Venue: Town Hall, Moorgate Street, Rotherham S60 2TH
Contact: Dawn Mitchell The webcast can be viewed at http://www.rotherham.public-i.tv
Declarations of Interest
Councillor Jarvis made a non-pecuniary Declarations of Interest in relation to Minute No. 33 (The Rotherham Foundation Trust Quality Priorities 2919-20) as she was a Governor of The Trust.
Questions from members of the public and the press
There were no members of the public or press present at the meeting.
Consideration was given to the minutes of the previous meeting of the Health Select Commission held on 19th July, 2018.
Resolved:- That the minutes of the previous meeting held on 19th July 2018, be approved as a correct record.
Arising from Minute No. 16 (62 day wait for treatment for cancer), the Trust had focussed on addressing this atypical dip in performance and at the quarterly briefing with health partners in July reported that it appeared to be back on track so far in Quarter 2.
Arising from Minute No. 19 (savings from Integrated Sexual Health Service), it was noted that the Chair was to provide feedback to the Overview and Scrutiny Management Board at its 12th September meeting.
Arising from Minute No. 20 (Adult Residential and Nursing Care Homes), all Select Commission members had been emailed the recent “Guide to Residential and Nursing Care for Older People”.
Arising from Minute No. 21 (Health Select Commission Draft Work Programme), it was noted that further work on co-production was taking place on the Autism Strategy so would now be submitted to the Commission later in the year.
It was also noted that Councillor Keenan would be a representative on RDaSH as well as YAS.
There were no communications to report.
Chris Holt, TRFT to present
Nathan Atkinson, Assistant Director Strategic Commissioning, presented the following 2 powerpoint presentations, the second on behalf of Chris Holt, Director of Strategy and Transformation, TRFT:-
Health Village – Update on Integrated Working in Rotherham
Key Activity Under Development
- Integrated Point of Contact – alignment of Single Point of Access (SPA) and Care Coordination Centre (CCC)
- Integrated Discharge Team
- Intermediate Care and Reablement - “Home First” strapline
- Integrated Rapid Response – better triage
- Integrated Care Home Support – Red Bag, End Of Life pilot, named GP, links to Quality Board
- Developing Integrated Pathways as the default
What is Working Well
- Clear priorities and vision, agreed by all partners
- Shared agendas and the ‘right conversations’ taking place
- Governance framework in place
- Momentum building in a number of areas
- Changes happening on the ground (Single Point of Access, Care Co-ordination Centre, Integrated Discharge Teams, Integrated Rapid Response)
What are we Worried About
- Balancing (often competing) priorities
- Capacity to deliver – balance of new vs existing
- Engagement, communications and language
- Organisational development across all parties
- Capturing key milestones and measures from a very comprehensive data set across the system
What needs to happen next
- Continue to develop areas of practice where joint outcomes can be achieved
- Develop an Unplanned Care Team
- Focus on Home First and new delivery models
- Preparation as a system for Winter Plan requirements to meet NHS England requirements and applying learning from 2017/18 plan outcomes
Discussion ensued on the first presentation with the following issues raised/clarified:-
· There would be a multi-disciplinary team approach in the community as to which professionals would visit a client in their home, rather than a stay in a nursing home, depending upon their individual requirements. The Winter Plan would factor in the issue of capacity as it was quite a sea change. It was acknowledged that there was an element of risk as it was easier to identify a building/number of beds compared to multi-disciplinary teams in the community. Incremental steps were being taken to mitigate having sufficient resources
· Acknowledgement that capacity was an issue and there were challenges in recruitment across Health as well as the independent sector. A key piece of learning from the Health Village pilot was that you could not transform if members of staff came with existing work and caseloads that they could not exit from; a phased approach was required. Healthwatch and similar organisations were key in referring in issues/difficulties in the system
· Capacity was the biggest concern. It was known that there were gaps in the Hospital in terms of staffing and that there were challenges around recruitment. A full complement of staff within staffing budgets to deliver maximum capacity was required, at the hospital and to deliver the new models.
· It was imperative that the key milestones for the implementation of locality working were set and agreed as soon as possible because they had to ... view the full minutes text for item 30.
