Meetings, Agenda and Minutes

The Panel noted with regret the recent passing of Mr Richard Burt. Mr Burt had been Chair of the Patients’ Forum and an advisory member of the Health Overview Panel. The Chair paid tribute to the sterling service that Mr Burt had given to the local community and led the Panel in a moment’s silence in his memory.

A message of condolence would be sent to Mr Burt’s family and Members would be informed of the funeral arrangements.

AGREED that the minutes of the meeting held on 31 January 2008 be confirmed as a correct record.

There were no declarations of interest.

David Smith, Chief Executive of Kingston Primary Care Trust, will give a presentation on the PCT’s Operating Plan. 

David Smith, Chief Executive of Kingston Primary Care Trust, gave a presentation on the PCT’s Operating Plan which would be approved by the PCT Board on 31 March. A copy of the full presentation is included with the agenda and minutes for this meeting on Kingston’s website (www.kingston.gov.uk/CommitteeMinutes).

The Operating Plan sets out the resources that the PCT has available to spend in 2008/09, the services it will commission and its targets.

Key points in the plan included:

·        A funding uplift of 5.5% had been received (although it was noted that half of this was needed just to keep pace with inflation)

·        The PCT was seeking to repay the remainder of its historical debt in 2 financial years. This had been reduced from the original 3 year target as the amount of central funding in the third year was uncertain and would also allow for greater investment in 2010/11.

·        In addition to the £7million savings planned, the PCT would be investing £5million in service improvements.

Achievements planned for 2008/09 included:

·        An 18 week maximum Referral to Treatment (RTT) time by December 2008 - £2.4million investment.

·        Extended GP practice opening hours - £1.6million investment (Primary Care Access including GPs, pharmacies and dentistry).

·        Safe and sensible drinking and targeting smoking and obesity - £1.1million investment.

·        Reducing HCAIs - Health Care Acquired Infections (max. of 23 MRSA, 344 Cdiff cases).

David Smith identified the following issues that he would welcome the opportunity to consult with the Panel on over the coming year:

·        Stroke Services (outcome of pilot project)

·        Sexual health

·        End of life care (arising from national strategy)

·        Mental health service changes

·        Healthcare for London 

In response to questions about steps to increase access to services, Penny Taylor advised that three new NHS dentist surgeries had opened in recent years and that steps were being taken to advertise locally for more. It was recognised that what was needed to increase access further was to attract more like-minded dentists who would be willing to take NHS patients. Panel Members also expressed the hope that the investment in increased GP access could see extended surgery hours, such as a return to Saturday morning openings.

Members of the Panel discussed the points raised in the Operating Plan. During the discussion the following points were made:

·        The improvement in the PCT’s overall financial situation was welcomed.

·        The national tariff system meant that additional costs arising from HCAIs, such as MRSA, were not borne directly by the PCT.

·        The PCT was working with partners to join up services in Kingston around the promotion of safe and sensible drinking. The Joint Director of Public Health would be able to address the Panel in depth on this issue and on other measures around

The Chair thanked the Primary care Trust for their presentation.

AGREED that the issues identified by the PCT be explored further as part of the development of the Panel’s work  ...  view the full minutes text for item 38.

The annual Health Check system was introduced by the Healthcare Commission in 2005/06.  Healthcare bodies are assessed against 24 Core Standards. These set a minimum level of service which patients have a right to expect. Each Healthcare organisation must submit a declaration by 1 May 2008 assessing their compliance against each standard.

As part of the process, health trusts are responsible for inviting ”third parties” to comment on their performance. Third parties include Overview and Scrutiny Committees, Patients’ Forums and Foundation Trusts’ Boards of Governors.  Comments must be supported by facts and evidence such as notes of meetings and evidence may be inspected.  Health bodies are unable to alter the comments of third parties.

In addition to the information on their compliance with core standards provided to the Panel by Kingston Primary Care Trust and South West London & St George’s Mental Health Trust, the Panel also received a presentation from Jane Gear and Helen Dirilen on behalf of Kingston Hospital Trust. The presentation gave details of the Hospital’s draft declaration including progress being madder to address concerns on its core standards covering training, Health Care Acquired Infections, confidentiality and the cleaning process for re-usable medical devices.

It was noted that the ‘deep clean’ of the Hospital had been particularly challenging, in part due to the lack of empty wards available to move patients into, and was not likely to be a regular occurrence. However regular cleaning standards had been improved and steam cleaning was now a part of ongoing routine cleaning.

In agreeing that the draft comments set out in the report, the Panel noted that some minor revisions were needed and these would be included in the final submission.

AGREED that the comments set out in Annex 1 to the Minutes be forwarded to the relevant health partners as the Panel’s submission as part of the annual health check process.

Helen Dirilen, Director of Nursing & Quality and  Sylvia Kennedy, Director of Operations will give an update on the Healthcare Commission’s awarding a “least well performing” rating to Kingston Hospital’s Maternity Services. Attached for information is the most recent report to Kingston Hospital Trust’s Board on this matter.

The Healthcare Commission published a review of Maternity Services in January 2008. Kingston Hospital Trust, along with the majority of hospital trusts in London, was given a rating of ‘least well performing’. Sylvia Kennedy and Helen Dirilen updated the Panel on the background to this rating and the steps being taken to improve the service to residents.

The Trust was surprised and extremely disappointed with the rating awarded by the Healthcare Commission’s rating. The Hospital is proud of its Maternity Service. The Service holds the highest rating for safety, is recognised as being popular with residents and the Hospital was looking to expand provision. However, whilst the Trust has always had a strong focus on safety within the Service, it recognised that it now needed to prioritise its focus on other aspects such as quality and choice.

