Apologies for absence were received from Councillor Dr Emma Jones and it was noted that Cllr Golds attended as substitute for Councillor Emma Jones and from Armjad Rahi, Co-opted Member( Healthwatch Tower Hamlets)

No declarations of discliosable pecuniary interests were declared.

To confirm as a correct record of the minutes of the meetings of Health Scrutiny Panel held on 3 September 2013 and the notes of the informal (inquorate) meeting held on 19 November 2013.

The minutes of the Health Scrutiny Panel held on 3^rd September 2013 and the notes of the informal Health Scrutiny Panel held on 19^th November 2013 were approved as a correct record of proceedings.

To receive a verbal update on Majlish Home Care services.

The Corporate Director, Education, Social Care and Well-being and the Education, Social Care and Well-being Representative gave a verbal update on issues relating to Majlish Home Care Services.  The Corporate Director noted that the Authority had been monitoring the situation at the Home Care Services provider for some time and advised the Panel that there had been no effective response to the three warnings issued by the Care Quality Commission (CQC).

The following maters were noted by the Panel:

The Education, Social Care and Well-being Representative noted that there were no issues related to care provision or safeguarding but with organisational matters such as management structures, staff training and management level issues.  However safeguarding remained the Council’s priority and therefore CQC were kept fully informed.   

The Panel was advised that:

• Some trustees of the care provider acknowledged the complaints made but they had been unable to implement the changes required.
• The Corporate Director had met with the new Chair of the trustees” and “the previous Chair and another trustee had resigned.
• CQC had inspected the service and were minded to withdraw its registration as a Dom Care provider.  They did serve notice withdrawing the registered manager status.  However the provider had a good history in terms of its service provision and therefore the Corporate Director had consulted with the Chief Inspector to ensure support was engaged. The Education, Social Care and Well-being Representative had been appointed as an external consultant and an interim manager was sourced to replace the de-registered manager.
• A support plan was agreed with the new Chair of trustees.  It was noted however, that generally, the trustees were not supportive of the Council's efforts and while relations with direct staff management was good, the Council had received less welcome from senior staff.
• Presently LBTH were dealing with the issues but due to the sensitive nature of the matter could not comment further at this time.

In response to Members’ questions the following information was provided:

Concerning assurance of safeguarding standards, the Panel was informed that, in its investigation, CQC applied their own investigative methodology.  All recipients of services from this provider had been surveyed and the vast majority had responded positively.  To investigate the quality of the provision and the Council had also approached the families of users and there had been some reports of wrong methodology training e.g. training in client lifting. 

Staff training such as coaching on day-to-day practices such as hoist usage was an area of concern.  It was noted that it was not alleged that staff were not trained however it had been found that a number of staff did not have the training that CQC expected.  It was noted that there was a formal, standard curriculum package for this category of staff training and the Council expected that this should be met since other providers of such service used training packages of this nature.  Additionally the Council had offered its own staff development facilities to the organisation but these had not been  ...  view the full minutes text for item 3.1

To receive a presentation and progress update from Dianne Barham – HealthWatch Director

The Director, HealthWatch Tower Hamlets, introduced the report advising that the data reported was based on comments collected from the following sources: online HealthWatch website, Rate Our Service workshops and telephone feedback interviews and also contained analyses of patient feedback from the following clinics; sexual health, renal unit, fracture clinics outpatients, and cancer clinic at Barts Hospital.  She advised that the report would be analysed to identify key issues and develop monitoring tools with which to measure improvements from the Clinical Commissioning Group (CCG).  These data would be shared with the Health Scrutiny Panel to support further mutually beneficial scrutiny.

The top 10 concerns identified in the period July – September 2013 were listed at page 34 of the agenda and these issues raised with CCG. 

The following common complaints were also noted:

• Shortage of beds/staff – there were concerns regarding levels of care on specialist wards
• Accident and Emergency – there were concerns with popularity/mis-use of A & E services
• Food – there were complaints regarding quantity, temperature, special diets and help with eating.
• Hospital (building) mapping – users with disabilities were unable to easily navigate hospital buildings – better signage was needed
• Hospital Transport – there were complaints relating to excessive waiting times and a lack of communication between drivers and passengers
• Discharge – there were issues around timings of patients discharges
• Complaints – the complaints process was not clear nor was it clear how complaints would improve services

In discussion the Panel noted the following matters:

• A Panel Member observed that the report revealed the nature of day to day processes/activity in delivering services
• The HealthWatch Tower Hamlets representative made a verbal submission:  He observed that there had been better patient participation and input in the HealthWatch exercises.  However he was concerned that Barts Patient Engagement Forum offered no mechanism where the public might speak with Barts management but, in his view, regarded HealthWatch as a substitute for patient engagement.  He clarified that this in fact was not the role of HealthWatch. 

