Joint Health Scrutiny Committee on the NHS Transformation Programme

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1 Joint Health Scrutiny Committee on the NHS Transformation Programme Minutes of a meeting held at County Hall, Colliton Park, Dorchester on 16 March Present: Bill Batty-Smith (Chairman - Dorset Health Scrutiny Committee) Members Officers Bournemouth Borough Council Chris Mayne and Allister Russell. Matt Wisdom (Democratic Services Officer) Dorset Health Scrutiny Committee Michael Bevan and Sally Elliot. The Borough of Poole Carol Evans, Charles Meachin and Ian Potter. Andrew Archibald (Head of Adult Services), Dan Menaldino (Principal Solicitor), Lucy Johns (Health Partnerships Officer), and Helen Whitby (Senior Democratic Services Officer). Kerry Flan (Principal Officer, Joint Commissioning). Health Representatives: NHS Bournemouth and Poole and NHS Dorset Cluster: Liz Kite (Deputy Director of Corporate Affairs) and John Morton (Director for Joint Commissioning and Partnerships). Dorset Healthcare University NHS Foundation Trust: James Barton (Director, Pan Dorset Mental Health Services). Dorset County Hospital NHS Foundation Trust: Dr Cecilia Priestly (Consultant in Genitourinary Medicine) and Ian Triplow (Head of Programme Management Office). Public Health Team: Sophia Callaghan (Consultant in Public Health) Dorset LINk: Annie Dimmick (LINk Development Officer) Election of Chairman 1. That Bill Batty-Smith be elected Chairman for the meeting. Apology 2. An apology for absence was received from Beryl Baxter (Bournemouth Borough Council). Code of Conduct 3. Ian Potter declared a personal interest in minutes 7-8 as a close family member was in receipt of mental health services. Minutes 4. The minutes of the meeting held on 5 December 2011 were confirmed and signed. Matters Arising Proposed Changes to Specialised In-patient Haematology Services Minute An from the Deputy Director of Communications at NHS Dorset was read out. This explained that the procurement process for Level 3 Haematology had been

2 2 suspended because two of the providers (The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust) were to consolidate on to one site and this would meet the procurement exercise s objective. The Primary Care Trust (PCT) Cluster would ensure that the specification consulted upon, quality standards and relevant accreditations were met. 5.2 One member questioned whether following this change, the matter remained under the purview of the Joint Committee, or whether it should be reported to the individual committees of the three authorities. He was assured that the change related to pan-dorset services and it was appropriate for the Joint Committee to scrutinise this. As to whether this change was a substantial variation, the Joint Committee noted that there was no need for further action currently but any future change or substantial variation would be referred to the Joint Committee for scrutiny. East Dorset Specialist Palliative Care Project Minute It was reported that the Trusts Boards had approved the detailed business case and the new service model would be implemented. Work Programme for 2012 Minute The Joint Committee noted that officers of the three local authorities had met and discussed the possible establishment of a standing Joint Health Scrutiny Committee to consider pan-dorset matters. Dorset officers were exploring this internally. It was not known what progress had been made by Poole and Bournemouth authorities. The matter would be re-considered once the internal deliberations had been completed. Update on the NHS Transformation Programme 6.1 The Joint Committee received a presentation from the Director for Joint Commissioning and Partnerships from the NHS Bournemouth and Poole and NHS Dorset Primary Care Trust Cluster, which explained the Cluster s activities during 2011/12, and organisational and service priorities for 2012/ Members were reminded that the Bournemouth, Dorset and Poole Primary Care Trust Cluster would cease to exist at the end of March 2013 and that this would be superseded by one Clinical Commissioning Group which would cover the Bournemouth, Dorset and Poole area, called the Dorset Clinical Commissioning Group (DCCG). 6.3 It was recognised that people were living longer and one of the Cluster s aims was to support people to stay healthy longer at home by providing integrated health and social care support in communities. This would lead to a reduction in hospital admissions and the need for fewer hospital beds so resources were moving from hospitals to community health services. 6.4 The Dorset Clinical Commissioning Group (led by Dr Forbes Watson) would comprise twelve bodies, six being coterminous with the Dorset County Council District and Borough Council boundaries and three in each of the Poole and Bournemouth areas. Each would be led by a GP and would take up responsibility for commissioning in March The Joint Committee were also reminded that Public Health would become the responsibility of the local authority in due course. 6.5 In response to questions, it was explained that commissioning support was currently provided at Canford House in Poole and Vespasian House in Dorchester. In future GPs would make commissioning decisions and support to help them carry out this function was to be developed.