The Hospital already had a commitment to increase the proportion of midwifery-led deliveries and a stated aim of reducing Caesarean Section rates and increasing home births. The number of midwives had been increased significantly. This would continue to be reviewed and would be a key factor in improving the continuity of care. As part of improvements to the booking and accessibility of antenatal classes, about which the review was very positive, the Hospital was also working towards being able to provide more midwives in the community.

Sylvia and Helen would be jointly chairing a working group to push forward the pace of delivering improvements to the Service. An action plan would be produced and, once agreed, would be circulated to Panel Members for information. In addition, due to the low ratings received across London, NHS London are leading an initiative to address any pan-London factors and improve services across the capital.

During questioning from the Panel, it was noted that the ratio of midwives to service users had improved from 1:44 to 1:38. The nationally recommended figure was between 1:32 and 1:34 and the Hospital had commissioned work to assess the correct provision for Kingston. The increase in proportion of newly qualified midwives had led to a transitional period over the last 18 months whilst new staff gained the additional experience to get to the capacity level of experienced staff. The challenges faced by Kingston in attracting staff, including relatively low pay, high costs of living and not receiving the full London weighting allowance, were noted. The Hospital was looking at incentives and rewards for loyalty as ways of attracting and keeping staff.

Sandra Berry advised that Maternity Services had received a very favourable response in the Patients’ Forum survey of privacy and dignity.

AGREED that the update from Kingston Hospital Trust be noted and that the action plan be circulated to Members once agreed.

At the request of the Health Overview Panel, the Chair wrote to the Secretary of State exploring the possibility of relief of Kingston Primary Care Trust’s historic debt. This request was made due to the Panel’s concerns that the need to repay this debt may impact on the future availability of services to Kingston residents.

A response was received from the Secretary of State stating that it would be unfair on other organisations within the NHS if the PCT did not have to repay its historic debt. He also advised that it would be the responsibility of the London Strategic Health Authority to ensure that such repayment does not affect the quality of patient care available to residents.

Members of the Panel expressed their dissatisfaction with the response. The consensus view of the Panel was that the service impact on current residents from having fewer resources available to be invested in improvements had not been weighted sufficiently against the desire for redressing a past in-year deficit. The Panel noted that the previous overspending had been balanced centrally in year as part of NHS central accountancy and, as such, no other trust was directly ‘owed’ resources from Kingston.

It was therefore agreed to pursue the request further with the Secretary of State.

AGREED that a letter be sent to the Secretary of State seeking further consideration of the repayment of the Primary Care Trust’s historic debt with an invitation to meet and discuss the Panel’s concerns.

At a recent training event for Health Overview Panel Members, ‘Getting the most from health overview’, it was agreed that a new approach to setting the Panel’s work programme would be beneficial. Setting an appropriate work programme each year is vital to the effectiveness of the Panel in contributing to improvements to services for residents.

The Health Overview Panel can review and scrutinise any matter relating to the planning, provision and operation of health services in the area. The potential scope of work open to health overview and scrutiny is therefore huge. This is both an opportunity and a challenge, particularly in terms of the overall effectiveness of the Panel to deliver changes in the services experienced by residents.

As a first stage in setting the work programme, the Panel considered the initial suggestions for topics which had been received from Members, health partners and patients representatives. In addition to the issues set out in the report, it was agreed that the topics suggested by the Primary Care Trust as part of their Operating Plan (stroke services, sexual health, end of life care, mental health and Healthcare for London) and the outstanding issues arising from the Patients’ Forum legacy document would be considered.

The Panel noted that the list of potential items was not final and further suggestions could be made at the planned workshop event in April/May.

AGREED that the work programme for 2008/09 be developed at a workshop event to be held in April/May 2008.

·        Update on LINks and the Patient Forum Legacy

·        Springboard Consultation

·        Henderson Hospital

·        Update on Healthcare for London JOSC

·        Health Bulletin

1.   Local Information Networks (LINks) Update and the Legacy of the Patients’ Forum

Sandra Berry presented the Patients’ Forum Legacy document to the Panel, setting out the achievements and outstanding work of the Forum over the past 4 years. The Panel noted the document and the areas of outstanding work that could be considered as part of the Panel’s work programme.

Charlotte Fitzgerald updated the Panel on the implementation of the arrangements for Kingston’s Local Information Network. Tenders had been received for the host organisation and would be examined the following week. Transitional arrangements were in place to cover after the Patients’ Forums formal role had ceased. In implementing the LINk, Kingston would be working with key organisations and focusing on governance first before progressing onto wider engagement.

Members would be informed of the host and timescales following the successful award of the tender.

2.       Springboard Consultation

It was noted that the Primary Care Trust would be considering the outcome of the Springboard consultation at its Board meeting on 23 May 2008. As the next meeting of the Panel is on 10 June, a special meeting would be necessary should the Panel wish to submit a further view on the Springboard consultation. It was therefore agreed that a special one-topic meeting would be arranged in early May to enable any views to be considered by the PCT Board.

3.      Henderson Hospital

David Smith advised the Panel that the Primary Care Trusts in the consortium with commissioning arrangements with the Henderson Hospital had received legal advice that a formal pan-London formal consultation was required. Although Kingston had commissioning arrangements for the Cassel Hospital, there was a view that if there was evidence that the PCT may have used Henderson Hospital in the past then it may also need to consult.

The Panel noted the update.

4.      Healthcare for London Joint Overview & Scrutiny Committee

The Chair updated the Panel on the work of the Joint Overview and Scrutiny Committee. The Committee would discuss its draft recommendations at its next meeting on 28 March and copies had been circulated to Members of the Panel for information.

The Panel noted the update.

5.   Health Panel Bulletin

The item was noted.