Agenda and minutes

To note the attendance at this meeting of any duly appointed Reserve Members.

Reserve Members may attend meetings:-

(i)                 to take the place of an ordinary Member for whom they are a reserve;

(ii)               where the ordinary Member will be absent for the whole of the meeting; and

(iii)             the meeting notes at the start of the meeting at the item ‘Reserves’ that the Reserve Member is or will be attending as a reserve;

(iv)              if a Reserve Member whose intention to attend has been noted arrives after the commencement of the meeting, then that Reserve Member can only act as a Member from the start of the next item of business on the agenda after his/her arrival.

RESOLVED:  To note that there were no Reserve Members in attendance.

To receive declarations of disclosable pecuniary or non pecuniary interests, arising from business to be transacted at this meeting, from:

(a)               all Members of the Sub-Committee;

(b)               all other Members present.

RESOLVED:  To note that the following interests were declared:

Agenda Item 7 – Mental Health: Payment By Results; Agenda Item 8 Proposal for Redistribution of Resources From Day Assessment Unit to Memory Services in Harrow; Agenda Item 9 - Project Plan for NHS Health Checks

CouncillorMrs Vina Mithani declared a non-pecuniary interest in that she was an employee of Public Health England, previously known as the Health Protection Agency.  She would remain in the room whilst the matter was considered and voted upon.

Agenda Item 7 – Mental Health – Payment By Results & Agenda Item 9 - Project Plan for NHS Health Checks

Councillor Lynda Seymour declared a non-pecuniary interest in that she had been an employee of the London Borough of Barnet until 2012 and in that a member of her family was a user of mental health services in Harrow.  She would remain in the room whilst the matter was considered and voted upon.

That the minutes of the meeting held on 16 July 2013 be taken as read and signed as a correct record.

RESOLVED:  That the minutes of the meeting held on 16 July 2013 be taken as read and signed as a correct record.

To receive questions (if any) from local residents/organisations under the provisions of Committee Procedure Rule 17 (Part 4B of the Constitution).

RESOLVED: To note that no public questions or petitions were received at this meeting.

To receive a reference from the Corporate Parenting Panel.

The Sub-Committee received the following Reference from the Corporate Parenting Panel: Report of Mental Health Care for Children Looked After.

The Sub-Committee agreed that the issues relating to the referral pathways between Harrow’s Clinical Commissioning Group and the Child and Family Mental Health Services (CAMHS) raised at the meeting of the Corporate Parenting Panel on 8 July 2013 be further investigated and that relevant Scrutiny Members engage in dialogue with the CCG.

RESOLVED:  That the Reference from the Corporate Parenting Panel be noted.

Report of the Payment by Results Programme Director.

Dr Mo Zoha, Consultant Psychiatrist, and Cathy Phippard, Care Pathways Project Manager, Central and North West London NHS Foundation Trust (CNWL) presented the report, on behalf of Sarah Khan, Programme Director at CNWL.  They highlighted the following areas of the report:

·                     Payment by Results (PbR) had originally been introduced in the area of acute care in 2004.  Under this system, a price was established against a procedure or set of procedures, with the aim of incentivising competition and choice, on the basis of quality rather than price alone;

·                     implementation of PbR would ensure greater standardisation of the process of assessing patients and the care they received;

·                     PbR was in its third year at CNWL, with some areas such as learning disability, substance misuse and children still to be developed nationally;

·                     under PbR, 21 needs-assessment groupings or clusters had been identified. Once a user was assigned to one of these clusters, it would trigger a package of care that would be routinely re-assessed;

·                     pricing would be local in the initial stages with the intention of a national pricing system in the future;

·                     in implementing PbR, CNWL had undertaken extensive staff training, engaged with frontline teams, implemented changes to its electronic records database, and undertaken dialogue with commissioners;

·                     CNWL’s current priority was to ensure that the care packages provided under PbR were evidence-based.

A Member stated that she was disappointed by the content of the report as it did not address the needs of residents in Harrow which was a vital component of any scrutiny report for Councillors.  Additionally, it did not address the implications of PbR in terms of outcomes for users and patients.  It was also felt that the report could not be easily understood by a lay person.

She added that, in her view, the report focussed on processes and systems and did not sufficiently focus on outcomes for service users.

The Consultant Psychiatrist stated that the report had been approved by the Programme Director at CNWL and by the Director of Operations and Partnerships.  It may be that there had been miscommunication regarding the Sub-Committee’s request about the content of the report.  He added that the report did focus on a range of outcomes and quality indicators, including patient outcomes.  He added that under PbR, patients would be afforded the opportunity to provide feedback on the standard and quality of the treatment they were receiving, consultants’ views would be sought.  There were seven quality indicators being piloted by the Department for Health, which were being used to assess the efficacy of the programme.

A Member asked how the PbR agenda linked in with personalisation of care.  A Doctor from CNWL advised that PbR was linked to social care and that CNWL:

·                     were evaluating the social care assessment process and ways of improving this to make it more transparent while focussing on the needs of the user;

·                     were assessing the care packages available, as these would be provided by a number of different providers such as third  ...  view the full minutes text for item 170.

Consultation document of the Central and North West London NHS Foundation Trust.

