NORFOLK HEALTH OVERVIEW AND SCRUTINY COMMITTEE MINUTES OF THE MEETING HELD ON 15 APRIL 2010 Present: Mr M Carttiss (Chairman), Mr J Bracey Mr J Chamberlin Michael Chenery of Horsbrugh Mr P Hardy Mr D Harrison Mr J Labouchere Dr N Legg Mrs B McGoun Mr J Perry-Warnes Mr G Sandell Mrs S Weymouth Mr A Wright Broadland District Council Breckland District Council South Norfolk District Council North Norfolk District Council King s Lynn and West Norfolk District Council Great Yarmouth Borough Council Also Present: Dr Bryan Heap Medical Director and Chairman of Unplanned Care Programme Board, NHS Norfolk Jim Barker Programme Manager, Unplanned Care, NHS Norfolk Mark Henry Director of Operations, Queen Elizabeth Hospital, King s Lynn Cherry West Divisional General Manager for Medicine, Norfolk and Norwich Hospital Pam Fenner Director of Nursing, NHS Great Yarmouth and Waveney PCT Jane Webster Commissioning Manager, Out of Hospital Care, NHS Norfolk Lisa Read Programme Manager, Marie Curie Delivering Choices Programme Hilary Mills Head of Commissioning and Partnerships, Community Services, Jenny Beesley Member of the Public David Matthews Deputy Interim Chief Operating Officer, NHS Norfolk Maureen Orr Scrutiny Support Manager, Democratic Services, Norfolk County Council Kristen Jones Committee Officer, Democratic Services, Chris Walton Head of Democratic Services, Patrick Thompson Norfolk LINk Karl Hills Norfolk LINk Ian Ayres Director of Strategy and Innovation, NHS Norfolk 1. Apologies for Absence Apologies were received from Mr D Bradford and Mr S Dorrington.
2. Glossary of Terms and Abbreviations 3. Minutes Members received a glossary of the terms and abbreviations used in the agenda papers. The minutes of the meeting held 4 March 2010 were confirmed as a correct record and signed by the Chairman, subject to a correction under Declarations of Interest. Tony Wright declared a personal interest because he had links with the King s Lynn and West Norfolk Mental Health Forum (not the NHS Foundation Trust). 4. Declarations of Interests 4.1 Michael Chenery of Horsbrugh declared a personal interest because he had a substantive contract with the Norfolk and Waveney Mental Health NHS Foundation Trust as a Mental Health Practitioner. 4.2 Tony Wright declared a personal interest because he had links with the King s Lynn and West Norfolk Mental Health Forum. 5. Urgent Business There were no items of urgent business. 6. Chairman s Announcements 6.1 The Chairman announced that he had received a letter from Norfolk County Council and NHS Norfolk inviting Members of the Committee to attend a stakeholder event on the implementation of the Joint Dementia Commissioning Strategy for Norfolk at UEA Sportspark on Friday 21 May from 9:00am to 4:00pm. 6.2 The Chairman also noted that on 27 May 2010, the Committee would be receiving a formal report on what had been included and prioritised in the Joint Dementia Commissioning Strategy. 6.3 The event on 21 May would be a good opportunity for Members to learn more about what was planned and to influence the implementation of the strategy. 6.4 The Scrutiny Support Manager would email Members with further details about the event and how to book. 7. Urgent and Emergency Services in Norfolk 7.1 The Committee received a suggested approach from Maureen Orr, the Scrutiny Support Manager for Health, to a report by NHS Norfolk. The 2
report updated the Committee on urgent and emergency health services strategies in light of a rise in emergency admissions to hospital. 7.2 The Committee received evidence from the following witnesses: Dr Bryan Heap Jim Barker Mark Henry Cherry West Medical Director and Chairman of Unplanned Care Programme Board, NHS Norfolk Programme Manager, Unplanned Care, NHS Norfolk Director of Operations, Queen Elizabeth Hospital, King s Lynn Divisional General Manager for Medicine, Norfolk and Norwich Hospital 7.3 In hearing from the witnesses and in answer to Members questions, the Committee noted the following: There was no data on the number of people who went straight to Accident & Emergency without making contact with NHS Direct. It was planned to develop a single point of entry for all patients in need of urgent care. There would be a team of healthcare professionals who would quickly assess the needs of the patient and ensure that their care was carried out in an effective and timely manner. Patient expectation in Norfolk was extremely high and they expected an immediate response from the service. NHS Norfolk did all it could to meet these expectations but an immediate response was incredibly challenging. Members questioned why more accessible GP opening hours could not be arranged, such as remaining open evenings and weekends. This could reduce the pressure on A&E during these times. Dr Heap responded by saying that there had been some success with longer GP opening hours, and at the walk-in centre at Timberhill which was open until 10:00pm, seven days a week. Members hoped that GPs would become more flexible and work in shift patterns. Members heard that many of the incidents were alcohol related and alcohol was a significant contributor to the increase of admissions into hospital. Alcohol also played a large role in other aspects, such as overall health and wellbeing and obesity. Alcohol related incidents were very predictable. NHS Norfolk were working with those few individuals who made a high number of attendances at A&E. Most of these individuals had documented mental health or alcohol related problems. Patient education was fundamental to making the health system work well. Patients needed to know how, where, and when they 3
