Agenda and minutes

Health Select Commission - Thursday, 5th September, 2019 2.00 p.m.

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

Contact: Dawn Mitchell  The webcast can be viewed at http://www.rotherham.public-i.tv

Items
No. Item

24.

Declarations of Interest

 

To receive declarations of interest from Members in respect of items listed on the agenda.

Minutes:

There were no Declarations of Interest made at the meeting.

 

25.

Questions from members of the public and the press

 

To receive questions relating to items of business on the agenda from members of the public or press who are present at the meeting.

Minutes:

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

 

26.

Enhancing the Respiratory Pathway pdf icon PDF 176 KB

Minutes:

Jacqui Tuffnell, Head of Commissioning at NHS Rotherham Clinical Commissioning Group (CCG) gave the following short presentation outlining the rationale for change to the respiratory pathway, what was being proposed and the plans for engagement.

 

Why do we need to make changes?

  • Poorer outcomes for our patients than our counterparts across the integrated care system (NHS Right Care data)
  • Fragmentation across the respiratory pathway
  • Fragmentation of the home oxygen service
  • Improve diagnosis across Rotherham – accreditation needed for spirometry testing
  • Improvement the management of respiratory patients
  • High numbers of patients going into hospital – for example other areas support patients with low level pneumonia at home
  • Longer stays for patients when they are in hospital
  • Long term plan states care should be provided closer to home

 

What changes are proposed?

The development of the enhanced respiratory pathway has been a clinically led process, developed in line with best practice and the clinical benefit for patients has been at the forefront of discussions

 

The enhanced model for respiratory includes:

  • Standardising the care across primary care for diagnosis and management – engagement on what this should look like.
  • Improving patient education and access to support patients to self-manage – including digital options/apps
  • Delivering care closer to home, with a specialist community respiratory team, reducing the requirement for inpatient care
  • Delivering care during the day, at evenings and weekends to fit in with patients’ lives
  • For those who do require inpatient support a dedicated respiratory unit at TRFT
  • Increased support for high intensity users to help stabilise their conditions

 

Service user, carer and stakeholder engagement

Patient and public and stakeholder engagement on the proposed changes is scheduled throughout September and will be via the following forms:

  • Surveys, online and paper
  • Face to face drop in sessions across Rotherham, including breathing space – different days and times so working population also have opportunity to be involved
  • Mjog (Memory Jogger) text messages to patients, aimed at those with a specific respiratory condition
  • Media messages
  • Animation – to follow

 

The intention is to try and involve the wider population of respiratory patients, not just the 20% who particularly use Breathing Space.

 

Next Steps

  • Incorporate engagement responses into the business proposal
  • Governing body 2 October 2019/ Trust Board
  • Commence recruitment to the new structure

 

The following issues were raised and discussed:-

 

·         Mjog

Mjog or Memory Jogger was a well-used texting system from GPs for sending reminders and messages, for example to alert people about flu jabs.  It would be used to inform a large number of people about the engagement sessions.

 

·         Current relatively poor outcomes - to what extent was there still a legacy from the old mining industry?

- Not so much now and there had been changes in smoking habits associated with that, but respiratory conditions were still growing.  It appeared to be linked more with how the pathway actually worked.

 

·         What was the scale of the poor outcomes for our patients and being worse than counterparts?

- It was significant enough to need  ...  view the full minutes text for item 26.

27.

Home First - Intermediate Care and Reablement pdf icon PDF 480 KB

Minutes:

Anne Marie Lubanski, Strategic Director for Adult Care, Housing and Public Health gave the following powerpoint presentation, recapping the information provided previously and focusing on how the work would be taken forward.  This included how it would link in with the service redesign in Adult Social Care, which would see a 30% reduction in its workforce, maximising the front door, reablement and the preventative offer.

 

The pathways would be joint integrated working pathways with health rather than structural changes, although these could follow at a later stage.  This was a significant piece of work and a testimony to partnership working and the maturity of it in Rotherham, as health and social care were two very different systems, especially regarding contributions and charging.  The pathways were based on best practice, on the 12-week recovery model seen in mental health principles and two proof of concept initiatives would run with the reablement team to test things.  The trusted assessment role would also be looked at so that people would not have to wait to see someone else to get something they might need. 

