Agenda and draft minutes

Health Select Commission - Thursday 16 April 2015 9.30 a.m.

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

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

Items
No.	Item
82.	Declarations of Interest View the background to item 82. Minutes: There were no declarations of interest made at this meeting.
83.	Questions from members of the public and the press View the background to item 83. Minutes: There were no members of the public and press present at the meeting.
84.	Communications View the background to item 84. Minutes: Information Pack Two queries were raised regarding the Health and Wellbeing Board minutes which were checked during a break in the meeting: Minute No. S59 (Health and Wellbeing Strategy Refresh Workshop) – it was clarified that the point made about delivery mechanisms for the Health and Wellbeing Strategy was in reference to the Casey Report and that the Strategy was currently being refreshed, together with the board structure and governance arrangements. Minute No. S60 (Health and Wellbeing Performance Update) – it was confirmed that the transition of the Stop Smoking Service to Midwifery referred to specialist support for pregnant women only not the generic Stop Smoking Service. No comments were received on the Commissioners Working Together update and it was agreed to receive further updates as the programme progressed. Work Programme An ongoing scrutiny work programme had been agreed with the Commissioners. For this Select Commission there would be a focus on Health and Social Care integration and, in particular, the Better Care Fund. At the present time it was not envisaged that there would be big changes to the Commission’s plans and standard work. A more detailed report on the work programme would be considered by the Overview and Scrutiny Management Board at its meeting on 24^th April. Yorkshire Ambulance Service - Performance Information Due to the number of items on the agenda, the Service’s draft Quality Accounts had been circulated for comments by 22^nd April in order that they may be collated and submitted in accordance with the 27^th April deadline. Chantry Bridge GP Practice Some information had been received with further detail requested to inform any response the Select Commission wished to make. Quarterly meeting with Rotherham Clinical Commissioning Group A meeting had taken place the previous week. The notes would be circulated when available. Rotherham Mental Health Hospital Liaison Service A 2 year pilot had been launched on 1st April to provide assessment, treatment and management of mental health problems to adults aged over 18, who were admitted to Rotherham Hospital. This was a positive example of partnership working between RDaSH and the Foundation Trust and an approach that recognised the links between physical and mental health and how ill health in one often impacted upon the other. Rotherham Foundation Trust The Monitor enforcement for governance had been lifted. NHSE Property Services A response had been received to the letter sent by the Select Commission regarding the issues being experienced at the Treeton GP practice. It seemed likely that all interested parties would be invited to the June Select Commission meeting as planned.
85.	Minutes of the Previous Meeting PDF 93 KB View the background to item 85. Minutes of meetings held on 15^th and 22^nd January, 2015 Additional documents: Minutes , 22/01/2015 Health Select Commission , item 85. PDF 81 KB Minutes: Consideration was given to the minutes of the meetings of the Health Select Commission held on 15^th and 22^nd January, 2015. It was confirmed that a progress report on the recommendations of the Continence review would be scheduled for a future meeting. Resolved:- That the minutes of the meetings held on 15th and 22^nd January, 2015, be agreed as a correct record for signature by the Chairman.
86.	Healthwatch Issues Minutes: No issues had been raised although Healthwatch continue to work with RDaSH on service improvements.