3 3 6.6 With regard to whether steps were being taken to inform the public about the changes, the Director for Commissioning and Partnerships explained that work was being undertaken to ensure that services were accessible in the evening and at weekends and the public needed to be made aware of the changes and the alternatives available to them. Noted Transforming Mental Health Services for Older People in Bournemouth, Poole and Dorset 7.1 The Joint Committee considered a report by the County Council s Director for Adult and Community Services which provided an overview of the engagement activity that had taken place to advise people of the proposed changes in mental health services for older people in Bournemouth, Dorset and Poole, and the feedback generated. Members were provided with an addendum to the report which outlined the impact of the transformation on the three local authorities. 7.2 The Director for Joint Commissioning and Partnerships explained that under the traditional model, no care was provided for those with dementia until a crisis point had been reached. They were then supported by Community Mental Health Teams or admitted to an older people s mental health bed until such time as a residential bed was available. The changes meant that there would be earlier diagnosis and assessment and that the memory service and drugs which were previously licensed were more widely available. Research had also indicated that more could be done to support individuals and their carers in the early stages of dementia so there was a need for more resources to be available in the community to educate and support people to manage the disease. The paper included proposals to invest 1M in Bournemouth and Poole to provide specialist community mental health teams for people with dementia. In addition there would be new investment of 1.5M from commissioners to increase the number of memory advisers, memory clinics and community psychiatric nurses to train and support primary care. The report detailed engagement undertaken so far and the Joint Committee noted that the Alzheimers Society, Age UK and Help and Care had been commissioned to undertake further engagement work with carers and services users. A further report would be provided for a future meeting. 7.3 The proposed changes could have an impact on social care budgets but there was evidence to show that in the longer term there would be a significant reduction in social care budgets. More details of the short-term and long-term impacts would be provided in the report for the next meeting. 7.4 The Director for Joint Commissioning and Partnerships emphasised that clinical evidence supported the change of direction, and early indications were that service users and carers supported people remaining at home as long as possible. Evidence showed that people with dementia became more confused if they were in a hospital environment and the proposed changes would enable more people to remain at home longer. There would be a need for some hospital care, but the changes involved early assessment and confirmation of diagnosis, and the creation of a treatment plan. 7.5 In response to what was meant by the term in the east of Dorset, it was explained that this referred to services accessed by residents in Bournemouth, Poole and South East Dorset and, in particular, those who accessed inpatient services at the Alderney and Kings Park Hospitals. For clarification South East Dorset included Christchurch, most of East Dorset and a significant part of Purbeck. It was also clarified that the additional 250,000 referred to in the report was for services across this same area.

