Agenda and minutes

To approve as a correct record the minutes of the meeting of the Health Overview and Scrutiny Panel held on 4 February 2014.

The minutes of the Panel held on 4 February 2014 were approved and signed by the Chairman.

Matters Arising

Minute 47: Heatherwood and Wexham Park Hospitals (HWPH)

The Head of Overview and Scrutiny confirmed that a letter had been sent on behalf of the Panel to Monitor, the Care Quality Commission, the HWPH Trust and NHS England to express the Panel’s concerns and lack of full confidence in the HWPH Trust. A response was awaited.

Members are requested to declare any Disclosable Pecuniary Interests and/or Affected Interests and the nature of those interests, including the existence and nature of the party whip, in respect of any matter to be considered at this meeting.

Any Member with a Disclosable Pecuniary Interest or an Affected Interest in a matter should withdraw from the meeting when the matter is under consideration and should notify the Democratic Services Officer in attendance that they are withdrawing as they have such an interest. If the Interest is not entered on the register of Members interests the Monitoring Officer must be notified of the interest within 28 days.

There were no declarations of interest.

Any other items which, pursuant to Section 100B(4)(b) of the Local Government Act 1972, the Chairman decides are urgent.

There were no items of urgent business.

To receive submissions from members of the public which have been submitted in advance in accordance with the Council’s Public Participation Scheme for Overview and Scrutiny.

In accordance with the Council’s Public Participation Scheme for Overview and Scrutiny the following question was submitted by Mr Pickersgill, a resident of Bracknell Forest:

The Health and Social Care Act was delayed to add protection against Clinical Commissioning Groups (CCGs) commissioning care conflicting with their own financial interests. As many local GPs (including those on the CCG) have a financial interest in "Specialist Services" which offers specialist musculo-skeletal services and this will be a service at the Urgent Care Centre in Bracknell, how can we be assured that there will be adequate safeguards against such a conflict occurring?

A written response was provided by Mary Purnell, Head of Operations, Bracknell and Ascot Clinical Commissioning Group:

In line with any public body, Bracknell and Ascot CCG have procedures and safeguards against potential conflicts of interest. This can be a particular challenge for CCGs as CCGs are member led organisations, and our member practices are by definition providers of primary health services. For that reason, the measures to identify and manage conflicts of interest are rigorously applied. On a routine basis, the registers of interests are maintained and published on the website http://www.bracknellandascotccg.nhs.uk/  and declarations of interest are made at each meeting (internal and public).

Whenever a change to service was being implemented, and particularly where there was any procurement or other contractual issue, potential conflicts were managed by ensuring that no conflicted member of the CCG participated in the decision making process. Separate registers of interest were kept for those participating in any procurement, including staff and patient representatives who may be supporting the process. This was clearly stated in the Bracknell and Ascot CCG Standards of Business Conduct policy and in the Bracknell and Ascot CCG Constitution.

In the particular case of the musculo-skeletal assessment and treatment service currently being procured for the Healthspace, these processes were being diligently applied. The procurement was not yet complete, and no contract had yet been awarded, so no details can be made available regarding any organisation who may have bid to deliver the service. It was hoped that the procurement would be completed shortly and an announcement would be made at a forthcoming CCG Governing Body meeting. The service would not run from the Urgent Care Centre itself, but would be delivered from elsewhere in the Healthspace building.

The Director of Adult Social Care, Health & Housing reported that the CCG Governing Body met in public and also had a public participation scheme and so if the public wished to submit questions to them directly, they could do so. Details of these meetings were available on the CCG’s website.

To meet Dr Flowerdew, Interim Chief Executive of Royal Berkshire Hospital NHS Trust, with particular reference to the Royal Berkshire Hospital’s services to residents of Bracknell Forest, the cancer and renal services facility at Brants Bridge and the actions taken to reduce Accident and Emergency waiting times.

Representatives from the Royal Berkshire Trust Mr Flowerdew, Mr Robson, Ms Morton and Ms Hutchins attended the meeting and made the following points:

·         The Trust had undergone considerable scrutiny from Monitor and there were a number of reasons for this, including the Trust’s financial situation, A&E waiting times and concerns around the Board’s ability to deliver the work required of it.

