Agenda and draft minutes

Councillor Emma Dewinton (other Council business)

Councillor Eileen Morley (leave)

Councillor Merlita Bryan declared a personal interest in agenda item 6 (minute 54 below) – ‘Overview of the work of OSCAR Nottingham’ – as a patron of the organisation, which did not preclude her from speaking or voting.

To confirm the minutes of the last meeting held on 27 January 2015.

The Panel confirmed the minutes of the meeting held on 27 January 2015 as a true record and they were signed by the Chair.

Report of the Head of Democratic Services

Naomi Robinson, Commissioning Manager – Primary Care, Nottingham City Clinical Commissioning Group, introduced a report and presentation, updating the Panel on the preferred provider for urgent care services, providing further detail on plans for interim and future service provision.

Ms Robinson made the following points in her presentation:

(a)  a review of walk-in service contracts took place in 2011/12, and identified a duplication of services and variances in delivery between both services. Patient feedback indicated high levels of satisfaction with the services, but also highlighted problems in accessing primary care. GP commissioners used these findings to inform a remodelling of walk-in services;

(b)  the remodelling approach presented to key stakeholders in 2013/14 was broadly welcomed. There was specific support for a more seamless ‘see and treat’ approach, for greater clarity between the roles of walk-in and primary care services, and for greater equity of access through having a city centre location;

(c)  there followed intensive clinical and patient engagement, involving the Patient Engagement Team and Healthwatch Nottingham and including ‘roadshows’ and 2 significant engagement events. The engagement findings confirmed support for a city centre location, increased diagnostics (particularly x-Ray), co-location with urgent dental services, consistent 7-day opening times and public transport and parking access;

(d)  a further period of engagement focused on ‘seldom heard’ groups. Feedback included the need for a welcoming and non-judgmental approach, maintaining current links between services and substance misuse and homelessness organisations and access to repeat prescriptions;

(e)  the key features of the final urgent care specification included high quality assessment, diagnosis and treatment of urgent health conditions, urgent diagnostic x-Ray without attending Accident and Emergency year-round opening hours of 7am-9pm, short waiting times for initial assessment and treatment and continued access for vulnerable patient groups with close links to specialist services;

(f)  the procurement process attracted 13 expressions of interest, and, following a market management-bidder event in September 2014, 3 organisations submitted a bid. The procurement process was supported by a Patient Procurement Panel, providing a ‘patient voice’ throughout;

(g)  Nottingham CityCare Partnership was announced as the preferred bidder in February 2015, and an Implementation Group is to be established to oversee the development of the Urgent Care Centre;

(h)  The Centre is to be sited at Seaton House, London Road and the CityCare Partnership is working to a commencement ate of 1 October 2015. Work is ongoing with providers of the 8-8 Health Centre and Clifton Nurse Access Point to manage transition.

The Panel commended the process for its high levels of transparency and stakeholder engagement. During discussion, the following points were made:

(i)  Ms Robinson confirmed that there will be consistent ongoing communication with citizens and through GP practices on transition arrangements. While it would be for the preferred bidder to clarify what was meant by ‘urgent’ care, communications leads from all relevant organisations involved in interim arrangements needed to liaise to ensure a seamless transition;

(j)  Ms Robinson confirmed that TUPE arrangements will apply for affected staff. While specific consultation with existing  ...  view the full minutes text for item 52.

Report of the Head of Democratic Services

The Chair introduced a report of the Head of Democratic Services on the services provided for and issues faced by people with Myalgic Encephalopathy (ME) and related diagnoses, to determine whether further scrutiny is required. The issue had been brought to the Panel’s attention by members of the public, and public concerns had been expressed about gaps in and consistency of service provision.

The Panel received a presentation by Russell Pitchford, Commissioning Manager – Community Services and Integration at NHS Nottingham City Clinical Commissioning Group (CCG), who highlighted the following points:

(a)  ME and related conditions, including Chronic Fatigue Syndrome (CFS), Post-Viral Fatigue Syndrome (PVFS) and Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) were prevalent in 0.2 to 0.4% of the population. The National Institute for Clinical Excellence classifies ME/CFS into 3 categories: mild, moderate and severe, but definitive figures for each category are not known;

(b)  It is acknowledged that there is a considerable variation in current practice by service providers;

(c)  Diagnosis is by exclusion of other possible diagnoses, with symptoms persisting for 4 months in adults and 3 months in children and young people, and may present with other conditions, making diagnosis complex;

(d)  It is acknowledged that the conditions have a significant impact on patients and families;

