Minutes for Health in Hackney Scrutiny Commission meeting, Jan 12 2009, 7.00PM official page

1.1  Member apologies - Councillor Maureen Middleton.

1.2  Officer apologies – Pauline Brown from Homerton Hospital

2.1  The Chair advised the Commission the Homerton Hospital was issued with an Improvement Notice as a result of an unannounced Hygiene Inspection by the Healthcare Commission (HCC) in November 2009.  An update received noted the trust was scheduled to meet with HCC on Thursday 15^th January 2009 and for the next meeting in February would provide HiH with details about their action plan in relation to this notice and update the Commission about the outcome of the meeting.

ACTION

Homerton Hospital to provide details of the trusts action plan related to the hygiene improvement notice issued by HCC and an update about the meeting with HCC on 15^th January 2009.

3.1  Co-opted Member Joy Beishon declared an interest as a treasurer for the North East London branch of the Stillbirth and Neonatal Death Society (SANDS).

4.1  Minutes of the meeting were approved subject to the following comments and amendments:

4.1.1  The Chair requested the minutes be amended on Page 12 Mr Vidal question 1 – Mr Vidal requested City and Hackney teaching Primary Care Trust (CHtPCT) to send LINks the TB Audit report not the PCT Commissioning Strategy as stated in the minutes.  This update to follow through to the action request also on page 13.

The Chair enquired if the TB report had been received?

Mr Vidal confirmed it had.

Mr McCabe asked for confirmation if the TB audit report was draft and not a final version and had subsequently been withdrawn.

The Director of Public Health confirmed the report had not been withdrawn, but noted the audit work was being undertaken in two stages.  The first stage and report produced related to clinical records and the second phase would involve talking to service users this was not complete.  The Director of Public Health advised as soon as this report was completed she would make it available to the scrutiny Commission.

Mr McCabe commented that he felt the TB Audit undertaken was shallow and enquired why it did not cover a range of issues, considering LBH has one of the worst TB rates in the country.

The Director of Public Health explained future audits and priorities are set by the TB Audit group.

RESOLVED

Minutes approved subject to the amendments stated in point 4.1.1.

4.2  Matters Arising

4.2.1  Page 14 minutes of HiH meeting November 2008 Action 1 and 2.

·  LBH Community Services to provide information about the service area review to tackle rising costs and budget constraints.

·  O&S Officer to schedule with LBH Community Services a date for an update on the service evaluation.

The Assistant Director Strategy, Performance and Improvement for London Borough of Hackney (LBH) Community Services explained implementation of the Transformation of Adult Social Care Services and impact of Individual Budgets (IB) is currently being evaluated.  The Assistant Director Strategy Performance and Improvement advised LBH Community Services would be in a better position to report on the first action point following the evaluation and requested if she could provide the Commission with an update early summer.

This was agreed

4.2.2  Page 3 action – An update from CHtPCT advised according to the last staff survey 68% of staff had been appraised in the past 12 months.

4.2.3  Page 8 action - The Director of Public Health advised she would confirm if this information had been passed on.

4.2.4  Page 10 action 1 - An update from The Homerton Hospital advised a meeting with Mrs Murgraff took place and agreed to include capturing the patients views as part of the audit of the patient and visitors policy.

4.2.5  Page 11 action 2 An update from The Homerton Hospital advised in relation to amending the PET hand held units to include a question about the policy this would not be possible in the present time.  This was because the  ...  view the full minutes text for item 4.

5.1  Presentation by Nicholas Garforth Joint Commissioning Manager Mental Health CHtPCT, Amanda Douglas Public Health Strategist CHtPCT, and Graham Caren Deputy Borough Director East London NHS Foundation Trust about the prevention work for suicides.  The main points of the presentation were:

5.1.1  On average a person dies every two hours in England as a result of a suicide.  This is the commonest cause of death in men under 35.  It is the main cause of premature death in

people with mental illness.