87.	Rotherham Foundation Trust Quality Accounts PDF 299 KB Tracey McErlain-Burns, Chief Nurse, to present Additional documents: TRFT Draft QA 01 04 15 , item 87. PDF 1 MB Minutes: Tracey McErlain-Burns, Chief Nurse, and Hilary Fawcett, Quality Governance Lead, gave the following powerpoint presentation:- Quality Account - The focus of the Quality Account is on how we take assurance that the services we provide are safe, effective and enabling our patients, their families and carers to have a positive experience of care Care Quality Commission Registration - The Trust was required to register with the Care Quality Commission (CQC) – its current registration status was ‘fully compliant’ with no conditions on registration - The Trust was subject to a routine, announced inspection between 23^rd-27^th February, 2015 – draft report awaited - The Trust was currently on Band 4 of CQC Intelligent Monitoring Report (scale of 1-6 where Band 1 represents the highest level of risk, 6 the lowest) Looking Back – our quality improvement for 2014/15 - Priority 1 – Mortality – to achieve a 4 point reduction in HSMR Confirmation of figures awaited - Priority 2 – SAFE – Harm Free Care (HFC) Achieve minimum 96% HFC Avoidable pressure ulcers grade 2-4 Zero avoidable falls with harm - Priority 3 – Achieve all national waiting times targets Cancer 2 week waits 31 days 62 days A&E 18 weeks 52 weeks target - Priority 4 – Achieve improvement in all Friends and Family Test scores Looking Forward – TRFT Quality Objectives 2015/16 - Clinical Effectiveness · Ensure maximum learning from unexpected deaths and reduction in mortality rates through review of all unexpected deaths in line with Trust Mortality Review process · Reduction in delayed discharge of patients – Safer patient care bundle - Patient Safety · SAFE – Harm Free Care- continue to aim for minimum 96% HFC · Sign up to Safety Campaign Improve responsiveness to diagnostic test results to ensure avoidable harm caused by missed/delayed diagnosis Improve processes designed to recognise and respond to signs of deterioration in condition of adult patients - Patient Experience · Achieve improvement in the outcome of the national in-patient survey specifically having a focus on reduction of noise at night · Achieve and maintain improvement relating to Friends and Family Test results both in terms of positive score rates and responsiveness · Improve care of patients with Dementia – ensure Trust colleagues undertake awareness training · Improve Trust responsiveness to complaints – 90% of responses with complainant by date agreed · Improve patient satisfaction with quality of complaints management process Discussion ensued on the presentation with the following issues raised/clarified:- - This was the first draft of the document and, due to the timeframe, had not allowed year-end information to be included - SAFE Harm Free Care was a national programme involving monthly audits. It looked at 4 very specific elements of care but focussed particularly on pressure ulcers and avoidable falls - The 96% target for Harm Free Care which, although not met, considerable progress had been made. Nationally the figure was for acute trusts whilst Rotherham’s was for both the Trust and Community Services. Rotherham had started to split the figure into “patients in ... view the full minutes text for item 87.
88.	Nurses in Special Schools PDF 45 KB Juliette Penney, Clinical Services Manager, Children and Young Peoples Services/Rotherham Foundation Trust, to present Minutes: Tracey McErlain-Burns, Chief Nurse, presented an overview of the Special Schools Nursing Service in Rotherham which provided holistic nursing care for children and young people with additional health needs enabling them to access education. The report highlighted:- - Composition of the Team – 3.5 staff - mixture of children’s trained and learning disability trained nurses (Bands 6 and 5) - Schools currently serviced by the Team – Abbey, Hilltop, Kelford, Milton, Newman and Willows as well as schools where there were children who had additional health needs requiring care plans (50 active cases) - Role of the School Nurse – assess the student’s health status, identify health problems that may create a barrier to educational progress and develop a health care plan for management of the problems in the school setting. The School Nurse would also ensure that the child’s individual health care plan was developed and implemented with the participation of School and the main carers to ensure the child’s needs were met - The Team also provided services that mainstream School Nursing carried out including immunisations, drop-in clinics, health assessments and assessment of growth - Training delivered – monthly Epipen training for new staff as well as annual updates, Gastrostomy, Suction, Tracheostomy care, Adrenal insufficiency and Medication training - Safeguarding – Team members must ensure they maintained their skills in managing Safeguarding cases and required to ensure their training was up-to-date. Individual supervision was given by a Specialist Nurse from the Safeguarding Team to support practitioners. If a child was identified as being sexually exploited, the Rotherham Foundation Trust’s Safeguarding procedures would be followed as well as making contact with the children’s advocate and appropriate agencies. - Future – with the advent of Education and Health Care Plans the Team would be well placed to contribute and become involved with the formation of Rotherham’s plans Discussion ensued on the report with the following issues raised/clarified:- · Discussions would take place with the Team Leaders to gain an understanding of their workloads particularly how the Teams were structured so there was confidence that the School Nurse caseloads were never disproportionate without good reason · Work was currently taking place with the MASH. School Nurses were often needed to attend a large number of strategy meetings and sufficient flexibility had to be built into their day to enable them to respond quickly. Their input was important because of the information and intelligence they held about the welfare of the children · The Service was currently commissioned by Public Health. Work was taking place on a refresh of the School Nurse specification including the needs analysis and discussions with CYPS in the longer term to develop a service for 0-19/24 year olds dependent upon the particular needs of the child/young person and reflecting either health needs or learning difficulties to the age of 24 years. Improvements were needed on performance information for the new specification. · The Health Visiting Service, currently commissioned by NHS England, would transfer to the Council on 1^st October ... view the full minutes text for item 88.
