Agenda and draft minutes

Venue: Town Hall, Moorgate Street, Rotherham S60 2TH

Contact: Dawn Mitchell  Email: dawn.mitchell@rotherham.gov.uk

Items
No. Item

44.

Declarations of Interest

Minutes:

There were no declarations of interest made at this meeting.

45.

Questions from members of the public and the press

Minutes:

There were no members of the public and press present at the meeting.

46.

Communications

Minutes:

Better Care Fund

Shona McFarlane, Director of Health and Wellbeing, reported that Rotherham had been required to submit a revised version of the Plan in accordance with a September deadline.  It had gone through a process of moderation and feedback was awaited.  Every Plan was checked by an independent assurance process commissioned by NHS England and a telephone conference call had taken place to check a few matters of fact and accuracy in the document. 

 

The revisions to the Plan had included an additional action (BCF15) regarding End of Life.  Each of the action plans were currently in the process of implementation and would update the Select Commission in due course.

 

Minor Oral Surgery

NHS England (NHSE) Area Team was consulting on proposals to commission dental procedures such as wisdom tooth extraction and removal of retained roots from specialists based in general dental practices rather than from the local hospital as at present.  The proposals affected Rotherham and Sheffield as Barnsley and Bassetlaw had had such services based in the community for a number of years and NHSE planned to recommission them.  There would be no overall reduction in the amount of activity commissioned.

 

The proposal was to have 1 contract for Rotherham to treat 600 patients per annum (which equated to 1 dentist seeing 14 patients per week).

 

The deadline for comments on the proposal was 6th November.

 

Resolved:-  That a response on behalf of the Select Commission be submitted including comments with regard to location, access and disability access.

 

Joint Health and Overview Scrutiny Committee

2 meetings were to be held in November to develop consultation responses to the proposed standards for Congenital Heart Disease Services for both children and adults.

 

(2)  That Councillor Wyatt be nominated as the Select Commission’s representative on the Joint Health and Overview Scrutiny Committee.

 

(3)  That Councillor Sansome be nominated as Councillor Wyatt’s deputy on the Joint Health and Overview Scrutiny Committee.

 

MyNHS

The above were the new web pages on the NHS Choices website containing health data that facilitated comparison with other areas on a number of measures/indicators for hospitals, social care, Public Health, services and outcomes and mental health hospitals.

 

NHS England Road Map

The Chairman commented on the information released in the press regarding the major issues facing the NHS and the budgetary pressures that needed to be addressed.

47.

Minutes of the Previous Meeting pdf icon PDF 66 KB

Minutes:

Consideration was given to the minutes of the meeting of the Health Select Commission held on 11th September, 2014. 

 

Resolved:- That the minutes of the meeting held on 11th September, 2014, be agreed as a correct record for signature by the Chairman.

 

Arising from Minute No. 33(7) (Joint Health and Overview Scrutiny Committee), it was noted that the meeting had not taken place in September as previously reported due to issues with regard to parental consent for some of the information in the reports.  The meeting would now take place on 21st November, 2014.

 

Arising from Minute No. 37 (Progress on Plans for New Emergency Centre), it was noted that the travel plan and IT procurement proposal were not ready for sharing with the Select Commission as yet.  A representative would attend a Select Commission meeting in due course to give an overview on the IT system and what this would mean for patients and services.

48.

Health and Wellbeing Board pdf icon PDF 60 KB

-        Minutes of meetings held on 2nd July, 27th August and 1st October, 2014

Additional documents:

Minutes:

Consideration was given to the minutes of meetings of the Health and Wellbeing Board held on 2nd July, 27th August and 1st October, 2014.

 

Resolved:-   That the minutes of the meeting be received and the contents noted.

49.

Issues from Rotherham Healthwatch Ltd.

Minutes:

It was noted that Melanie Hall was to leave her post at Healthwatch.  The Chief Executive post was out to advert.

50.

Rotherham Foundation Trust pdf icon PDF 25 KB

Minutes of meeting held on 29th September, 2014

Minutes:

Resolved:-  The minutes of the meeting with the Rotherham Foundation Trust held on 29th September, 2014, be noted.

51.

NHS Rotherham Clinical Commissioning Group - Commissioning Plan 2015-16 pdf icon PDF 425 KB

Presentation by Chris Edwards, Chief Officer, and Dr. Robin Carlisle, Deputy Chief Officer

Minutes:

Chris Edwards, Chief Officer, Robin Carlisle, Deputy Chief Officer, and Lydia George, Rotherham CCG, referred to the powerpoint presentation which had recently been given to SCE/GPs which covered:-

 

-          2014/15 commissioning plan was available on the intranet – www.rotherhamccg.nhs.uk/our-plan.htm

-          2015/16 Plan was a refresh rather than a complete re-write

-          CCG transformation capacity was finite so it was important that if new initiatives were prioritised some exiting initiatives were stopped

-          Strategic Clinical Executive

-          Clinical Referrals, Medicine Management and Mental Health

-          Medicines Management

-          Mental Health

 