5.1.2  The suicide audit is important for the following reasons:

·  Because it is major public health issue

·  increase local intelligence and identify high risk groups

·  inform ongoing development of local suicide prevention strategy & mental health promotion.

5.1.3  The aim is to achieve a 20% reduction on the suicide rate using the 1995 baseline.

5.1.4  Various data sources were used to produce the report these being:

·  Office of National Statistics annual Public Health Mortality File

·  Local coroners - St Pancras, Poplar & the City of London

·  Partnership work with North & East London PCTs – Islington, Camden & Tower Hamlets (to increase local knowledge set up meeting in partnership)

·  Primary Care - GP practice reporting - Significant Event Audits (SEAs)

·  Secondary mental health care – East London NHS Foundation Trust - Serious Untoward Incident (SUI) 60 day reports and Action Plans.

5.1.5  It was reported that GPs would now report directly to the Public Health Strategist CHtPCT.

5.1.6  It was noted the rates are taken over a 3 year period to smooth out variances over the year.  A graph shown at the meeting demonstrated how the rate of events had fallen from 1999 to 2003/05 but had taken an upward trend since then.

5.1.7  Comparisons to neighbouring boroughs and borough with similar profile showed City and Hackney to compare favourably although statistically higher than the London average.

5.1.8  It was reported that suicide rates in women had fallen than men.

5.1.9  Areas for development:

·  Downward trend in suicide rates, but higher than London & England

·  High risk groups - young men, Eastern Europeans, Turkish Kurds need for up to date local intelligence

·  More effective suicide risk assessment & monitoring required, as well as better communication between primary and secondary care.

5.1.10  Joint Commissioner for Mental Health outlined the action plans for the Community which noted various different projects being supported by CHtPCT some of which were:

·  Newham Asian Women’s Project

·  Derman (Turkish/Kurdish communities)

·  Talking Matters (OJC): Portals Project

·  Saneline: out of hours helpline/research

·  Providence Row Housing Association

·  Psychological Therapies for BME Communities.

5.1.11  Joint Commissioner for Mental Health outlined the action plans for the Primary Care which noted various different projects being supported by CHtPCT some of which were:

·  C&H as an IAPT Expansion site for talking therapies

·  Working with GP’s on suicide prevention.

5.1.12  The Deputy Borough Director for East London NHS Foundation Trust (ELFT) out lined the action plan for ELFT  ...  view the full minutes text for item 5.

6.1  Chair to advise the Commission the document for the service update was not included in the agenda dispatch owing to the Christmas holiday period there was an early dispatch date.

6.2  Presentation by Graham Caren Deputy Borough Director for City and Hackney from East London NHS Foundation Trust (ELFT) of the quarterly service update and also in attendance was Lynne Hunt the Deputy Chief Executive / Director of Partnerships  The main points of the presentation were:

6.2.1  The trust provides a wide range of community and inpatient services for children, young people, adults of working age and older adults who live in the City of London, Hackney, Newham and Tower Hamlets.

6.2.2  The trust has made improvements in developing the participations of service users and their carers in shaping, delivery and evaluation of services through a new public participation strategy and the appointment of Trust-wide and Borough lead officers to improve the participation and engagement of service users and their carers.

6.2.3  Increasing social inclusion and tackling health inequalities through the implementation of our Social Inclusion and Equality and Diversity plans. Including appointment of new posts to support the delivery of these plans.  A progress report by the previous Equalities and Diversity Officer highlighted work needing to be conducted on the implementation of the Equality and Diversity training strategy in Hackney.  The strategy is designed to ensure that the trust is able to meet its general and specific duties under equality legislation.  The training strategy includes the following programmes for staff:

·  The Trans-cultural mental health care programme

·  Equality and Diversity Training level 1 & 2 (mandatory for all staff)

·  Race Equality and Cultural Capability Training (RECC) (mandatory for clinical staff).

6.2.4  Equality and Diversity Schemes – Single Equality Scheme.  A single equality scheme is currently being drafted and is out for consultation, the single equality scheme will state what the Trust is doing over the next 3 years to ensure people are treated fairly and have access to the services they need. 