4 4 7.6 The County Council Member Champion for Older People and Mental Health stated that it was his duty to try to maximise resources for older people and those with mental health problems. He referred to the demography of Dorset which attracted retiring older people, which led to increased numbers of people with mental health problems and dementia, and increased demand on the limited resources available. He referred to the financial implications referred to under the budget/risk assessment heading and asked how and when clarification would be available. He supported the need for people to be treated at home but drew attention to the increase in the number of cases of older people s abuse and the need for home care. He drew attention to the impact of the transformation on the local authorities and the fact that these patients were vulnerable and should be treated with dignity and respect. 7.7 One of the Poole members reported that he had been so concerned by the report that he had called a meeting with officers and was equally concerned by the tabling of an addendum to the report at the meeting. Poole officers had shared his concerns at the time but now supported it in principle pending further detailed work being undertaken. 7.8 The Principal Solicitor reminded the Joint Committee that the report provided an update and a further report would be provided for consideration in due course once additional work had been concluded. The Principal Officer, Joint Commissioning stated that the Borough of Poole s concerns had already been discussed with the Trust and she now supported the direction of travel. Work had taken place since the agenda papers were published and the addendum report addressed the fast pace of development and the financial impact the changes would have on the three local authorities. Officers were working together to assess the financial implications and the Principal Officer was confident that a clear indication would be available by the time of the Joint Committee s next meeting in June With regard to the position in Dorset, the County Council were working with the PCT Cluster and Dorset Healthcare University NHS Foundation Trust (DHUFT) on the provision of more integrated services. This was being done under the Connecting Health and Social Care Programme and included work to co-locate staff who would provide integrated services in localities. In the wider context, the increased joint working would reduce admissions to hospital and care homes The Principal Solicitor sought clarification that the County Council and Bournemouth Borough Council were aware of concerns expressed by the Borough of Poole and vice versa. The Principal Officer, Joint Commissioning, confirmed that officers were liaising closely and agreed to provide her concerns for Bournemouth members to report to their Health Overview and Scrutiny Panel With regard to whether a reduction in the long term social care budget could be delivered, the Director for Joint Commissioning and Partnerships explained that a joint working group had been established to oversee the transformation. There was national documentation and clinical research to support the view that the dementia care pathway in the longer term would provide a social care saving by significantly reducing the end phase of dementia in terms of severity and length. The Group would explore whether the assumption that it was more expensive for an individual to be looked after in a dementia bed residence or specialised home than receiving a package of care in the community was true or whether packages of care would be so intense that they would prove more expensive. The Director for Joint Commissioning and Partnerships offered to arrange for a clinician to attend the Joint Committee s next meeting to explain the evidence base for the transformation.

5 One member expressed serious concerns about the report and asked whether an update report would be provided for the Dorset Health Scrutiny Committee on 10 April The Director, Pan Dorset Mental Health Services, explained that an update would be provided for the Joint Committee to consider at their next meeting in June The Principal Solicitor reminded the Joint Committee that it had been established by the three local authority health scrutiny committees to consider any matters which related to the NHS Transformation Programme which affected the three local authorities. The work of the Joint Committee could be reported to the individual committees by way of the minutes but this would be for information only Attention was drawn to the considerable strain placed upon carers of people with dementia and the fact that the report did not refer to any support for carers. The Director for Joint Commissioning and Partnerships confirmed that there is separate additional investment for support for carers The Principal Solicitor drew attention to the recommendations contained in the report and asked the Joint Committee to consider whether the engagement undertaken was sufficient or whether any other measures needed to be undertaken The Director for Joint Commissioning and Partnerships explained that significant engagement with clinicians, partners, service users and carers had been undertaken and third sector organisations were to undertake further engagement with relevant groups which would be reported to the next meeting. He asked whether engagement was sufficient or whether other groups should be included. The Deputy Director for Corporate Affairs considered the engagement undertaken to have been comprehensive as 200 people had been directly involved, with other feedback received from individuals, focus groups, services users and carers, older people and non service users. An Equality Impact Assessment was being completed to identify any groups that may not have been included. This would also be provided as part of the report to the next meeting The County Council Member Champion for Mental Health and Older People was unhappy not to have been informed about the engagement process and its progress. The Deputy Director for Corporate Affairs referred to an engagement event which the Member Champion had attended The Principal Solicitor stated that it was difficult for members to gauge whether adequate engagement had been undertaken as it was not apparent whether there was an engagement strategy and, if there was, whether this was being followed. The Deputy Director for Corporate Affairs reminded the Joint Committee that this had been presented at their first meeting in July It was suggested that this be included in the report to be considered in June 2012 as there had been previous concerns expressed by various members of the Joint Committee and there had been no reference to engagement with the general public. The Deputy Director for Corporate Affairs confirmed that engagement had concentrated on service users and those affected by services in order to shape future service provision. Age UK had been contacted with regard to the general public s views but, other than this and a general survey, the general public had not been involved. The Director for Joint Commissioning and Partnerships added that regular listening events were held (led by the Cluster) to support engagement with the general public and to inform strategies and plans The Director, Pan Dorset Mental Health Services, summarised by saying that there was engagement between NHS and local authority officers, that engagement with service users and carers had been sufficient and the results of further engagement were to be reported to the Joint Committee s meeting in June 2012.