 

From a commissioning perspective across the CCG and RMBC the view was that this would become a more cost-effective model, not immediately as some of it would be iterative going through the process.  In Year 2 it would be a question of looking at where things could be done differently and whether it was about efficiencies or reinvestment would be considered later on.  

 

Heading into winter was part of the challenge of how to double run and test things, at a time when it was also critical for the Trust not to impact on flows in and out of the hospital. 

 

Communication and engagement were key areas to get staff on board and to understand the cultural changes and potential professional changes necessary.  Work would also be needed with the GP Federation following the introduction of Primary Care Networks (PCNs).

 

Why Change?

·         People have told us

They would like to be at home wherever possible

They would like to regain their independence

Current services were disjointed and could be hard to navigate

·         Care Quality

Evidence shows people did better at home

We know that a large number of people received care in a community bed when they could have gone home with the right support

Rotherham had significantly more community beds than other similar areas

Current services were focussed on older people and their physical needs

Through changing the way we worked, more people were going home and our community beds were not fully utilised

 

Current Services

·         Community-based Services

Integrated Rapid Response (TRFT)

Community Locality Therapy – urgent (TRFT)

Independent and Active at Home Team (TRFT and RMBC)

Reablement (RMBC)

·         Bed-based Services

     Intermediate care at Davies Court and Lordy Hardy Court (RMBC    and TRFT)

     Oakwood Community Unit (TRFT)

     Waterside Grange (Independent Sector)

·         Services currently provided by a range of teams and bed-based sites

·         In addition, several teams of Social Workers and therapists working into the bed-based provision

·         People moved  ...  view the full minutes text for item 27.

28.

Developing Rotherham Community Health Centre pdf icon PDF 600 KB

Minutes:

Jacqui Tuffnell, Head of Commissioning at NHS Rotherham Clinical Commissioning Group (RCCG) gave the following short presentation recapping the context and proposals and showing the outcomes from the engagement with patients/families. 

 

Rotherham Community Health Centre

      Rotherham Community Health Centre (RCHC) – purpose built to house the walk-in centre, GP practice, dental services and community /outpatient facilities, already includes quite a lot of therapy

      Services have changed resulting in 2/3 of the centre now being empty – clear feedback from our population that it needs to be better utilised

 

What will work best for the centre and our population?

      5 options considered - CCG worked with our estates and advisers across our community and undertook a One Estate Review as well, including the Council, RDaSH and the hospital. 

      Recommended option to relocate Ophthalmology outpatientsenabling:

            - amalgamation of the service

            - to meet CQC requirements separating children from             adults

            - ensuring the estate is fit for purpose to meet current and future      capacity (double the floor space)

            - reducing the footfall substantially on the hospital site (by     approximately 48000 visits per year), freeing up car parking and
            increasing the footfall into Rotherham’s town centre, which should             contribute to regeneration of the town centre

            - responding to the public’s request to utilise this central, good         quality facility

 

Slides 4-11

Responses to questions regarding:

- Being a patient/carer

- Age/Disability

- Environment in Ophthalmology Out-patients and seating sufficiency

- Travel mode to the hospital

- Parking/Drop off at the hospital

- Ease of getting to the RCHC compared with the hospital

 

Headlines from the engagement

107 surveys were completed over 2 days 13-14 August in ophthalmology outpatients and B6, covering a variety of clinics. People from a wide variety of ages and backgrounds took part. The clinics were not as busy as usual, due to the time of year, in particular a number of the paediatric appointments were DNA (Did Not Attend).

 

Generally, most people were very supportive of the proposal, with  a substantial number who were extremely enthusiastic - 61 felt it would be easier, 22 felt it would be harder; 24 were neutral; either they felt it would be the same or were unsure. 

