Agenda and minutes

Cllr Eileen Morley – medical appointment

Cllr Merlita Bryan – Non-Council business

The Panel considered a report of the Head of Democratic Services detailing Nottingham CityCare Partnership’s progress against its quality improvement priorities for 2014/15; and proposals for their Quality Account 2015/16, including plans for public engagement in developing the Quality Account.

Rosemary Galbraith, Assistant Director of Quality & Safety and Deputy Director of Nursing at Nottingham CityCare Partnership advised the Panel of the progress and, during discussion, stated the following;

(a)  Phlebotomy services are now being offered in a wider range of locations, with fewer complaints and shorter waiting times.  More information will be available in the annual quality account.  Rosemary will provide further written information from a provider perspective;

(b)  Healthwatch voiced concern that offering a choose and book service for blood tests is confusing for patients who are used to going straight to the phlebotomist in their own Health Centre following a GP referral

(c)  Members of the panel were also aware of concerns about the new phlebotomy arrangements and may consider further scrutiny in the future;

(d)  A mixture of practical and Admiral Nurses (dementia specialists) are employed to tackle the growing concern over Dementia.  Admiral Nurses have more all-round awareness of the condition.  Rosemary assured the Panel that collective work will continue to address the issue of Dementia;

(d)  Connect House, a care home run by an arms-length subsidiary of Nottingham CityCare Partnership (CityCare Connect Ltd), will impact on hospital discharge rates by providing an extension to the core care offer;

(e)  An evaluation of instances of falls in care homes will be carried out.  Early assessment and providing an appropriate high quality response will be a priority in the quality account, and will include case studies of how hospital admission can be prevented;

(f)  The following are coming year priorities for 2015/16:

  (i)  Pressure ulcers – a national and regional priority.

(ii)  Duty of Candour (ie the duty to ensure that providers are open and transparent with people who use services and receive care and treatment, and specifically when things go wrong with care and treatment) – has now been published and will be applied;

(iii)  Development of wider scrutiny – the needs of the patient can be met by public patient involvement.

(iv)  Carer support – signposting of carers to be improved for patients and families, by providing early information on initiatives and new projects;

(g)  A new DVD has been launched in care homes, and this contains information on how to prevent pressure ulcers.  In addition to this, the Tissue Viability Scheme provides more information on what pressure ulcers are, and how they can be recognised;

(h)  New priorities have been decided after a range of consultations with the NHS and patients, as well as other factors such as quality indicators, and feedback from last year’s priorities.  Patients provide a large proportion of feedback, through their complaints and praise, and also through their needs;

(i)  Ruth Rigby from Healthwatch voiced concerns over CityCare’s identity.  In some cases, the public do not  ...  view the full minutes text for item 43.

The Panel considered a report of the Head of Democratic Services detailing the findings of recent commissioner and provider reviews of Child and Adolescent Mental Health Services in Nottingham, and how changes being made as a result will impact on service users.

Lucy Davidson, Assistant Director of Commissioning at NHS Nottingham City CCG, Deborah Hooton, Head of Joint Commissioning at NHS Nottingham City CCG, Rachel Towler, Assistant General Manager at Nottinghamshire Healthcare Trust CAMHS (Child and Adolescent Mental Health Services), Tajinder Madahar, Acting Head of Service, Extensive and Specialist Services at Nottingham City Council, Anna Masding, Service Manager CAMHS Tier 2 at Nottingham City Council, and Ann Wright, General Manager, Specialist Services at Nottinghamshire Healthcare NHS Trust advised the Panel of their findings and, during discussion, stated the following;

Pathway

(a)  The review was necessary to identify young people that are at high risk. Many of these young people have emotional and mental health needs; in addition to this, the number of ‘looked after children’ is increasing year on year.  It is clear that the demand for Child and Adolescent Mental Health Services (CAMHS) services is increasing, and some of the mental health issues are more complex;

(b)  Work commenced on the CAMHS pathway prior to review, as it was anticipated that the review would back this work up.  The Pathway itself has been approved for children and young people, and it can be seen online by any parent, carer or guardian.  A key part of the pathway is early intervention and prevention of escalation to specialist services such as paediatricians, Tier 2, 3 and 4 CAMHS and in care placements;

(d)  Emergencies are dealt with by the emergency pathway.  This would either be escalated to Tier 4, or reintegrated into the universal pathway;

(e)  The Pathway is also being contributed to by Family Support Workers and Paediatricians to make sure that children are receiving the best possible care;

(f)  The next steps in the process include:

(ii)  Further learning – this scheme is still a pilot

(iii)  Performance management

(iv)  Further work with organisations such as Healthwatch

(v)  Continue to gain feedback; so far it has been positive;

CAMHS Tier 2

(g)  Nottinghamshire Healthcare Trust has been working in partnership with Tier 2 colleagues to ensure that there is collaborative working.  It is imperative that existing relationships are built on;

(h)  Young people who have received services, and want to contribute to the system can apply for a Peer Support Worker post.  One area that has specifically been identified for peer support is transition from CAMHS to Adult Services;

Following questions and comments from the Panel, additional information was provided:

(i)  Healthwatch are doing a piece of work on young people and mental health from the perspective of a critical friend providing a positive challenge.  They have recently had a helpful meeting with Nottingham City CCG and will be meeting with all partners.  Once completed, this information will be shared with the Health Scrutiny Panel.

