Agenda and minutes
PDF 183 KBVenue: Ashcombe, County Hall, Kingston upon Thames, KT1 2DN
Contact: Ross Pike or Lucy Collier
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APOLOGIES FOR ABSENCE AND SUBSTITUTIONS
There are no apologies or subsitutions. Minutes: Apologies were received from Bill Barker and Graham Ellwood
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MINUTES OF THE PREVIOUS MEETING: 16 SEPTEMBER 2015
To agree the minutes as a true and accurate record of the meeting.
Minutes: The minutes were agreed as a true record of the meeting. |
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DECLARATIONS OF INTEREST
To receive any declarations of discloseable 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 recieve any questions or petitions.
Notes: 1. The deadline for Member’s questions is 12:00pm four working days before the meeting (Friday 6 November 2015) 2. The deadline for public questions is seven days before the meeting (Tuesday 3 November 2015) 3. The deadline for petitions was 14 days before the meeting, and no petitions have been received.
A public question was received from Bess Harding Minutes: Question received from Bess Harding MBE, on 28 October 2015
The Board agreed to take this question under item 7
NHS response at annexe 1
Question received from Mrs Helena Windsor on 6 November 2015
Awaiting response
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CHAIRMAN'S ORAL REPORT
The Chairman will provide the Board with an update on recent meetings he has attended and other matters affecting the Board. Minutes: Management Problems at South East Coast Ambulance Service (SECAmb)
The CEO has accepted the findings of an investigation by Monitor and has begun to implement changes that Monitor requires.
I will be inviting the CEO of SECAmb to 7 January 16 meeting of this Board to explain matters, and on 18January I will be meeting Chairmen of other HOSCs in the South East to compare impressions.
Patient Transport Service
The re-commissioning of this non-urgent service is in its Prequalification Questionnaire stage with Invitations to Tender and responses to take place between January and March 2016. October Newsletter
We published our first Wellbeing and Health Scrutiny Board Newsletter in October. Please provide any feedback or suggestions to Ross or me.
Since our last meeting I have attended the Annual General Meetings of Surrey Heath CCG, NE Hants & Farnham CCG and Surrey and Sussex Hospital. All three achieved excellent involvement for the many members of the public who attended. Children and Adolescent Mental Health Service (CAMHS)
Margaret Hicks and I received a briefing on the joint work by the County Council and the CCGs to re-commission the CAMH Service. The documentation will be released in mid-November. The subject will be brought to this Board at our 7 January meeting.
Mental Health Crisis Concordat
· The Safe Haven Café in Aldershot is credited with reducing by 30% the number of people in crises attending A&E. Each Surrey CCG is introducing its own safe Haven Café. · Mental Health staff are providing a 7 night support service to Surrey Police. In a single year Surrey Police and Surrey and Border Partnership Trust (SABP) have reduced the number of people in crises that are held Police custody by a factor of 3 down to 6% · A plan has been agreed to develop an integrated communication and pathway between 111 and SABP, known as the ‘single point of contact’ · An out-of-hours assessment and respite service for young people in mental health crises is planned. Musculoskeletal (MSK) Services in North West Surrey
North West Surrey CCG had intended to re-commission its MSK Services from a single supplier in order to facilitate improvement to the patients’ pathway. A suitable supplier did not step forward and so that line has been abandoned for the time being at least. Re-commissioning of Community Services
The 6 Surrey CCGs and Surrey County Council have begun recommissioning of Community Services with some new contracts expected ... view the full minutes text for item 25. |
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ACCESS TO PRIMARY CARE
Purpose of the report: Scrutiny of Services
Following the investigation of the Board’s GP Access Task Group NHS Commissioners, including NHS England South, NHS Guildford & Waverley CCG and NHS Surrey Heath CCG, will be asked to discuss with the Board how the situation can be improved in the future.
