Agenda and minutes
PDF 136 KBVenue: Ashcombe Suite, County Hall, Kingston upon Thames, Surrey KT1 2DN. View directions
Contact: Leah O'Donovan or Victoria Lower
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APOLOGIES FOR ABSENCE AND SUBSTITUTIONS
Minutes: Apologies for absences were received from Hugh Meares, Caroline Nichols and Colin Taylor. |
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MINUTES OF THE PREVIOUS MEETING: 24 JANUARY 2013
To agree the minutes as a true record of the meeting. Minutes: The minutes were agreed as an accurate record of the meeting. |
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DECLARATIONS OF INTEREST
To receive any declarations of disclosable pecuniary interests from Members in respect of any item to be considered at the meeting.
Notes: · In line with the Relevant Authorities (Disclosable Pecuniary Interests) Regulations 2012, declarations may relate to the interest of the member, or the member’s spouse or civil partner, or a person with whom the member is living as husband or wife, or a person with whom the member is living as if they were civil partners and the member is aware they have the interest. · Members need only disclose interests not currently listed on the Register of Disclosable Pecuniary Interests. · Members must notify the Monitoring Officer of any interests disclosed at the meeting so they may be added to the Register. · Members are reminded that they must not participate in any item where they have a disclosable pecuniary interest. Minutes: No declarations |
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QUESTIONS AND PETITIONS
To receive any questions or petitions.
Notes: 1. The deadline for Members’ questions is 12.00pm four working days before the meeting (Friday 8 March 2013). 2. The deadline for public questions is seven days before the meeting (Thursday 7 March 2013). 3. The deadline for petitions was 14 days before the meeting, and no petitions have been received. Additional documents: Minutes: A question was tabled from County Councillor Will Forster.
“I understand that about 16% of over 75s need emergency readmission to hospital within 28 days of being discharged. This number has doubled in the last 10 years.
“Is the Health Scrutiny Committee aware of this? What discussion has it had with the local NHS on this issue?
“Please could the Chairman tell this Council about work that is planned to lower the numbers of patients, especially elderly patients, being readmitted in Surrey?”
Comprehensive responses were received from all but two of the CCGs by the time of the meeting. These responses were tabled and are attached to these minutes as an annexe. Members were advised to read these at their leisure and any further responses would be circulated upon receipt. |
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CHAIRMAN'S ORAL REPORT
The Chairman will provide the Committee with an update on recent meetings he has attended and other matters affecting the Committee. Minutes: Epsom Hospital Meeting On Friday 1 March I attended a Hospital Summit organised by Epsom & Ewell MP Chris Grayling. We discussed the future of Epsom Hospital in relation to the BSBV programme. The outcome was for a working group to be put together under the Health & Wellbeing Board to look at options for Epsom Hospital going forward.
BSBV decision delayed You are likely to have seen the news that the BSBV board has delayed the decision on its preferred options for consultation. This is due in part to lobbying by the County Council, local MPs and councillors along with GPs and consultants in Epsom. I am glad that the BSBV team is taking time to look again at all options, avoiding a rush to a decision before the 1 April NHS restructure.
CCG Meetings Members of the Committee and I have been meeting with the CCGs in readiness for the new NHS structures going live on 1 April. These meetings have been extremely useful to gain understanding of their priorities for the next year and getting to know them informally. We look forward to welcoming them to our meetings next year.
Healthwatch Tender Outcome The outcome of the Healthwatch tender has been announced. Surrey Independent Living Council, Citizens Advice Surrey and Help & Care will together be Surrey Healthwatch. The group will take on its role on 1 April and will be able to influence policy, planning and delivery of health and social care services. They will also provide information and advice to help people access and make choices about services.
The Committee thanked LINk officers and volunteers for all their hard work.
Alan Young spoke about the announcement that morning from the Health Secretary regarding the abolition of gagging clauses in NHS severance packages. The Committee agreed this was a welcome change that would bring additional transparency.
