With growing problem of Type 2 Diabetes and Pre-Diabetes, what additional services will you be establishing?

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1 TITLE: BRENT HEALTH PARTNER FORUM CLIENT: NHS BRENT CLINICAL COMMISSIONING GROUP RE: ADDITIONAL COMMENTS / QUESTIONS / EVALUATION COLLECTED AT FORUM MEETING 11 TH JUNE 2014 DATE: 23 RD JUNE 2014 Topic 1. Urgent care and A&E 2. Priorities / range of services available Comments / questions When Central Middlesex A&E closes: How will the system cope? How will people know where to go? (Leaflets door-to-door, newspapers, talking to different communities, social media, local forum, libraries, and GP surgeries?) Sickle cell most sickle cell crisis happens at night. Who do we call? The pressure will now be on St Mary s and Northwick Park. How quickly will we seen? How long we will have to wait? Is Northwick Park equipped to provide specialist care for Sickle Cell? What plans are there to recruit more A&E doctors? How will Brent cope with a major disaster (natural or otherwise)? What is in place to support people to go to Northwick Park (e.g. transport)? Concerned about the safety/logistics of the plan to transfer inpatients after 72 hours from NPH to CMH again. People may not be stable. What about patient choice and experience? Will we still be able to access specialised units, such as CG Cardiac Unit at Hammersmith (which has just been upgraded)? I.e. can ambulance go directly to these units, not via A&E? How much longer will it take an ambulance to attend a Code Red after the closure of CMH A&E? In view of the fact that the ambulance service is having difficulty because of cuts and reductions of staff, how can you ensure that patients will not die from having to wait a long time for an ambulance to transport them across the borough? Need to be clear what the Urgent Care Centre does, particularly for people using services to deal with mental health issues. With closure of CMH A&E, the contract for the Urgent Care Centre has to be renegotiated so can it be given to NWLHT? Because a) Care UK performs badly; b) Care UK s parent company is based offshore to avoid taxes; c) Care UK employs staff who don t have the requisite skills; d) Care UK does not pay a living wage. Childhood obesity in Brent is the highest in London and yet we do not have any interventions to tackle this? What plans will CCG, jointly with LA, put in place to tackle this ticking time bomb? With growing problem of Type 2 Diabetes and Pre-Diabetes, what additional services will you be establishing? How can we improve access to psychological services (talking therapies) in Brent? The ccpc recently published a report on the health needs of disabled people aged 19+ (in transition) not being met properly. How will you ensure you meet their complex need till 25 and beyond?

2 How will you help people with dementia? How to lose weight? Where is learning disability in the priorities? Why are therapies for SEN mainstream children (including OTs, physio, speech & language) being so cut / in such short supply? Prevention is better than cure community classes (yoga, etc) aimed at say carers to help them cope with caring! People are told to change eating habits and exercise more but not everyone can afford gym membership. How will the CCG support (or will they?) more community classes? How are we including into the Health Partners, groups which are not obvious to the public who do not experience the process of this partnership (which is more than just Health and Patients) but which can trigger stress because of their ignorance! (E.g. Passport Office staff, which are not organised as they should be). (Brent Residents and Family members living alone / Trainers / Citizenship training). 3. Mental Health What changes is CCG considering for mental health services, specifically regarding dual diagnosis mental health/addiction? How have you assessed the changes needed? Who have you asked for feedback? Agencies and charities in the field? Users involvement? At present, it is possible to get a patient admitted to the CNWL mental health wards at Park Royal by taken them to CMH A&E. When A&E closes, will it be possible to take patients to the Urgent Care Centre at CMH, or directly to emergency admission room at the CNWL at Park Royal? How can we ensure that mental health patients have qualified carers? Why do mental health patients who present with physical problems (such as severe abdominal pain) just have pain killers shoved down their throats with no follow-up? Why does most medication given to mental health patients have unexplained death as a side effect? 4. Access to care, especially GPs If someone with a learning disability behaves badly, does the doctor section them? GP Hubs the public doesn t know where they are or how to access them. Are they accessed via GP referral? Kingsbury Hub not located in network. Will CCG or NHS ensure sign language interpreters are booked for deaf patients? Pen and paper, lip reading or I can manage is NOT good enough. Due to lack of signing services, deaf people are at risk of missed diagnosis. (See SignHealth Sick of It Report ( With the 7 day Challenge for primary care to open, will you be commissioning other services to support GPs such as community nurses, physios, dieticians, etc?

