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Health & Wellbeing Board
Wednesday, 4th December, 2013

Health & Well-Being Board (Croydon) Minutes

Date:
Wednesday 4th December 2013
Time:
2:00pm
Place:
The Council Chamber, The Town Hall, Katharine Street, Croydon CR0 1NX
 

Attendance Details

Present:

Elected members of the council:

Councillors Jane AVIS, Adam KELLETT, Maggie MANSELL, Margaret MEAD - chair, Tim POLLARD - vice-chair
 

Officers of the council:

Hannah MILLER (Executive Director of Adult Services, Health & Housing)

 

NHS commissioners:

Dr Agnelo FERNANDES (NHS Croydon Clinical Commissioning Group)

Dr Jane FRYER (NHS England)

Paula SWANN (NHS Croydon Clinical Commissioning Group)

 

Healthwatch Croydon

(no representative)
 

NHS service providers:

Steve DAVIDSON (South London & Maudsley NHS Foundation Trust)

Karen BREEN(Croydon Health Services NHS Trust)
 

 

Representing voluntary sector service providers:

Sarah BURNS (Croydon Voluntary Action)

Nero UGHWUJABO (Croydon BME)

 

Representing patients, the public and users of health and care services:

Lynette PATTERSON (Croydon Voluntary Sector Alliance)


Non-voting members:

Andrew McCOIG (Croydon Local Pharmaceutical Committee)

Annette ROBSON (Croydon College)

 

Also present:

Solomon Agutu (head of democratic services & scrutiny), Fiona Assaly (office manager, health & wellbeing, Croydon Council), Steve Morton (head of health & wellbeing, Croydon Council), Alan Hiscutt (Head of Commissioning Vulnerable Adults and Supported Housing, Croydon Council), Shirley Johnstone (Adults Commissioning manager), Brenda Scanlan (Director of Adult Care Commissioning)

 

Notes: Margot Rohan (senior members’ services manager)

Absent:
Ashtaq Arain, Supt Rob Atkin, Paul Greenhalgh, Mark Justice, David Lindridge, Lissa Moore, Guy Pile-Grey and Dr Mike Robinson
Apologies for absence:
Dr Mike Robinson, Lissa Moore, Paul Greenhalgh, Guy Pile-Grey, Mark Justice

Item Item/Resolution
MINUTES - PART A
A61/13 INTRODUCTION

The Chair, Cllr Margaret Mead, welcomed Lynette Patterson to the Board, replacing Kim Bennett, representing Croydon Voluntary Sector Providers.

A62/13 MINUTES OF THE MEETING HELD ON WEDNESDAY 23RD OCTOBER 2013

The Board RESOLVED that the minutes of the meeting of the Health & Wellbeing Board (Croydon) on 23 October 2013 be agreed as an accurate record.

A63/13 APOLOGIES FOR ABSENCE

Apologies were received from Dr Mike Robinson, Paul Greenhalgh, Guy Pile-Grey (Healthwatch), Mark Justice (Croydon Charity Services Delivery Group) and Lissa Moore (London Probation Trust).

Cllr Jane Avis apologised in advance for leaving the meeting, to attend another meeting, at 14:20 and returning at 15:00.

A64/13 DISCLOSURE OF INTEREST

There were no disclosures of a pecuniary interest at this meeting.

A65/13 URGENT BUSINESS (IF ANY)

There was no urgent business.

A66/13 EXEMPT ITEMS

There were no exempt items.

Item 9 was taken first due to technical difficulties with the projector.  Item 8 was then taken before Item 7.

A67/13 SUBSTANCE MISUSE TREATMENT RECOMMISSIONING

Alan Hiscutt (Head of Commissioning Vulnerable Adults and Supported Housing, Croydon Council) and Shirley Johnstone (Adults Commissioning manager) summarised the report:

  • The current main core of service users is people in the 35-55 age range with long term addiction issues with heroin
  • Amongst younger people, the issues are with other drugs such as cocaine, legal highs, cannabis
  • Alcohol - services recently focused on heroin, to exclusion of alcohol - but there is a bigger impact on families and communities
  • There is a range of services but a number of issues with their performance - the recommissioning exercise has considered the design of the whole system
  • In the past services have been designed around funding streams, the recommissioning instead that they are designed around people's needs
  • Integrated system difficult to work with current providers
  • Recommissioning in two phases
  • Looking to strengthen integration with new services
  • Services to be geared around recovery
  • Clear line of accountability - one key provider
  • Focus on prevention and integration with criminal justice system
  • Consultation - providers welcoming approach being taken

 

The following issues were raised:

  • Care pathway not straight. Crack cocaine is easily available in Croydon, although very expensive. It produces terrible consequences. Peer support very important. AA very good - several meetings each week, but very God-orientated. Hunger is associated with alcohol - why not advice given by the services so we can identify triggers?

 

Alan Hiscutt: The comments are consistent with the approach being proposed. Children - we are aware of under-reporting of drug use in families. Will ensure services fully linked up with children's services.

 

  • What are time frames on phase one and two?

 

Shirley Johnstone: We start work in the new year.

 

Alan Hiscutt: There are time constraints on phase one due to contract end dates. No time frames yet for phase two. 