Ms Parmjit Rai, Deputy Service Director, Central and North West London NHS Foundation Trust (CNWL) Dr Shirlony Morgan, Lead Clinician, CNWL and Dr Pramod Prabhakaran, Lead Clinician, CNWL took turns in presenting the report and highlighted the following areas:

·                    the proposals under consultation related to the redistribution of resources from the Day Assessment Unit (DAU) in Harrow to Memory Services in Harrow.  This was a joint initiative between CNWL and the Harrow Clinical Commissioning Group (CCG) to support the delivery and evaluation of integrated, needs-driven, evidence-based care packages.  Brent and Hillingdon had already moved to this model;

·                    over 35% of the UK’s population was over 65 years of age.  North West London had one of the highest concentrations of those over 65 years of age and current provision for this group was stretched;

·                    identifying dementia pathways was a key priority for the NHS and there was increasing pressure to develop and implement a local strategy to meet the needs of older people, other users of the service and their carers; 

·                    the Day Assessment Unit offered services to functional patients two days a week and to organic patients e.g., those suffering from dementia, two days a week, seeing an average of twenty patients over the four days;

·                    the DAU operated along the lines of a day hospital and was deemed to be an outmoded method of delivering services, was not cost-effective and did not cater for the needs of the population.  This was the reason for the shift to Memory Services which would work in partnership with older peoples’ services and carry out outreach work;

·                    patients attended the DAU for a time-limited period, usually for between 3-4 months.  Patients attended therapy groups, drop-in sessions or cognitive stimulation sessions at the DAU.  These were evidence-based therapeutic groups that should continue to be available to users;

·                    the diagnosis rate for dementia in Harrow was one of the lowest in the country and was at 32% in the borough.  This meant that approximately 70% of those suffering from dementia did not get diagnosed, which led to additional complications later on.  Early intervention could prevent entry or delay entry into long-term care for these patients and could enhance their quality of life;

·                    it was intended that the consultation would take on board the views of a wide cross-section of opinion and relevant stakeholders;

·                    it was proposed that Memory Services would focus on recovery-based models and was seeking support from the Health and Wellbeing Board and Harrow CCG to ensure that dementia care in Harrow was sustainable, accessible and effective.

A Member asked why the DAU only saw approximately 20 patients per week and why the dementia diagnosis rate in Harrow was so low.  The Consultant Psychiatrist advised that the DAU was not considered to be integral to care and was under-used as demonstrated by the low referral rate to the DA.  This was because most GPs considered it to be an outmoded method of delivering dementia care. If the service were available five days  ...  view the full minutes text for item 171.

Report of the Divisional Director, Strategic Commissioning.

The Sub-Committee received a report of the Divisional Director of Strategic Commissioning which set out the project plan for the Barnet and Harrow Scrutiny Review Group looking at NHS Health Checks, which had been included in the work programme agreed by the Overview and Scrutiny Committee (O&S).

An officer advised that the Review was time-limited and the Chair of the Health and Social Care Scrutiny Sub-Committee was the Chair of the Review Group, which was a cross-party group.  She added that the take up of health checks in Harrow had been low compared to that in Barnet.

Members commented that there may a number of reasons for the low take-up in Harrow.  The Chairman advised that a meeting of stakeholders was planned and data relating to the take-up of health checks would be collected from local GP surgeries.  She added that the Centre for Public Scrutiny had agreed to provide officer time to Harrow in carrying out this Review.

RESOLVED:  That the project plan be noted.

Report of the Harrow Community Services Director, Ealing Hospital NHS Trust.

The General Manager of Harrow Community Services atEaling Hospital NHS Trust and Deputy Director of Nursing and Clinical Practice, Ealing Integrated Care Organisation presented the report and highlighted the following areas:

·                    District Nursing provision in Harrow had not been reviewed for approximately 10 years.  The service’s values, cultures and practices needed to be reviewed in or to be able to respond to the changing context of increasingly complex local needs and nursing needs;

·                    the District Nursing Service model introduced in January 2012 aimed to deliver service productivity efficiencies through a revised service skill mix which would be supported by a range of service quality improvements and innovations;

·                    the new model had been implemented following a service-demand, capacity and productivity review with the aim of:

-            supporting integrated care delivery by aligning District Nursing Teams to General Practice Peer Groups;

-            a revised skill mix to more effectively manage the needs of patients and improve patient outcomes;

-            realising service productivity and savings efficiencies;

·                    extensive caseload analysis had been undertaken to identify the most complex cases, i.e. the 10% of clients who received the most visits and   less complex clients were supported in self-care in order to target resources appropriately;

·                    service-users’ feedback and complaints data had been evaluated.  Service quality and improvement had been undertaken through focussing on Key Performance Indicators;

·                    End of Life Care (EOLC) pathways had been agreed with the CCG;

·                    there was collaborative working in a local, national and professional context;

·                    ensure that provision was clinically efficient, safe for nurses, caring and compassionate and meeting the patient’s needs.

A Member stated that the patient feedback from the survey was very positive and asked which patients had been consulted.  The General Manager advised that 100 surveys had been carried out in the first tranche, with a 42% response rate, which was low.  Additional patient feedback would be sought and this would be triangulated against performance data and complaints data.  The Deputy Director of Nursing added that GPs, those delivering acute care and carers would also be surveyed.

A Member stated that some local authorities were using Patient Opinion, an online patient feedback platform which was a good resource for health professionals in designing care.

The Chairman asked whether there was enough capacity within nursing teams.  The Deputy Director of Nursing advised that there was a team of 36 nurses in total.  She added that there was a high vacancy rate among District and Community nurses across a range of skill-sets and that it would be important to support nursing teams through this period of transition and strengthen their professional practice and leadership. 

A Member asked who was eligible to receive this service and the difference between a District Nurse and a Community Nurse.  The General Manager advised that adults who were house-bound were eligible and that there was a separate community paediatric service for those under 18 years of age.

The Deputy Director advised that District Nurses and Community Nurses had similar responsibilities, but different accountabilities, and  ...  view the full minutes text for item 173.