could go to get the services they required. The first meeting of the emergency care network would take place on 28 May 2010 and NHS Norfolk was inviting the senior officers in Community Services to ensure that they were working in partnership. Regarding the number of elective operations which were being cancelled at the hospital to make way for emergency medical admissions, Mr Henry stated that between 10 and 15 were cancelled at the Queen Elizabeth Hospital each week but were subsequently rearranged. The service tried to ensure that these were still carried out within the 18-week timescale. He also noted that operations for cancer patients were very rarely cancelled. Cherry West stated that 157 operations had been cancelled at the Norfolk and Norwich Hospital in the period between January and March 2010. 7.4 The Chairman thanked Dr Heap, Mr Barker, Mr Henry, and Ms West for their attendance and answering the Committee s questions. 8. How We Manage Death and Dying 8.1 The Committee received a suggested approach from Maureen Orr, the Scrutiny Support Manager for Health, to progress reports by NHS Norfolk and NHS Great Yarmouth and Waveney in partnership with Marie Curie Delivering Choice Programme. These progress reports gave an update on the implementation of the Committee s recommendations for improvement of end of life and palliative care services in the County, including information about the implementation of National Institute for Health and Clinical Excellence (NICE) guidance on end of life care for cancer sufferers. 8.2 The Committee received evidence from the following witnesses: Pam Fenner Jane Webster Lisa Read Hilary Mills Director of Nursing, NHS Great Yarmouth and Waveney PCT Commissioning Manager, Out of Hospital Care, NHS Norfolk Programme Manager, Marie Curie Delivering Choices Programme Head of Commissioning and Partnerships, Community Services, 8.3 The Chairman invited Ms Jenny Beesley to ask a question: Great Yarmouth and Waveney PCT have completed Phase 1 of Marie Curie Delivering Choices (MCDC) Programme. This excellent document included clearly stated views on desired End of Life Care expressed by those surveyed. Referring to, The Health Debate at the House of Commons on 30 4
March 2010 we have recorded: - Mr Nigel Evens: I agree with the Minister that health trusts should listen to people Mr Mike O Brian: Of course health trusts need to listen to people and ensure that they make local decisions to manage health provision effectively,... Therefore can we expect Great Yarmouth and Waveney PCT to implement the public s wishes stated in the MCDC Phase 1 report? 8.4 Pam Fenner responded that the public had been fully involved in Phase 1 of the MCDC and that now in Phase 2 and the current seven workstreams there was representation across health social and the voluntary sector. These workstreams were fully informed by the findings of the Phase 1 report. Service specifications including inpatient specialist care were being developed. 8.5 In hearing from the witnesses and in answer to Members questions, the Committee noted the following: Members questioned how much attention was given to the religious needs of patients and their families. Ms Read relied that extensive work had been carried out during Phase 1 in partnership with religious groups. Regarding religious needs, the physical environment was an important factor, such as having the bed facing a certain way, and dying at home made this more flexible for patients. The Marie Curie project was mainly for patients aged 18 or over. Children would be taken through the children s services route and work was being carried out to ensure a smooth transition between children s services to adult services. By the end of 2010/11, NHS Norfolk was expecting to have invested more than the original planned 2.2m in specific end of life services. Members questioned whether this area had been ring fenced for future investment and the security of this funding. It was confirmed that this funding was secure for 2010/11 but that it was not possible to comment for the following years as this depended on the outcome of the General Election in May 2010. 8.6 The Committee asked NHS Norfolk to provide detailed information on how management savings from the 2006 PCT reorganisation have been invested in end of life services and cancer services. 8.7 The Committee requested a progress report from NHS Norfolk and NHS Great Yarmouth and Waveney in one year s time for the NHOSC Internal Briefing. 5
9. Intermediate Care Implementation Monitoring Group 9.1 The Committee received a progress report by Dr Legg, the Chairman of the Intermediate Care Implementation Monitoring Group. This group was set up by the Committee in March 2008 to monitor the implementation to changes in intermediate care services in central Norfolk, which were agreed by NHS Norfolk s Board in July 2007. The Monitoring Group was required to report to every third meeting of the Committee and this was its fifth report. David Matthews, Deputy Interim Chief Operating Officer, NHS Norfolk, was present to help answer questions from Members. 9.2 The Committee noted the following: Mr Matthews noted that the reason there were no weekend recordings of patients waiting at the Norfolk and Norwich Hospital for intermediate care beds was because the staff who recorded this data did not work over the weekends. They were working at implementing 7 day/week recordings. Mr Matthews confirmed that NHS Norfolk were rolling out a model for the next 12 months to include coverage for peak usage, over the winter, and over holiday periods. 9.3 The Committee agreed that the working group would continue monitoring implementation of the changes to intermediate care agreed by NHS Norfolk in 2007, and the issues arising, and report back to the Committee as required. 9.4 The Committee thanked Dr Legg and Mr Matthews for their report. 10. Forward Work Programme 10.1 The Committee agreed the addition of GP Out of Hours Services in Norfolk (excluding Great Yarmouth) to the 27 May 2010 agenda, when the Committee would agree the Terms of Reference and form a working group to scrutinise the service commissioned by NHS Norfolk and provided by the East of England Ambulance Service NHS Trust. 10.2 NHS Norfolk and NHS Great Yarmouth and Waveney were asked to include provision of services to prisoners in their update on Improving Access to Psychological Therapies report on 27 May 2010. The meeting concluded at 1:00pm. CHAIRMAN If you need this document in large print, audio, Braille, alternative format or in a different language please contact Kristen Jones on 0344 800 8020 or 0344 800 8011 (textphone) and we will do our best to help. 6