6.2.5  Equality Impact Assessments in Hackney.  A key priority for the trust is the equality impact assessment of all trust policies, procedures and service functions.  The following equality impact assessments have been completed in Hackney:

City and Hackney Psychological Treatments Strategy

City and Hackney Specialist Alcohol Team Operational Policy

City and Hackney Approved Social Worker Team Operational Policy.

6.2.6  Improve psychological talking therapies for the BME community.  The Trust is part of the Delivering Race Equality Trailblazers programme which has funded the development of the following pilot project in Hackney.  The Trailblazer Talking Therapy programme this programme targets Black African and Caribbean men and the first introduction to psychological therapies would take place on 16^th December 2008.  The programme is being delivered by the Hackney BME Access project.  The 4 Sight Mentoring Service, this service provides mentors for Black African and Caribbean service users.

6.2.7  The trust’s strategic objectives for the next 1-3 years were outlined to be:

·  Ensure  ...  view the full minutes text for item 6.

7.1  Presentation by Mary Clarke, Governance, Estates, ICT and Nurse Director from City and Hackney teaching Primary Care Trust about the progress of Annual Health Check (AHC) documents being available on the CHtPCT website.  The main points of the presentation were:

7.1.1  CHtPCT wanted to make documents available externally for AHC process.

7.1.2  CHtPCT invested in new website but this is not available currently.

7.1.3  The aim being to have the website available for three types of audiences:

·  Potential recruits

·  Partners and Public

·  Patients.

7.1.4  It is anticipated the new website will be available by February 2009.

7.1.5  Each department will have a web champion who will have responsibility of keeping the documents on the website up to date.

7.1.6  CHtPCT is developing a new extranet with the aime of providing the ability to share information with their partners, the partners listed were:

·  London Borough of Hackney

·  Corporation of London

·  The Learning Trust

·  The East London and City Mental Health Trust.

7.1.7  The Commission was advised the extranet should allow specified members of the scrutiny commission access to information in relation to the AHC.

7.1.8  It is expected the extranet will be available by spring 2009.

7.1.9  The Governance, Estates, ICT and Nurse Director advise she would inform the Overview and Scrutiny Officer when the website was launched.

7.2  Questions and Answers

The Chair enquired how CHtPCT proposed to engage with LINks as they were not listed a partner and if a member of the public wanted access to the information how would it be made available to them.

The Governance, Estates, ICT & Nurse Director from CHtPCT advised for the AHC they have always had a good relationship with the previous Patient and Public Involvement Forum (PPIF) and expected it to continue with LINks.  The Governance, Estates, ICT & Nurse Director from CHtPCT advised a formal letter inviting LINks to see the annual health check documentation had been sent out before Christmas.  In relation to public access some documents supporting the declaration are quite large but they can provide a link to get access but it would not be published on a regular basis.

Mrs Murgraff advised as a member of LINk they had no record of receiving the letter sent by CHtPCT.

The Chair requested for a copy of the letter was resent.

The Governance, Estates, ICT and Nurse Director from CHtPCT confirmed a copy of the letter would be resent.

Mr Vidal enquired how CHtPCT intended to make sure the website was user friendly.

The Governance, Estates, ICT and Nurse Director from CHtPCT advised she would find out from the ICT development team and report back to the Commission.

Mr McCabe enquired if CHtPCT proposed to put information on the new website about Healthcare Commission recommendations and action plan responses following a complaint.

The Governance, Estates, ICT and Nurse Director from CHtPCT advised if the information related to a particular patient this information would not be published as it was confidential, but  ...  view the full minutes text for item 7.

8.1  Presentation by Rachel Turner Specialist Trainee in Public Health and Lesley Mountford Joint Director of Public Health from City and Hackney teaching Primary Care Trust about the draft Maternity Strategy 2008-2011.  The main points of the presentation were:

8.1.1  The document seeks to be high level to get partnership agreement and will contribute towards commissioning services.