·         The Trust had initially been given a rating of one by the Care Quality Commission (CQC), this had now been reviewed and the Trust was pleased to report that CQC had given the Trust a rating of five. The initial rating had dismayed staff who had felt that their rating had always been a five. Mr Flowerdew considered that the methodology used by the CQC was somewhat arbitrary. The CQC would be inspecting the Trust again on 24-26 March 2014. Much preliminary work had been undertaken by the Trust to prepare for this and there would be a public engagement session held ahead of the inspection to gauge public views around services provided by the Trust. An external peer review would also be carried out.

·         Monitor had been encouraged by the work undertaken by the Trust and there had been a public announcement made by Monitor to this effect.

·         The waiting times currently experienced in A&E indicated that a review of the whole system was needed, the Trust recognised this and that their performance had been consistently below the Government target of 95% of patients to be seen in A&E within four hours. It was noted that the only Trust achieving this government target in Berkshire at present was the Frimley Park Trust. It was also noted that attendances at A&E were increasing year on year.

·         It was reported that there had been a change in the type of patients being seen in A&E. There had been increases in patients needing resuscitation or with major issues and a decrease in the number of minor injury patients. Throughout the winter period there had been a larger than average attendance in the number of over 75’s attending A&E. There was a particular issue with ‘frequent fliers’, where 69 people had accounted for some 1,000 attendances at A&E.

·         It was reported that in terms of whole system actions, a Berkshire West System Recovery Plan had been agreed to improve performance and an operational teleconference was in place three times a week to monitor actions agreed within this, supported by Almanac. A whole system review had been undertaken by ECIST (Emergency Care Intensive Support Team) in March 2013. A steering group had been formed and an action plan developed to implement the recommendations from ECIST. A predictor model would be developed from data.

·         The Director of Operations reported that the vision for the Royal Berkshire Bracknell Healthspace had been to bring care closer to home and create a modern, calm and patient centred facility. To reduce congestion at acute sites and provide innovative patient pathways. The  ...  view the full minutes text for item 53.

To receive a briefing from Sally Grant (Team Manager) and Maureen Chapman, (Outreach Co-ordinator and Advocate), on the role and activities of SEAP Complaints Advocacy Service.

Representatives from SEAP delivered a presentation explaining their role and activities, with reference to case studies and made the following points:

• The SEAP service was run across Berkshire and had been commissioned to provide the Independent Mental Health Advocacy and Community Mental Health Advocacy services for Berkshire by the Clinical Commissioning Groups. They were commissioned to provide the NHS Complaints Advocacy Service for Berkshire by the six local authorities.
• SEAP ensured that those with mental health issues had a voice and were properly informed and enabled to make informed choices.
• Anyone could refer to SEAP and SEAP were experiencing a steady rise in referrals.
• SEAP presented to the Panel a number of case studies to illustrate the kind of work they undertook.

The Healthwatch representative advised that whilst SEAP could take up individual complaints, the role of Healthwatch would be to consider issues, complaints and trends more generally. In addition, in the first instance, patients should always consider speaking to providers before contacting either SEAP or Healthwatch.

The Panel asked how SEAP would be informing the public about their service.

SEAP representatives reported that they were currently working on their marketing and promotion strategies. They would be running a number of drop in sessions across Berkshire, in various centres as well as attending the Healthwatch launch events and speaking on Radio Berkshire. SEAP worked closely with Bracknell Forest Voluntary Action to choose venues and community settings for their drop in sessions. Any ideas for venues would be welcomed from the Panel. SEAP also provided leaflets to all GP surgeries in Berkshire promoting their role. SEAP had its own complaints procedure if anyone wanted to complain about their advocacy service.   

The Panel asked how SEAP would be liaising with Clinical Commissioning Groups (CCG’s)?

It was reported that SEAP had already established regular contact with CCG’s and leaflets about SEAP’s role had been provided for all GP surgeries. CCGs had acted as a mouthpiece for SEAP at GP surgeries.   

The Chairman thanked the SEAP representatives for a very informative presentation.

To consider:

-          The results of the December 2013 GP Patient Survey for Bracknell Forest GP Practices.

