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					                                   HEALTH PANEL

                          Thursday 12th May 2005 at 7.00pm

     PRESENT: Councillors Woodroofe (Chair), Castle, Crawford, Rose,
     Woodgate and Mrs Ware (substituting for Mrs Emment).

     Co-Opted Members: D Bhasin (PPI Forum for Ealing Hospital), F English
     (Ealing Community Network) A March (PPI Forum for West London Mental
     Health Trust) and P Seers (informal member).

     ABSENT: Councillor Dhindsa and Sharma.

     Councillor Crawford declared that she was a beneficiary of the carers grant*

     Councillor Hosking
     The Chair invited those at the meeting to introduce themselves. He also
     explained that Councillor Hoskins had resigned as a member of Ealing
     Council and thanked her for her contribution.

1.   Minutes

     The minutes of the meeting held on 22nd March 2005 were agreed as an
     accurate record.

     The Chair announced that, following a meeting with the Hospital Chief
     Executive, the meeting focusing on Ealing Hospital would now take place in
     September, not June as stated in the minutes (Item 14).

2.   Local Patients Advice and Liaison Services (PALS)

     Nigel Spalding, Scrutiny Officer, introduced this item, explaining that the
     Panel‟s agreed work programme provided three reasons for its inclusion on
     the agenda, ie to enable members to:
          learn about the work of the Patient Advice and Liaison Services
          understand what types of queries/feedback were received from the
            members of the public
          find out how this information is being used to improve NHS services

     Andrea Winkley, PPI and PALS Manager for Ealing Primary Care Trust, and
     Sue Cumming, Head of PPI at West London Mental Health NHS Trust, then
     gave a presentation on the operation, aims and objectives of the Patient
     Advice and Liaison Services (PALS) provided by the PCT and Mental Health
     Trust. [Copy available on request.]

     A document which itemised the category of enquiry for logging PALS calls
     was circulated to the Panel for information.

     Mr Bhasin observed that the PALS presence was not visible within local
     surgeries and more publicity was needed to promote the service.




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     Councillor Rose commented that many GPs did not reorder additional copies
     of PALS information leaflets once they had run out of them. Thus there was a
     failure to raise awareness of PALS amongst patients and public in the area.
          Andrea Winkley reported that these issues would be considered in
             June as part of a review of where the PALS were being advertised and
             how they could be better promoted to prospective users.

     Councillor Crawford asked how complaints were monitored to ensure that
     they were successfully resolved?
         Sue Cumming explained that all complaints had to be acknowledged
           within 2 working days and that patients should, normally, have a full
           and prompt reply to any complaint made against a Trust or PCT within
           20 working days. Furthermore, in cases where the issue looked
           serious or complex the manager/chief executive could intervene -
           either to investigate the problem or to co-ordinate, in conjunction with
           appropriate staff, and confirmed that all are followed through to
           ensure a resolution of the issue.
         David Williams, Director of Services at Ealing PCT, added that data
           from the PALS was crucial not only because it helped trusts identify
           areas where patients‟ experiences needed to be improved, but it also
           highlighted developments in PALS.

     Adrian March was of the opinion that PALS did not have proper resources to
     fulfil its potential and that its structure should be completely revised. He also
     added that access to Mental Health Service PALS should be equal across the
     three boroughs and that issues to be considered in future were whether PALS
     should be independent of the NHS and how the service would develop/evolve
     over time.
           Andrea Winkley felt that there were advantages to being employees of
               the NHS as this enabled the PALS staff to know who to speak to.
               Colleagues were generally receptive. Sometimes the work could be
               difficult but it was about challenging positively.

     The Chair noted that, similarly Scrutiny is undertaken by Council members
     and supported by officers who were employed by the Council, but
     independence was an issue worth raising.

     It was agreed that Sue Cumming and Andrea Winkley provide 20 copies of
     their PALS information leaflets to Nigel Spalding, Scrutiny Officer, for
     distribution to Panel members.

     Resolved
      i.   That the report be noted.


3.   Further information on Access to Primary Care Services

     David Williams, Director of Services at Ealing PCT, circulated a document
     which provided details on surgery opening times in the borough, as advertised
     by the surgeries in their practice leaflets. He asked Panel members to inform
     him if any of the surgeries listed did not adhere to their advertised opening
     times. All surgeries were expected to be accessible to patients at the times


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advertised. This however did not mean that they had to be open for
consultation. The GMS contract did not stipulate for how many hours
surgeries had to remain open each week. Average opening hours were 39 per
week but the range was between 20 and 50. Discussions were taking place
with those at the bottom of the range. Those which were open for more than
45 hours gained additional payments.