Dianne Graham, Director of Rotherham Care Group, RDaSH, to present
Dianne Graham, Director of Rotherham Care Group, RDaSH, and Rachel Cadman, Transformation Lead for Rotherham Care Group, RDaSH, presented the following powerpoint presentation:-
Rotherham Estates Consultation
- Aim – To seek stakeholder views on the two preferred options within the estates transformation plans”
- Part of wider consultation, 700 staff, service users, other stakeholders events
- Improved access for local people
- Aligned to GP surgeries
- Part of place based plans
- Integrated mental health, all age, Learning Disability Services
- Town centre facility
- More efficient use of resources
- Badsley Moor Lane – Learning Disability Services
- Ferham Clinic – Adult Mental Health
- Clifton Lane – Improving Access to Psychological Therapy (IAPT)
- Howarth House – Older Persons Mental Health (OPMH) and Dementia Clinics
- Swallownest Court – Adult Mental Health (AMH) inpatient/community
- Woodlands – OPMH inpatient
- Swallownest Court – South services
- Woodlands – Borough-wide/front end services
- Clearways – Town centre facility/clinics and base for IAPT team
Option 4 – Badsley Moor Lane (BML) (plus Ferham annex)
Option 5 – Ferham (plus Ferham annex)
Buildings we will no longer require
- Reduce buildings from 6 to 4
- No longer require Clifton Lane (IAPT)
- No longer require Howarth House (OPMH)
- Impact of agile working
- Riverside (local authority building)
- The Bank
- Rawmarsh Health Centre
- Maintain status quo
- Best use of Rotherham pound
- Best value out of estates
- Reducing from 6 to 4 buildings
- Providing town centre clinic based services
- Services will continue to be delivered
The estate plans were temporary with some moves for one to 2 years and further consideration with partners about a possible health clinic in the North for integrated health, mental health and social care. Savings would be around £100,000 for RDaSH but there were other benefits from co-location and greater integration and possibilities for other efficiencies, so it was a stepping stone.
Discussion ensued with the following issues raised/clarified:-
· Work was taking place to identify whether Ferham or Badsley Moor Lane was the best option. Both facilities compared favourably with regard to cost and both were accessible to their localities. It had formed part of the stakeholder consultation with questions asked as to what it was like for them in terms of accessibility, environment, how difficult it was to get to both places, with the outcome being that Badsley Moor Lane was the preferred building. Having said that Ferham had not been discounted. Ferham Clinic Annex would remain whatever the final option was
· Whilst recognising the ambitions behind the review in terms of joint working and close working with GPs, in the days of austerity how much was financial pressures or was it purely just reconfiguring services? It was both. RDaSH needed to be much more integrated. It was the vision that ... view the full minutes text for item 31.
Anne Charlesworth, Public Health, to present
Further to Minute No. 25 of the Cabinet and Commissioners Decision Making Meeting held on 6th August, 2018, Anne Charlesworth, Head of Public Health Commissioning, gave an update on the recommendations and corresponding actions arising from the Scrutiny Review of the Drugs and Alcohol Service Treatment and Recovery Services.
Rotherham’s new Adult Substance Misuse provider, Change, Grow, Live (CGL), had been providing the Service since 1st April, 2018. Mobilisation from a client perspective had been very smooth, staff transferred from RDaSH to CGL and they had managed the Service very well. Work was progressing on the pathways.
Monthly meetings were held with CGL to consider all the key performance indicators. Progress so far had been steady, as had been requested, for the first 3 months. 6 clients had exited the Service positively in the first few weeks of the new contract due to being drug free. It was now back to its normal 2/3 new clients a month. CGL would now be looking in more detail of who now was ready to exit the Service.
Since the new Service started, there had been 8 deaths of clients in Service; 5 had died in Hospital as a result of long term conditions and not directly their substance misuse, 2 had died as a result of overdoses but not directly attributable to the drugs they were in receipt of from the Service and the Coroner’s verdict was awaited for the 8th. None of the 8 clients would have been aged under 18 as the Service was for those aged 18 years and over; and there were none who were aged under 30.
The following update was given on each of the Review’s recommendations:-
1. A full suite of Performance Indicators was to be submitted to the November Select Commission meeting
2. As stated above, monthly meetings took place and so far progress was good
3. More suicide prevention and self-harm work would take place as and when funds became available
4. MECC training was going quite well; as of yesterday 215 people had attended the training so the alcohol message was getting out. There was a clear pathway that those who received MECC training understood they also got Health Rotherham services as first point of contact but then screening tool then referred people into CGL
5. As mentioned at a previous meeting, drugs and alcohol soft marketing testing had taken place but needed to ensure that it happened in all the commissioning. Work was taking place with procurement to make it part and parcel of what agencies did
6. There was a new pathway around notification of death. A concern from the NHS, if the Service was no longer a NHS Service, was that it would stop some level of scrutiny, however, CGL reported all deaths on the national template, did their own death investigation and were reporting deaths to the CQC, Public Health and the Head of Service for Safeguarding, so a decision could be ... view the full minutes text for item 32.
