Minutes for Health in Hackney Scrutiny Commission meeting, Sep 7 2009, 7.00PM official page

1.1  Apologies for absence from Councillors: Gulay Icoz, Jonathan McShane, Joseph Stauber and Michael Desmond.

1.2   Apologies for absence from Co-opted members: Clare Wykes and Joy Beishon.

1.3  Apologies for absence from Officers: Dr Lesley Mountford, Nancy Hallett and Kim Wright.

2.1  Order of business is as per the agenda

3.1  None

4.1  Minutes of the meeting were approved.

RESOLVED

Minutes approved

4.2  Matters Arising

4.2.1  Action page 7 related to East London NHS Foundation Trust (ELFT) confirming the previous service users from the Nurse Counselling Service were given an emergency number in case of relapse. 

ELFT provided the following update at the meeting.  The Borough Director for City and Hackney from ELFT explained following discussions with the head of service (for that service provision) it was decided it would not be appropriate for discharged service users to be given an emergency contact number.  The Borough Director for City and Hackney advised if the discharged Nurse Counselling Service, service users felt they needed support services they should contact their GP for referral to services. 

It was advised in January the service had 38 service users of which 27 were discharged by the planned end date of the service and for 11 it had been agreed they would be followed up and were in discussion about alternative treatment.

Mrs Russell the representative speaking on behalf of the 38 service users of this service explained to the Commission from her personal experience she was unaware of being formally discharged from the service provision (i.e. she had received no written confirmation that she was discharged from the service provision) but it was her understanding that the service was discontinued not that she or the other service users were discharged.  Highlighting to date she had received no formal decision about the continuation of her care following the closure of the service provision.

The Chair agreed to follow up action to this dispute with the Trust and report back.

4.2.2  Action page 8 related to ELFT confirming the Trust had complied with the statutory obligations to service users as stated in the National Health Services Act 2006 when making the decision to close the service. 

ELFT provided the following update.  The Director of Performance and Business Development explained the trust had reviewed this and felt it had complied with the spirit of the Act and believe the service change was not a substantial variation as mention in the previous HiH meeting during discussion.

Mrs Murgraff Chair of Hackney LINk advised the Commission she wrote to the trust regarding this matter in July but highlighted the Trust failed to provide a response by the required statutory deadline and requested the Commission noted this. 

The Chair enquired if a response had been received now.

Mrs Murgraff explained she was lead to believe a response may have been received now but could not confirm until she had returned to the office.

The Chair request that she check and report back to the Commission.

4.2.3  Action 1 page 9 related to ELFT confirming that a special meeting for all service users of the nurse counselling service was conducted and the outcome of the meeting.

ELFT provided the following update.  The Borough Director for City and Hackney advised the Commission the meeting had not been arranged due to staff annual leave.  However  ...  view the full minutes text for item 4.

• Draft Primary and Community Care Strategy
• NEL Acute Services Review

5.  Presentation by Steve Gilvin, Director of Primary Care Commissioning about the Primary and Community Care Strategy and Marian Goodrich, Director of Strategic Commissioning about NHS City and Hackney’s Commissioning Strategy Plan (CSP)refreshed for 2009-14.  The main points of the presentation were:

5.1  It was explained that this presentation was a review of the progress made against the CSP and would outline the 8 priorities for 2009/2014.  They are:

a)  Improving Primary Care  (100% access/choice)

b)  Tackling the emergency led health economy

c)  Improving outcomes in cardio vascular disease (diabetes, heart attack, stroke, high blood pressure)

d)  Improving outcomes in cancer (treatment, screening and prevention)

e)  Improving life chances for children (maternity, immunisation, teenage pregnancy)

f)  Improving mental health and well being (psychology, dementia and social inclusion)

g)  Improved management communicable disease (TB, sexually transmitted disease, swine flu)

h)  Improving patient, user and carer experience

5.1.1  The top ten outcomes achieved were outlined to be:

1  Increased life expectancy (↑0.6%) now 76 years for men now 82 years for women (↑0.4%)

2  Reduction in inequalities - deprivation score (N/A)

3  Improved blood sugar control in diabetes (↑2%)

4  Reductions in emergency hospitalization – alcohol related (↓2.5%)

5  Increase detection of high blood pressure (↑8%)

6  Increase in number of smoking quitters (↑40%)

7  Reduction in childhood obesity (↓2%)

8  Increase in number of drug users in effective treatment (↑20%)

9  Increase in percentage of TB patients completing treatment (↑8%)

10  Increase in patient satisfaction rates (↑4%).

5.1.2  The areas were small / limited or no progress had been made were:

·  Primary care access–pt satisfaction (↓4%)