Panel members requested that the addresses of the surgeries be added to
the list to aid identification in the case of duplicate doctors names.

David Williams added that the accessibility target was that 100% of patients
should be able to see a GP within 48hrs and a nurse/healthcare professional
within 24hrs. The situation had undoubtedly improved over the past years and
there was now a better access to Primary Care Services.

Councillor Crawford referred to the problem of aging GP‟s, especially in the
Southall area, and asked how the forecast shortfall would be solved. What
was being done to recruit more, particularly younger, GPs?
    David Williams reported that there was a definite requirement to recruit
      more GP‟s, amalgamate smaller practices into a larger service and
      provide walk-in facilities with a wider health care team. Whilst Health
      Care Professionals wanted to work in challenging situations they, in
      return. expected good facilities and support. A new walk–in centre
      was planned for Southall Broadway to assist access issues in the area.
      He further reported that there was a need to make patients aware that
      consulting with other healthcare professionals on a first visit rather than
      a GP could fill their healthcare needs and this needed to be
      communicated to patients. The NHS was now moving into a new world
      of wider primary care access, eg pharmacists, NHS Direct and – soon
      – NHS online, where nurses and therapists were often the first point of
      contact. He recognised there was an issue about patients getting
      through to surgeries on the phone; the PCT was asking surgeries
      questions about this.

Councillor Crawford enquired whether any work had been done in schools to
encourage students to take up science and showing them the possible
careers pathways.
    David Williams responded that Shabnam Sharma, Southall
      Neighbourhood Manager, visited to schools to talk about health
      education and promotion but not jobs – this was a good idea.

Councillor Rose posed a question about the facilities for visiting surgeries on
Saturdays.
David Williams pointed out that under the new General Medical Services
(nGMS) surgeries were contracted to be available between 8.30 and 6.30 five
days a week and whilst some surgeries did provide access over the weekend
it was not a requirement.

It was suggested that patients may be experiencing problems with pre-
booking appointments with their doctor if they wanted to be seen after the two
day period.



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         David Williams reported that, in a recent survey, all surgeries in Ealing
          stated that they were able to offer patients pre-booked appointments
          where necessary. The PCT would be engaging in extensive monitoring
          of GP practice access issues where patients were continuing to
          experience problems

     The Chair asked how much power or influence he had over how GPs
     managed their surgeries.
         David Williams reported that the PCT was responsible for
          commissioning services in line with the requirements of the new GMS
          contract. There were incentives and requirements as part of the
          contract that the PCT were responsible for administering to ensure high
          quality primary care for Ealings‟ patients.

     Councillor Crawford asked about the inter-relationship between attendances
     at A&E and the use of primary care.
          David Williams noted that a recent analysis of primary care
           attendances at Ealing A&E would be used to discuss accessibility
           issues with Ealing GP practices.

     Resolved:
     (i)   That further monitoring information be provided to future Scrutiny
           meetings.
     (ii)  That the addresses of the GPs (along with the opening hours) be
           provided to Panel members.


4.   Planned development of a primary care walk-in centre on Southall
     Broadway

     David Williams, Director of Services of Ealing Primary Care Trust, presented
     this report which summarised PCT‟s plans to develop a walk-in primary care
     centre at 71-73 Southall Broadway. The report set out the case for change
     and the expected improvements in access to healthcare as well as outlining
     the current and planned public involvement in the development. The report
     also responded to the concerns raised by the Panel at its meeting in January
     2005 regarding particular difficulties accessing primary care services in
     Southall. It also and provided more detail of the planned development.
     Planning permission was now in place.

     The Chair said that the centre would be in a good location and as such there
     would be a danger of it being oversubscribed.
         David Williams responded that the PCT needed to ensure that the
           service complemented services that patients already received from
           their GP.

     Councillor Mrs Ware asked if there was a dispensing pharmacist nearby that
     would be open at similar hours as the centre.
        David Williams said that there were many dispensing chemists in the
           area and that he would be confident that this need would be met.




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     Resolved:
             i.    That the development of the walk-in centre be welcomed
            ii.    To welcome the offer of an invitation to the opening of the centre


5.   Update on Learning Disabilities Services

     Cheryl Batt, Ealing PCT, presented this report.

     The report described the services and facilities supplied by LBE and PCT
     which included :
         A short breaks service based at Green Lane
         Day services at Cowgate and Sterling Road Centres
         Choice – a Housing Support Project
         Learning Curve – an education and training service
         Community Learning Disability Team (CTPLD) based at Green Lane,
            which comprises Social Care staff, Nurses, Doctors, Psychologists and
            a limited range and number of therapists.
         Until September 2004 the PCT also managed a six-bedded inpatient
            residential respite care unit at Greenford Lodge. This service had been
            closed and part of this paper (Appendix C) sets out the proposed new
            model of service currently being discussed with staff, users and carers
            and other relevant local partners such as Mencap.