2014/15 Progress and Issues

-          Clinical Referrals

Early 2014/15 data show referrals and electives rising after 2 flat years

Audit programme and feedback via PLT working well, TRFT starting medical directorate ‘PLT

Follow-up audits failing to identify many opportunities to reduce follow-ups

 

-          Medicines Management

Cost growth currently on track

33 out of 36 practice plans agreed

Service redesign projects performing well but some risks regarding TRFT re-organisation

Waste

 

2015/16 Proposals

-          Clinical Referrals

Develop a “Plan B” for the increase in referrals

Monitor and address issues with “other referrals”

Closer involvement of CCG in the development of RFT medical pathways

Improve access to neurology and develop appropriate pathways

Bench marking for GPs to improve quality and consistency

Development of pathways to provide advice on access to blood tests and imaging

Explore opportunities for self-care and non face-to-face consultations

Explore the market for primary care based Dermatology and Diabetes Services

Develop the prevention agenda with Public Health England

 

-          Medicines Management

Same priorities plus realising the benefits of electronic prescribing (decreased waste)

Address the high admission tate for respiratory conditions and prescribing rates

Consider local and national risk of reducing waste

Address waste in term of general waste and in particular nursing home waste

Plan for the risk to special projects due to TRFT restructuring

 

-          Mental Health and Learning Disabilities

3 reviews carried out (Adults, CAMHS and Learning Disabilities)

Learning Disability – following consultation would implement the decision taken at 3rd September Governing Body

Action plan for RDaSH Services due to be agreed in September/October, common messages agreed, included being minded to contract with RDaSH as main provider but investing QIPP in voluntary sector or general practice

Adult and Older Peoples Mental Health Liaison Services most urgent issue

Issues with partnership working

 

-          Adults and Older People

Implement action plan including improved data and pathways, Adult Mental Health liaison, primary care focussed model, improved IAPT, improved Dementia Services

Increase the number of mental health patients on the case management programme

Develop a dementia pathway with more focus on Primary Care and “one stop shops”

Involve the voluntary sector on the dementia pathway

Improve RDaSH communication with stakeholders and providers

Support RDaSH management of change

Obtain patient experience of instances of poor service in respect of long waiting times and poor communication

Parity of esteem and 7/7 working

Long term impact of Child Sexual Exploitation

Learn from CRMC referral pathway work

Address the acute management of the  ...  view the full minutes text for item 51.

52.

Update on Scrutiny Review - Hospital Discharges pdf icon PDF 28 KB

Michaela Cox, Service Manager, NAS, and Maxine Dennis, Director of Operations, TRFT

Additional documents:

Minutes:

Further to Minute No. 42 of 12th September, 2013, Michaela Cox, Service Manager, and Maxine Dennis, RFT,  presented an update on the action plan in response to the recommendations arising from the spotlight review that had taken place in 2013. 

 

The recommendations had been welcomed and addressed through effective joint work between NHS Rotherham and the Council with good progress having been made in addressing the recommendations.

 

The potential for unsafe discharges had reduced.  The Care Co-ordination Centre and the Hospital had done a lot of work on managing how it planned and co-ordinated discharge including talking and having written communication to both patients and carers about predicted date of discharge.

 

An update on the actions was appended to the report the majority of which were now complete.  Maxine highlighted the following:-

 

-          In 2013 there were approximately 75,000 attendees at the Emergency Department every year together with 70-75,000 admissions both elective and non-elective.  To put into context there had been 33 complaints regarding delayed discharges in 2013/14 and 49 in 2012/13

-          The Trust was in the process of, through work with the Emergency Care and Intensive Support Team, implementing SAFER Care Bundle which had addressed some concerns.  It pre-empted discharge problems and involved talking to patients about their predicted date of discharge and having written communication with patients and relatives.  It had already been implemented on the Medical Wards

-          The Community Transformation Programme was under way

-          A report on the Care Co-ordination Centre and the Supported Discharge Service, which included an assessment tool for risk of hospital admission, was being compiled

-          The hospital and patient agreed a time for a post discharge follow up call within 72 hours of discharge

-          Out of 70 patients discharged only 2 had been re-admitted

-          The Care Co-ordination Centre worked until 10.00 p.m. with some cover at weekends.  It was hoped to run it 24 hours a day as it was a good single point of access.

-          The Operational Discharges Group had now been replaced by a Forum that met 3 times a week including Hospital and Social Services colleagues to review delayed discharges and operational issues.  Continuing Health Care colleagues joined the Forum once a week.  Currently developing a Discharge to Assess model which would support earlier discharge whilst ensuring a robust assessment process.  There were a number of patients in hospital who required a complex assessment process prior to discharge.  A pilot was to be launched of 14 beds in the community where the patients could go whilst the assessment process was completed rather than stay in hospital. Patient choice is important as choices can effectively be rest of life choices.

 

Resolved:-  (1)  That the report be noted.

 

(2) That a further update, including details of the Community Transformation Programme, be submitted in January, 2015,

 

(3) That the following information be submitted to Members:

 

- Up-to-date figures for delayed discharges and complaints relating to discharges

- Report on Care Co-ordination Centre

-  ...  view the full minutes text for item 52.

