Approved by email Minutes Fareham and Gosport Community Engagement Committee (CEC) held on 6 th January 2015 at 1.00pm 3.00pm at CAMS Hall Estate Golf Club 1 Attendees Dr Keith Barnard Councillor Brian Bayford Martin Brown Dr John Buchanan Amy Castles Elizabeth Kerwood Sue Martin David Miles Janie Millerchip Paul O Beirne Jill Sadler Mark Wagstaff Margaret Wilkinson Nick Wilson Brenda Woon Guest Speakers Introduction Lay member of the F&G CCG Governing Body and Chair of F&G Community Engagement Committee Fareham Borough Council Consultant in Old Age Psychiatry Co-Chair of the Gosport Locality Patient Group Health Facilitator, Learning Disabilities F&G & SEH Head of Communications & Engagement F&G & SEH CCGs Deputy Chair of the Fareham Locality Patient Group Chief Officer, Gosport Voluntary Action Community Development Manager, Fareham Borough Council Chief Executive, Community Action Fareham Chair of the Friends of Fareham Community Hospital Co-Chair of the Gosport Locality Patient Group Chair, Gosport Voluntary Action Lay member of the SEH CCG Governing Body & Chair of the SEH Community Engagement Committee Engagement & Partnership Manager F&G & SEH CCGs Dr Iain Cranston, Consultant Physician (Diabetes & Endocrinology) PHT Sharon Osterfield, Locality General Manager, F&G, Southern Health Foundation Trust Sandra Spong, Community Matron, Southern Health Foundation Trust Heather McCleod, Team Manager, Adult Services 1.1 1.2 1.3 Welcome and Apologies Apologies were received from: Richard Samuel, Simon Holmes, Louise Spencer, Alyson Stainer, Peter Kershaw, Alex Berry, Sarah Malcolm, Glenn Duggan, Claire Pond, Sara Tiller, Lisa Skinner, Raymond Hale Requests for Any other Business None Conflict of Interest Elizabeth reported that new guidance has been issued by NHS England. Members of meetings will now be required to declare any conflict of interest they may have, at the start of the meeting and a conflict of interest register will need to be set up. This will need to be a 1
standing item on the agenda. document. The declaration form and policy are embedded in this Declaration of Interest Form.docx COR 007 v2.0 FG Standards Of Busines 2. 2.1 2.2 2.3 Minutes from previous meeting on 4 th November 2013 and matters arising There is a correction on the previous minutes Donna Simpson is from Gosport Borough Council not Gosport Voluntary Action Keith reported some inaccuracies in the Mental Health update It is not Eavesdrop House but Eastrop House near Basingstoke. The Meadows has now been sold. Elmleigh Acute Adult Mental Health Unit in Havant has closed its 8 PICU beds, thus increasing its capacity of adult mental health beds to 28. The PICU beds are now at Roehampton, Basingstoke and Southampton. Concern has been expressed that this is not a satisfactory arrangement for patients in Fareham & Gosport as they are so far out of the area. Recruitment is now up to the established requirement. The training of mental health nurses in Southampton does not appear to be producing staff staff who have sufficient hands-on experience as some other training centres. It has been suggested that the training in Southampton is too academic without sufficient emphasis on practical nursing competence. Cllr Bayford mentioned an item on Radio 4 this morning stating the same thing. Better Care Fund David Miles attended the first meeting on behalf of the Voluntary Sector. The meeting was about processes and procedures. When there is more detail about the Voluntary Sector, David will report back to this group. 3 3.1 Focus Items Integrated Care Teams A presentation was given by Sharon Osterfield, Locality General Manager F&G, and Sandra Spong, Community Matron, Southern Health Foundation Trust and Heather McCleod, Team Manager, Gosport South, Adult Services. The presentation is embedded here: Answers to queries raised: If a patient is being seen regularly, there will be a care plan for them Anyone can refer to ICTs including patients/families Everyone referred will be seen Housebound patients are also being managed Patients will be seen in a maximum of 48 hours The service is led by a multi-disciplinary team ICT presentation for CEG 41114.pptx 2
3.2 3.3 Insulin Pump Service Dr Iain Cranston, Consultant Physician (Diabetes, Endocrinology) PHT gave a presentation on this service. Iain explained that this was another way to deliver insulin, and is not a separate therapy and has been around since the late 1970 s. The early forms of pump were unreliable. In the local catchment area three types of pumps are used by three different suppliers. People require some insulin all the time or at different times of the day. All pumps are highly technical and have built-in safeguards which mean they are also expensive. The cost is 2,500-3,000 per pump. They cost between 1,500-2,500 per year to run. The life span is about four years. NHS pumps are under warranty from the manufacturer/supplier and have a 24 hour replacement service direct between the patient and the company involved. There are about 110 users of pumps in the area. The clinic has been running since 2001 with an increase in patients of 15-20 annually. Southampton Hospital now has an adult pump service and also one of the largest paediatric pump services for over 150 children. The future hope is that pumps will be able to automatically monitor blood levels and dispense insulin accordingly, saving the patient the need to take finger-prick samples so frequently. Patients are thoroughly educated to understand how to best manage their pumps. The name of the local education programme is called Jigsaw which is a similar programme to DAFNE (Dose Adjustment for Normal Eating). The programme helps people to achieve goals without necessarily using a pump. One in four will fail to achieve goals and move on to pump therapy. They need to measure glucose levels four to six times per day. People are given a six month trial of the pump and are seen approximately eight times in the first three months. They are then reviewed at the end of the six months. The benefits can be dramatic. One lady had 142 admissions to hospital in a year. She went onto pump therapy and