     Appendix A set out the background and the role of the Learning Disability
     Partnership Board for the Valuing People White Paper

     Cheryl Batt further reported that the Council is behind target in the provision of
     Health Action Plans as it had only 4 trained nurses in the CTPLD, which is a
     small number for a population of approximately 1,000 known clients. A bid
     had been made to the Local Delivery Plan, under improving the patient‟s
     experience, for additional staff to support the provision of Health Action Plans.
     Funding had also been requested for an additional Consultant Psychiatrist to
     support the service.

     Cheryl Batt also reported some issues that the partnership board need to
     focus on to improve:
         The delivery of primary health care services including health promotion
            prevention and screening services
         The provision of care within our Institutions: Ealing or West London
            Mental Health Trust.
     She also gave an example of a case which illustrated the type of problems
     that need to be addressed.

     Additionally, discussions had taken place with colleagues in Regeneration
     (LBE) to ensure that the employment needs of people with disabilities were
     integrated into the Ealing Economic Development Strategy.          Also the
     “Learning Curve”, an education and training service provided by LBE, had -
     through the Learning and Skills Council - bid for European Social funding to
     develop training and employment opportunities for people with disabilities in
     Ealing and reported on the Changes in Services necessary to achieve:


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   an Integrated Community Team for people with a learning disability
   the prioritisation for the provision of new accommodation for the Green
    Lane services
   closer working, possibly via the 1999 Health Act Flexibilities with LBE to
    move towards pooled budgets and joint commissioning of services.
   the work to improve services to carers of people with a learning disability

Councillor Crawford congratulated Cheryl Batt on an excellent report and
agreed that the situation would improve with the development of the Carers‟
Centre> But she was concerned about the missing lins with education,
schools, colleges. Transition started at age 14 and there was very little choice
about pathways. It was necessary to find out individuals talents and strengths
using a person-centred approach. She would interested, later on, in hearing
more about the work with education and carers.
        Cheryl Batt agreed, noting partnerships were key to the „Valuing
          People‟ agenda. Work started at age 14 with the Year 9 review. She
          was happy to report back further on plans to engage with partners
          in Education, Housing and Children‟s Services.

Cheryl Batt reported that the Greenford Lodge Service had closed and finance
and staff had been diverted to provide outreach support and residential
respite service.

Concern was expressed regarding carers and in particular the plans for
replacing older carers at the end of their career. Information was requested on
the number of people employed so far.
        Cheryl Batt agreed to provide this data. The number of people
          supported into employment from the PCT was low, so far. One of
          issues was who was being included. There had recently been a
          report on behalf of the Supporting People Team on the housing
          needs of vulnerable people, including adults with learning
          disabilities.

Councillor Crawford added that the Council were in the process of rewriting ta
“Carers Assessment – Plan for the future”, which would include an appraisal
of the situation regarding matching carers supply and demand.

Resolved
To support:
   i. The requirement of the Valuing People White Paper and the Ealing
      Learning Disability Partnership Board‟s role in over-seeing the delivery
      of local action plan
  ii. The need to work closely with health partners, including general
      practices to address issues of discrimination faced by local people with
      a learning disability
 iii. The Public Sector Ealing in its role of promoting social inclusion and
      offering employment to people with a learning disability
 iv.  The plans to create an Integrated Community Team for people with a
      learning disability



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      v.    The need to prioritise the provision of new accommodation for the
            Green Lane services
      vi.   The exploration of closer working, possibly via the 1999 Health Act
            Flexibilities with LBE to move towards pooled budgets and joint
            commissioning of services.
     vii.   The work to improve services to carers of people with a learning
            disability


6.   Diabetes

     Nigel Spalding, Scrutiny Officer, presented a report that contained a draft set
     of recommendations on diabetes for the Panel to approve, with any
     amendments. The report also explained how the draft recommendations had
     been developed.

     Resolved
       i.  That the draft recommendations, incorporating all the suggested
           revisions and additional points, be agreed.
      ii.  That the recommendations (along with a copy of the background report
           presented to the Health Panel on 23rd March) be forwarded to the
           bodies identified (Cabinet, Ealing PCT, Ealing Hospital and OSC) for a
           response.