He also spoke about a report published that morning regarding the number of CCG board members that were likely to have a conflict of interest in organisations with whom the CCG would be contracting. He indicated that it would be beneficial for the Committee to look into this in future. The Chairman indicated that there would be continuing informal meetings with the CCGs and this could be monitored through these meetings. |
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SOUTH EAST COAST AMBULANCE (SECAmb) PERFORMANCE DEEP DIVE
Purpose of report: Scrutiny of Services
The Committee will scrutinise South East Coast Ambulance (SECAmb) on its performance in the Guildford and Waverley areas, comparing urban and rural response times. Additional documents: Minutes: Declarations of Interest:
None.
Witnesses:
Geraint Davies, Director of Corporate Services, SECAmb Rob Bell, Head of Commercial Services Lorna Stuart, Senior Operations Manager Marion Heron, Associate Director supporting Transition, NHS Surrey Cliff Bush, LINk Chair Carol Pearson, Chief Executive, Surrey Coalition of Disabled People
Key Points Raised During the Discussion:
1. The Director of Corporate Services provided an overview of the service. The plan is to have three Make Ready Centres (MRCs) at Chertsey, Tongham and Merstham. There are 18 old ambulance stations being replaced by 29 patient led Ambulance Community Response Posts (ACRPs). Across the south east coast , SECAmb performance year to date is 76% of Red 1 calls responded to within eight minutes; however Surrey is just under at 74%. The target is 75%. The service faces several challenges, one of which is reducing emergency hospital admissions. SECAmb uses ‘Hear & Treat’ to try to deal with patients over the phone when an ambulance may not be necessary. The aim is to reduce pressure on the acute hospitals.
2. Calls to the ambulance service are categorised into Red 1 and Red 2. Red 1 calls are the most critically ill patients and should have an ambulance response within eight minutes. SECAmb receives about 18 Red 1 calls a day.
3. Members queried patient satisfaction with the service. The Director of Corporate Services indicated that a patient satisfaction survey is carried out by the service and that this would be shared with the Committee. Overall, patients indicated they are satisfied with the ambulance service. Where a patient is dissatisfied, a sample of these is followed up with a telephone call. The Director of Corporate Services also indicated that, often, the primary complaint is not receiving an ambulance; however, when the rationale for not sending an ambulance was explained, patients tended to understand better and were then satisfied with the service received.
4. Members queried how the calls were categorised: for example, if a patient is having a stroke that is not severe, a road accident victim or an elderly person collapsing. Witnesses responded that this can be a grey area; however there are keywords that, if heard during the phone call, will inform the call responder to appropriately assess whether the call is a Red 1 or Red 2. Members queried the use of ‘Hear & Treat’ on patients: for example, someone in severe pain but it is not life threatening. Witnesses responded that, again, it is very dependent on the responses given to the key questions the responder is asking.
5. There was concern amongst Members that calls were being downgraded in rural areas in order to meet performance targets. Witnesses responded that, across Surrey the service is managed on a daily basis to serve the community, be it directly with the patient or through a healthcare professional. SECAmb are transparent on their data and recognise that rural areas do not always receive the same service as urban areas. All calls are assessed clinically, in line with the appropriate ... view the full minutes text for item 15/13 |
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PATIENT TRANSPORT SERVICES
Purpose of report: Scrutiny of Services
The Committee will scrutinise South East Coast Ambulance (SECAmb) and Surrey County Council on the delivery of the patient transport contract. Additional documents: Minutes: Declarations of Interest:
None.
Witnesses:
John Furey, Cabinet Member for Environment & Transport Geraint Davies, Director of Corporate Services, SECAmb Rob Bell, Head of Commercial Services, SECAmb Tracey Coventry, Transport Co-ordination Team Manager Marion Heron, Associate Director supporting Transition, NHS Surrey Carol Pearson, CEO, Surrey Coalition of Disabled People Cliff Bush, Chair, LINk
Key Points Raised During the Discussion:
1. The Cabinet Member attended the meeting and gave an update on the contract. He recognised that there had been several issues with the delivery, since the contract had gone live in October 2012. One of these key issues was the transfer of G4S staff into SECAmb, assessing their skills and competence. Many had to be retrained to ensure that they were in line with PTS and SECAmb requirements. The second issue was the age of some of the vehicles. He advised that the new vehicles had not been delivered in time but that they had begun to be rolled out in mid-February 2013. The service is now delivering 18,000 transports a month within Surrey. It was reported that 85% of journeys were on time and that 91% of patients were on the vehicle for less than one hour. There is work currently being done to ensure that the eligibility criteria are clear for all groups and there are plans to roll out the booking solution.
