Minutes for Health in Hackney Scrutiny Commission meeting, Jul 13 2009, 7.00PM official page

1.1  Apologies from Mrs Murgraff representative of Hackney LINk

2.1  None

3.1  None

4.1  Minutes of the meeting were approved.

RESOLVED

Minutes approved

4.2  Matters Arising

4.2.1  Action 1 page 4 NHS City and Hackney advised a written response was provided to Cllr Middleton.  Cllr Middleton confirmed receipt of the letter but requested it was recorded she was unhappy with the response.

4.2.2  Action 1 page 5 following no response received from Hackney LINk or Mr McCabe.  The Chair advised the Commission would proceed with the Work Programme outlined at HiH meeting on 15/06/09.

4.2.3  Action 1 page 9/10 – The Chair advised a written submission was received from the voluntary sector organisation Shoreditch Spa noting it was included in the agenda on pages 87-94 for the Commission to note as part of the Health and Worklessness Review.

Presentation by Dean Henderson, Borough Director City and Hackney and John Wilkinson, Director, Performance and Business Development from East London Foundation Trust of the quarterly service update from the trust and the response to queries raised about the closure of the Nurse Counselling Service.  The main points of the presentation were:

5.1  The service update to the Health in Hackney Scrutiny Commission covered the following:

•  Service Developments and Highlights in the City & Hackney Directorate during the last 6

·  months

•  The Trust’s Priorities in 2009/10

•  Respond to Questions raised regarding the Closure of the Nurse Counselling Service

5.1.1  Service developments in the last six months were in relation to new and improved premises were:

•  In January 2009 the Assertive Outreach Team moved to New Premises in Shore Road.

•  In March 2009 the Adult Community Mental Health Teams serving the south of the

•  Borough moved to the Donald Winnicott Centre.

•  Homerton Re-provision Project – to provide a new Inpatient Facility for City & Hackney continues. St Leonard’s Hospital has been identified as the preferred site for the new Inpatient facility. The Outline Business Case for this development will be presented to the Trust Board for approval in July.

•  In March a new primary care liaison psychiatrist commenced work with the trust.  This was a new service aimed at assisting GPs.

5.1.2  The Ray Bould Dementia Centre opened in April 2009 this was a new development in the community in partnership with the primary Care Trust (PCT) aimed at improved awareness of dementia to provide early diagnosis.

5.1.3  A review was undertaken by ELFT Chief Executive looking at adult community services.  Proposals on the adult community services reorganisation was out for formal consultation with staff and trade unions.  The consultation was scheduled to end mid July 2009 and it is anticipated implementation will take place in September 2009.

5.1.4  Key points of the proposals were:

•  Maintaining the division in the Borough of North and South Sector

•  Community Mental Health Team (CHMT) Staff within each sector would be split into four sub-teams based around GP patches/postcodes

•  Within each sub-team, a small group of senior staff will comprise a Triage, Assessment & Brief Treatment Team; all service users will initially be seen by a member of this team

•  Consultant Psychiatrists will provide clinical leadership for each individual sub-team

•  New Roles of Associate Clinical Directors will be managerially and professionally accountable for the quality and performance of the sub teams in their sector.

5.1.5  The ‘Toward Independence Project’ was underway and making good progress against its objectives.

5.1.6  The trusts annual plan priorities were outlined for 2009/10:

·  Priority one Older Adult Services - particular focus in City and Hackney will be developing community services

·  Priority two In-patient Services - various pieces of work continue

·  Priority three Adult Community Services

·  Priority four Physical Healthcare – appointing physical healthcare team

·  Priority five Carer Services

·  Priority six Learning from  ...  view the full minutes text for item 5.

Presentation by David Woodhead, Joint Head of Healthy Communities for London Borough of Hackney (LBH) and NHS City and Hackney to talk about the draft JSNA document.  Some back ground information related to the JSNA was outlined noting this was the second year for the production of this document.  The main points of the presentation were:

6.1  Over time the JSNA is expected to produce trends and allow prediction of what will be needed in the future.

6.1.1  Production of this document is led by the Director of Public Health with input from Director responsible for Adult Social Care and Director of Children Services.  In Hackney the decision has been taken that the JSNA is driven by the local Strategic Partnership (Team Hackney) Thriving Health Partnership Board.

6.1.2  This year the JSNA has had active involvement from Hackney and City LINks and will also see a voluntary sector representative on the JSNA project board.

6.1.3  The aim this year is to get the JSNA document embedded to influence the commissioning of services, as this aspect of its role was uneven last year and the purpose of the document is to inform commissioning of services.  A further aspiration is to have in-depth dialogue on health and welling being with stakeholders and partners.

6.1.4  It was noted a decision was taken to remain with a similar structure to the previous years JSNA to enable demonstration of year on year changes. The core of the JSNA is determined by guidance form the Department of Health.

6.1.5  There would be an interactive website established holding more information that was used to inform the JSNA.

6.1.6  The heading for the chapters and structure of the document were detailed in the report (in the agenda) and the Commission was advised suggestions for information to be included in the JSNA were welcomed along with information about data source for the suggested information input.