Additional documents: Minutes: Declarations of interest:
None
Witnesses:
Dr David Eyre-Brooke, Clinical Chair, NHS Guildford & Waverley CCG
Dr Claire Fuller, Acting Clinical Chief Officer, NHS Surrey Downs CCG
Rose Hopkins, Head of Primary Care, NHS Surrey Heath CCG
Matthew Parris, Engagement and Insight Manager, Health watch Surrey
Key points raised during the discussion:
1. The Clinical Chair of Guildford & Waverley CCG stated the main issues related to access to primary care in Surrey. Principally, caring for the frail/ elderly was said to be one of the main financial costs as patients were getting older and had higher expectations. The Board queried the likelihood of NHS England recruiting 5,000 new GPs they were advised the probability of achieving this was quite low. Surrey’s recruitment problem was deemed to be less severe than elsewhere in the country allowing the NHS to learn from others experiences. Instead, the challenge was to offer services in a new way for example, urgent care was being integrated across hospitals and general practices.
2. The Head of Primary Care informed the Board that general practices in Surrey Heath had extended opening hours to 8am-8pm to increase GP appointment availability. This would reduce the number of patients going straight to A&E. Patients would be able to call up on the day and make an appointment for the same day. Surgeries will stay closed on weekend and patients will be urged to use the out of hour’s system. It was expressed that by working together, practices could control wasted appointments.
3. It was highlighted by the Board that communication is a key aspect of making the system work to its best ability. There was agreement that the public could be better informed of the extended surgery opening hours and accessible walk-in centres. It was noted that the main funding was also spent on extendable hours being applied to Nurses and Health care assistants, as well as GPs. The Board were given the example in this area of the Community Assessment and Diagnostics Unit on the Epsom Hospital site which had received good feedback from patients had prompted a meeting with the local press to publicise the services more broadly across the Mole Valley district.
4. It was reported that Healthwatch Surrey’s understanding of current patient experience of general practice is one of deterioration. It was suggested that part of the solution would require partners working together to agree and communicate what patients can expect when accessing their GP. It was stated that some GP practices are very successful in managing appointments in a way which suits patient’s needs, whilst others are not. This remains a priority for Healthwatch Surrey and it will be undertaking further work in this area. It was agreed by the Board that communication is vital when looking at ways to strengthen GP services in Surrey.
5. The Board asked what could be done by CCGs, by working together with the NHS and general practices to create a new model sharing practices in federations and by developing the ... view the full minutes text for item 26. |
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NORTH EAST HAMPSHIRE AND FARNHAM CCG COMMUNITY BED REVIEW
Purpose of the report: Scrutiny of Services
To describe the progress to date on North East Hampshire and Farnham CCG’s Vanguard Primary and Acute Care System new models of care project to review its community beds model. Minutes: Declarations of interest:
None
Witnesses:
Charlotte Keeble, Associate Director of Integrated and Urgent Care, NHS North East Hampshire and Farnham CCG
Key Points raised during the discussions:
1. The Board were advised that this project forms part of the CCG’s Vanguard programme which aims to reduce the number of people who are admitted to hospital. The main aim for the community bed review was said to be to ensure improvements of people’s experiences and to make sure the use of beds and facilities was meeting local needs.
2. The Board inquired about the scale of the review and the development of future options. They were advised the project was about admission avoidance – who could be cared for at a lower level. The CCG reviewed anonymised patient notes. There were flexible timescales attached to the project due to complexity and engagement has been extensive including working with the Wessex Clinical Senate.
3. A number of issues were identified by the review including the scale of the community portion of the health system and understanding the impact these services have on acute activity. The CCG had to deal with complex geography with different access criteria operating under different providers in different areas of the patch. For example, Farnham Hospital is a shared resource across neighbouring CCGs so there is a difficulty in controlling patient flows. Community bed stock needs to be seen alongside Integrated Care Teams – Frimley Outreach and Southern Health are merging services to transform Out of Hospital Care – to reduce admissions.
4. The Board inquired about the use of ‘step down beds’ - patients who are discharged from acute hospitals for specialist help or care - and whether this was hampered by delayed transfers of care. The Associate Director of Integrated and Urgent Care advised that this was not necessarily the case and that step down care did not always mean community beds and advised that Farnham hospital was underutilised as patients are inclined to travel longer distances to use their local services.
