Agenda and minutes

There were no Declarations of Interest.

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

1.         An information pack had been circulated separately, including:-

            RDaSH Child and Adolescent Mental Health Services (CAMHS)

            Performance Report – the Health Select Commission (HSC) would be having an update on CAMHS in October and this might help to inform Members’ key lines of enquiry

            Social Prescribing overview

            Health and Wellbeing Board minutes from July

2.         Schools Mental Health pilot evaluation event on Wednesday 25^th October – the Chair asked if one of the Members who had been involved in the monitoring visits to the schools would be available to attend the event to represent the Select Commission

            After the meeting it was confirmed that Cllr Marriott would attend.

3.         An early date to note for diaries was a two part event facilitated by the LGA on health prevention, with all Select Commission Members encouraged to attend. The sessions would be on 23rd and 30th November.  More detail would follow but it was noted that useful Ward profiles would be available

Consideration was given to the minutes of the previous meeting of the Health Select Commission held on 20th July, 2017. 

Arising from Minute No.16 Membership of the Health, Safety and Welfare Panel 2017/18, it was noted that there was still a vacancy for a Member from HSC.  Expressions of interest were requested.

Arising from Minute No. 17 (Adult Social Care Provisional Year End Performance 2016/17), follow up information for performance measure No.14 (permanent admissions to residential care of people aged 18-64) on sub-cohorts by age and service user group had been included in the agenda pack.

Arising from Minute No. 19 (Health Select Commission Work Programme), it was noted that the item on the refresh of the Health and Wellbeing Strategy had been postponed to November but there was still a good opportunity for the Select Commission to be involved at an early stage.

Arising from Minute No. 21 (Healthwatch Rotherham), Councillor Roche confirmed that the Autism Partnership Board had met on 20th July, work on the Autism Strategy was underway and an officer had recently been appointed who had been involved in developing the national Autism Strategy.

Resolved:- That the minutes of the previous meeting, held on 20th July, 2017, be approved as a correct record.

Dominic Blaydon, TRFT to present

Dominic Blaydon, The Rotherham Foundation Trust (TRFT), presented a briefing paper to update the Health Select Commission on progress in relation to further development of the Care Co-ordination Centre (CCC) and Integrated Rapid Response (IRR) services currently provided by TRFT. The ambition within the Rotherham Place Plan was to extend both services to include mental health and social care, providing a multi-disciplinary approach to address the whole needs of the service user, resulting in an improved experience and more effective use of resource.

The role of the Care Co-ordination Centre, which was developed about five years ago, was to provide a telephone based nurse-led approach providing advice to health professionals on the correct care pathway for patients in urgent need. This could be through a district nurse, community physician or a referral to intermediate care. It was intended to address the high number of GP initiated hospital admissions and to act as a portal to community health to see whether they were able to support a patient rather than them going to hospital. It has been very successful, for example reducing GP referrals to the Medical Assessment Unit by around 20%.

A phased approach was being taken to implementation to realise benefits within the available resource and to manage risk.  The first phase was to include urgent mental health referrals; work on this had commenced and from a local authority perspective was quite straight forward.  Then they would be looking at linking up with RMBC and the work that they were doing on social care referrals, for people in crisis or with a high level of need.

The Integrated Rapid Response Service, formerly known as both the Fast Response Service and as the Community Assessment Rehabilitation and Treatment Scheme (CARATS), was commissioned to provide short term care packages at home for people at risk of hospital admission.  It could also be used to expedite hospital discharges of vulnerable patients who no longer had a medical need and to prevent hospital re-admissions, and was working well.  Instead of a patient being admitted to hospital because they were not safe at home, the IRR service went in and provided wrap around care, followed by a handover to Community Health after 72 hours.

The Service works alongside the CCC and the intention was also to extend IRR to include Mental Health and Social Care needs by working with the local authority, to provide time limited re-ablement for people experiencing a short term crisis. This would lead to a more holistic approach to care to support people with a greater level of need or more complex needs and would address any safety issues arising from providing a more one dimensional service.

Partners were also considering how IRR would link in with the integrated locality.  The thinking was that urgent on the day care could be transferred to IRR, thus freeing up integrated locality workers to carry out the planned work with people with long term conditions and to be more proactive.  Phase 1 of  ...  view the full minutes text for item 28.

Steph Watts and Michaela Bateman to present

Steph Watt and Matt Pollard presented an update on the RDaSH Adult Mental Health transformation activity, as outlined to the Commission in Summer 2016. 

Members were reminded of the key issues that had emerged from consultation with stakeholders, which had been drivers for the reconfiguration.  In particular, care closer to home, “telling it once”, better access to health and not being bounced between services due to issues within the organisational structure had been raised by patients and carers

RDaSH had now moved from age related, cross-Trust business divisions to place based locality Care Groups. The Rotherham Care Group was comprised of Adult and Older People’s Mental Health Services, Learning Disability Services and Drug and Alcohol Services.  A recovery and wellbeing ethos underpinned the services with care wrapping around the patient through multi-disciplinary teams and a new pathway framework. The new structure was based around two localities, north and south, although smaller specialist services, such as young onset dementia, continued to be borough-wide. A “deep dive” into access to front door services was also planned.

The Trust had also considered how IT would support the new structure and a new patient record system (PRS) would be introduced from April 2018 to be more streamlined and effective.  Information governance was an important issue for mental health and processes were in development. RDaSH were working with TRFT on Electronic Patient Records (EPR) to help with information sharing across physical health and social care, supported through funding from the Better Care Fund (BCF).

It was hoped to extend the two social prescribing pilots with the voluntary and community sector to “front door” work. Discussions were taking place with The Samaritans regarding work with people needing support but who did not necessarily meet statutory service requirements, again through the BCF.