89.	RDaSH Quality Accounts PDF 4 MB Karen Cvijetic, Head of Quality Improvement, to present Minutes: Karen Cvijetic, Head of Quality Improvement, gave the following powerpoint presentation:- What is a Quality report? - Nationally mandated - 2014/15 was the 7^th Quality report 2014/15 Quality Performance - Care Quality Commission (CQC) – registered with no conditions - CQC Inspections – 1 inspection of Trust services – Rotherham Learning Disability: Cranworth Close - Complaint with all essential standards of quality and safety reviewed - CQC Mental Health Act monitoring visits – 12 monitoring visits of Trust Mental Health Inpatient Services – 6 in Rotherham - Compliant with some minor improvement actions - Commissioner-led quality visits · 2 visits to Mental Health and Community Services in Doncaster – Woodlands (Older Peoples’ Mental Health), Swallownest Court (Adult Mental Health) · Positive feedback Positive patient interaction Staff demonstrated competence and confidence in care planning, commitment and compassion in care delivery Environment was clean with staff doing activities with patients Patient feedback forms available on the Ward and the patients knew how to complain · Areas for improvement Develop training plan to help increase staff awareness on how to recognise and help patients with a learning difficulty Easy read should be used whenever possible for patient information Look at how the Ward areas help prevent the spread of infections Support staff to help them understand the use of Deprivation of Liberty Safeguards Quality Improvement Strategy 2014-16 Patient Safety - Sign up to Safety A national Campaign led by NHS England Aims to deliver harm free care for every patient, every time, everywhere Champions openness and honesty and supports everyone to improve the safety of patients Sign up to Safety’s 3 year objective is to reduce avoidable harm by 50% and save 6,000 lives - Five key areas Pressure ulcers Medication errors Suicides Falls Restrictive interventions - Clinical Effectiveness Care Pathways and Packages Commissioning for Quality Indicators (CQUIN) NICE - Patient Experience Commissioning for Quality Indicators (CQUIN) Listen to Learn National Mental Health Service User Survey NHS Friends and Family Test - Our Staff Safer staffing Leadership Professional Strategy Leading the way with quality NHS Staff Survey Francis Declaration - Trust Francis Declaration jointly signed off by Board of Directors and Council of Governors in December, 2014 - 4 Francis priorities for 2014 Culture Engagement Non-professionally qualified staff Whistleblowing Local Commissioning Priorities 2014/15 - Consideration of investment in priority areas - A review of Mental Health and Learning Disability Services - A review of the Learning Disabilities Assessment and Treatment Unit and Community Services - Development of a comprehensive CAMHS Strategy - Development of care pathways and packages (Mental Health Payment and Pricing Systems) Next Steps - Receive Select Commission comments for including in the Quality report – May, 2015 - Report to Board of Directors – 30^th April, 2015 - Report to Council of Governors – 15^th May, 2015 - Report to Monitor – 29^th May, 2015 - Review by Audit Commission – April/May, 2015 Discussion ensued with the following issues raised/clarified:- · Ensuring quality of care ... view the full minutes text for item 89.
90.	Scrutiny Review - RDaSH CAMHS PDF 51 KB Additional documents: RDASH CAMHS Scrutiny Review Report v2 , item 90. PDF 2 MB Minutes: Consideration was given to a report presented by Councillor Sansome, Chair of the Review Group, which set out the findings and recommendations of the above Scrutiny Review. The 7 main aims of the Review had been:- · Understand the prevalence and impact of mental health problems and illness amongst children and young people in Rotherham · Understand the costs, value for money and quality of current services · Clarify how partners work together to support children and young people across all the tiers, especially the role of the RDaSH Duty Team · Establish how RDaSH engages with Service users and their families/carers in order to deliver appropriate and effective services · Ascertain how identifying and responding to child sexual exploitation is integrated within RDaSH Child and Adolescent Mental Health Services provision · Determine how effective support for the mental health and emotional wellbeing of Looked After and Adopted Children is provided · Identify any areas for improvement in current Service provision and support A full scrutiny review was carried out by the Health and Improving Lives Select Commissions with evidence gathering beginning in September, 2014, and concluding in February, 2014. It had been comprised of round table discussions and written evidence from health partners, RMBC officers, the Youth Cabinet and desktop research. Although the principal focus of the review had been RDaSH CAMHS, the Services were not provided in isolation and were part of a complex system of Service commissioning and provision. The new Emotional Health and Wellbeing Strategy and recent changes to RDaSH CAMHS were positive with a more flexible service across a range of community settings and greater links to Youth Services and school a priority to be progressed further. The volume