Janet Spurling, Scrutiny Officer, presented the following powerpoint presentation on The Rotherham NHS Foundation Trust Quality Priorities 2019/20.
It was noted that TRFT was to hold a public consultation event on their Quality Priorities, however, it clashed with a meeting of the Select Commission. It had been agreed that the Select Commission’s discussion would feed into the consultation.
Quality Improvement Priorities
- Every year The Rotherham NHS Foundation Trust developed a set of Quality Improvement Priorities for the year ahead
- These priorities helped ensure that there was a continuous drive to improve the quality of care provided for patients
- Each of the priorities had a lead who developed the details for each and what the aims, objectives and measures would be
Reminder for 2918/19 Priorities
- Patient Safety
· Missed or Delayed Diagnosis
· Deteriorating Patient (including Sepsis) (new focus)
· Medication Safety
- Patient Experience
· End of Life Care
· Learning from the views of Inpatients (new)
- Clinical Effectiveness
· Improving the quality of services provided through preparing for Care Quality Commission (CQC Inspection (new)
· Mental Capacity Act (increasing staff knowledge and awareness)
· Effective outcomes for women and baby (new)
Initial Quality Priorities for 2019/20
- Patient Safety
· Embedding the use of the National Early Warning Score (NEWS2)
· Improving the assurance regarding the implementation of national safety alerts
· Improving the learning and changes in practice arising from action plans from Serious Incidents and Inquests
· Improving the safety of care provided to patients requiring respiratory support
· Embedding the ambition of zero avoidable pressure ulcers
- Patient Experience
· Improvement in Patient and Public Involvement and Engagement
· Improving the experience of children receiving care in non-paediatric focused services
· Embedding the treatment of all patients in an equal and diverse manner
· Improving the experience of patients transitioning from Children to Adult Services
· To be identified following the outcome of the Patient Experience Framework (NHS Improvement June 2018) and Trust Wide Diagnostics
- Clinical Effectiveness
· Improving the quality of services provided through implementing the findings from the CQC Inspection
· Effective outcomes for women and babies
· Improving conversations about public health matters
· Improving the outcomes from the Sentinel Stroke National Audit Programme (SSNAP)
· Improving the outcomes from a National Audit (exact audit to be confirmed)
With regard to a query regarding Sepsis, Janet Spurling, Scrutiny Officer, reported that there had been a national focus on this, not just Rotherham Hospital, and training had taken place with YAS telephone call handlers. Janet would follow this issue up. Further information would be sought.
Councillor Andrews provided more details about the National Early Warning Score tool for recording patient observations.
Resolved:- (1) That the Select Commission feedback their views to TRFT through Janet Spurling, Scrutiny Officer.
(2) That the Quality Account Sub-Group meet in December to discuss the final set of priorities as part of the half year update.
Janet Spurling, Scrutiny Officer, presented papers requested by JHOSC at its previous meeting for information regarding progress with the implementation of Children’s Surgery and Anaesthesia and the designation process and an overview of the South Yorkshire and Bassetlaw ICS areas of future scrutiny.
When the papers for the next JHOSC meeting were published these would be circulated to all Select Commission Members with regard to identifying any questions or issues to raise through the Chair.
Resolved:- That the information be noted.
Healthwatch Rotherham - Issues
No issues had been raised.
Minutes of meeting held on 11th July, 2018
Consideration was given to the submitted minutes of the Health and Wellbeing Board held on 11th July, 2018.
Resolved:- That the minutes of the Health and Wellbeing Board held on 11th July, 2018, be noted.
Arising from Minute No. 3 (Questions from Members of the Public and Press), it was clarified that the original application for a Judicial Review had been for the Hyper Acute Stroke Services which was rejected as it was also on appeal.
Date and time of next meeting
Thursday, 18th October, 2018, commencing at 10.00 a.m.
Resolved:- That a further meeting be held on Thursday, 18th October, 2018, commencing at 10.00 a.m.