• The dashboard format would be revised to better indicate period movements.
• The ratings scale  ...  view the full minutes text for item 3.2

To receive a verbal presentation on integrated care

– ESCW Deborah Cohen, Service Head of Commissioning and John Wardell CCG

The Service Head Commissioning and Strategy tabled an update report which has been appended to the minutes.  She reminded the Panel of the presentation made by the Associate Director Community Health Services, Barts Health NHS Trust and the Deputy Chief Officer, Tower Hamlets Clinical Commissioning Group at the meeting on 3 September 2013 about the redesign of health services in the borough over the next two years.  The intended plan would be to relocate some services away from hospital setting to community settings, in GP surgeries, and in people’s homes.  She advised this work had evolved into the Integrated Care Programme and this had itself evolved and expanded to encompass neighbouring East London Boroughs of Newham and Waltham Forest to become a one of the 14 designated Department of Health Pioneer sites.   The WELC Pioneer programme was about developing care pathways for older adults.  The three local authorities were part of the programme of change and in this connection the following was to be noted:

• Transfer of some social care into these community-based services was proposed - although the timing of these changes had yet to be established.
• Local authorities would need to consider which services and staff would be most appropriately redeployed into the programme. 
• It was felt that the single point of access and co-location of services was best method to deliver co-ordinated care.  This would have implications for the workforce for example one consequence may be a requirement for home care workers to be up-skilled. 
• Participation in the Pioneer programme did not attract additional funding but there was access to expertise.  This advice has already been accessed to help resolve information governance issues
• There was ongoing work on financial modelling of the impact of the service redesign on activity flows, with the aim of ensuring that funding followed the activities. 
• Funding for these developments would be in the Better Care Fund but this is not new money into the system but one fund into which several pre existing funding steams have been merged.  Funding in 2014-15 was a centrally determined allocation. However for 2015-16 a proportion of the grant would only be paid if targets were met therefore the Partnership of the CCG and Council were considering which targets were most appropriate to measure.

The Panel was informed that:

• The first draft of the plan for the use of the Better Care fund had to be submitted by 14^th February and therefore the Health and Well-being Board was required to consider this matter at its meeting on 6^th February.
• There were risks around the programme for those involved and there were potential cost pressures.  However the Council's focus should remain “better care for residents".  Learning could be drawn from previous integrations which showed a need for significant input of formal programmes of organisational development 
• The duration of the programme was expected to be three years and there would be regular progress updates made to Health Scrutiny Panel
• Carers Breaks funding would be located in  ...  view the full minutes text for item 3.3

To undertake a verbal discussion on the subject of the Health Scrutiny review of A & E services.

The Panel was informed that its draft report titled ‘Scrutiny Review of A & E Services had been circulated to all Panel members for comment.  The following key issues were identified from the review findings:

·        Recruitment of local people was generally at less skilled levels

·        Issues concerned with the management of Winter Pressures

·        A and E services were viewed by residents as a convenient form of service access

The Panel discussed the findings of the review and the following observations were noted:

• A & E services were popular because they were quick convenient and provided good tests to users of the service. In contrast GP services were less convenient for patients to access
• There was no patients groups’ representation on the CCG Urgent Care Group
• The Health and Well-Being Board would hear from NHS England on the matter of hours for primary care provision

The Chair requested that the report should also address the following:

• To whom will review recommendations be made
• How much has changed since McKenzie in 2008:
• What is the agency that can influence GPs in the absence of the PCT:
• Are there any changes in the large numbers of young people choosing to attend A and E:
• Include a suggestion that a GP practice be cited within A and E
• Include a note on the general issues of accessibility to GP surgeries/services

It was agreed that the Panel's comments would be incorporated into the review following which the final draft would be circulated to Members for comment.  The review report would then be presented to the Panel at its next meeting prior to submission to Overview and Scrutiny Committee in April 2014.  Additionally it was agreed that any recommendations outside of the scope of the Council would be referred to Tower Hamlets Health and Well-being Board.

The Chair also requested that an item for funding for extra GP hours be added to the next HSP agenda

RESOLVED

That the discussion be noted

Action by:

TahirAlam / Sarah Barr (Strategy, Policy and Performance)

• The Chair advised the Panel that Sarah Barr, Policy Performance and Scrutiny Officer would shortly be undertaking a secondment with a neighbouring authority.  She thanked Sarah for her comprehensive support to the Health Scrutiny Panel and wished her success in the progression of her career.

• The Panel was reminded of the meeting of INEL JHOSC that would be hosted by Tower Hamlets Council on 17 February 2014.  At this meeting the joint committee would discuss:

o       The recent CQC inspection of Barts hospital (Barts and CQC would attend the meeting)

o       Receive a financial update

o       Consider a proposal to move Moorfield's Eye Hospital.