There were two outstanding questions from the previous meeting:
Peter Howard: As someone who was Chair for 5 years of the Statutory PPI Forum responsible for Mayday, under Helen Whalley & Vanessa Wood, we did numerous unnanounced visits,and reported on the web what we observed. Something the LINK/Shadow Healthwatch did not. Despital what John Goulston said yesterday, Croydon University Hospital (CUH) is still getting very bad reports from the Care Quality Commission (CQC) & is low on the list of good Hospitals. This is appalling &, in my opinion, reflects the various managements over the past few years.
When will the Health & Well Being Board & Scrutiny Committee of the council responsible for health get a grip of the Mayday Management & not sit back & accept everything they say?
What, if anything, will the Health & WellBeing Board of Croydon Council do about this?
Responses: Recent inspection highlighted a lot of good things. Recognition of good practice being put in place. Staff working extremely hard.
The health and wellbeing board and the overview and scrutiny committee have distinct but complementary roles. The role of the health and wellbeing board is to assess the health and wellbeing needs of the population (the JSNA), to agree joint priorities on the basis of the needs it identifies, and to set those priorities out in the health and wellbeing strategy. Overview and scrutiny committees can hold NHS bodies to account for the quality of their services through powers to obtain information, ask questions and make recommendations for improvements that have to be considered. It is not the role of the health and wellbeing board to comment on the performance of individual organisations. I do want to acknowledge your concerns, however. I take them very seriously. I have asked that your question is forwarded to the chair of the health, social care and housing scrutiny sub-committee. I am aware that they will be considering and commenting on the outcome of the CQC inspection of Croydon Health Services and quality summit at their meeting on 28 January 2014.
Hospital inspection is powerful - not just inspectors - commissioners of services and users. Significant number of hours day and night talking to patients and staff. Very fair reflection of journey on which the hospital is. Respiratory and other services. In particular imp to recruit more nurses to provide more personal care. Large scale recruitment programme. Nearly 40 new nurses started.
Mortality - data was not correct. Analysis from CQC - mortality rates are of no concern. Takes long time to turn round a bad reputation. Long memories despite improvements. Looking at how can give people of Croydon more confidence. Challenge to promote positive message.
In last month the 3 local hospitals were approached, inviting them to provide vaccinations for staff. Only one hospital responded - Croydon University Hospital (CUH) will give free vaccinations for all frontline staff. St George's and St Helier did not respond.
Mortality data reveals important facts. Since CCG in place, issues are being addressed. Maternity was an issue. Whole range of other pathways have been redesigned. In last 14 months we have seen more change than in the previous 5 years. Lot of changes taken on board by CUH to provide improvements. National shortage of nurses and doctors in specialisms.
CUH should be congratulated for what they have done. CQC gave a very positive report but have to highlight issues of concern. However, there are grave concerns regarding the Virgin Urgent Care unit.
Unfortunate the way the report was worded. Concerns not about entirety of patients' welfare. Particular concerns about interface between Virgin Care and patients. If patients were not seen quickly enough or not transferred appropriately and seen quickly, there were concerns that service might not be safe. Virgin and Urgent Care board looked at the issues and made recommendations which have and are being implemented. We have put in place an additional review, that ensures that every patient streamed to the UCC has their initial observations taken. On average one or two patients are immediately transferred a day to the ED stream. Take safety concerns very seriously.
There are parts of the way services are operated which CQC did not understand. Some of issues raised were due to this. 20 minute window - some patients may not wait. Report could have been worded differently. Solutions have been implemented to ensure patient safety. Patients require review within 20 minutes.
Mixing ED with primary care - better to triage from ED perspective.
40%+ should not be in ED anyway. System in place, unless ambulance patient, initial assessment uses protocol by receptionist.. Have constraints in terms of space for developing new ED dept. Not fit for purpose - need new dept. As safe as can be - and safer than majority of other hospitals in UK.
Urgent care sees 140 patients a day. Need to think seriously how to use health resources.
Peter Doye: Regarding mental health and homelessness, please can you give some clarification about the 98% of homeless households which have somewhere to live: Is there any gender breakdown and what number of people are involved in homeless households?
Response: Breakdown of applicants by gender attached (Appendix)
6 out of 10 homeless applicants are lone parent females with dependent children.
As at the end of September 2013 the council was accommodating 2363 homeless households in temporary accommodation, of these 2077 were households with dependent children or someone who is pregnant and these households had 3472 children.
In the preceding 6 months the council accepted 397 households as homeless under the full duty, of which 89 were couples with dependent children and 242 were lone parent female applicants (also with dependent children) - the remainder were single homeless applicants or lone parent male applicants.
In 2012/13 the council accepted 912 households as homeless under the full duty, of which 164 were couples with dependent children and 581 were lone parent female applicants (also with dependent children) - the remainder were single homeless applicants or lone parent male applicants.
The following questions were also raised at the meeting:
Anne Milstead: If I may I'd like to give you a quick update on the question I asked that the last health and well-being board about exercise referral.
I had suggested that many people were being referred for exercise but once the 12 weeks were up that they no longer continued. I asked a contact that I have what the true situation is and the response was, "it's very patchy". I then asked what statistics were kept and again the answer was, and "very patchy".
My questions at this time firstly are to do with care. For the last 10 or 15 years of my working life as an independent financial adviser I had an interest in long-term care. In order to be able to advise, I needed to sit an examination and I needed a good understanding of the CRAG regulations (Charging for Residential Accommodation).
In that I understood that there were five levels of care need that one can be discounted if you have Alzheimer's disease.
These are:
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minimal needs
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low needs
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medium needs
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high needs
Croydon Council was recently highlighted on a radio four programme by the ex-MP Chris Mullin's in the way it disposed of its care employees and zero hours contracts my understanding is that zero hours contracts cannot possibly cope with proper care for elderly people. What can be done in 15 minutes?
It is also becoming very apparent that third-party providers are consistently under bidding for all sorts of NHS contracts and then finding that they cannot run the services at the price they have claimed. Many of these contracts run for five years or more so that much damage can be done before it comes to light and the providers are brought to book.
So my questions are:
What safeguards are there for the users of those services like care in the home under zero hours contracts?
What safeguards are there for whistleblowers when things start to go wrong when services are run by third parties?
Is there a place for public scrutiny and input of the procurement place BEFORE implementation?
Responses: There are 4 levels of care in Croydon. Govt moving towards having national levels. Should not have changes to Croydon's care levels. If someone at moderate or light need, can channel through to voluntary sector - meals on wheels etc. Not direct from council. Zero contract hours - everyone who receives home care has assessment - they get the level of need - care package - they require. If someone needs more than 15 minutes care, they will get it. If deteriorated and need reassessing, then pass that on. Limited resources so have to make best use of them.
We will go back to service and ask for information requested.
There are very stringent procedures - number of methods where quality and safety of services are monitored. There is a clinical review group which is in place for all contracts. Procurement - developing - substance misuse - joint approach between CCG and the local authority - focus on outcomes. That approach picks up issue of care.
Every patient should be registered with a GP - soft intelligence from frontline. Commissions ask questions - more robust. Contacts and quality now together.