Agenda and minutes

To approve the minutes of the meeting held on 13 June 2017.

The minutes of the previous meeting held on 13^th June 2017 were agreed as an accurate record.

Apologies for absence were received from Debbie Domb and Patrick McVeigh.  Apologies for lateness were received from Councillor Andrew Brown.

If a Councillor has a disclosable pecuniary interest in a particular item, whether or not it is entered in the Authority’s register of interests, or any other significant interest which they consider should be declared in the public interest, they should declare the existence and, unless it is a sensitive interest as defined in the Member Code of Conduct, the nature of the interest at the commencement of the consideration of that item or as soon as it becomes apparent.

At meetings where members of the public are allowed to be in attendance and speak, any Councillor with a disclosable pecuniary interest or other significant interest may also make representations, give evidence or answer questions about the matter. The Councillor must then withdraw immediately from the meeting before the matter is discussed and any vote taken.

Where Members of the public are not allowed to be in attendance and speak, then the Councillor with a disclosable pecuniary interest should withdraw from the meeting whilst the matter is under consideration. Councillors who have declared other significant interests should also withdraw from the meeting if they consider their continued participation in the matter would not be reasonable in the circumstances and may give rise to a perception of a conflict of interest.

Councillors are not obliged to withdraw from the meeting where a dispensation to that effect has been obtained from the Audit, Pensions and Standards Committee.

Councillor Joe Carlebach declared an interest as a trustee of the Royal National Orthopaedic Hospital.

Verbal update – a regular update provided by Healthwatch on local, Hammersmith and Fulham related health concerns and issues. 

Eva Psychrani provided a brief verbal update on work priorities and activities that Healthwatch were currently engaged with.  There had been changes proposed on prescriptions and podiatry services and it was noted that the consultation on prescription charge changes had been extended to the 8^th August.  Healthwatch expressed concern about the possible impact of patients with protected characteristics who might be affected by the changes.  Podiatry services changes were expected in December following a review as to who would qualify for the service.  There had been no prior consultation with residents but there had been two engagement events which had raised several issues, such as service capacity or private sector charges. Both these matters, together with limited consultation and stakeholder engagement, in a short period, required closer examination.

It was reported that Healthwatch would be supporting a mental health event on 18^th October, taking place at the Irish Centre, with the aim of identifying gaps in mental health service provision, working with organisation such as MIND.  They had recently recruited three new volunteers and were currently in the process of recruiting a volunteer co-ordinator.

Bryan Naylor asked about the way in which the CCG communicated with Healthwatch, expressing concern that this might evidence a lack of appropriate communication on issues requiring consultation and engagement with residents.  Eva Psychrani responded that this was not the case, although concurred that there was a lack of communication on the changes to prescription charges. 

Jim Grealy supported this view, observing that the CCG had extended the consultation following protests from a range of stakeholders.  Referring to podiatry services, he added that elderly residents would be among the most affected by the changes, which he felt had not been fully consulted upon.  Councillor David Morton continued, that podiatry services which operated across a number of centres, had struggled last year following a failure in the computerised booking system.  A reduced service might be necessary but people with long term conditions such as diabetes were concerned about losing the service.

Following further discussion, particularly focusing on the regulatory guidance on the requirement to fully consult on service changes, Councillor Coleman suggested that the PAC was the most appropriate forum for discussing the way in which the CCG undertook consultation and engagement. 

RESOLVED

That the PAC consider reports on both podiatry service changes and GP prescription changes, at a future meeting, particularly considering the way which the service changes had been consulted upon by the CCG. 

This report outlines plans to reduce delayed transfers of care to improve the patient experience, reduce length of stay, and improve flow through our hospitals.

Councillor Vaughan welcomed Dr Sarah Brice, Director of Integrated Care and Geriatrician, Rebecca Campbell, Head of Discharge and Mick Fisher, Head of Public Affairs.  Rebecca Campbell explained that the service cared for people with challenging and complex needs, helping them navigate clinical care pathways, discussing treatment options with family members and liaising with the Community Independence Service (CIS) colleagues.  Dr Sarah Brice recognised that tensions existed between hospital provision and ASC, particularly in terms of handover and responsibility but that recent developments had ensured increasing collaboration and co-operation, in what was a difficult financial climate. 

