Agenda and minutes
PDF 65 KBVenue: Ashcombe Suite, County Hall, Kingston upon Thames, Surrey KT1 2DN
Contact: Ross Pike or Victoria Lower Email: ross.pike@surreycc.gov.uk or Email: victoria.lower@surreycc.go.uk
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APOLOGIES FOR ABSENCE AND SUBSTITUTIONS
Minutes: Apologies were received from Tim Evans, Rachel I Lake, Chris Pitt and Karen Randolph. |
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MINUTES OF THE PREVIOUS MEETING: 19 MARCH 2014
To agree the minutes as a true record of the meeting. Minutes: The minutes of the meeting on 19 March 2014 were agreed as a true 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: None received. |
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QUESTIONS AND PETITIONS
To receive any questions or petitions.
Notes: 1. The deadline for Member’s questions is 12.00pm four working days before the meeting (26 May 2014). 2. The deadline for public questions is seven days before the meeting (23 May 2014). 3. The deadline for petitions was 14 days before the meeting, and no petitions have been received. Minutes: None received. |
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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: Item 6 was taken before Item 5.
Declarations of interest: None.
Witnesses: None.
Key points raised during the discussion:
1. The Chairman provided the following oral report:
Proposed Merger of Frimley Park with Heatherwood and Wexham Park The catchment area of Frimley Park Hospital is largely contained within the geography covered by Surrey County Council, Hampshire County Council and Bracknell Forest Unitary Authority.
I have therefore been in informal discussions with the Chairmen of the Health Scrutiny Committees for Hampshire, that is Pat West, and for Bracknell Forest, Tony Virgo. I am pleased to welcome Tony Virgo to our Meeting here today.
Ashford and St Peter’s Merger with Royal Surrey Hospital Since our last Meeting the 2 Management Boards have agreed to a merger. We intend to hear from Royal Surrey and Ashford and St Peter’s at our next Meeting on 3 July.
Health Accountability Forum Ross and I attended this event hosted by the Centre for Public Scrutiny. The event was attended by about 60 Officers and Members from around England.
The high point was a presentation by Mark Browne who is the Senior Civil Servant leading on the development of the role of Scrutiny in the changing Health Environment. Mark will be producing the long promised Government Guidance for Health Scrutiny, which understandably has been delayed because of the rapidly changing Health Service environment.
I brought away the following 3 messages for us: · The Health Service needs to change dramatically in the next few years. For example, the Keogh Report pointed the way ahead for Emergency Care. Generally Acute Health units need to become bigger and have Consultant level cover extending towards 168 hours a week. This will mean more major service reconfigurations that would be classed as ‘significant’ in our Terms of Reference. We have two such changes going forward in Surrey at the moment where Acute Hospital Trusts are merging and I mentioned those earlier.
Some reconfigurations may be highly controversial. The provisions of Clause 119 of the new Care Bill will make it possible, under certain circumstances, for changes to a local Health Economy to be dictated by a Government appointed Inspector. The impact of Clause 119 will be radical if it goes ahead as currently intended.
· Our role in scrutinising possible reconfigurations will change. The process of examination of such proposals will be expected to broaden to include more emphasis on local partnership. For us that will continue to include active engagement with residents. There will be a better defined resolution process with reference to the Secretary of State only as a very last resort.
· The move towards further integration of Health and Social Services is a key activity in meeting the challenges facing the Health Service. We have an important role to play in insuring that good value for money is obtained from the Surrey Better Care Fund.
Planning Our Work Programme All Members of the Committee will have the opportunity to become involved in planning our work –programme.
Ross has been organising ... view the full minutes text for item 27/14 |
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Care Quality Commission
Purpose of the report: Scrutiny of Services
The Committee will be given an overview of the developments in how the Care Quality Commission (CQC) inspects and regulates health services. Additional documents: Minutes: Declarations of interest: None.
Witnesses:
Claire Martin, Inspection Manager GPs (Surrey and Sussex), CQC
Key points raised during the discussion:
1. The Care Quality Commission (CQC) Inspection Manager provided the Committee with a presentation on how the Committee and CQC should work together, copies of the slides can be found attached to the minutes.
2. The Chairman welcomed the invitation for the Health Scrutiny Committee to interact more with CQC and suggested quarterly meetings be held with representatives of CQC and himself and the Scrutiny Officer.
3. Members requested further details on the inspections, including the planning and monitoring of Get Well Plans. The Inspection Manager explained that during inspections specialists also took part to ensure there was clinical expertise. Inspections would focus on any specific concerns that had been raised and would involve a sufficient number of CQC staff and specialists in order to address the requirements of the new inspection methodology. The Wave One inspections for hospitals had involved teams of up to thirty people.
4. For Primary Care inspections there would be a smaller team and a percentage of surgeries would be inspected within a CCG area; these often took place at the same time as acute hospital inspections so as to enable to CQC to gain an understanding of the health environment in an area. The CQC worked closely with NHS England and wanted to work more with partners including Health Scrutiny Committees.
5. The CQC were currently considering how often they should inspect sites, though they would always inspect if there were particular issues.
