Minutes for Health Overview and Scrutiny Panel meeting, Jan 19 2012, 7.30PM official page

To confirm the minutes of the meeting held on 24 November 2011. 

RESOLVED that the minutes of the meeting held on 24 November 2011 were confirmed as a correct record.

Sue Denby, Service Director for Kingston and Richmond’s Mental Health Team will update the Panel on latest developments

Ian Wilson, Interim Chief Executive, South West London and St George’s Mental Health Trust was welcomed to the meeting.  He joined the Trust on 3 January 2012.  Both Ian Wilson and Sue Denby updated the Panel. 

Key points included:

Intensive Care – Interim changes have now been implemented.  Male clients are now admitted to Ward 1 on the Springfield site; this took effect on 12 December 2011.  Female patients are now cared for by the Central and North West London Mental Health Trust at St Charles’ Hospital, Ladbrook Grove.  Discussion took place about a recent admission and the concerns raised in relation to her elderly parent.  The Panel was advised that the Modern Matron’s role includes making contact with relatives of clients and discussing concerns such as transport to the new sites.   It was confirmed that these changes are an interim solution until the conclusion of future public consultation.  Cllr Fraser stressed the importance of knowing the views of patients and carers. 

S136 – a new model of care is being piloted in Wandsworth; this began in February 2011 and evaluation is underway.  This will include a stakeholder event  in the next few weeks.  Whilst it was noted that the Borough Police Commissioner was satisfied with the new arrangements, Councillor Heathcote questioned whether clients and carers views were being obtained.

Shamrocks – the Unit temporarily closed on 6 January 2012.  Information sessions were held with carers and families in December.  The question of transport arrangements was one of the main issues raised at stakeholder events.   Final arrangements for this care group will be subject to formal consultation but before that takes place the Joint Strategic Needs Assessment (JSNA) needs to be completed and this work is being lead by the South West London Cluster.  The JSNA document should be finalised in May. 

Jasmines – the number of clients on Jasmines is declining.  Jasmines cares for people with dual conditions i.e. mental health and learning disability.

Fuschias – in response to a question from the public gallery, the Interim Chief Executive apologised that this change had not been managed well.  He confirmed this issue was very important to him and he wanted to ensure that care provided by the Trust was good enough for a member of one’s own family. 

The Interim Chief Executive read out a statement:

“I think that, at some point in the future, and for other reasons nothing to do with Fuschias, the Tolworth site will stop being viable as an in-patient facility.  Before that, there will need to be a PCT-led consultation about the future of the site.  We need to work with relatives of Fuschias patients to find solutions that they find acceptable for their loved ones, so that there is no need for anything rushed or unplanned should the point come when the site ceases to be suitable.”

The Chair requested the Interim Chief Executive to clarify the anomaly between the need to close service areas whilst there is not current strategy for doing  ...  view the full minutes text for item 25.

Dr Jane Wilson, Medical Director, Kingston Hospital Trust and Bill Gillespie, Chief Executive, Sutton and Merton PCT will give a presentation on the draft reports published in December 2011

Bill Gillespie gave a presentation on the latest developments from the Better Services, Better Value review including outcomes from the meeting of the SWL Patients and Clinical Strategy Group which met the previous evening. 

An introduction to the draft clinical reports published in December was included in the agenda item. 

Key points included:

Planned Care

• Currently urgent cases take priority over planned care and often lead to cancelled operations
• Planned care has been broken down into:  70% day case, 12% hips and hernias requiring inpatient care, 12% care risky/complex requiring specialist care eg at St George’s

End of Live care

• Most people would prefer to die at home; currently most people die in hospital

Urgent, unscheduled and emergency care

• outcomes for patients admitted to hospital at weekends are less good than those admitted during the week due to factors such as limited consultant cover at weekends
• 28 hospitals in London provide A&E services
• NHS London has 27 standards for A&E services
• 40-50% of A&E attendances could be dealt with by urgent care centres located alongside A&E

Maternity and new born care

• Few hospitals currently meet the required standards which include 24/7 consultant cover
• 10% projected increase in births
• increasing births to older mothers
• levels of risk can be  difficult to assess individually and can change, requiring more specialist care
• Possible ways forward would be to have just three hospital based maternity units with 24/7 consultant care or four units but 24/7 care would not be available at all.