Bryan Naylor expressed concern about treatment he had recently received at Charing Cross hospital, which he described as disgraceful.  He explained that he was one of several patients receiving treatment on the same ward and that he had seen patients being discharged prematurely.  Dr Sarah Brice apologised for his experience, recognising that the system did not work perfectly.  She indicated that they were keen to ensure that the service improved and were working hard to resolve a number of challenges. 

In response to a question from Councillor Morton, Dr Sarah Brice explained that they had a facility where patients could be supported as they continued treatment outside a hospital setting, with a view to progressing support for those with long term conditions, back in the community.  She explained that they would utilise beds carefully, ensuring that patients were properly assessed outside the ward.

Jim Grealy commented that the report needed to be more complex and offered an incomplete picture. He enquired about the category of people being discharged, referring to page 14 of the report.  He recognised that there was a lack of specialist staff but held no confidence that the aspirational outcomes expressed in the report would be forthcoming.  In response, it was noted that a further, more detailed report could be provided, together with an update.

Councillor Carlebach commented that it was essential for patient welfare, to be clear on who was responsible for their care, treatment and future support, particularly at different stages of the clinical pathway.  Rebecca Campbell responded that they had focused on the delays but could provide greater detail on the patient journey, how they could anticipate late discharge protocols, and how they worked closely with doctors and nurses, sharing information with patients.  Dr Sarah Brice explained that the hospital was working at high capacity, with often complex cases. Extended hospitalisation could lead to challenging pressures for patients and families, with difficulties in making adjustments at home. 

Councillor Carlebach's second point related to sheltered housing contact, and the importance of housing officers engaging with colleagues and residents, which could be further improved.  It was noted that development work around clinical services was on-going, allowing information to be shared across the service, by for example, ward based social workers. Social workers now accompanied clinicians on ward rounds, embedded the process, receiving information about a patient’s treatment care and progress.  Cross communication facilitated improved care for patients. This was a pilot  ...  view the full minutes text for item 147.

This report provides an update on the uptake and coverage of seasonal influenza vaccinations during the winter of 2016/17.

Councillor Vaughan welcomed Vanessa Andreae and Lucy Rumbellow to present the report on Seasonal Influenza Vaccination Uptake, covering the headline points.  Improvement was demonstrable across all areas, except for the over 65₊ but there was a slight uplift, as these also included pharmacy figures.

Jim Grealy referred to page 23-24 of the Agenda pack, paragraph 2.2 on healthcare workers and Table 2, respectively, which demonstrated disappointingly low uptake by Imperial Trust staff.  It was noted that the decision to have flu vaccination was a matter for each individual.  It was offered to all employees, who had the right to exercise patient choice.

Councillor Carlebach asked why known, vulnerable patients were not offered the vaccine, whether nurses based in maternity hospitals could ensure uptake and similarly, improve uptake in schools by ensuring clear information to pupils.  Lucy Rumbellow explained that there may be contra-indicators for a patient receiving treatment in hospital which would compromise their safety.  There was also no facility for sharing records of vaccination therefore difficult to maintain an accurate record to avoid duplication.  It was noted that if there was a mass outbreak, then vulnerable people would be the most affected.  Vanessa Andreae suggested that the Quality Steering Group included guidance in their correspondence to GPs and concurred that it would be helpful if vulnerable groups such as those receiving chemotherapy treatment or were pregnant benefit from having the vaccine.  The benefits to those immuno-compromised patients were briefly discussed, noting the difficulty in attending a GP surgery.  The alternative was to go the local pharmacy but the immune system might be so supressed that they would more vulnerable.

It was agreed that the Committee would write to NHSE to formally address why the vaccination was not being made more widely available to vulnerable patient groups. 