6. The Chairman queried whether the Committees Member Reference Groups would be welcome to attend the Care Summits so to enable better engagement with the process.
7. The Vice-Chairman requested the CQC be involved in the Committees Primary Care Task Group. The Inspection Manager confirmed that the CQC was aware that there were issues regarding access to GPs and the organisation was looking at Out of Hospital care.
8. The Inspection Manager informed the Committee that the CQC gathered information from a range of sources and they utilised this information to inform the inspections which took place. The Inspection Manager requested Members to pass on specific concerns from residents so they could be assessed by specialists.
9. Members queried whether the financial position of services was considered during inspections and were informed that the CQC were required to determine whether regulations were being breached and could not consider whether there were financially issues involved. It was the role of Monitor to work with acutes in financial difficulties.
10. Members queried whether the specialists worked permanently for CQC and whether they were paid for their services. They were informed that the CQC had a bank of specialists as they all had day jobs as clinicians, and that they were paid for their services.
11. The CQC felt that they did have enough resources to carry out their duties as they had been given more by the government.
12. The Inspection Manager informed ... view the full minutes text for item 28/14 |
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Frimley Park Hospital NHS FT merger with Heatherwood & Wexham NHS FT
Minutes: Declarations of interest: None.
Witnesses:
Andrew Morris, Chief Executive, Frimley Park NHS Foundation Trust Dr Timothy Ho, Medical Director, Frimley Park NHS Foundation Trust Alison Huggett, Director of Quality and Nursing, North East Hampshire and Farnham CCG Nick Markwick, Surrey Coalition of Disabled People
Key points raised during the discussion:
1. The Chief Executive informed the Committee that the hospital had a catchment area of around 420,000 people and that it was important that the hospital continued to increase its catchment to ensure it continued to be a super-acute hospital supply specialist super-acute services.
2. Heatherwood & Wexham had been in debt since 2009 and CQC had completed a full scale inspection and found the hospital to be inadequate. The hospitals Board and Monitor had reviewed the situation and decided that Heatherwod & Wexham needed a partner and that Frimley would be the best option. Frimley were aware that there was a lot of work to be done, and were strongly of the belief that the performance at Frimley should not suffer due to the merger. Rather, the hospital aimed to raise the standards at Heatherwood & Wexham to the Frimley level.
3. It was envisaged that the merger would save around £10million from back office costs, but would not affect frontline services.
4. Frimley had developed services to be more consultant led with 132 hour consultant cover in the maternity department, one of the highest in the country. It was the aim of the hospital to be at the forefront of delivering services and they wanted to change the culture at Wexham & Heatherwood so as to improve the service delivery.
5. Members were concerned that there needed to be a long term resolution to the issues identified and that services at Frimley should not be adversely affected by the merger. The Medical Director stated that they wanted to maintain the high clinical standards at Frimley, however there was the risk that the hospital would lose services if the merger did not go forward as good clinicians were attracted by hospitals with a broad range of services. Frimley were adamant that the issues at Wexham would be sorted at Wexham. The Chief Executive was firmly of the belief that it was not about rationalising services, however Heatherwood would need to be rebuilt and could become the elective care centre.
6. Members queried whether hospitals could close and were informed that hospitals cannot choose to close services as they were required to respond to the community’s needs. However, once a hospital was in financial difficulty it was hard to get out as they were required to make 4% savings each year. The hospital would need to find solutions to get out of special measures and it was felt that often a culture change was what was needed.
7. The Surrey Coalition of Disabled People were concerned about the patient experience and the requirement to travel long distances for services. The Chief Executive of Frimley Park stated that acute services would be ... view the full minutes text for item 29/14 |
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Rapid Improvement Event - Acute Hospital Discharge
Purpose of the report: Scrutiny of Services
The committee will review the progress and impacts of the actions identified in the July 2013 Acute Hospital Rapid Improvement Event. Additional documents: Minutes: Declarations of interest: None.
Witnesses:
Sonya Sellar, Interim Assistant Director – Adult Social Care Susan Reed, Associate Director of Site Services, East Surrey Hospital Melanie Nunn, Social Care Manager, Ashford & St Peter’s Hospitals
Key points raised during the discussion:
1. The Interim Assistant Director provided the Committee with an overview of the work which had taken place during and after the Rapid Improvement Event (RIE) on Hospital Discharge. The aim of the work had been to improve discharge by working together and sharing best practice with colleagues across the health environment in Surrey and representatives from Sussex and Hampshire County Councils.
2. The Associate Director of Site Services of East Surrey Hospital informed the Committee that they were auditing the Going Home Plan to ensure that it for fit for purpose, and there were starting discharge assessments as soon as possible. Furthermore the hospital had started to put on additional patient transport, at cost to the hospital, to ensure that patients were able to travel home.
3. Members queried whether the use of the step-up and step-down beds had been discussed with community providers as they had a number of beds available. The Interim Assistant Director explained that community providers were separate to the RIE and that the work was looking whether Social Care would be able to provide more beds for patients, however she would look into community provider involvement within her area.