2. The Committee was advised that the contract had still not been signed but that it should be done within the next week, before the end of the financial year. There had been concerns regarding the Director appointed by NHS Surrey but this has now been resolved. The Cabinet Member indicated that Surrey County Council was fortunate to have such a good working relationship with SECAmb that ensured the service was delivered effectively without a contract. He indicated that SECAmb had worked closely with the Transport Coordination Centre to ensure a smooth PTS transition. He continued by saying that it was due to good will on all sides that ensured patients had not suffered and it should be acknowledged and applauded that these groups had worked together well.
3. LINk, providing a patient perspective, stated that the patient experience had not been good; however the various groups have worked together to resolve and take forward a better service for the patient.
4. SECAmb’s Head of Commercial Services informed the Committee that they were seeking feedback regarding the patient experience and this will be reported back in due course.
5. Surrey’s Transport Co-ordination Team Manager reported that there is a centralised booking service that had initial problems, but these have now been resolved. Patients will soon be able to access one telephone number, which will then have options for the centralised booking service or for SECAmb.
6. The Chief Executive of Surrey Coalition of Disabled People stated that the problems had arisen due to lack of clear direction and this had been disappointing. She indicated that the Cabinet Member and his team have ... view the full minutes text for item 16/13 |
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LINk STROKE REHABILITATION PROJECT FINAL REPORT
Purpose of report: Scrutiny of Services/Policy Development
The Committee will receive the final report of an investigation by LINk and scrutinise post-stroke rehabilitation services across the County. Additional documents: Minutes: Declarations of Interest:
None.
Witnesses:
Jane Shipp, Development Officer, LINk James Stewart, Patient Carer, LINk Cliff Bush, Chair, LINk Marion Heron, Associated Director supporting Transition, NHS Surrey (representing Maggie Ioannou, Director of Nursing and Quality, NHS Surrey)
Key Points Raised During the Discussion:
1. The Chair of LINk indicated that the report had been produced by volunteers who had worked many hours to gather and compile evidence. The Development Officer indicated that they had collected many patient stories that were unfortunately similar to the carer’s story.
2. Witnesses highlighted three of the recommendations in the report to be addressed. First, for the struggling carers what is offered or available is not always clear. Sometimes there is no written no care plan nor any indication of what is happening and a genuine lack of available support. The second is to work with commissioners on engaging with patients and carers to deliver the best service after leaving acute care. Finally, therapy for stroke patients after leaving hospital. When patients are in a rehab hospital, they often receive daily therapy, seven days a week, but this then drops to sometimes less than five days a week. The report also highlighted inequity of provision in the east of the County. The report recommends a review of services county-wide, ensuring that patients are receiving rehabilitation and focusing on gathering evidential stories to back up what patients’ needs are.
3. The Carer thanked the Committee for allowing him to share his story and raise the systematic issues that he and his wife had faced post-stroke. He stated that their concerns had been highlighted in many of the stories. He praised the work of the volunteers and thanked the Stroke Association for their support. He also encouraged organisations to work together to ensure that the patient is the central focus. He stated that strong leadership would ensure these improvements.
4. The LINk Chair was grateful for the Carer bringing the story to his attention. There is pressure on hospitals to discharge quickly but there needs to be quantifiable investment to ensure that stroke patients are provided with relevant therapy. He mentioned that the cost of early discharge may be not cost effective in the long run due to other impositions on the patient, such as cost of long-term therapy.
5. Members questioned impartial assessments of the person undertaking the Milford Hospital visits given the volunteer’s involvement with the hospital pressure group some years earlier. Witnesses advised that the individual was a volunteer and that the group had used all of the resources that were available to them at the time. The enter and view reports were shared with the providers prior to inclusion in the report, giving them an opportunity to address any issues.
6. Members queried if there was additional information regarding how post-stroke rehabilitation impacts children. Witnesses responded that there was no specific data within Surrey around post-stroke rehabilitation for children. They also advised that there are now stroke patient registers and, going forward, ... view the full minutes text for item 17/13 |
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PERFORMANCE AND QIPP UPDATE
Purpose of report: Scrutiny of Services
The Committee will scrutinise performance against QIPP savings targets and national performance indicators. Additional documents: Minutes: Declarations of Interest:
None.