ACTION: PAC

It was noted that the provision of the vaccine to children in primary schools would commence in October 2017, covering reception to Year 4.  Children aged 2-3 years would receive the vaccine in GP surgeries.  The issue regarding religious objections to the content of the vaccine (porcine element) had largely been addressed from within the relevant communities, who opt to refuse the injection.  It was acknowledged that further work could have been conducted with faith groups last year and that more extensive work would be undertaken this year.

Councillor Umeh commented that many people were sometimes put off by the number of complex questions that were asked by the pharmacy in trying to obtain the vaccine and enquired about other available alternatives. Vanessa Andreae explained that it was necessary for the pharmacist to ask detailed questions to ensure that the person was clinically safe to receive the injection.  Over 4000 vaccinations were administered by local pharmacies last year.  These were “live” vaccines and need to be administered safely.  The benefit of going to the pharmacist meant that the vaccine could be obtained “opportunistically” and at the same time, helped alleviate pressure on GP surgeries.  In response to a query  ...  view the full minutes text for item 148.

The following report provides an update on progress made by the Community Independence Service, which helps to support residents in their own homes or community.

Councillor Vaughan welcomed Helen Poole (H&F CCG), Susan McCabe (WLMHT) and Katherine Murray (Central North-West London NHS Foundation Trust), who jointly presented this item.  The report provided an overview of how the service had been operating since being implemented on 1^st November 2016.  Helen Poole explained that the main element of the process ensured that there was a single point of referral, strengthening the process, with the introduction of an integrated patient record.  Referring to a case study, set out in section 4.2 to 5 of the report, it was reported that 85% of patients referred to the Community Independence Service avoided re-admission and that there had been improvements to the triage service.

It was noted that the clinical priority was to improve the patient pathway, prescribing the optimum patient journey.  This was an on-going area of work, to ensure a seamless transition and integration of care between health and ASC.  Looking ahead to 2018, the current contract with the provider was under review.

Jim Grealy referred to section 1.3 of the reports, point 4, Reduce readmission rates, observing that the Hammersmith and Fulham service, serves residents with complex needs, and, the number of residents appear to be much higher in number compared to other boroughs.  It was noted that this was a separate piece of work that was currently being undertaken by the CCG and that the data would be shared at a later date.

Bryan Naylor sought clarification regarding the difference between a failed discharge and a premature discharge.   Part of the process of identifying if there had been a failure of treatment or if a person’s condition had deteriorated, dependent on the information available.  Katherine Murray referred to the case study in the report, and explained that they had access to a diagnostic tool at Imperial which could help with diagnosis. 

Councillor Carlebach enquired about the large number of residents who were based outside of the borough.  Katherine Murray responded that the figures were maintained across the three boroughs and that WLMHT made provision for placements in Ealing and that reciprocal arrangements across Brent, Harrow and Hounslow were in place. 

In response to a query from Councillor Brown regarding the friends and families test, Katherine Murray explained the Trust was keen to communicate as widely as possible, utilising tools such as friends and families. 

Councillor Vaughan enquired about the data and information sharing that might come from the deep dive, to indicate for example, if a clinical decision led to a reaction in a complex illness, and whether this was feasible.  Vanessa Andreae clarified that a failed discharge was not the focus of the CIS and that this would not necessarily be happening to patients that were not under the care of the service.  Katherine Murray explained that CIS was a multi-disciplinary team consisting of GPs, nurses, occupational therapists, pharmacists and social workers.  She added there was an enhanced provision of community based services within the borough, a model of care which  ...  view the full minutes text for item 149.

The Committee is asked to consider its work programme for the remainder of the municipal year.

The Committee noted that that two further items had been included on the long list of future items for inclusion in the Work Programme, including podiatry services and prescription charges.  Councillor Vaughan indicated that he would like the Transitions task and finish report to be considered by the Committee, which had recently been considered by CEPAC.  The Annual Safeguarding Adults Executive Board Report would also be included in the Work Programme. 

RESOLVED

That the Work Programme be noted. 

·         Tuesday, 14th November 2017

·         Tuesday, 12th December 2017

·         Tuesday, 30th January 2018

·         Tuesday, 13th March 2018

·         Tuesday, 24th April 2018

The next meeting of the Committee will be Tuesday, 12th December 2017.