8.1.2  Looking at the current service framework the Maternity Strategy was developed through a partnership body - the Maternity Services Strategy Group (MSSG) and implementation will also be overviewed by this group.

8.1.3  MSSG reports to Teams Hackney’s Children’s Health Board. Includes representatives from CHtPCT, City and Hackney GPs, the Homerton, Mental Health Trust, the London Borough of Hackney and the City of London, as well as a local voluntary sector organisation & a user representative.  Chaired by Lesley Mountford, the Joint Director of Public Health and Medical Director at CHPCT and LBH. 

8.1.4  The aim of the strategy is to present a joint vision, aims and principles and guide service planning and development over the next 5 years. 

8.1.5  A relatively high-level strategic document – details to be worked through (some difficult issues yet to be solved).

8.1.6  The strategy highlights a new directions and initiatives/ recent areas of best practice and detailed action plans including specifying measurable/ auditable outcomes to be developed following publication. 

8.1.7  New City and Hackney Maternity Services website.

8.1.8  An agreed service model developed following Community Midwifery Review, will detail a service model and be attached to the final document.

8.1.9  The strategy will operate on the following commissioning principles:

·  Involve users and stakeholders

·  Support our workforce

·  Use data and information

·  Facilitate joint working and service integration

·  Financially support our providers.

8.1.10  Current activities to help meet the agreed aims are:

·  Increased number of community midwives

·  Every general practice has a named midwife

·  Some mainstreaming of elements of the RIMP programme

·  Breastfeeding co-ordinator – new post

·  Health visitor with special interest in domestic violence

·  Health visitor with special interest in maternal mental health

·  Training for midwives and health visitors on domestic violence and mental health

·  GP Local Enhanced Service

·  Work on ‘the productive ward’

·  Discussions re 1:1 care in labour, obstetrician cover on labour ward, specialist midwife mental health problems

·  Group developing local perinatal mental health guidelines.

8.1.11  There was consultation with service users through the Maternity Service Liaison Committee.

8.1.12  Draft strategy finalised 21st October and circulated very widely on email by representatives on MSSG circulated within their organisation

8.1.13  Requested written comments by end of November (23 received).

8.1.14  The draft strategy is on the agenda for discussion at key meetings, e.g. CHB, MSLC, CCE, Overview & Scrutiny Committees (City & LBH).

8.1.15  To date the strategy has been well received on whole but comments to be incorporated – some relate to details which need to be worked through at implementation stage.

8.1.16  Comments received will be reviewed for revised draft.  ...  view the full minutes text for item 8.

9.1  The Chair referred to the document on pages 127-128 of the agenda and introduced this item and advised the Commission as scheduled in the HiH work plan we have received an update from CHtPCT on the current position of the contract retender for the GP out of hours services and the proposed consultation.

9.2  The Chair invited the Chief Executive to add any further points in relation to the update.

9.2.1  The Chief Executive from CHtPCT advised they are working towards having some GPs opening between 8 am - 8 pm and noted this would have an impact on the PCT’s requirements for out of hours services.  Whilst this work is being carried out the contract is still in place.

9.2.2  CHtPCT advised they are happy to consult with the Commission when the contract specification was being reviewed.

9.3  Questions and Answers

The Chair referred to the written update in the agenda and asked for clarification about one PCT opting to take a different action and enquired what were they doing.

The Chief Executive from CHtPCT confirmed she had no details on the current position the other PCTs had taken.

The Chair enquired if they would be looking at the contract again and taking views.

The Chief Executive confirmed the contract would be reviewed.

Mrs Murgraff referred to page 127 last paragraph and commented that it was her opinion the Hackney LINk should be involved in the work to amend the specification.

Mr Vidal enquired what was meant by bullet point 2 on page 128.  Did it mean to imply CHtPCT may not consult?

The Chief Executive from CHtPCT advised it was there intention to consult as they would normally.

10.1  The Chair led the discussions and suggested the following areas for recommendations:

10.1.1  All schools are encouraged to achieve Healthy Schools Status and implement the National Health Schools Standard.  Requesting TLT include non state schools.