 

Main points

     The majority of concerns were around parking

     A small number of people noted they live close to the hospital or on a bus route/road  where they would pass the hospital, so it would be further for them

     Several people wanted assurance that the staff would be the same

     Even though the walk from car to unit would be shorter, some people will still need a wheelchair to be available

     From the patients attending B6 often on a monthly basis, there was more concern and apprehension about a change of location; often with no concrete reason (i.e. ‘I like it here’); this is felt to be due to the fact that these are likely to be the most dependent patients, who have become very familiar with  ...  view the full minutes text for item 28.

29.

Maternity and Better Births pdf icon PDF 254 KB

Minutes:

June Lovett, Associate Chief Nurse and Head of Nursing, Midwifery and Professions at The Rotherham NHS Foundation Trust (TRFT) gave the following presentation to provide an overview of current activity and the course of direction for  maternity services.

 

Work to improve the strategy for maternity services was particularly focused on the seven key lines of enquiry within the national “Better Births” strategy.  These encompassed stillbirth and neonatal deaths; intrapartum brain injuries; personalised care plans; choice agenda; continuity of care; midwifery settings; and smoking.

 

What’s working well

*        Partnership working across the place e.g. one Personalised Care Plan

*        Local Maternity System Board (LMS) and Hosted Network (HN) Collaborative approach, jointly chaired by Louise Barnett and Chris Edwards

*        TRFT representation and attendance at the SY&B ICS Local Maternity System

*        Local Maternity System  Board and place working

*        Rotherham Maternity Transformation Plan including new tracker development and Funding Plan – sets agenda for next 12 months

*        Robust governance arrangements and reporting structures set up:

- Better Births Group (in Rotherham) – Key external stakeholders including Maternity Voices  Partnership (MVP), service user representation

- Sub Groups in place for progression of the 7 Key Lines of Enquiry - Action and Monitoring Logs created and maintained and reported to Better Births Group

*        Reporting into the Maternity Governance Group

*        Maternity Voices Partnership enhancing women and families engagement – robust and active group

*        Leadership, dedicated, energised and enthusiastic Team to drive forward transformation – staff engagement, ownership and vision

*        Place Partnership working to improve the health and wellbeing of mum and baby such as smoking cessation, and sub groups  with appropriate representation

*        LMS Achievement of Continuity of Carer LMS trajectory 20% and Use of a Personalised Care Plan 40%

*        Commitment and support from CCG Communication Lead regarding a communication Strategy to help the service raise its profile and encourage women to use the service

*        Involvement in the development of the Rotherham Health App – early stages

 

Smoking cessation was viewed as a golden thread across all the workstreams, ensuring the best health of the mother to then give the best chance in terms of health outcomes for the baby.  A strong smoking reduction focus for women would make a huge difference in relation to the Public Health agenda, on which TRFT worked collaboratively and in parallel with Public Health colleagues.

 

What are we worried about?

*        Achievement of all future key trajectories and sustainable support

*        The Rotherham NHS Foundation Trust  Estates provision that is required to progress the Place Plan – such as a Alongside Midwifery Led Unit, Hubs in communities Delivery Suite alterations including Bereavement Suite and Greenoaks relocation

*        Achievement of 35% Continuity of Carer by  31 March 2020 and embedding a new service model

*        Sustained funding and commitment in relation to workforce staffing for achievement of continuity of carer

*        On call processes and business continuity at times of increased capacity on the delivery suite, especially as simultaneously changing the  ...  view the full minutes text for item 29.

30.

Healthwatch Rotherham

Minutes:

No issues had been raised by Healthwatch in advance of the meeting. 

 

Members raised concerns that Healthwatch had not been in attendance at the meeting. 

31.

South Yorkshire, Derbyshire, Nottinghamshire and Wakefield Joint Health Overview and Scrutiny Committee Update

Minutes:

The Governance Advisor confirmed that the committee had not met since the last Health Select Commission meeting but that a meeting was currently being arranged, probably to be held in October.

 

With regard to the Hospital Services Programme, the hosted networks for the five specialties were now operational.  The intention was to let these gain traction and deliver changes through transformational work for 12-18 months before considering any potential service reconfiguration.

32.

