Minutes for Health in Hackney Scrutiny Commission meeting, Apr 20 2009, 7.00PM official page

1.1  Member apologies – Cllr Demirci

1.2  Co-opted Member Apologies – Sebastian Taylor

1.3  Apologies from Officers were – Jacqui Harvey, Chief Executive CHtPCT, David Woodhead, Head of Healthy Communities CHtPCT, Dean Henderson, Borough Director City and Hackney ELFT and Steve Rowlands, Director of Community Health Services and Deputy CEO CHtPCT.

2.1  Order of business was per the agenda.

2.2  The Chair welcomed Members of the public to the meeting and made an announcement:

Can I remind you that the Council’s Constitution allows members of the public to ask questions, present petitions or present a deputation at Full Council meetings but not at overview and scrutiny meetings.  If time and the agenda allows I will exercise my discretion to allow questions from members of the public.

2.3  The Chair advised he noted an article in the Hackney Gazette which advised the Healthcare Commission published a report in which the Homerton Hospital was noted to have lower standards of care since the initial inspection for children services areas noted related to staff training, maintenance of specialist skills etc.  The Chair asked the Homerton Hospital representative at the meeting to respond.

2.3  The Chief Nurse and Director of Governance from the Homerton Hospital firstly the trust wanted to advise the Commission the trust provided a high quality, safe care for children.  The findings should be viewed in the context of overall positive findings of the way children services are provided at the Homerton Hospital and made the following main points in her response:

2.3.1  The report referred to in the Hackney Gazette was a follow up report produced by HCC following on the initial inspection conducted in 2005/06.

2.3.2  The trust was asked to submit data related to 19 areas of which 12 areas they were scored as high performing and 7 areas are low performance.

2.3.3  The seven areas of low performance were:

·  Consultant surgeons with child protection training and paediatric life support training in the last year

·  Emergency care settings - registered nurses with administration of analgesia training.

·  Day case settings - registered nurses with pain assessment training, administration of analgesia training and advanced paediatric life support training

·  Consultant anaesthetist with low levels of anaesthetics on children (critical mass).

2.3.4  The trust does not do a lot of children surgery, but they do larger volume of day surgery.

2.3.5  The consultants are jointly appointed for Homerton and The Barts and the London Trust.

2.3.6  The trust wanted to assure the Commission they have robust processes and procedures in place and the level of paediatric life support training for consultants in day cases is advanced and the nurses would probably be basic level life support.  In day cases there would always be staff available with all levels of training.

2.3.7  The trust dispute the accuracy of the interpretation of the data they submitted by Healthcare Commission (HCC).

2.3.8  However following this and identification of areas of concern the trust has asked relevant staff are reviewing the report and developing action plans for these areas.  The plans will focus on specialist training provision where appropriate.  The specialist senior nurses for pain management and resuscitation training are conducting the review and developing the action plan.

2.3.10 The trust acknowledged they have experienced problems with the recording  ...  view the full minutes text for item 2.

3.1  None

4.1  Minutes to note the following amendments:

4.1.1  Page 7 point 6.1.4 amend spelling for word to read unusual instead of usual.

4.1.2  Page 7 point 6.1.5 amend spelling to read second line ‘this meant the..’ instead of ‘they’ and third line ‘their population was below the estimate..’ instead of ‘they’.

4.1.3  Page 12 question 7.2 from Mr Vidal noted the reference in the minutes he had a discussion with Chief Executive for the London Ambulance Trust this was incorrect it should state Mr Vidal referred to the comment made by the Chief Executive for LAS in the consultation document.

4.1.4  Chair noted an amendment to page 14 last paragraph last line should have the word NOT inserted to read ‘if the discussion and agreement were held in public meeting the selection would not have been different’.

RESOLVED

Minutes approved subject to the amendments stated above

4.2   Matters Arising

4.2.1  Action page 2 Chair of HiH spoke to the C hair of PPIAG and it has been agreed a Member of HiH Scrutiny Commission can be on the PPIAG.

4.2.2  Action page 9 Chief Executive provided the following update to the Commission:

It is planned that the new Primary Care Resource Centre will be developed on the Pewson House site as part of the overall regeneration of the estate. The PCT is in discussion with the SRB team over the timescale for the development.

The Chair asked Cllr Middleton to confirm if the response satisfied her request.

Cllr Middleton advised her original request was a query as to why the proposed resource centre at Woodberry Down was scheduled to be the last one developed and implemented.

The Chair requested for a response to be provided to this request.

ACTION

Chief Executive of CHtPCT to advised why proposed resource centre in Woodberry Down would be the last to be developed.

5.1  Presentation by Pauline Brown, Chief Nurse and Director of Governance from Homerton University Hospital NHS Foundations Trust.  The main points of the presentation were:

5.1.1  The trust was declaring compliance to all core standards except C4a and C4c.  The commentary provided to explain compliance was supported by a data base of information.  Further information and access to supporting data would be made available upon request should any member of the Commission wish to view it.

5.1.2  The trust advised they had presented to Hackney transitional LINk.  Commentary had been received for inclusion in the annual health check declaration from the trust foundation Governors and Child Safeguarding Board.

5.1.3  Domain 1 Safety core standard 1a - Complaint.  The trust noted following an assessment with the new NHS Litigation Authority and retaining level 2.  This was accepted as sufficient evidence of having good robust procedures in place and accepted as good performance therefore the trust did not cite any further evidence of compliance to this.  It was noted this evidence covered C1a, C9, C10a, C11b, C14a, C14c and C20a without the need to supply additional evidence.