7.   An Overview of Children’s Services

     Marcella Phelan, interim Director of Children‟s Services, gave a presentation
     on Ealing‟s Children‟s Services including the measures being taken to
     improve performance. She reported that there was a requirement to report on
     children and adults separately and to provide a link with education.

     For the past 2 years Ealing‟s children‟s services had been assessed as
     “serving most children well” and it was hoped to maintain this judgement this
     year. Additionally, the authority‟s capacity to improve was assessed under
     the heading of prospects for improvement as being either poor, uncertain,
     promising or good. 2 years ago the rating for Ealing‟s children‟s services was
     promising, but this dropped to uncertain this year. Combined with Adults
     social services receiving a rating of only “serving some adults well”, with a
     prospects rating of poor, this has led to the rating of social services, overall,
     as zero stars in the current year. Key Indicators PAF AI,A2,C20 and C23 had
     shown some improvement over the past year

     Resolved
     That the report be noted.


8.   Review of Performance Indicators for Children’s Social Services
     2004/2005

     Marcella Phelan, interim Director of Children‟s Services, presented this report
     that informed the panel of the performance indicators associated with


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     Children‟s Social Services and assessed how well the service is serving
     children and young people. Linked to this, there would be an annual
     assessment by the Commission for Social Care Inspection (CSCI) of the
     service‟s prospects for improvement. This assessment formed the basis of the
     services “Star Rating” announced each autumn and fed into the CPA
     assessment, announced in December, of the Council‟s overall performance.

     Marcella Phelan referred to the table in the report that showed the
     performance for the past year across the main indicators and reported that
     improvements had been achieved on the key indictors PAF A1, C20, and
     C23. Indicator D35 - Long Term Stability of Children Looked After was the
     worst performing indicator and referred to those in care for a period of four
     years or more. The practice of removing children prior to this period of time in
     order to prepare them for independence worked against Ealing regarding the
     statistics. Targets been exceeded in some areas and not met in others.
     Overall, however, improvements had achieved as compared with the
     previous year and this was encouraging, particularly as it came at a time of
     wider uncertainty and change across the authority.

     The main priority for the coming year would be to improve performance in
     PAF A1 Placement Stability and linked to this, PAF D35 Long Term Stability.
     An action plan had been prepared and was being implemented – this should
     deliver marked improvements over the coming year. In addition, a bid had
     been submitted to the DfES to become a pilot authority for a new model of
     delivery of placements “Multi-dimensional treatment foster care” and a
     decision was expected on this by the end of May. If unsuccessful a smaller
     localised model would be piloted in any event.

     Resolved
     That the report be noted.


9.   Agenda Item 12 - Joint Health Overview and Scrutiny Committee on the
     re-development of Northwick Park / St Mark’s Campus.

     Nigel Spalding, Scrutiny Officer, presented this item which provided
     preliminary information about the proposed re-development of Northwick Park
     and St Mark‟s Campus (Watford Road, Harrow) and advised the Panel of the
     invitation to participate in the forthcoming consultation by joining a Joint
     Overview and Scrutiny Committee that had been initiated by LBs Harrow and
     Brent. A document providing information on the usage of Northwick Park by
     Ealing residents was also circulated.

     Nigel Spalding explained that, if Ealing‟s Health Panel wished to take part in
     this consultation, it (a) must recommend to the Council that Ealing form (ie
     join) the Joint Overview and Scrutiny Committee and (b) should propose the
     nominee(s) to the Council, who must not be executive members. A Direction
     from the Secretary of State on the establishment of Joint Committees would
     prohibit Ealing (or any other borough) from making separate arrangements for
     participating in, or responding to, the consultation.



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    Resolved
    The Health Standing Scrutiny Panel recommends that Council:
       i. Agrees to form (ie join) a Joint Health Overview and Scrutiny
          Committee (JOSC) with Brent and Harrow Councils on the proposed
          re-development of the Northwick Park/St Mark‟s campus, noting that
          the first meeting of the JOSC would be an all-day event on Friday 20th
          May.
      ii. Appoints one member from the majority party and one substitute from
          the minority party.
     iii. Notes the preliminary terms of reference of the Committee, as set out
          above.
     iv.  Delegates to the member attending the first meeting the power to
          agree with other members of the Committee the final terms of
          reference for the Committee.

10. Date of Next Meeting

    It was noted that the date of the next full meeting of the Health Standing
    Scrutiny Panel was 16th June 2005.

    The Chair
    Councillor Woodgate extended a vote of thanks to the Chair (Councillor
    Woodroofe) for his work on behalf of the Health Panel during the past
    municipal year.



    The meeting finished at 9.36pm.




    Cllr Woodroofe
    CHAIR                                                         DATE




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