·  Quality of primary care (↓1.5%)

·  Prescribing for respiratory conditions - (↑2%)

·  Control of cholesterol (↓1%)

·  Deaths from Cancer - (↓7%)

·  Breast screening for cancer - (↑1%)

·  Teenage pregnancy (↑2%)

·  Early assessment in pregnancy (9% below target).

5.1.3  It was noted the JSNA held more information related to the determinants of health and well being but generally the key messages from 2008/09 have remained unchanged.  The information produced in the JSNA informs the planning for local health services commissioned.

5.1.4  The Commission was asked to confirm if the priorities outlined in the presentation related the areas of need in London Borough of Hackney or were there areas the Commission would recommend more emphasis was needed.

5.1.5  It was noted the CSP outlined was for Hackney Borough, however the plans still needed link into the plans of other London PCTs; the London wide strategy and plans for health. 

5.1.6  The Londonstrategic plans cover the following areas:

•  Maternity and newborn

•  Children and young people

•  Staying healthy

•  Mental Health

•  Acute care

•  Planned care

•  Long term conditions

•  End of life

Across six settings

•  Home

•  Polysystem (primary care, primary care resource centres and community services)

•  Elective centres (none at present in Hackney)

•  ...  view the full minutes text for item 5.

6  The Chair referred to the report on pages 27- 50 of the agenda and noted this provided an update on the key findings of the JSNA.  Confirming the Commission looked forward to receiving the full JSNA document in due course for comments.

6.1  The Chair invited the Head of Healthy Communities for any further comments before questions from Members of the Commission.

6.1.1  The Head of Healthy Communities from NHS City and Hackney and LBH advised the production of the document was being driven by the JSNA project team.

6.1.2  A decision was made to rename the document Health and Well Being Profile for Hackney and City JSNA 2009.

6.1.3  The draft of the full document would be posted on the NHS city and Hackney website and would be approximately 160 pages due to some areas being expended.

6.1.4  A formal consultation event for the JSNA would be held on 25/09/09.

6.1.5  The JSNA project team requested a formal consultation to the JSNA from HiH.

6.1.6  It was noted the JSNA was scheduled for signed-off by early December 2009.

6.2  Questions And Answers

Mr Sills referred to page 35 of the report (in the agenda) the ‘homeless section’ and enquired if there was any means of capturing data on the hidden homeless e.g. people who were homeless but moved from one friends home to the next.

The Head of Healthy Communities advised there was not formal data collated for this aspect of homeless people, and suggested this could be taken into consideration as a future work area.

Mrs Murgraff expressed the process of service user involvement for the JSNA had improved over last year and thanked the Project Team for the improvement in the process.

Mr Vidal enquired if consideration could be taken to hosting consultation events in the evening to assist people who worked- .

The Head of Healthy Communities noted this request.

• Service Change Update

7.  Presentation by John Wilkins - Director of Performance and Business Development, Dean Henderson - Borough Director Cityand Hackney and Richard Evans - Consultant Psychiatrist in Rehabilitation and Clinical Director for Adult Psychiatric services from East London NHS Foundation Trust (ELFT) about the service change for mental health in-patient adult rehabilitation services in Hackney.

7.1  The proposed change outlined was in noted in their three year business plan which was reviewed annually with Members of the trust.

7.1.1  This service change related to the reorganisation and modernising of adult rehabilitation services. 

7.1.2  It represented re-providing existing services and would utilise resources effectively providing the same volume of service provision but in a different way.

7.1.3  It would mean the closure of the 12 bed facilities on the Homerton Hospital site with in-patient provision being transferred to their trust wide facilities in Newham Borough.  It was noted this service change had already been implemented in London Borough of Tower Hamlets.

7.1.4  This service change would not result in a reduction of staff but instead increase staffing levels for the community mental health teams and assist with providing a new premise for the team.