3 How will you keep people informed about 7-day GP access? Practicalities? 5. Resources and consistency It is difficult to access services for disabilities. Sent to wrong place. Long delays. How will you deliver these changes despite cuts to social care budgets? Worried about privatisation of NHS how does it affect how much money is going to services? Does the NWL plan/programme link up with plans from other parts of London? If not, service delivery can not be consistent within London. 6. Staffing, monitoring and assessment Is this affordable? How can we make sure that all carers have the skills to properly care for people who do not have the ability to communicate their needs? Some of them seem to be trained on the job? Proactive interventions You propose to undertake assessment of carers every six months. How realistic is this when carers are currently not obtaining assessments annually? We may also be increasing expectations within more frequent assessments. Evaluation and monitoring must be complete. 7. Care Plans / personal budgets / self-care Proposal - mystery shopper style monitoring of GPs diagnosis and treatment of patients. How/who will create a personalised care plan? How will this be funded (as GPs only do things they are paid to do)? WSIC sounds a big jargony council wants to call it Whole Person Care. Personal budgets Where are we at in Brent with regards to Health Personal Budgets and social care (self-directed support) and how they would be delivered to us as a package? Self-care education on how to manage conditions / need a clear care plan. 8. Integrated care How would integrated services work in practice? Is there a framework to ensure that people with multiple health issues do not have to go round and round within the system of care? Does the CCG envisage that the informal voluntary sector (neighbourhood groups, church congregations, school parents, etc) will support the integration of medical and social care? There was an article in The Guardian by Jackie Ashley which detailed a set up in Twickenham. What does the CCG know about this? (MK Turner / mkturner27@aol.com). How would the integrated care package benefit the patient specifically how is it different? Similar initiative six years ago what is different this time? Why are Harness and Kilburn the pilots?

4 CMH (A&E) how will it benefit How are you using public health information to make decisions? Has Brent Council bought into integrated teams? What is happening re: transport to support this? (e.g. car parking at Imperial) Use pharmacy for signposting Clear pathway on first contact 9. Information needed 10. Personal medical experiences / issues Mapping of services so that staff are aware of what is available Social services and health need to work closer together Carers need to be better informed/advised How do we develop integrated care to meet individual needs in the community at a cost that is affordable (e.g. diabetes) Need to decide which group(s) of patients integrated care is focused on Mental health patients are not supported through an integrated model Communications between GPs and Las need to improve GP might prescribe social care support Who will take responsibility when patient care goes wrong? Integration of patient info/data systems will need to be carefully considered How do we share risk across the partner organisations Individuals/groups of individuals could have a care champion/dealing with the large numbers of patients Potential for raising patient expectation Can we have an easy-to-understand plan? Please could I have a family tree of what the CCG does and doesn t commission, and, if possible, the names of its staff and their positions. Can I assume then that NHS England commissions the rest? If not, who? (no name/contact details given). At what point should a GP refer a patient to a hospital who has been suffering from chronic knee pain for five years and has just been prescribed pain killers? Why are patients asked to change their medication, even though it is working, to a cheaper brand? They end up having to fight to stay on the same, trusted brand which they are happy with. Is it to do with the GP s budget (as said by local pharmacist)? What if my GP is not in Brent? Communication is lacking between the patients and the GPs. Why can t patients chose their own GP if they are not satisfied by their current GP? Difficulties experienced with information after day surgery with reports being sent to the wrong place, or not being sent. When SEN children have hospital appointments (e.g. for eyes, audiology, etc), they are double booked, or take place after such long delays that the children then don t perform at the appointment. However, if we are five minutes late, we are reprimanded.

5 11. Other No facilities for disabled, elderly (e.g. chairs to sit on whilst waiting on ground floor) 12. Evaluation and Equality We collated 82 evaluation forms which is a return of just over 50%. In addition to the evaluation, the CCG has reviewed the additional comments from Monitoring this report. Q1 How would you rate the event? 90% of respondents liked the venue and found it easy to find and get to. This demonstrates that local people supported this HPF. Q2 What would you change about the content or design of the event? There was very little that respondents would change about the event apart from having more time for table discussion and longer time overall. Q3 Are there any issues which you feel were not raised? The issues that people would like raised at future events were various e.g. greater emphasis on carers involvement and support, topics on Diabetes diagnosis and treatment, further discussions on Mental Health. Q4 Where did you hear about the event? There were various ways that respondents heard about the event. The majority heard about the forum via the direct mailing from the CCG, via local networks and voluntary sector e.g. Brent CVS, Healthwatch and Mencap. Lower numbers of respondents saw posters via their GP practice and no one who responded heard the advert on Bang Radio. Q5 We asked attendees to tell us whether they would like to be involved moving forward and gave a list of options:- Over 50% would like to attend meetings/focus groups as part of an established patient/carer/special interest group and would like to be invited to events like the Health Partners Forum A good number of respondents 30% would prefer briefings and requests to comment sent electronically A smaller number 5% would like hard copy briefings and requests to comment in writing sent by post 1% of respondents requested keeping in touch with issues via Twitter/Facebook and other social media The CCG will be contacting all those respondents who shared their contact details in order to establish how and when their choice could be put in place. Equality Monitoring The number of equality monitoring forms completed has increased since the last event - there were 57 forms collated. As expected the diversity of the attendees improves with each event and this may have also due to the locality of the venue which reflected the diversity of the local population. There

6 were 6 religious groups represented as well as attendees with no religion. The age range has improved slightly since the last event with a greater number within the range of years. However the majority of attendees are still within the ranges of and Numbers for the under 35 s could still be improved and this might be down to the start time of the event. However this may also be due to the marketing efforts therefore the CCG will ensure that an integral part of the proposed engagement plans going forward targets age and demographic communities and groups with relevant messages and specific health, wellbeing and social care issues. The CCG will be undertaking focus groups for young people and the working age population under 35 age ranges to identify the needs and aspirations.