Witnesses:
Marion Heron, Associate Director supporting Transition, NHS Surrey
Key Points Raised During the Discussion:
1. Members noted the mixed sex accommodation breaches and asked if there were any further details, specifically those at Epsom & St Helier Hospitals. The witness did not have any specific information but would be able to find out and report back via the Scrutiny Officer. The Scrutiny Officer also responded that, in the past, Epsom & St Helier had been affected by mixed sex accommodation breaches primarily at Epsom Hospital and mainly when the patient had been moved from the High Dependency Unit onto a regular ward. Nonetheless, further clarification would be sought from NHS Surrey.
2. Members also sought clarification regarding Healthcare Acquired Infection breaches within the limit and whether Epsom & St Helier hospitals had now been fined for this. The witness stated that the target had been met, meaning there had been a fine. It was noted that, from a previous conversation, this would be a £5.7m fine.
3. Members queried why Ashford & St Peter’s A&E were not meeting their waiting times targets. The witness responded that Ashford & St Peter’s is reviewing its A&E pathways as well as the services outside of the hospital. The CCG will be setting quality targets and reviewing the overall performance of the hospital.
4. Members queried why Frimley Park Hospital and Royal Surrey County Hospital were on amber for their A&E waiting times. Were recent events the cause for the drop in performance? The witness stated that she didn’t have specific data but that there has been pressure on all acute hospitals in the last few weeks.
5. Members questioned if the provision of Health Checks had stopped. The witness indicated that, previously, targeted groups of individuals received invitations for a health check, but that this would be opened up further going forward.
6. Members questioned what the current situation was with the Jarvis Centre and other providers taking its breast cancer work. The witness indicated that Virgin Healthcare and Royal Surrey County Hospital will be managing the additional demand for the time being. The mobile units will be used for assessing and the Royal Surrey County Hospital will be used for further investigation.
7. Members sought clarification on the Improving Access to Psychological Therapies (IAPT) target of 15% but only showing as 2.4%. The witness advised that the aim of 15% is for March 2015 and that procurement is currently being reviewed by CCGs.
Recommendations:
1. The officer from NHS Surrey is thanked for attending and providing the performance information. |
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REVISED HEALTH SCRUTINY REGULATIONS
Purpose of report: Policy Development and Review
The Committee will be updated on the revised Regulations governing Health Scrutiny Minutes: Declarations of Interest:
None.
Witnesses:
Leah O’Donovan, Scrutiny Officer
Key Points Raised During the Discussion:
1. The Scrutiny Officer updated the Committee on the key changes to regulations governing health scrutiny that had been amended and recently published.
2. Members questioned the requirement for a 20 working day response to a Healthwatch formal referral and the involvement of full Council in referring matters to the Secretary of State for Health. The Scrutiny Officer responded that the Committee would not have to consult the full Council before responding to Healthwatch and that a ‘holding letter’ would suffice as a response, prior to further investigations about the matter referred. Full Council will not have to endorse referrals to the Secretary of State but it may be useful for the Committee to ensure it is aware of what the Committee intends to do. |
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RECOMMENDATION TRACKER AND FORWARD WORK PROGRAMME
Purpose of report: Scrutiny of Services/Policy Development
The Committee is asked to monitor progress on the implementation of recommendations from previous meetings, and to review its Forward Work Programme. Additional documents: Minutes: Declarations of Interest:
None.
Witnesses:
Leah O’Donovan, Scrutiny Officer, Democratic Services
Key Points Raised During the Discussion:
1. The Scrutiny Officer indicated that the draft work programme was suggestions for the next year and was available for members to review at their leisure and comment on outside of the meeting.
2. Member thanked the Chairman for all of his hard work and showing excellent leadership for the group. Members also thanked the Scrutiny Officer for her support for the Committee. |
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DATE OF NEXT MEETING
The next meeting of the Committee will be held on 4 July 2013. Minutes: Noted that the next meeting of the Committee would be held on 4 July 2013. |