6.1.7  The information paper previously brought to HiH outlined the consultation proposals that would inform the JSNA.  Response to tenant association surveys were low and would be reissued.

6.1.8  Dialogue with the Patient and Public Involvement Commissioning Advisory Partnership (PPICAP) aided consultation proposals because they gave advice on the best methods to secure engagements with service users / groups.

6.1.9  Plans for dissemination and communication were discussed at a stakeholder event in June and some useful comments were made that would be taken into consideration.  This year the project team has taken the issue of communication dissemination as a priority. 

6.1.10  It was noted the draft document should be available in September 2009 highlighting the Commission would have an opportunity to comment.

6.2  Questions and Answers

Mr Vidal referred to the list of chapters outlined in the update report and pointed out there was no direct mention of mental health and wanted assurance it was addressed in the document

The Joint Head of Healthy Communities informed that mental health related issues were addressed in various sections throughout the document.  The Joint Head of Health  ...  view the full minutes text for item 6.

Presentation by Dr Jose Figueroa, Deputy Director of Public Health from NHS City and Hackney about the finding and recommendation from the TB Audit of DOT Services.  Also present was Sarah Addiman, Consultant Nurse from the North East and North Central Health Protection Unit of the Health Protection Agency and Sue Collinson TB Nurse from Homerton University Hospital (HUH) Tuberculosis (TB) Team.  The main points of the presentation were:

7.1  Reference was made to the aim and objectives of the audit which was outlined in the report in the agenda.

7.1.1  The audit was conducted by a team of six people representatives from:

·  NHS City and Hackney,

·  North East London TB Commissioning Unit

·  North East & North Central London Health Protection Unit of the Health Protection Agency.

7.1.2  The audit reviewed records of all individuals receiving DOT at HUH Department of Respiratory Medicine as of 3^rd of Sept 08.

7.1.3  Several randomly selected files were discussed in detail with their respective case workers and all members of the TB team.

7.1.4  Conducted semi-structured interviews with 17 people attending HUH TB clinic for DOT administration or for a review visit (self-administered).

7.1.5  The TB Team in Hackney provide Specialist care, diagnosis, follow-up and support for people with, and affected by, TB.

7.1.6  The Team consists of:

·  1 respiratory medicine consultant physician,

·  4 TB nurse specialists,

·  1 TB support nurse and

·  1 TB case worker.

7.1.7  Provisions at Homerton include :

·  Adult and paediatric TB case management

·  In-patient and outpatient care

·  Patient support

·  Treatment adherence support

·  Community and home visits

·  Outreach clinics

·  Community outreach services and community follow-up

·  TB contact screening (walk in nurse-led clinic)

·  Supports TB outreach work and community risk assessments and screening for TB contacts i.e. in educational institutions, the work place, hostels and shelters, etc.

7.1.8  The demographics of the TB patients on DOT included high levels of unemployment, sex workers, high proportion of males and more than a third were UK born with the average age of 36.

7.1.9  All patients had an assessment as required by the NICE guidance.

7.1.10  The services offered a choice of DOT, but the process for involving patients in their choice of DOT was not always recorded in the clinical notes.  It was noted the Homerton did not use the dosette box.

7.1.11  The following treatment criteria’s were met by the Homerton:

·  All cases of tuberculosis to be treated by or in collaboration with the TB team.

·  Combined preparations of TB drugs including at least Rifampicin and Isoniazid should be used for all adults able to swallow and tolerate these tablets who are taking daily, unsupervised treatment.

·  DOT regimen should be thrice-weekly.

7.1.12  There was no international standard for the minimum number of consultations with doctors/nurses during treatment. The minimum contact expected for TB patients is approximately 3, all Hackney patients had more than this with an average of 6 for  ...  view the full minutes text for item 7.

8.1.  This was noted for information

9.1  This was noted for information

The Chair explained about the site visit the Health in Hackney Commission undertook related to the Health and Worklessness Review.

10.1  The site visit was to the local PCT (NHS City and Hackney) Adult Community Rehabilitation Services to observe two action role plays of care pathways for two different medical conditions.  This allowed Members of the Commission to have simulated experience of a service user care pathway.  Bringing to life through observation service user experience as well as providing details of the support services available to clients wishing to return to work.  It demonstrated the services, (timings etc) support on offer in the primary care for people with an illness and rehabilitation aids for the service user to return to work or remain in work. 

10.1.1  The two case scenarios showed two very different patient cases and care pathways that accessed vocational rehabilitation.  This service is currently a pilot within the Adult Community Rehabilitation Services for 6 months providing an advocacy role for the patient to get back to work or in paid employment.

10.1.2  The role play showed the PCT had identified a gap in service provision and highlighted the use of vocational rehabilitation to support people back to work being provided in the community by health services.  It was viewed the health professional had the knowledge of the patients medical condition and would know what adjustments needed, that would provide assistance to the service user to complete daily tasks and in the work environment.  However this was very resource intensive and required their knowledge base to include legislation, and referral points for other relevant services e.g. housing support, debt advice etc.

10.2  The Chair explained owing to the late finishing of the meeting the discussions for the recommendations would be discussed at the Action Learning Event on 21^st July 2009 related to the Health and Worklessness review and at the next HiH meeting on 7^th September 2009.