Minutes:
Item 103: BHRUT hospital admissions. There had been a slight recent drop, but the total was relatively static. There had been a drop of about 1% in the meeting of A&E targets with a significant dip expected in January, but otherwise totals remained the same. At Queens, looking at the seasonal variation, there was an overall drop in performance in meeting the A&E targets, but there were grounds for optimism as it was the right direction of travel.
There were issues within the Care Board around the Joint Assessment and Discharge team due to the reduction in size of the team. The Health and Wellbeing Board wanted some reassurance about how the team was to work. The reorganisation which created the Joint Assessment and Discharge team – hosted by Barking and Dagenham (and set up jointly with NELFT) – had shown a very good improvement of management organisation. The reduction in staff level was due to the funding being cut, but for the time-being those members of staff were being kept on (to June) whilst attempts were made to put in place other funding arrangements. In the short term, funding was covered, but planning for its replacement was needed now.
Conor Burke reported that Winter Planning had cost £5m and that projects were being reviewed to see what could be kept and what dropped. He reminded the Board that it needed to be aware of these funding issues. Doubts were expressed about the Primary Care Strategic Commissioning framework.
Item 106: Primary Care Commissioning – Orchard Village. Alan Steward stated that the CCG were looking for a move to different facilities, partly due to CQC requirements. They were in the process of negotiating a move from the current clinic accommodation. It was asked whether this would have greater medical capacity and the answer was that it would provide more than the existing facility as it would include a “walk-in” centre and a practice on the estate. The Chairman expressed his concerns about this being an under-resourced area within Havering. He was assured that there would be more local control than previously.
The Chairman emphasised the need to have a medical practice on the estate and asked for more information to come to the next Chairman’s Briefing. He said that there was a need to provide a ”proper” service to what was, he added, the most deprived area in the borough. He felt that there needed to be an end to the referrals to Harold Wood. This was not good. He was informed that temporary measures would be in place shortly.
Dr Aggarwal observed that there would be some 10,000 people in the area and there was a need to match service provision to the population’s needs. The Chairman agreed saying that there would be a huge demographic swing and there would be a need to model all provision for the area over a ten year period. He wondered whether there would be a large influx of people from Barking & Dagenham. It was observed that there would be a large Somali population growing in the area and he added that this was what the HWB should be doing: looking closely at the infrastructure required.
Anne-Marie Dean observed that there was a need to inform the population about what services were available and how they could be accessed.
Item 107: The Chairman asked whether the Federation Hub had received any publicity and was informed that a full page advert had been placed in the Romford Recorder as well as advertising in other local papers. The Chairman was concerned that advertising needed to be more widely presented as newspaper sales and general circulation were falling. Other media needed to be exploited.
Anne-Marie Dean stated that there was a need to ensure that reception staff etc. were properly briefed and trained to ensure they could advise properly. The problem was that it was difficult to get all the staff together at the same time due to their different shift patterns. She added that it was happening, it just needed developing.
The Chairman asked how many people were using the Hubs. It was stated that in the Romford Hub there was a 50% - 60% take-up of this new service. He asked whether there was scope for a third hub at the northern end of the borough and was reminded that the Harold Wood Centre had a walk-in facility so there was a possibility that one in Harold Hill could be used. There had been a pilot trial of weekend openings. This closed at the end of March (this had always been the intention) and was now being evaluated. The Chairman observed that the Romford Hub should receive more promotion that the Astra Close Hub.
A question was asked about the funding of the hubs. Conor Burke replied that once the initial funding from the Prime Minister’s Challenge Fund expired, the CCG would continue to match-fund them from the Nuffield Trust (LBBD). If the hubs failed to prove effective, it would be wrong to continue to seek funding and the availability of the PM’s Challenge Fund was very much dependent on the outcome of the General Election. The Chief Executive added that funds could be taken from other services to use where it was most needed. There was an element of dual running, so the Challenge Fund money would be useful.
Conor Burke stated that hospitals needed to cover their costs. This would not be easy, particularly in light of their reduced income. This would challenge most to manage themselves more efficiently.
The issue concerning the retirement of many of the borough’s General Practitioners was raised. The reality was that Havering was likely to be particularly hard hit as it differed from the rest of London – and even the rest of the country - as most of its current GP partners were reaching – or soon would be reaching – retirement (50% were already over 60) and there were serious concerns about what was being done to secure GP cover for the future. Conor Burke stated that he had only taken over primary care a fortnight earlier and so was only beginning to get to grips with the problem, but he agreed that it needed to be addressed as a matter of urgency because it took a long time to produce a GP.
The Chairman said that there was a need to look at single practice issues. One in three GPs said they were “fed up” and wanted to leave general practice whilst the General Medical Council had fewer numbers becoming qualified.
Dr Aggarwal added that new doctors were expressing a preference to be salaried rather than become partners. This could have an unfortunate effect when current partners came to retire; indeed, many returned to work even though they were officially in retirement. It was because of this that accurate figures in respect of GPs in an area could be skewed. To add to the problem, the earlier creation of “nurse-practitioners” was misleading – they simply did not exist.
The Chairman observed that to make matters worse, there was no accredited course for training health-care assistants who would help take pressure from GPs. He was of the opinion that such a course needed to be set up as a matter of urgency. He also wondered whether it would be feasible to employ underused education establishments and whether, if a suitable course could be found, the Board could set it up.
Conor Burke stated that this issue about aging had an impact across all health-care areas, for example: 50% - 60% of all care workers were over 50. The situation for the future did not look very promising.
Reference was made to the Commissioning Board and that it should become a Transformation Board. Anne-Marie said that it was the responsibility of the CCG and should be held in public and that perhaps a paper should be provided. Alan Steward replied that he would bring one to the next meeting.