5. The Board were informed that Farnham Community Hospital had opened another ward for the overflow of winter with 22 new beds. A strict criterion had been introduced for patients admitted onto this ward (14-17 days use for those reabling) but these were closed at the end of March 2015 and were now under evaluation and engagement with the community and partners would continue over upcoming months to consider further options.
6. The Associate Director of Integrated and Urgent Care commented that local health and social care services would make the most impact, following this report and the development of new options, by giving people the right care at the right place.
Recommendations:
The Board welcomed the Vanguard work on community beds and the simplifying/standardising the pathways across geographies and providers.
The Board recommended that:
· A request on an update in the second quarter of 2016 in order to help publicise the results across Surrey. · An update on the broader Primary and ... view the full minutes text for item 27. |
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SURREY STROKE SERVICES REVIEW UPDATE
Purpose of the report: Scrutiny of Services
A countywide review of the stroke pathway is underway and the leaders of the review will present the work undertaken thus far and the next steps for the review
Report to follow
Additional documents: Minutes: Declarations of interest:
None
Witnesses:
Dr Claire Fuller, Acting Clinical Chief Officer, Surrey Downs CCG
SuziShettle, Head of Communications and Engagement, Surrey Downs CCG
Key points raised during the discussion:
1. A public question was received by Bess Harding (see item 4) about funding for consultants at Epsom General Hospital complementing the work done by the community to raise funds for equipment. The Acting Clinical Chief Officer answered the question by stating that the management for the stroke unit has improved and that they are recruiting a specialist stroke doctor to deal with the shortage issue. It was explained that this review aims to improve outcomes for Epsom and Surrey patients as a whole; it is not about individual services.
2. Witnesses felt that there was misinformation about treating stroke; in that it is not simply about the number of consultants there are, there is challenge because of a regional shortage of Speech and Language Therapists. Work to re-shape geriatrician roles may help but Health Education England have a role to play to improve quality, improve attractiveness and retain staff in this area.
3. The Clinical Chair also explained that strokes are more common among people with an irregular heart beat and that identifying this condition (known as Atrial Fibrillation) is important to help prevent strokes. It was stated that 70% of Atrial Fibrillation (AF) strokes are preventable, if all cases of AF were idenitifed and all patients correctly treated with anticoagulation. National campaigns such as ‘FAST’ have helped to raise awareness about the signs of stroke and what to do if someone witnesses someone having a stroke. The Board queried whether there should be a Surrey wide campaign for stroke recognition and the precursor to a stroke: Transient Ischaemic Attacks (TIA).
4. There was an overall agreement with the Board that stroke services were not acceptable, as it was stated that if you had a stroke in Surrey you are more likely to die than if you had a stroke and were living in London. It was decided by the Board that a more creative solution needs to be thought of to increase standards within Surrey hospitals by allowing everybody to access the right care.
5. The Board was advised that the Commissioners do not want to replicate London’s models but they do want to achieve their outcomes. This would require hyper specialist acute units in Surrey with the whole pathway under consideration – community provision; discharge capacity needs to improve especially in the east of the county around SASH.
6. The Board was concerned by the lack of access to Stoke Units in Surrey and what the workforce challenges were. They inquired when they will start to see progress and were informed that there will be a sustainable solution for Surrey, including Epsom, with six potential new consultants and recruitment opportunities for speech and language therapists.
7. A question was asked regarding the data presented to the Board including differences between Epsom & St Helier hospitals and ... view the full minutes text for item 28. |
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RECOMMENDATIONS TRACKER AND FORWARD WORK PROGRAMME
The Board is asked to review its Recommendation Tracker and Forward Work Programme. Additional documents: Minutes:
Key points raised during the discussion
None
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DATE OF NEXT MEETING
The next meeting of the Board will be held at 10.30 am on 7 January 2016. Minutes: The Board noted its next meeting will be held at 10.30 am on Thursday 7 January 2016.
Meeting ended at 12.55 pm. |