7.1.5  This service change affected service users with long term mental health problems.

7.2  Questions and Answers

Cllr Middleton referred to a past case within her ward that involved a mental health service users living in the community needing assistance from people within the community when the person stopped taking their medication and started to lose headway.  Cllr Middleton raised concern about moving to community based service provision and service users falling through the gap in the system by taking away in-patient care services in the borough.

The Consultant Psychiatrist in Rehabilitation and Clinical Director for Adult Psychiatric services from ELFT explained there were different community teams looking after different types of cases.  It was highlighted this option of services provision was the one preferred by service users and the type of care provided was based on the recovery plan in place navigated by the service user.  The Consultant Psychiatrist in Rehabilitation and Clinical Director for Adult Psychiatric services explained it was harder to teach people life skills whilst in a hospital setting and highlighted this service related to a small proportion of people who had lost the ability to look after themselves in daily life.  It was also advised that the risk associated with community care were assessed.

The Chair enquired if the provision would be the new Jade ward in Newham.

The Consultant Psychiatrist in Rehabilitation and Clinical Director for Adult Psychiatric services advised the new provision is in Jade Ward in Newham but not the Jade ward in St Clements which is now closed.

Mr Vidal referred to point 4.4 in the report on page 55 in the agenda and enquired if the staff and facilities would be operational by 1^st October 2009 implementation date.

The Borough Director of City and Hackney from ELFT explained there were two vacant posts within the community  ...  view the full minutes text for item 7.

• Written Update for Information

8.  The Chair explained unfortunately due to IT technical problems week commencing 24/08/09 a revised report sent by NHS City and Hackney was not received in time for the statutory agenda dispatch and the agenda was dispatched with the old version.  It was noted the new version would be printed in the next agenda under matters arising.

• Written Update for Information

9.  This was a written updated noted for information.

9.1  Mr Sills enquired if the HiH work programme had flexibility to allow for the review of the Health4NEL proposals when the public consultation commenced.

9.2  The Chair confirmed there was flexibility in the work programme for the proposals to be reviewed once the consultation commenced.

10.  The Chair led the discussion and outlined to the Commission the proposed recommendation following the scrutiny review on Health and Worklessness.

10.1  The Chair proposed:

Recommendation area 1

A recommendation to encourage large employers in the Borough to adopt themed ‘Health Fairs’ and explore the feasibility of expanding further to include employees’ family members.

10.1.1  Recommendation area 2

The Commission was conscious it did not explored or identify whether there was a sufficient number of small and medium sized employers (SMEs) in Hackney that would benefit from access to occupational health services for their employees. 

The Commission could recommend it is identified first if there is a sufficient SMEs that would benefit from this service and explore the possibility of doing a pilot similar to the one being operated Westminster Council and Westminster Primary Care Trust (PCT).

10.1.2  Recommendation area 3

A recommendation that local health services consider developing a single access referral point for information and support services for GPs.

A recommendation to encourage GPs, Practice Based Commissioning Groups (PBC) and local health service commissioners find a way to improve communication between the employer’s Occupational Health (OH) service and employee’s GP to support the employee through sickness absence.

10.1.3  Recommendation area 4

Recommendation for the PCT to explore the feasibility of using voluntary sector premises to overcome the challenge of lack of clinical space.

The Commission was impressed with the innovative approach taken to training for employers by City and Hackney Mind.  A recommendation to encourage this method of training is hosted by LBH for SMEs in Hackney if identified.

10.1.4  Recommendation area 5

We noted during the review the service user views of the perceived ‘benefits trap’ and comments about having a single access point for information on the health and well being services available.  A recommendation to encourage all local partners to come together and consider how to improve local knowledge about the range of health and wellbeing services in the borough. 

10.1.5  Recommendation 6

It was encouraging to see a service model developed to suit the needs of Hackney and the Commission would like to see a reasonable time frame given for the continuation of the pilot service demonstrated in our site visit to generate an evidence base for cost benefit analysis.

10.1.6  Lastly we noted during the review our colleagues in Commission Safety and Social Inclusion Scrutiny Commission (CSSI) did a review on Tackling Worklessness looking at the long term unemployed and the Commission noted CSSI review made recommendations in its ‘Tackling Worklessness Report’ (recommendation 5 and 7) these areas were also identified in the review and highlighted in the Dame Carol Black review.  Therefore HiH will not be making recommendations on the same areas but in our report note HiH request to be updated with a copy of the response provided to CSSI in due course.