6 6 8.1 That the report be noted. 8.2 That a further report be provided for consideration at the Joint Committee s June 2012 meeting which would include the engagement strategy, the Equality Impact Assessment, information about costs for local authorities and additional engagement undertaken. The Commissioning Strategy for Sexual Health Services for The Joint Committee considered a report by the County Council s Director for Adult and Community Services on the development of a commissioning strategy for sexual health services for 2012 to The Consultant in Public Health presented the report and explained that the Sexual Health South West Quality Assurance Peer Review Visit for Dorset, Bournemouth and Poole had received a positive judgement on nine core standards but had raised some concerns relating to workforce core competency development, lack of governance across services, the need to simplify and improve access to services, the need to develop community screening for Sexually Transmitted Infections (STIs) and HIV screening, and the need to deliver an integrated service. Good progress on addressing these was being made and access to services was improving. She then explained the commissioning intentions in detail. 9.3 The Consultant in Genitourinary Medicine considered Sexual Health Services to be in good shape. There had been a reduction in the number of teenage pregnancies and STIs. She reminded the Joint Committee that ten years ago sexual health clinics did not meet demand and since this time there had been investment to help meet targets. She stated that clinicians supported the Commissioning Strategy. 9.4 In response to a question, the Joint Committee were told that there were no seasonal (ie holiday) fluctuations in demands for services as the majority of people were not aware of any problems until they returned home. They noted that more university students were seen during holiday periods and that there were also increased attendances for emergency contraception from people who had forgotten their medication. 9.5 The Committee noted that terminations of pregnancy would be the responsibility of the Clinical Commissioning Group, HIV the responsibility of the Specialised Commissioning Group and there would be different streams of money for different aspects. 9.6 Members congratulated officers on the clear and comprehensive report and supported the commissioning intentions set out within it That the work done to gather views of people to inform the draft commissioning intentions be noted. Work Programme 11.1 The Joint Committee considered their work programme for With regard to why mental health services for the under 65s was not on the work programme, it was explained that the Joint Committee considered service changes affecting pan-dorset and there were no changes planned for services for the under 65s currently. If any emerged then they would be considered by the Joint Committee Members asked that Specialised Haematology Services be added to the work programme as a matter for future consideration.

7 That Specialised Haematology Services be added to the work programme That the revised work programme be noted. Future Meetings 13. The Joint Committee noted that future meetings would be held on 11 June, 21 September and 7 December Noted Update of Telehealth 14.1 The Joint Committee received a joint oral update from NHS Dorset s Lead Locality Commissioning Manager and the Director for Service Improvement, on the development of the Telehealth Service, potential savings and health gains and the enablement of patients to take control of their conditions Telehealth had been launched on 27 February 2012 and currently 500 units were provided across Bournemouth, Dorset and Poole, mainly for use by patients with Chronic Obstructive Pulmonary Disease or heart failure. A few were being used for other conditions such as asthma. An explanation of how patients used the system was given. The system collected information and key workers were able to access their patients information and would be notified of any adverse information received. GPs would also be able to access the information. It was hoped that the system would lead to a reduction in medical appointments, increased control of their condition for patients, a reduction in emergency admissions, attendances at accident and emergency units, elective admissions and mortality It was explained that the system was visual and all instructions were written so that the hard of hearing were able to use it. Any difficulties experienced by patients would be reported to the service provider so that they could be addressed and the patient s needs could be met With regard to the concern that this was yet another system for GPs to monitor rather than see a patient face to face, it was explained that the keyworker would receive notification if no action was taken and the system would save the GP time and reduce patient travelling time Members then received a practical demonstration of the Telehealth system. Noted Committee duration: 10:00am to 12:15pm.

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