Minutes of the previous meetings held on 13th June and 11th July, 2019 pdf icon PDF 149 KB

 

To consider and approve the minutes of the previous meetings held on 13th June and 11th July, 2019 as a true and correct record of the proceedings.

Additional documents:

Minutes:

Consideration was given to the minutes of the previous meetings of the Health Select Commission held on 13th June, 2019 and 11th July, 2019.

 

Further to Minute No. 3 (Minutes of the previous meeting held on 11th April, 2019) the Autism Strategy had been confirmed for the meeting in November and possibly an update on the Carers Strategy for February, although that could be later in the year in light of the discussion on Intermediate Care and Reablement.

 

With regard to Minute No. 4 (Yorkshire Ambulance Service) the service might be looked at by the joint health scrutiny body later in the year. 

 

Members raised the possibility of the Health Select Commission setting up a working group before this if further investigation identified a need for local scrutiny, as various issues had been raised anecdotally.  The Chair was actively following up the previous issue that had been raised.

 

Further to Minute No. 5 (Sexual Health Strategy) and a question regarding the gender imbalance in new STI diagnosis for people aged 15-30 and how Rotherham compared with other areas – further research had shown a similar distribution in other areas. The recommendations from Health Select Commission would be discussed at the Strategy Group meeting on 17th September, 2019 with feedback expected for the HSC meeting in October.  The Equality Analysis was being finalised to go with the final refreshed strategy and would be sent through.

 

From Minute No. 6 (Response to Scrutiny Workshop – Adult Residential and Nursing Care Homes), follow up information on capturing service user voice in residential and nursing care homes had been provided. Healthwatch had not undertaken a great deal of this to date but were keen to do more and had been involved in the engagement work on intermediate care and reablement.  They had legal powers to “Enter and View” and had discussed how they would look to introduce these at a recent Registered Managers Meeting. 

 

From an Adult Care perspective, capturing the service user voice formed part of the work on quality. It was also being looked at across the Yorkshire and Humber region as well through Association of Directors of Adult Social Services (ADASS), so there would be more concrete activity to report on early in 2020.

 

Councillor Roche informed the Select Commission that two care homes which had previously closed, in Maltby and in Greasbrough, would be re-opening after being taken over by two new organisations.  Adult Care were working with the new companies and would keep a close eye on the quality of those care homes.  It was also reported that at that time Rotherham had no care homes in measures.

 

Resolved:-  That the minutes of the previous meetings held on 13th June, 2019 and 11th July, 2019 be approved as a correct record, subject to the following correction from July regarding Minute No. 5 Recommendation 4 which should refer to the Sexual Health Strategy Group.

33.

Communications

Minutes:

The Chair congratulated Cllr R Elliott on his appointment as Vice Chair.

 

Information Pack

Contained within the information pack disseminated to the Commission were:-

-   Presentation from the My Front Door seminar

-   Presentation from Healthy Weight Declaration seminar – with questions for Members to send a response to the Cabinet Member or Public Health team

-   Notes from the quarterly health briefing with health partners

-   Health and Wellbeing Board minutes from July

-   Year end Performance Report for the Rotherham Integrated Health and Social Care Place Plan

 

No questions were asked or comments made on the information pack.

 

Improving Access to Psychological Therapies (IAPT) Service

It was confirmed that the IAPT team had now moved from Clifton Lane to a more central location at the Centenary Clinic on Effingham Street (formerly Clearways).

 

Infertility Treatment

Proposals to improve access to services, including for same-sex couples, had previously been circulated.  No further information was requested.

 

Drug and Alcohol Treatment and Recovery Services

A small number of Members would have a further visit to Carnson House to learn more about the challenges faced by people with long term methadone use in giving up their methadone prescriptions.

34.

Urgent Business

 

To consider any item(s) which the Chair is of the opinion should be considered as a matter of urgency.

Minutes:

There was no urgent business to report.

35.

Date and time of next meeting

Minutes:

Resolved:-  That the next meeting of the Health Select Commission take place on Thursday, 10th October, 2019, commencing at 2.00 p.m.