-          The current information from the NHS Choices website, for the NHS Foundation Trusts providing most NHS Services to Bracknell Forest residents.

The report asked the Panel to review the latest survey responses given by patients of Bracknell Forest GP practices and the current information from the NHS Choices website for the NHS Foundation Trusts providing most secondary NHS services to Bracknell Forest residents.

The Panel noted that much of the results had not changed significantly since the last survey six months ago. It was reassuring to see that confidence and trust in GP’s remained good across surgeries. It was noted that there were issues around people being able to get appointments in a timely manner.

The Healthwatch representative reported that patient experience was an area that was of high priority to Healthwatch as whilst a high proportion of people were content with the health care they received, the service side of healthcare was more likely to raise issues. Healthwatch would be collecting soft data from the Urgent Care Centre to gauge the extent to which people were having difficulty getting appointments with their GP. Any good practice gleaned would be shared across the borough with practice managers. This work would also be shared with the Panel.

The Chairman felt that further work would be necessary around this in order for the Panel to explore the issues more robustly. It was agreed that this item be considered at the Panel’s six weekly meeting to establish the focus of the work and to establish when the work could be brought back to the Panel.

To consider the response of the Executive and the NHS Trusts to the recommendations of the Panel’s Working Group which reviewed the lessons of the report by Robert Francis QC for Health overview and scrutiny.

Councillor Mrs McCracken, Lead Member of the Working Group reported that this report had now been submitted to the Executive and had received some complimentary remarks from Executive Members. She thanked Working Group Members and the Head of Overview and Scrutiny for all their work. It was noted that the recommendations of this Working Group were now being put into practice.

To consider the parts of the Quarter 3  2013/14 (October to December) quarterly service report of the Adult Social Care, Health and Housing department relating to public health.

Please bring the previously circulated Quarterly Service Report to the meeting. Copies are available on request and attached to this agenda if viewed online.

In response to Members queries, the Director of Adult Social Care, Health & Housing (ASCH&H) reported that with reference to 6.9.2 of the report, pharmacies acted as a frontline practitioner and were able to give people a range of advice this included advice around reducing harm caused by drugs and alcohol abuse.

The Director ASCH&H reported that the department’s underspend was not as great as initially anticipated. Public Health activity was currently within budget.

The Chairman asked what the big issues were that most concerned the Director at the present time.

The Director reported that the big issue going forward would be the Better Care Fund. It would be a challenge to deliver the integration work required and the emphasis on diverting activity away from acute services. The entire pathway would need to be explored to deliver this effectively. The Executive Member for ASCH&H added that it was also imperative to ensure that the focus on the Better Care Fund was not undertaken to the detriment of other service areas in the department.

The Chairman stated that it would be useful to have the Better Care Fund on the agenda of a future Panel meeting.

Councillor Mrs Temperton reported that she and Councillor Thompson, as part of their specialist scrutiny role, had recently met the Public Health team and attended a workshop on sexual health.

To determine the Panel’s comments on the 2013-14 NHS Quality Accounts for those nearby Trusts serving Bracknell Forest residents.

The Chairman asked that all Members of the Panel read through each of the five Trust’s Quality Accounts carefully. Consideration could then be given as to how Members wished to respond to each set of Quality Accounts. All responses would need to be made by the end of April 2014.

The Executive Member ASCH&H reported that the Quality Accounts for the Royal Berkshire Healthcare Trust reported very little about the Child & Adolescent Mental Health Services (CAMHS) specialist services, this was a concern as this was an area that wasn’t performing very well. The Director ASCH&H reported that he was working with other Berkshire local authorities to address this issue. An action plan had been agreed and 15 recommendations had been made to NHS England around their specialist services around CAMHS. This had included that there wasn’t currently any provision in the Berkshire area, young people with complex needs had to travel outside of the region to get the specialist support they needed. The recommendations also included the need to increase the capacity of out of hours services.

To receive an update on the progress of the Panel’s Working Groups.

It was noted that Working Group activity had been postponed as currently Members would be following up work in their specialist areas.

To consider scheduled Executive Key and Non-Key Decisions relating to Health.

The Panel noted Executive Key and Non-Key decisions relating to health.

3 July 2014

3 July 2014.