(e)  There is a dedicated Nottinghamshire Adult CFS/ME Clinic based at the City Hospital, providing services to those with mild to moderate diagnoses. The programme offered seeks to sustain and/or extend the person’s physical, emotional and cognitive capacity, to manage the physical and emotional impact of their symptoms and to provide cognitive behaviour therapy and/or graded exercise therapy;

(f)  The nearest facility for treating severe ME is in Leeds, but there are no current patients from Nottingham referred to the facility;

(g)  Services should be needs-based and delivered under local integrated services, with support from specialist services;

(h)  The CCG has identified training and education and continuity of care and access to services as the key development areas going forward. The CCG will look to offer education and awareness raising among non-specialists on the symptoms, diagnosis and management of the ME, will look to make local clinicians aware of the specialist services available, and seek to ensure that specialist services consider providing education and awareness training to non-health professionals;

(i)  The CCG will also establish agreed pathways to ensure timely diagnosis, consider local referral protocols so people are treated in the right setting, include guidance in protocols so that care is consistent across services.

The Chair then invited Jenny Billings of the ME Self Help Nottingham Group (MESH) to address the Panel, who made a number of points, summarised below:

(j)  sufferers of ME/CSF in Nottingham City have experienced delays in diagnosis, have been misdiagnosed and have not been taken seriously by GPs when presenting with ME/CSF symptoms. Sufferers of Fibromyalgia have had similar experiences;

(k)  there is a need for a training refresh for GPs in Nottingham to address attitudes to ME/CSF, and to ensure consistency of diagnosis  ...  view the full minutes text for item 53.

Report of the Head of Democratic Services

Craig Galpin and Chrissie Wells of OSCAR Nottingham (Organisation for Sickle Cell Anaemia Relief) gave a presentation on the disorder and the organisation’s work in Nottingham, addressing the following points:

(a)  Both Sickle Cell Disorder (SCD) and Thalassaemia Major (TM) are related inherited blood conditions affecting red blood cells, primarily affecting people with family backgrounds in in areas where malaria is or was prevalent;

(b)  It is estimated that there are 250,000 SCD carriers and 214,000 TM carriers in the UK. There is no current information on prevalence in the East Midlands, but in 2009 there were 320 SCD and 35 TM sufferers diagnosed in the region;

(c)  In Nottingham, OSCAR provides non-medical support to SCD and MT sufferers and their families. It also runs the WHY (Health and Wellbeing for You) Project to help address wider Black and Minority Ethnic health inequalities, and engages in education and awareness raising activities;

(d)  OSCAR has trained 120 Police custody officers from across Nottinghamshire on the care of people with SCD and TM, and it is hoped this service will be rolled out nationally. It also works closely with health and housing partners to improve outcomes and opportunities for sufferers;

(e)  The organisation gave a presentation to the All Party Parliamentary Group for Sickle Cell and Thalassaemia, informing it of a pilot screening project commissioned by Nottingham Clinical Commissioning Group Norcomm Cluster Group;

(f)  OSCAR Nottingham’s main challenges going forward include helping secure sustainable social and welfare support for people with blood disorders, and to identify further funding streams and efficiencies for general health and wellbeing through bringing together health and social care.

The Panel thanked Mr Galpin and Ms Wells for their informative presentation, and made the following points:

(g)  In response to a Panel member’s query, Ms Wells explained that the symptoms include chronic pain, fatigue, dehydration, shortness of breath and palpitations. Because symptoms can be episodic, it can be difficult to maintain jobs or education opportunities, or find appropriate housing that does not exacerbate symptoms;

(h)  It was suggested that OSCAR Nottingham should inform the review of Nottingham’s Joint Strategic Needs Assessment to help identify prevalence and gaps in provision;

(i)  It was suggested that GPs sometimes misdiagnose the conditions. While babies and pregnant women are screened, being diagnosed as a carrier of the conditions is not considered a major medical issue by some doctors. Ruth Rigby of Healthwatch Nottingham advised that issues about specific GPs should be referred to them to help ensure a consistent approach;

(j)  The Chair advised that there is a specialist team of NHS nurses doing outreach work in Nottingham to address blood disorders, including SCD and TM;

(k)  OSCAR Nottingham is involved with the social element of a medical research project on SCD and TM being conducted by De Montfort University;

(l)  A Panel member undertook to raise awareness of the conditions’ symptoms among Trade Union colleagues;

(m)  City Council actions to license the private rental housing sector will help improve housing  ...  view the full minutes text for item 54.

Report of the Head of Democratic Services

The Panel considered a report of the Head of Democratic Services relating to the work programme for the Health Scrutiny Panel’s first meeting in 2015/16. The Panel noted that there will be an extended work programme planning session at the May 2015 meeting.

RESOLVED to note the Panel’s work programme.