of referrals to RDaSH was high and, although waiting times had been reduced for routine assessment, the target was still being exceeded with the Service likely to continue to face high demand. Improved communication between agencies and with families, clear access criteria, referral and care pathways and renewed attention on health promotion, self-help and early support would help to reduce the number of young people with deteriorating mental health and emotional wellbeing. Data quality remained an issue and greater attention should be paid to improving and measuring outcomes. Prevention and early intervention should remain a focus to try and reduce the number of young people needing support at higher levels or continuing into adulthood given the emergence of many lifelong conditions during adolescence. The review had made 12 recommendations:- 1. Once the national refresh of prevalence rates of mental disorder is published, RMBC and the Rotherham Clinical Commissioning Group should review the local Analysis of Need: Emotional Wellbeing and Mental Health for Children and Young People and the Mental Health Services commissioned and provided in Rotherham across Tiers 1-3. 2. Through the CAMHS Strategy and Partnership Group service commissioners and providers should work towards improved and standardised data collection and information sharing on the Service users and patients: a. to help maintain a detailed local profile of C&YP’s mental health over time ... view the full minutes text for item 90.
91.	Scrutiny Review - Access to GPs - Updated Response PDF 121 KB Minutes: Janet Spurling, Scrutiny Officer, submitted an updated response to the above Scrutiny Review following the referral back to the Select Commission by Cabinet (Minute No. 86 refers) for further consideration. A special meeting of the Select Commission had been held on 15^th January to which NHS England South Yorkshire and Bassetlaw Area Team and the Clinical Commissioning Group had attended to provide further information. The Care Quality Commission had also been invited due to their forthcoming inspections of Rotherham GP practices. Also, since the Review had been carried out, there had been changes in the NHS that had impacted upon the original Review recommendations. The updated version of the responses were attached at appendix 1 of the report submitted for consideration. Attention was drawn to the following issues:- - Each GP practice was an individual business and NHS England could not dictate how they operated/organised themselves as long as they met their contractual requirements - A new Primary Care Strategy was being developed with engagement with the public, patients and GPs due to commence in June - NHS England had visited the GP practice that had been in the news recently regarding waiting time for an appointment. It had been clarified that that was not the case for those in need of urgent/immediate care but was for routine appointments - Recently published LGA report on Planning and Public Health would be considered by the Health and Wellbeing Board which stated that Planning should take into account Public Health in all its functions including exercise - A Limited Trust was to be set up for 35/36 GP practices in Rotherham to allow them to bid for funding under a Limited Trust - Confusion/concern as to the governance arrangements of such a Trust and GPs’ ability to commission when the CCG had devolved the responsibility for decision making to GPs Resolved:- (1) That the updated response be noted. (2) That the Health and Wellbeing Board be requested to ensure responsible agencies report progress to the Board and the Select Commission. (3) That the Health and Wellbeing Board be requested to discuss the relevant elements of recommendation No. 7 with regard to Borough-wide publicity and awareness raising. (4) To note that further liaison with NHS England and Rotherham CCG has been undertaken to finalise certain timescales and actions. (5) That the report be forwarded to the Overview and Scrutiny Management Board. The following is an extract from the Rotherham Clinical Commissioning Group’s Commissioning Plan regarding the concern expressed above:- “Governance It is recognised that CCGs taking on delegated responsibility of the commissioning of GP services creates a conflict of interest. Our Governance section 6.5 outlines our approach to dealing with these conflicts. Primary Care Sub-Committee To ensure the effective commissioning of high quality, safe and sustainable primary medical services for the population of Rotherham · To oversee the development of an operational plan for safe and sustainable Primary Care Commissioning · To oversee the development and agreement of primary care contracts for 2015/16 ... view the full minutes text for item 91.
92.	Retiring Members Minutes: As this was the last meeting before the end of the 2014/15 Municipal Year, the Chairman thanked all the Select Commission members for their work on Health Scrutiny during the past year and in particular those Members who were retiring from the Council.
93.	Date and Time of Next Meeting View the background to item 93. - Thursday, 11th June, 2015 at 9.30 a.m. Minutes: Resolved:- That the next meeting of the Health Select Commission be held on Thursday, 11^th June, 2015, commencing at 9.30 a.m.