10.1.2  Request for consideration to be given to having organised activities supervised e.g. by a youth worker in a leisure centre etc.

10.1.3  The provision of fresh fruit in the infant classes to be extended to all classes throughout primary school.

10.1.4  Recommend LBH and TLT to bid for the national pilot for free school meals.

10.1.5  TLT to consider all schools adopting the approach of keeping children in schools at lunch time.

10.1.6  Ask CHtPCT how child obesity methods for intervention and prevention will be sustained over for example a five year period.

10.1.7  LBH Planning undertake a commitment to do health impact assessments more regularly.

10.1.8  Consideration be given to the merits of pursuing the restriction proposals like the one being actioned by London Borough of Waltham Forest.

10.2  Questions and Answers

Mr Vidal raised concern about having recommendations that would result in additional work for school staff and asked for further information about the free school meals pilot.

The Chair replied the Government was considering doing two pilots for the provision of free school meals to all children and the Commission was encouraging Hackney to bid for the pilot.

Mr Sills commented about the reduction in climbing frames in recent years following health and safety concerns and suggested this areas could be addressed.

Co-opted Member Ms Wykes suggested in relation to organised activities maybe a more focused approach would be beneficial than being general for example in schools / after school clubs.

Mrs Murgraff commented children needed an environment that provided challenge and risk as noted in the play strategy presentation and focusing activities in schools would prevent this.  Mrs Murgraff suggested the recommendation could start small e.g. one area with supervision in the form of park rangers.

11.1  The Chair of the Commission led the discussions and updated Commission Members about the proposed Healthcare for London (HfL) stage 2 consultation.

11.1.1  The stage 2 consultation of the review will see two consultations one on acute stroke and the other on major trauma services across London.  It is anticipated the consultation will start end of January 2009 and run for 12 weeks. 

11.1.2  HfL are proposing to run both consultations simultaneously.

11.1.3  HfL are also proposing to conduct a third consultation in summer 2009 on paediatric major trauma.

11.1.4  These consultations will require the set up of another pan London JOSC of which it will be proposed that a Member of HiH is approved on behalf of LBH Scrutiny.  The Chair advised he proposed to put himself forward for HiH as the LBH representative.

11.1.5  The first JOSC meeting is scheduled for 4^th February 2009 at 10am venue TBA.

11.2  Questions and Answers

Mrs Murgraff made the following enquires:

a)  Would HiH keep interested members advised of the JOSC meetings as they did previously

b)  Would members of the public be allowed to participate in the second JOSC.

The Chair confirmed HiH would do the same as previously in keeping interested people updated.  In relation to public participation in the pan London scrutiny meetings this was at the discretion of the Chair elected and that he could not comment on how the meetings would be chaired and if members of the public would be allowed to participate.

Mr Vidal commented there was a slight chance the consultation start date maybe extended.

Mr Sills commented it might be useful for the NHS consultation if they consulted area forums too.

The Chair confirmed CHtPCT who would be leading the consultation in Hackney had already made the request to consult the Hackney’s neighbourhood area forums for the second stage HfL consultations.

12.1  Chair held up a copy of the ‘Have Your Say’ leaflet produced by LBH to get feedback from local residents about issues that mattered most to them to feed into the scrutiny reviews work plan for 2009/10.

12.2  The Chair reminded Members present to make reference to these in their public consultations / surgeries with residents.

12.3  The Chair also advised members of the public in attendance at the meeting they could take a copy away and complete it and send it in to the address stated.

12.4  Mr McCabe asked for the Annual Health Check process if all three health trusts review would be on the same night and would they have access to the trusts declaration.

The Chair advised two health trusts would be on the same night at the HiH meeting in April 2009 but for ELFT there would be a joint scrutiny meeting with London Borough of Tower Hamlets and LB Newham.  The date to be advised.

The Governance, Estates, ICT and Nurse Director from CHtPCT confirmed CHtPCT would provide a copy of the declaration for the meeting in April 2009.