4. The witnesses felt that the RIE had enabled the providers to do more for patients and better, as they were now considering the whole system process of a patient’s journey. The RIE had been about a change in culture for all involved in hospital discharge with more collaborative working.
5. Members stated that they hoped that there were no longer any discharges taking place during the night.
6. The witnesses stated that the RIE had been a catalyst to bring colleagues from across the health service together and there had been a recommendation to continue to have bi-annual workshops to continue conversations and improvements within the service, as there would always be a need for collaborative and innovative working. The work of the RIE had come to an end, with an evaluation process in July 2014, though best practice would continue to be shared across Surrey.
7. The Committee felt that the RIE had been a good piece of work and looked forward to seeing the evaluation documents to review informally.
Recommendations:
1. The Committee notes the progress made on hospital discharge as a result of last year’s Rapid Improvement Event and recognises that the changes made now constitute ‘business as usual’.
2. Officers to circulate the evaluation of the work-streams on completion in July whereupon scrutiny of the RIE will come to an end.
Actions/further information to be provided:
1. The Committee to be provided with the evaluation of the work-streams following the evaluation work in July 2014.
Committee next steps:
None. |
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Surrey Downs CCG Out of Hospital Strategy
Additional documents: Minutes: Declarations on interest: None.
Witnesses:
Miles Freeman, Chief Officer, Surrey Downs CCG Michael Gosling, Cabinet Member for Public Health and Health & Wellbeing Board
Key points raised during the discussion:
1. The Chief Officer of Surrey Downs CCG provided the Committee with a presentation on the Out of Hospital Strategy, a copy of which can be found attached to the minutes.
2. Members queried whether the CCG were monitoring progress against the actions taken, and what had been successful and what had caused difficulties. The Chief Officer explained that they had been focussed on the implementation of new services and felt that it was too early to review the success of the strategy. However, he stated that it appeared they had been able to reduce hospital activity marginally but that the costs had gone up which was being looked into.
3. The CCG felt that they were getting the health system and care right, but still needed to work on the finances. With specialist care commissioned by the Local Area Team it was estimated that costs had risen by 10 – 12%.
4. The Chief Officer informed the Committee that the number of referrals were 500 per week, rather than the stated 500 per year in the strategy document.
5. The CCG were looking to provide GP appointments for patients more at their convenience, whether that be at the patients surgery or elsewhere. The aim was to have a different surgery open later each day, however patients would need to opt in to having their details shared with other surgeries.
6. Virtual Wards aimed to avoid avoidable acute hospital admissions by providing care in the community through Community Medical Teams.
7. The Chief Officer explained to Member that GP services were commissioned by NHS England, and thus the CCG had no contractual control over the service provided by surgeries. However, the CCG was looking to put in an enhanced service with funding, but only if the surgery was of the right standard with appointments available and good customer service. Although the main issue within Primary Care was that there were not enough doctors. The Chief Officer felt that there needed to be a financial incentive to improve customer care at surgeries.
8. The Committee were informed that CCGs were able to put in expressions of interest for co-commissioning GP services by 20 June 2014. The CCG would only consider co-commissioning the service with caveats in place which ensured they would not take on financial strain.
9. Members queried the CCGs strategy for Cottage Hospitals and were informed that there were some ideas, however these had not been formed into a strategy to-date. The CCG had however, modelled where beds were needed during the year and were in discussion with other CCGs which did not have Cottage Hospitals as to whether they would commission beds. Stroke rehabilitation was also a consideration for the use of the beds.
10. Members queried whether difficulties with the different contract types were being tackled. All acute ... view the full minutes text for item 31/14 |
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Review of Quality Account Priorities
The Committee will review the MRG’s comments on priorities for the next year’s QA for those Trusts submitting priorities since the last meeting. Minutes: Declarations of interest: None.
Witnesses: None.
Key points raised during the discussion:
1. The Committee agreed to consider Quality Account priorities informally.
Recommendations: None.
Actions/further information to be provided: None.
Committee next steps:
1. The Committee to consider Quality Account priorities informally.
2. The Committee to continue to have Member Reference Groups to enable Quality Accounts to be reviewed by the Health Scrutiny Committee. |
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RECOMMENDATION TRACKER AND FORWARD WORK PROGRAMME
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:
Ross Pike, Scrutiny Officer
Key points raised during the discussion:
1. The Committee noted its recommendations tracker and forward work programme.
2. The Chairman informed Members that after the Committee meeting on 3 July 2014 there would be an informal workshop to discuss items to be scrutinised in the next year.
Recommendations: None.
Actions/further information to be provided: None.
Committee next steps:
1. The Committee to review its recommendations tracker and forward work programme at future meetings. |
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DATE OF NEXT MEETING
The next meeting of the Committee will be held at 10am on 3 July 2014. Minutes: The Committee noted the next meeting would be held on 3 July 2014 at 10am in the Ashcombe Suite.
Members were also reminded that the Health Scrutiny Event would be taking place on 19 June 2014 at Guildford Borough Council. |