Healthwatch  ...  view the full minutes text for item 44.

The Panel considered a report of the Head of Democratic Services detailing proposals on the Adult Integrated Care programme. Dave Miles, Assistive Technology Project Manager of Nottingham CCG advised the Panel of the proposals and, during discussion, stated the following;

(a)  The Adult Integrated Care Programme will be delivered through the Nottingham Better Care Fund Plan.  Nottingham was one of only six authorities in the whole country that required no amendments following submission of its Better Care Fund Plan to NHS England.  Nottingham has also received a nomination as an ‘Integrated Pioneer Site’;

(b)  The Office for Public Management (OPM) was commissioned to carry out an evaluation on key areas of Adult Integrated Care, which included:

(i)  Have key pathways been implemented?

(ii)  What lessons have been learnt?

(iii)  How is successful information influenced by context?

(c)  The report revealed that 74% of the workforce felt that patients had to repeat themselves a lot of the time.  It also suggested that the majority of the workforce agreed that services were now joined up, and that 52% of users thought that services are inaccessible.  Positive responses were received in relation to Telecare, with 95% of service users feeling safer, and 75% of carers feeling less stressed;

(d)  One area of improvement being considered is for calls to the service to be answered straightaway, rather than being given five options by an automated service;

(e)  Financial savings for patients will be looked at in the next wave of reviews;

(f)  The ‘You said, we did’ approach is used to communicate changes made in response to feedback;

(g)  Exploring the reality or real-life situation of a patient could be introduced.  These patient outcomes could work alongside existing DVD communications;

(h)  Evidence gathered on what is working well so far has come from care-co-ordinators.  More feedback and evidence is required from patients themselves.  New care-co-ordinators are getting people into Social Care quicker;

(i)  Multi-disciplinary team meetings offer the opportunity for joined up care plans.  People who require social care can receive this care quicker if their holistic needs are discussed at a single meeting, rather than a GP having to be consulted first.  This is working well from a provider perspective, but patient views have yet to be evaluated;

(j)  Three areas that are impinging on the workforce (technology, cultural change, workforce development) cannot be tackled independently; they must be tackled together;

(k)  Telecare is currently provided by Nottingham City Council, and Telehealth is provided by Nottingham CityCare Partnership.  There are plans to consider more joined up working of these two services;

(l)  Tracking the patient and the carer experience can be done through a series of evaluations.  There needs to be a concentration on giving the public the right service at the right time.  For example, 100 participants will be tracked pre-Telecare/health, and then after Telecare/health has been introduced, the results can be monitored to discover the patient experience;

(m)  Further evaluation reports are due in September 2015, and in March  ...  view the full minutes text for item 45.

The Panel considered a report of the Head of Democratic Services detailing the Council’s progress in responding to requirements of the Care Act 2014 to ensure that it meets statutory deadlines for implementation.

Linda Sellars, Chief Social Worker, Sarah Gibbons, Senior Social Work Practitioner, and Laura Catchpole, Policy Officer advised the Panel of  progress to date and, during discussion, the following points were raised;

(a)  Part 2 of the Care Act (related to funding reform and the care cap) is due to be implemented by April 2016.  Currently, no guidance has been received, but a draft is expected in February 2015.  Final guidance is due in October 2015.  This will include consultation over fairer charging;

(b)  A proposal to jointly manage citizens’ joint budgets has been put forward.  Some citizens are funded by health and social care, and the need for clarification on direct payments under the Care Act could arise, now that the personal health budget pilot has come to an end.  Ultimately, whatever is best for the citizen will prevail;

(c)  Contributors assured the Panel that Nottingham City Council will be compliant with Part 1 of the Care Act by April 1^st 2015.  There is further work to be carried out, but compliance is of primary importance

(d)  The Care Act involves some significant cultural changes; there will be a cultural programme next year focusing on embedding the Care Act;

(e)  The fact that Nottingham City Council adopted the personalisation agenda at a very early stage contributes to helping with the required cultural change.  There is less of a cultural shift needed at Nottingham City Council than there has been at other Local Authorities because of existing experience of personalisation;

(g)  Colleagues are engaged with national discussions on the cap on care costs and associated risks, for example the potential impact on private providers who may want to withdraw services if they can’t set charges for self-funders.  The need to prepare for the risk of market failures is being addressed;

(h)  All of the work carried out so far has been done by using existing resources at Nottingham City Council.  Some additional money has been allocated for carers and self-funders, and there has been some expense to cover the cost of the new duty to cover people in prisons, and the cost of training;

(i)  Carers can also be employers, and can potentially be funded from two sources (health and social care).  Currently, these individuals are assessed by Nottingham City Council for social care funding, and are supported by account providers.  In the future, there is the potential to have an internal team that can provide this service for both health and social care funding;

(j)  Service users will not see a huge amount of difference when Part 1 of the Care Act is implemented in April 2015.  The main differences will be for carers, as their level of eligibility may change, and carers may see more support from April 2016, when Part 2 is  ...  view the full minutes text for item 46.

The Panel considered a report of the Head of Democratic Services relating to the work programme for the Health Scrutiny Panel for 2014/15.

RESOLVED to note the work programme.

The time of the meeting for May 27 2015 has been brought forward to 10am, with a pre-meeting for members of the panel at 9:30am;

RESOLVED to note the change in time.