had no hospital admissions in the following year. The diabetes service as a whole only sees between 40-50% of type 1 diabetic patients. The rest are being cared for by their GP practice and this in part may explain why insulin pump uptake is not higher. In Portsmouth the commissioning arrangement means that the hospital buys the pumps and re-charges the CCG and there is one grey cupboard to hold all the equipment and this is administratively and practically unsatisfactory. There has been no review of the commissioning process in recent years. The service is way over budget since it was commissioned in 2003. Dr Keith Barnard asked how do we address the grey cupboard issue? Iain replied that Southampton s model of supply could be used. Dr John Buchanan asked about the reason for the high amputation rate in Fareham and Gosport. Iain replied that foot care is about self-care. Access to podiatry needs to be accelerated to the people who require it. The paediatric pump service in Portsmouth has about 40 patients in addition to the 110 adults using pumps. NICE guidelines are different for children but pumps are only used if children and their parents can cope with the technology. Primary Care Co-Commissioning Elizabeth Kerwood gave a presentation on this topic. The presentation is embedded here: Co-Commissioning of Primary Care 1.pptx Delegated commissioning has been proposed as the way forward for Fareham and Gosport. If the CCG receives approval it will start on 1 st April as a graduated service, it will not all change at once. Nick Wilson informed the Committee that the CCG has recruited additional lay members to the Governing Body to help with the anticipated increased workload and will place greater emphasis on the views of the members in decision making. If Primary Care Commissioning was not included in what the CCG is responsible for, new models of delivery would be far more 3
4 4.1 4.2 4.3 4.4 4.5 4.5 difficult to achieve. Sue Martin asked how Primary Care is performance managed at the moment. The reply was that this sits with the Wessex Area Team and will be retained with them for re-validation and appraisal purposes. Elizabeth said there are problems in Gosport with GP recruitment and several GPs are coming up for retirement. The 11 GP practices in Gosport are discussing ways in which they can work together more closely with the support of the CCG on issues such as the Work Force, IT, Accessibility, Recruitment and Training, This project is known as Transforming Primary Care in Gosport. Standing Items Commissioning and Engagement Strategy Elizabeth is currently working on the draft and will bring the paper to the next meeting and discuss the contents with the Locality Patient Groups to seek their views. Dr John Buchanan said he would welcome the opportunity of Elizabeth attending the Locality Patient Group to discuss this and co-commissioning further. Quality Report The Quality Team were unable to attend but provided a briefing paper, copies of which were handed to the Committee members. Key Issues from Members Jill Sadler from Friends of Fareham Hospital said that she would forward a copy of their latest newsletter to Brenda for distribution to the Committee members. Action: JS/BW Locality Patient Groups updates Sue reported that the last Fareham LPG was held on 26 th November. Tracy Childs from the Finance Team was invited and explained how the primary care finances operated. There was an update on the situation with identifying dementia patients in primary care. The 55 per patient will discontinue in April 2015. There was also a review of the PPG websites. The CQC intelligent monitoring report and twice yearly annual surveys were discussed. DNAs are still a problem. Bury Road Surgery in Gosport have sent letters out to patients informing them that if they have three consecutive DNAs they will not get another appointment. The flu clinics were used to approach patients for the annual survey and as a result, 700 surveys were completed. Most practices have a notice board advertising their PPGs. The Voluntary Sector can help with supplying information for a noticeboard to promote local VS services. Gosport Locality Patient Group has not met since the last F&G CEC. Their next meeting will be on 20 th January. Virtual PPGs are increasing in size. Voluntary Sector Health Forum update Paul O Beirne The next Forum will take place on 13 th January and will be held in the Masonic Hall, Gosport. Alex Berry, Chief Commissioning Officer will be coming to talk about the Better Care Fund and give an overview of services commissioned through Solent Health and Southern Health NHS Trusts. Paul produced a poster to support Dry January and Brenda will forward it to members of the Committee. Action: BW Healthwatch report Madeline Close from Healthwatch was unable to attend the meeting due to illness so the report will be deferred to the next meeting. 4
4.6 4.7 5 5.1 5.2 6 6.1 Items to escalate to the Governing Body There will be an Engagement Report which will include relevant details from this meeting. Action: EK Jill Sadler stated that there is still no news about the Red Cross being based at Fareham Community Hospital. Libby Morris, the Development Worker has left the service. Other Updates/Discussion Areas Friends and Family Test This is being escalated in the GP practices at the moment. Equality & Diversity E&DS2 paper This briefing paper was circulated to the Committee. The CCG is seeking volunteers from this Committee to work on the 2014/2015 assessment. The first assessment is on the CCG and then again with volunteers and local representatives. The report needs to be published by the end of the month and the final grading by the end of March. Please contact Brenda if you are interested in taking part in this. Action: all Any other Business None 7 Potential Agenda Items for next meeting Community Ophthalmology Service/GOS18 referrals 8 Dates of Next Meetings: (all Tuesdays at CAMS Hall Estate Golf Club) 10 th March 12 th May 7 th July 8 th September 10 th November 12 th January 2016 8 th March Fgccg.enquiries@nhs.net www.farehamandgosportccg.nhs.uk Twitter: @NHSfgccg 5