The new management team was in place and work is underway on estates to move teams into the localities – on an interim basis initially, with a view to future co-location with health and social care, generating economies of scale and efficiencies as well as benefits for patients.

A phased roll out of the new pathways was commencing with brief interventions initially - prevention and stopping deterioration.  RDaSH would be working proactively with TRFT and RMBC on the Integrated Rapid Response service mentioned above.

Benefits for patients would be a better experience through care closer to home, improved access and a more unified structure.  There were also efficiencies, firstly from the management restructure and the PRS, plus an admin review was taking place. Efficiencies had been looked at from back office functions rather than clinical teams.

More integrated working had many positives but changes did bring about anxieties and the trust was continuing to work closely with stakeholders and patients.

Discussion ensued with the following issues raised/highlighted:-

·         Patient records kept and stored in paper files, including off-site, and practical issues and timescales for moving fully to EPRS
– Services were trying to be “paper-light” but there would still be a need to archive  ...  view the full minutes text for item 29.

Nathan Atkinson,  Ian Atkinson and Claire Smith to present

Ian Atkinson, Rotherham CCG introduced an update on progress with regard to reducing Delayed Transfer of Care (DTOC) at TRFT. As with the other workstreams discussed this was again very much a partnership approach.

NHS England defined patients as ready to transfer out of the hospital setting when:

a)           A clinical decision had been made that the patient was ready for transfer

AND

b)           A multi-disciplinary team decision had been made that the patient was ready for transfer

AND

c)            The patient was safe to discharge/transfer.

Delays in discharge could be linked to a number of different reasons; common areas of delay related to patients waiting for assessment and decision regarding Continuing Care, patients waiting for care packages to be established in the community or awaiting a care home package. 

One of the four national conditions set out in the 2017 Better Care Fund planning guidance required health and social care systems to work jointly to reduce DTOC to a level of no more than 3.5% of patients at any one time being classified as DTOC within the hospital setting (equates to an average 15 patients at any one time).

Historically Rotherham health and care community had performed well on DTOC, consistently delivering below the 3.5% target. However throughout 2017 (although comparable to many other areas of the country) TRFT had reported a more challenged position.

In terms of numbers, on average the hospital had 400 beds for patients daily.  83 people per day were discharged from Acute Care, so 3.5% meant around 10 patients being delayed and 5.5%-6% was approximately 24/25 patients classed as being delayed for discharge. 

DTOC had had a raised national profile recently and although Rotherham was not a significant outlier; it was a key performance indicator and was at the heart of three main indicators in the Improved Better Care Fund that needed to improve upon.  In response partners commissioned an external review undertaken by the Local Government Association and a peer NHS Foundation Trust. This provided an objective view of how flows of patients, assessment processes were managed and the capacity going forward. 

Flow back end of patients out of hospital and bed availability also impacted on A&E performance. Therefore the multi-agency A&E Delivery Board had agreed and was overseeing the Rotherham DTOC action plan based on the recommendations from the review. Key points that partners wanted to challenge themselves on before the onset of winter pressures were highlighted in red in the action plan.

Key issues in the improvement challenge were:-

·                    integration of the discharge teams (Health and Hospital based Social Work Team) in terms of teams going and providing support around the patient and the family to expedite care out of the hospital

·                    data and information joined up by using similar data sets e.g. for the stop/start time for the assessment process

·                    discharging patients home first when it was medically safe to do so then the full assessment

Integrated Better Care Fund (IBCF) funding would  ...  view the full minutes text for item 30.

The Scrutiny Officer introduced a short briefing paper on forthcoming changes to national ambulance standards. Following positive evaluation of a national pilot (which Yorkshire Ambulance service had been involved in) new ambulance response categories and standards were being introduced nationally. 

Key drivers for change to modernise the service to be suitable for patient demand and current care pathways were outlined.

This issue would be considered by the Yorkshire and Humber Joint Health Overview and Scrutiny Committee as it was a regional service with Wakefield Clinical Commissioning Group (CCG) as the lead commissioner for the region.

Clarification was provided on the targets being applicable to 90% of calls and a request would be made to see if performance data on meeting the response time targets could be disaggregated between urban and rural areas and what performance data could be disaggregated to CCG level, as most data reporting is at regional level.

Rotherham CCG confirmed that YAS would be collecting data based on the new standards from September and would begin to report from October.  This data would be available via the CCG website, including any that was reported at a Rotherham level.

Resolved:- That theSelect Commission determine any specific questions to submit to the Yorkshire and Humber Joint Health Overview and Scrutiny Committee to ask the Yorkshire Ambulance Service in relation to the new standards.

There was no update to report.

The Chair gave an update from the last meeting of the Joint Health Overview and Scrutiny Committee (JHOSC) held on 31st July, 2017:-

Children’s Surgery and Anaesthesia - plans for implementation would be in place by the end of December 2017, with a further update to the JHOSC, probably in October. 

Hyper Acute Stroke – the decision from the Joint Committee of CCGs was due in the autumn with an update expected for the next JHOSC.

South Yorkshire and Bassetlaw Hospital Services Review – a new workstream under NHS transformation had commenced recently:-

- to define the criteria to help understand what a sustainable hospital
  service would be. 

- to look at services and define those which were non-sustainable.

- to advise on future models of delivery to ensure long term sustainability.

JHOSC Terms of Reference – a refresh was under way and would be communicated to the Select Commission. 

Copies of a powerpoint presentation about the hospital services review and a stakeholder briefing were circulated to Select Commission Members at the meeting.

There were no issues to report.

Thursday, 26^th October at 3.00 p.m.

Resolved:- That the next meeting of the Health Select Commission be held on Thursday, 26th October, 2017, commencing at 3.00 p.m.