53.

Health and Wellbeing Board - Making Every Contact Count pdf icon PDF 33 KB

Dr. John Radford, Director of Public Health

Minutes:

Dr. John Radford, Director of Public Health, presented an overview of the Making Every Contact Council (MECC) initiative.

 

MECC had been discussed at the Health and Wellbeing Board and, although partners agreed in principle with the concept, actual engagement with and tangible implementation had been disappointing.

 

The approach to MECC was currently subject to review and alternative strategies to engage partnership organisations considered.  Discussion ensued on the approach and the resources required to promote MECC and whether it was viable:-

 

-          In principle it was a great idea that whilst in hospital or your path crossed with any health care worker you would be spoken to about any issues that affected your health and possible interventions

-          It had been hoped to integrate the initiative into an employee’s training (health and social care) and, although that had not happened in a system-wide approach, it did not mean that it did not take place, but there were not the resources to ensure that it did

-          It would require 2-3 members of staff dedicated to producing a framework that could be used to persuade organisations to implement the initiative

-          Asking someone who was visiting/treating a client/patient to engage in MECC would cut into the time allocated for that person so it needed to be a proportionate response

-          A lot was being done in this regard through NHS Healthchecks (see below)

-          Hard evidence was required as to what the actual benefits of MECC were, including examples of effectiveness elsewhere

-          Need to engage commissioners to understand there would be additional resources required to deliver the initiative

-          Resources were also required to collate the information once it was gathered in order to measure the scheme’s impact, which could lead to a danger of it becoming a “tick box” exercise

-          Safeguarding concerns for both adults and children should be reported/identified by staff as a matter of course in their professional roles

 

Resolved:-  That information be provided following the current review of the approach to MECC for consideration by the commission

54.

Health and Wellbeing Board Strategy Progress - Prevention and Early Intervention - NHS Health Checks pdf icon PDF 803 KB

John Radford, Director of Public Health

Minutes:

Dr. John Radford, Director of Public Health, gave the following powerpoint presentation:-

 

-          Risk Assessment

Cardio Vascular Disease (CVD)

Type 2 Diabetes

-          Risk Communication

-          Risk Management

Lifestyle advice

Referral for behaviour modification

Prescribing

 

Our Objective

-          Screen 18% of eligible 20% of population annually

-          Challenge to deliver this in the most deprived communities

 

Lipid Modification NICE 2014

-          Systematic approach 40-74

-          QRISK2

-          Ethnicity, BMI, family history

-          High intensity statin for risk conditions with 10% risk

-          High intensity 20 mg atorvastatin for primary prevention

 

Diet

-          Reduce saturated fats

-          Replace saturated fats with olive oil and rapeseed oil

-          Reduce refined sugar and fructose

-          Fruit and vegetables whole grains

-          2 portions of fish

-          Signpost to NHS Choices

 

Exercise

-          High risk CVD 30 minutes of at least moderate activity daily

-          If unable to do this offer exercise to maximum capacity

-          Recommended physical activity could be built into daily living

-          Additive 10 minutes or more accumulated as effective as longer sessions

 

Q Risk 2

-          Age

-          Gender

-          Smoker

-          Premature family CVD

-          Hypertension treatment

-          Social deprivation

-          Total HDL cholesterol

-          Ethnicity

-          Rheumatoid

-          Chronic Kidney Disease

-          AF

 

Risk Communication

-     Individual risk and benefit

-     Numerical presentation

-     Signpost to appropriate information

-     Feelings and beliefs

-     Readiness to change lifestyle

-     Shared management plan

-     Check what had been discussed

 

Discussion ensued on the presentation with the following issues raised/clarified:-

 

·           Health Checks were aimed at everyone over the age of 45 years and were repeated every 5 years

·           It gave the opportunity to assess lifestyle and risk of heart disease/stroke and offer interventions for that risk

·           Since Public Health had joined the Council there had been a 30% increase in the number of health checks undertaken

·           A promotion programme would run from January, 2015

·           The prescribing of Statins could greatly reduce mortality from chronic heart disease

·           The participation rates at GP practices varied across the Borough

·           Stress and anxiety were not specifically included in possible causes of Q Risk 2 which were drawn up many years ago.  Social deprivation had been added as a means of acknowledging that if you were in control of your life you were less stressed

·           Timing of interventions and the life course approach of the Health and Wellbeing Strategy

·           The importance of winning “hearts and minds”

 

Resolved:-  (1)  That the presentation be noted.

 

(2) That Select Commission Members consider ways to champion and publicise NHS healthchecks, for example through town and parish council magazines.

 

(3) That details of the current membership of the following working groups be provided at the next meeting - Obesity Strategy Group, Rotherham Heart Town, Tobacco Control Alliance and the Self-Harm and Suicide Prevention Group.

55.

Date and Time of Next Meeting

-       Thursday, 4th December, 2014 at 9.30 a.m.

Minutes:

Resolved:- That the next meeting of the Health Select Commission be held on Thursday, 4th December, 2014, commencing at 9.30 a.m.