Dr Agnelo Fernandes: We are looking at the process where the pathway for patients goes down a long. Needs to be taken into account for this service. Under-reporting - we do not know how many people have alcohol-related problems. We need to capture the right data. Children - we need a prevent agenda - to use children as ambassadors for health and wellbeing - particularly in relation to alcohol. Burglaries - impact immense. Addressing the issues will go a long way to solving other problems - link to criminal justice system is vital.

 

Having considered the public sector equality duty and the Joint Health and Wellbeing Strategy, the Health and Wellbeing Board RESOLVED to:

  1. Endorse the procurement strategy identified within the report which will result in one contract award recommendation for a single provider or the lead provider of a consortium to deliver drug and alcohol treatment services as phase one of a redesigned, recovery-orientated treatment system:
    Service A: Engagement and treatment service for service users who have dependencies on alcohol, opiate and crack use. The provider will engage the service user in a variety of ways including outreach, hospitals, criminal justice system, primary care and self-referrals. Once engaged service users will access structured treatment interventions including substitute prescribing, key-working and group work.
    Service B: Will engage service users who do not require medical interventions who use drugs, including cocaine, cannabis, synthetic drugs and service users who use alcohol in a harmful or hazardous way.
    Service C: Recovery and re-integration service will provide peer support and access to services A&B (above) and provide on-going support once treatment has been completed.
    Service D: Young People specialised substance misuse treatment service.
     
  2. Note that:
    • All services will be recovery focused, working in partnership with children services, adult safeguarding, criminal justice, employment services and mental health providers
    • All services will have a preventative role in providing identification and brief advice for alcohol use in a variety of settings including primary care
  3. The recommendations for the contract awards for phase one of the redesigned, recovery-orientated treatment system will be presented at a provisional date of May 2014 
A68/13 JOINT COMMISSIONING INTENTIONS 2014-15

A presentation was given by Stephen Warren (Director of Commissioning, CCG) and Brenda Scanlan, Director of Adult Care Commissioning)

  • Integrated commissioning unit being developed.
  • Following Winterbourne Report, clear plan in Croydon to ensure people with learning disability are planned for and services needed are provided.


The following issues were raised:

  • Improved capacity in Psychological Therapies - are we involving the charity sector how?

 

Stephen Warren: We commission services from the voluntary sector. We have major challenges ahead.

 

  • The walk-in centre offers a fantastic service and welcoming atmosphere. Orthopedics - new consultant to be appointed but there are some failures to diagnose, so the processes need to be looked at.

 

Brenda Scanlan: We are recommissioning to get the right services in the right place and make them more welcoming. People have different needs.

 

  • It is an impossible task. There is insufficient funding. The report is light on harnessing the population's goodwill to take better care of themselves. We should be more aggressive to make people realise the lack of funding in future. Medicine mismanagement impacts on services - people need to manage long term conditions better.

 

Cllr Margaret Mead: People need to be supported.
Paula Swann: We are redesigning care pathways. Each of the redesigns includes prevention, self management, peer-support where appropriate, and shared decision making. 

  • To make a difference, we need to start now on self-care. Use technology - apps - to get better outcomes.
  • There is enormous pressure - challenge in recommissioning - changes in demands for mental health. As we transform, significant support is needed. 

 

The Board COMMENTED on the alignment of the Council and CCG 2014-15 health and social care commissioning intentions to the joint health and wellbeing strategy priorities for action.

A69/13 PHARMACEUTICAL NEEDS ASSESSMENT

Kate Woollcombe (Deputy Director of Public Health) gave a summary of the report.


The PNA is about provision of pharmacies not with commissioning drugs.
 

The following issues were raised:

  • Shingles vaccine is in extremely short supply
  • Oxygen - the supply of this was stripped from community pharmacies 5 years ago with no notice - since 1948 pharmacies had supplied to patients. It was farmed out to national contractors and the cost has soared

 

The Board RESOLVED to:

  • Agree to the publication of the current PNA (Appendices NHS PNA 2011 on the council website)
  • For the reasons detailed in paragraph 3.6, agree that the three supplementary statements (PNA2011_3,4 & 5) to this report be published alongside the current PNA on the council website
  • Approve the two further supplementary statements (PNA2011_1 and PNA2011_2) as set out at 3.7 in the report.
     
A70/13 PUBLIC QUESTIONS

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:

  • minimal needs
  • low needs
  • medium needs
  • 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. 

A71/13 WORK PLAN

Steve Morton drew attention to a few points.

 

The Board RESOLVED to agree the Work Plan and note work undertaken by the executive group on behalf of the Board.

A72/13 RISK REGISTER

Steve Morton summarised the report. He asked for comments before 24 December, in time for the next meeting of the executive group.

 

The Board RESOLVED to:

  • Comment on the risks identified in the strategic risk register, including identifying any additional risks not captured
  • Comment on planned actions to mitigate identified risks
  • Agree that the executive group will maintain and review the strategic risk register with regular reports to the Board
A73/13 DATES OF FUTURE MEETINGS (VENUES TO BE ADVISED)

12 February 2014
26 March 2014

MINUTES - PART B
  None
The meeting ended at 4.22pm.