Children’s Services

• Quality standards require 24/7 professional support
• Inpatient care can be distressing for children
• Likely option for one or two sites alongside increased community facilities

Long Term Conditions

• Aim for increasing self management for patients with support in the community leading to greater stability of conditions and less inpatient care.

Details of professional and public engagement were noted including a range of stakeholder events, initial discussions with proposed JOSC and Borough OSCs, PPAG and social media initiatives. 

Next steps:

Currently there are over 3500 options for care and rules are being developed/applied to reduce these to a more meaningful level of around 20.  This process includes the development of decision trees and a weighting system.   The weighting system has considered the following elements:  outcomes, workforce development, patient experience, access to service travel and transport plus deliverability.  These are all non-financial criteria.  Last night’s weighting process  by the SWL Patients and Clinical Strategy Group ranked the following three as of most importance – outcomes, patient experience and workforce development.  Scoring of options will be undertaken by a large inclusive group and this will be independently facilitated.

Fixed service points have been agreed and signed off by the Programme Board.  System changes i.e. arising from the six clinical working group areas will drive acute reconfigurations.

If the Programme Board signs off the options then the decision tree scoring process will be undertaken by the Scoring Panel probably in March.  A pre consultation business case setting out preferred options will  ...  view the full minutes text for item 26.

Sarah Tedford, Chief Operating Officer will update the Panel on latest developments

No representative from the Trust was able to attend this meeting. 

The attached report gives an update on Gosbury Hill GP Services, disabled parking and Out of Hours performance

Members noted the report which updated on positive progress by the Gosbury Hill GP Services and Out of Hours performance in the past year.  Performance has improved since the take over of Out of Hours services by Harmoni.

Letters pursuing questions and issues raised by the Panel have been sent to both the South West London Breast Screening Service and the Jarvis Centre, Guildford and responses are awaited.

An update on the Breast Screening issue was tabled which detailed the response received from the Jarvis Centre in Guildford.  The update included details of breast screening uptake for the 3 GP practices in the South of the Borough together with the average uptake for Kingston as a whole.  This indicated that uptake in the South of the Borough was higher than the average. 

It was also  noted that the Mobile service Hawks Road was closing and this service would transfer to Kingston Hospital where an improved digital service will be available.  The Chair confirmed that she had discussed the breast screening question with David Smith and NHS Kingston would put in funding arrangements to enable patients to choose individually whether to attend the Jarvis Centre or the South West London Screening Service.

The attached report was discussed by the South of the Borough Neighbourhood on 18 January 2012.   

The Panel considered the South of the Borough Neighbourhood report on Air Quality which had been discussed at the Neighbourhood meeting on 18 January.   The Chair had attended the meeting as a member of that committee.  Whilst air quality monitoring was underway it was difficult to improve air quality without a reduction in vehicle usage.  Evidence suggested that walking on the inside of paths did reduce exposure to pollutants.

An initial discussion will take place about issues which the Panel considers need to be explored. 

The Chair proposed that the Panel look at this topic at the March meeting to ensure that discharge process were optimal; she was aware of an example where this was not the case.  Councillor Mary Heathcote pointed out the need to balance patient confidentiality with raising awareness of neighbours who may be able to provide some support.

Simon Pearce agreed to co-ordinate attendance of key officers at the meeting on 21 March.   

Councillor George suggested that the Panel also look at the question of recovering the treatment costs of overseas patients.  Simon Pearce confirmed that there were dedicated staff at Kingston Hospital Trust who undertook cost recovery.