a psychiatric intensive care unit. Female intensive care beds were spot purchased as required. Two complex recovery wards covered the four boroughs. Specialist in-patient services included Moore ward comprising 12 beds for patients with learning disabilities and Brookside – a tier 4 in-patient unit for young people. There remained two female and two male wards for older people.

Emergency mental health admissions via the police were conducted under section 136. There were two suites for this at Sunflowers Court where staff were available to carry out assessments. Once assessments were completed, patients would be moved to wards.

It was the case that there was no statutory requirement under some forms of section for patients to continue to be supervised after their release. There would however normally be some monitoring of these cases by the community recovery teams. The key was to ensure monitoring and stabilising of people in the community.

In-patient detox services were no longer commissioned but each borough had its own substance misuse services. It was confirmed that some psychological services continued to operate at Thorpe Coombe in Waltham Forest. The NELFT officers would supply further information concerning continuing care for older people in Waltham Forest.

The IAPT (Improving Access to Psychological Therapies) team was a primary care service. The team operated by phone or face to face but contacts were mainly by phone and allowed specialised cognitive behavioural therapy for depression or anxiety. The service was accessed by self-referral although information could also be given a person’s GP. Details on accessing the service were also available on the NELFT website.

Budgetary information was given in the NELFT annual report and the Trust was required by Monitor to retain a certain level of reserves.

The Committee noted  ...  view the full minutes text for item 51.

To follow if available.

The Committee noted that the report of the review by the London Clinical Senate into the proposals for changes to services for prostate cancer had been delayed and was now expected to be available towards the end of April. It was agreed that the clerk to the Committee should circulate this to all Members once it was available.

To consider any other item 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.

The Committee was addressed by a representative of a patients’ group in Essex concerning the cancer and cardiac proposals following a recent decision by the Essex Health Overview and Scrutiny Committee to refer the group to the Joint Committee. The representative felt that the views of Essex residents, particularly as regards access to alternative facilities under the proposals, had not been sufficiently taken into account and that mandatory, full public consultation should take place.

Members noted the address and sympathised with some of the views expressed. It was pointed out however that the Joint Committee had already reached a decision on the proposals and this included a strong recommendation that scrutiny of all aspects of the plans should continue as they were implemented.

The Committee agreed to note the continuing discontent with the cancer and cardiac proposals in the Essex area.     

It was suggested that the Committee should review GP contract arrangements at a future meeting.

The Chairman stated that the work of the Joint Committee had been very valuable and recorded his thanks to the Committee Chairmen from the different boroughs and to the officers supporting the Committee.