Agenda and minutes
Venue: Committee Room 1, 1st Floor, Town Hall, Mulberry Place, 5 Clove Crescent, London, E14 2BG
Contact: Antonella Burgio, Democratic Services
Note: Please note change of meeting time
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INTRODUCTION The Chair opened the meeting and welcomed Members guests from Bart's Health, Tower Hamlets CCG and Tower Hamlets Healthwatch. |
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DECLARATIONS OF DISCLOSABLE PECUNIARY INTERESTS PDF 71 KB To note any declarations of interest made by Members, including those restricting Members from voting on the questions detailed in Section 106 of the Local Government Finance Act, 1992. See attached note from the Monitoring Officer.
Minutes: No declarations of disclosable pecuniary interest were made. |
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REPORTS FOR CONSIDERATION |
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To receive: a. a presentation on managing winter pressures at RYL b. a verbal update on last year’s review of A&E review recommendations (scrutiny review circulated for information) Additional documents: Minutes: The Deputy Group Director, ECAM and Clinical Director, Emergency Departments together with Deputy Director of Operations, ECAM and Acting Hospital Director, Royal London Hospital (Barts Health) and Associate Director of Public Health spoke to the Panel on the matter of Accident and Emergency (A&E) winter pressures. He informed the Panel that: · Yearly, 300,00 patients were seen by Barts Health and of these, 155,000 per year were treated by Royal London Hospital (RLH) for a range of both minor and urgent conditions. · The service was delivered through structured facilities designed to deal with a range of severity of conditions. · Performance targets at Royal London Hospital (RLH) for A&E were set at 95% and performance was presently at 90% of targets. · The following factors detrimentally affected access of local people to A&E services and were factors which each contributed to poor access to RLH beds o Bed-base issues – discharges o Trend towards elderly patients incurring prolonged length of stay o RLH was the specialist centre for gunshot wound events and received A&E referrals from other areas o Delayed return of referred patients to their home Health Trusts in each trust area o Demographic changes indicating a trend towards an increased incidents of elderly trauma (e.g. hip fracture) than seen in previous years
He noted the following measures/initiatives to alleviate prolonged stay in acute beds:
Dr Ramadhan noted that notwithstanding these schemes there were still pressures with patient influx into A&E and that other Trust Hospitals experienced the same pressures except that of tertiary care.
In response to the Panel's questions, the following information was provided:
The no impacts of the implementation of the Better Care Fund on the service had yet been observed. However the fund was announced by Government in 2013 and formed part of NHS two-year operational plans and five-year strategic plans. Therefore it would be more appropriate to monitor impacts in the forthcoming year.
One incident of Norovirus had been posted at RLH presently with no further spread.
The information campaign on buses and billboards promoting appropriate use of A&E and other forms of access to healthcare services had had no impact on public behaviour.
It was noted that outcomes of the last A&E review provided indications of the motivators for the patterns of A&E usage observed and, resulting from this, more investigations would be undertaken.
No data on the proportions that unnecessarily attended A&E was available at the meeting. However the Panel was advised that:
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To receive an update on community health services procurement and engagement activities planned Additional documents: Minutes: The Community Health Services Procurement Programme Director (CCG) and Community Health Services Procurement Clinical Lead (CCG) made their presentation which provided an update on community health services procurement and engagement plans with the aim of delivering these services more effectively. The present contract has been held by Barts Health since 2011.
The Panel was informed that one year ago NHS Tower Hamlets CCG canvassed a range of stakeholders regarding the re-procurement of community health services. The competitive dialogue model of procurement has been chosen with the aim of having a care coordinated function to underpin the services and to coordinate local services using a single point of access model.
In response to the Panel's questions, the following information was provided:
Concerning the effectiveness of the approach chosen, the Panel was informed that work on cardiac care had been done by Bexley CCG, which had resulted in new ways of procurement which were not solely price-based but more focused on patient outcomes and quality for the benefit of local patients.
The responses received in regard to the TH community health services re-procurement were encouraging and the approach CCG had adopted was one that had not, to date, been used extensively throughout CCGs in England. The CCG’s aim was to ensure a more patient centred approach and provide more patient centred outcomes. Early indications were favourable.
Concerning organisation of the dialogue days, the Panel was informed that there would be separate days dedicated to specific areas such as service model, mobilisation, IT, governance etc.
Concerning whether the outcome-based approach would incur greater financial risk, the Panel was informed that a new approach had been implemented with the aim of securing better quality and better targeted services.
The CCG has identified a cost range of £30-33M for the procurement. Mechanisms to support the approach would have the risks assessed so that appropriate risk boundaries could be set. The chosen range was intended to: · Enable providers to be more innovative in regard to IT and access to contemporaneous records and also in regard to standards of facilities. · Give bidders flexibility to move funding and prioritise responses to deliver the appropriate care · Enable bidders to make longer term plans as the initial contract would be for five years with the possibility of extension to seven years.
The Panel discussed the composition of the Programme Board and was informed that:
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Health watch progress update PDF 546 KB To receive an update on: a. the paper to the Health & Wellbeing Board, outcomes of the work performed by the voluntary sector in the previous year, and b. key priorities Healthwatch are working on this year Additional documents: Minutes: Director, Healthwatch Tower Hamlets presented the update and progress report. The Panel was reminded of Healthwatch core functions and strategic aims. Following this Members were informed of the initiatives undertaken in 2014 to achieve/promote Healthwatch’s aims in relation to the themes of governance, understanding and support, influencing those with power to change services and leading to ensure local insight can influence services. In regard to the ‘patients’ journey’ the most common issues were found to concern:
Healthwatch has worked to help mitigate these by:
In response to the Panel's questions, the following information was provided:
Getting to the root of an issue might be complex, therefore it was suggested that 4 of the most common issues should be identified and a trace-back audit undertaken to identify cause and appropriate remedy.
Concerning delays in getting GP appointments, the Panel was informed that the call-back system of appointment making was the most effective method but those for whom English was the second language experienced difficulties in this circumstance. It was necessary therefore, that GP surgeries should offer more than one method of making appointments to avoid excluding sections of the community.
Statistics showed that use of walk-in centres was preferred by the same demographic as that which tended to use A&E.
Noting the difficulties that non-English speaking resident could encounter in booking a GP appointment, the Panel was informed that a survey of how the Somali population accessed GP services would be undertaken to explore how strategies for better access could be developed.
Concerning what progress was being made to address the structural issues in accessing A&E services via inter agency partnerships, the Panel was informed that pressures at RLH remained and CAGs were not effective. There was much data but this needed to be analysed to explore how things could be done differently.
Concerning how Barts Health utilised internal audits, the Panel was informed that Healthwatch had requested baseline data on complaints but this had not been made available.
RESOLVED:
The presentation and update report be noted |
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ANY OTHER BUSINESS WHICH THE CHAIR CONSIDERS TO BE URGENT Minutes: Dr Banerjee wished to make the Panel aware of the Transforming Services Together programme and encouraged Members to become involved. It was also noted the Inner North East London JHOSC was monitoring the matter.
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