5.1.4  Domain 1 Safety core standard 4a. The trust is declaring a significant lapse in compliance to this core standard.  Following an unannounced inspection by HCC the trust was served with an improvement notice for failures to observe the hygiene code in respect of four areas.  The trust advised an action plan was put in place to address the failings; the improvement notice was lifted following a re-inspection in March 2009 which the trust passed.  It was noted it remained under close monitoring and the action plan would remain live.  It was highlighted the trust had remained consistent in meeting its targets for MRSA and Cdifficile prevention and infection control.

5.1.5  Domain 1 safety core standard 4c. The trust is declaring a significant lapse in compliance to this core standard resolved by 31^st March 2009.  The trust had conducted a review and over haul of decontamination facilities and replaced old and faulty equipment.  They have implemented more rigorous daily checks and reporting processes with close monitoring by the Matrons and the infection control team.

5.1.6  Domain 2 Clinical Cost and Effectiveness C5d.  The trust is declaring compliance to this core standard.  The trust ensures clinicians participate in regular audits and reviews of clinical services.  The audit and audit cycle are recorded and all audits are signed off by a clinical supervisor ensuring the recommendations and outcomes are incorporated in practice.  The audit programme for the year is derived from a range of sources including patient complaints, reported incidents, national clinical guidance and local policies.  The trust holds an annual audit day which puts on display the trust wide audit activity and key findings. 

This year the audit that won was the Pharmacy team for their work in reducing hospital acquired infections through changes to antibiotic prescribing.  (For further examples please refer to the report in the agenda pack).

5.1.7  Domain 5 Accessible and Responsive  ...  view the full minutes text for item 5.

Presentation by Lesley Mountford, Joint Director of Public Health City and Hackney Primary Care Trust (CHPCT) and London Borough of Hackney (LBH), Cathy Williams, Associate Director of Strategic Development (CHPCT) and Ruby Mangal Complaints, PALs and FaD Manager (CHPCT).  Also in attendance to assist with questions and queries was Marian Goodrich, Director of Strategic Commissioning/Deputy CEO (CHPCT) and Mary Clarke, Director of Governance, Estates and ICT (Nurse Director).  The main points of the presentation were:

6.1.1  It was noted all examples stated were backed by supporting evidence data available upon request if any Member of the Commission wished to view it.

6.1.2  Domain 7 Public Health core standard 22 a &c (Commissioner) – Complaint.  The trust listed the participation groups they were involved in e.g. Team Hackney Partnership Board, The City Together, Safer Cleaner Partnership Board and Drug and Alcohol Action Team etc.  Examples of joint work conducted were Joint Strategic Needs Assessment and Domestic Violence Review.

(The full presentation is available from Overview and Scrutiny Officer).

6.1.3  The Commission requested information related to appropriate mechanisms through which the PCT would identify and, where appropriate, respond to any significant concerns arising from their commissioned services with regard to the overall standard(s).  The trust advised this was not a core standard but would address the query.

6.1.4  The trust advised the PCT in it’s Commissioner role:

·  held formal contracts with all providers including Homerton Hospital, PCT provider arm, East London Foundation Trust.

·  Regular contract monitoring meetings.

·  Had a comprehensive performance framework in place for all services, national, regional and local indicators.

·  Service specifications for key services, quality included in the contracts e.g. maternity services - the number of hours for cover on the ward. 

·  Management groups/Boards for different areas of work e.g. Cancer Board, Sexual Health Management Group, Maternity Services Strategy Group, TB Strategy Group, Blood Spot Screening Group.  (A subtle way to influence service improvement)

·  Serious untoward incidents (e.g. homicides and suicides) notified to the PCT and reported to the Board.

6.1.5  Domain 7 Public Health core standard 24 (Commissioner) – Complaint.  The trust advised they have robust and an updated Major Incident Plan (MIP).

6.1.6  The PCT noted it had regular programmes of simulated incidents and noted some small incidents such as power cuts and adverse weather recently tested the aspects of the MIP.

6.1.7  CHPCT advised they recently tested out its response procedures to two live major incidents; PCT internal power failure incident and the severe weather conditions (Feb 2009) that resulted in PCT staff shortage – for both incidents essential services were maintained.  The lessons identified from the PCT internal power failure were used to update the plan.

6.1.8  Domain 1 Safety core standard 1a (Commissioner) – Complaint.  The trust advised they have robust Risk Management team and plan which was approved by the risk management committee in February 2009 and developed an electronic incident reporting system.

6.1.9  Revision of policies had taken place for health and safety, incident reporting  ...  view the full minutes text for item 6.

7.1  Chair referred to pages 45 and 46 on the agenda and explained this proposal was made by Co-opted Member Ms Beishon to have a template for discussion items or consultation items presented to Health Scrutiny to give back ground information to the service area being discussed.

7.2  The Chair advised health partners had agreed to use the template.

7.3  A recommendation was made to the Commission Members to adopt the template as outlined in the agenda.

7.4  The Chair highlighted HiH scrutiny commission increasing had a large agenda and was conscious of meetings running regularly past 9pm.  As such they would hold a discussion at the next meeting to discuss the list of proposed work items and agree what items will be discussed at the public meetings and what items would taken as a Chair’s action.

RESOLVED

Members agreed to adopt the template

8.1  Mrs Murgraff Chair of Hackney transitional LINk advised HiH the LINk would be hosting their launch event at Hackney Town Hall Assembly Rooms on Saturday 9^th May between 12-4pm; and urged attendees to come and register.