HEALTH OVERVIEW AND SCRUTINY COMMITTEE by vev19514

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									HEALTH OVERVIEW AND SCRUTINY COMMITTEE

MINUTES of a meeting of the Health Overview and Scrutiny Committee held at County
Hall, Lewes on 30 November 2006.


       PRESENT       -       Councillor Lacey OBE (Chairman)
                             Councillors Mrs Healy, Maynard, O’Keeffe, Howson, Wilson
                             and Rogers OBE (Vice-Chairman); Councillor Mrs Angel
                             (Eastbourne Borough Council); Councillor Mrs Martin
                             (Hastings Borough Council); Councillor Taylor (Lewes
                             District Council); Councillor Starnes (Rother District
                             Council); Councillor Mrs Phillips (Wealden District Council)
                             Voluntary Sector Representative: Ralph Chapman,
                             Chairman of Age Concern, East Sussex

       WITNESSES             Nick Yeo, Chief Executive, East Sussex PCTs
                             John Barnes, Chairman, East Sussex Downs and Weald
                             PCT
                             Dr Diana Grice, Director of Public Health, East Sussex
                             PCTs
                             Terri Agnew, Choose and Book Programme Manager, East
                             Sussex Area
                             Juliet Hewitt, Dental Services Development Manager, East
                             Sussex Downs and Weald PCT
                             Andrew Demetriades, Director, East Sussex Downs and
                             Weald PCT
                             Phil Hamlin, Acting Clinical Director for Community Dental
                             Services and Emergency Dental Services, East Sussex
                             Downs and Weald PCT
                             John Tovey, Joint Head, Children’s Services
                             Commissioning Unit
                             Sandy Thomas, Policy and Planning Manager for Disabled
                             Children
                             Liz Fenton, Chief Executive, Care for the Carers;
                             Mary Law, Young Persons’ Services Manager, Care for the
                             Carers
                             Liz Burchett, Development Officer, Sussex Partnership PPI
                             Forum

       LEAD OFFICER          Paul Dean, Scrutiny Lead Officer

       LEGAL ADVISER         Richard Partridge, Assistant Director of Law and Personnel

21.    MINUTES

21.1 RESOLVED – to approve the minutes of the meetings held on 22 September
2006 as a correct record subject to:
      (1)     Cllr Howson being added to the ‘PRESENT’ list; and
      (2)     Item 14.2 - The correct facts on All Saints are contained in the work
              programme at page 61.

22.    APOLOGIES FOR ABSENCE

22.1   Apologies for absence were received from Rosemary Iddenden.

23.    INTERESTS

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23.1      None declared.

24.       REPORTS

24.1 Copies of the reports dealt with in the minutes below are included in the minute
book.

25.       FIT FOR THE FUTURE

25.1      The Committee considered a report by the Director of Law and Personnel.

25.2 Nick Yeo, Chief Executive, East Sussex PCTs, Councillor John Barnes,
Chairman, East Sussex Downs and Weald PCT and Dr Diana Grice, Director of Public
Health, East Sussex PCTs were present. Mr Yeo advised the Committee that:

      •   Consultation on plans for health services in East Sussex, under the ‘Fit for the
          Future’ is scheduled to start, at the earliest, by the end of January 2007 and
          possibly later. The plans take account of national and local needs and will include
          strong hospital services and more services based in the community. There is a
          commitment to get the right balance of care across the two PCTs in East Sussex.

      •   There should be consultation on a range of options. There will be far reaching
          proposals and the PCTs want to ensure that they are sensible, robust and
          appropriate. The key drivers are:

             Clinical quality and safety
             Meeting patients’ needs
             Accessibility
             Best use of the finite set of resources

      •   The consultation will take three months which means that any decision on
          services will not be taken until May 2007 at the earliest.

      •   The boards of East Sussex Downs and Weald PCT and Hastings and Rother PCT
          will make the final decision on the services. The board of East Sussex Downs
          and Weald PCT will also have influence on decision about services in Brighton
          and the southern part of Kent. This will include plans for Princess Royal Hospital,
          Haywards Heath. Patients living in the west of East Sussex access many of these
          services.

25.3 Councillor Barnes, speaking as Chairman of East Sussex Downs and Weald PCT,
advised the Committee that:

      •   The delay in consultation was very much at the request of the chairmen of the
          PCTs, in part because the new boards only came into place on 1 October and
          needed time to get up to speed. But much more importantly because they are still
          looking at and assessing options.

      •   The PCTs are the drivers of the consultation document and its content will be
          settled by a joint board of the two PCTs. Decisions on services in East Sussex
          will be taken by the two boards and these decisions will be taken on behalf of the
          people of East Sussex.

25.4 The Committee expressed concern about speculation and rumour surrounding the
plans for obstetrics services in East Sussex. Mr Yeo confirmed that the alternatives had
not yet been agreed let alone decided upon regarding obstetrics. He said that East
Sussex Hospitals NHS Trust (ESHT) is responsible for delivering the service as
commissioned by the PCTs. ESHT has voiced concerns about the sustainability of
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obstetrics under the current arrangements and these will have to be addressed in the
alternative options that eventually the PCTs put forward for consultation. The factors that
will influence the proposals put forward will include: the impact on manpower of Training
Directives and European Working Time Directive, Royal College standards and
recommendations from the Department of Health on service levels for patient flows.

25.5 The Committee expressed concern about what would happen if the PCTs’
preferred option for settings of care was unacceptable to local people. Mr Yeo confirmed
that it is very unlikely that they will put forward a single option. The PCTs will do their level
best to come up with the best set of proposals. Consultation would take account of the
views of the public and clinicians and the final decision would have to be the best fit but it
is highly unlikely that any decision will have universal support. The PCTs are committed
to making decisions about the pattern of services that is best for the county as a whole
and in Mr Yeo’s experience this process will result in a better outcome than failing to
agree a reasonable decision and then having decisions imposed from outside the county.

25.6 The Committee expressed concern that any single siting of a service will impact
on ambulance resources. Mr Yeo confirmed that the ambulance trust is included in the
PCTs’ deliberations and that they also take account of the rural nature of much of East
Sussex in planning any services.

25.7 The Committee expressed concern that community services are not always
planned to be in place in time for new housing developments. Mr Yeo confirmed that the
PCTs take account of population growth and that they always negotiate with developers.
However, the outcome is not always as satisfactory as the PCTs would want. Mr Yeo
said the PCTs try and exercise their leverage in terms of the planning process to make
sure the developers are responsible and understand that there is an implication in terms
of infrastructure in new developments.

25.8 The Committee expressed concern that closure of a service can happen before
the replacement services are available e.g. closure of All Saints Hospital and the delay in
expansion plans of Seaford Health Centre. Mr Yeo confirmed that the PCTs take a
holistic approach and aim to provide the right care in the right setting. Acute care settings
and community services need to be looked at in tandem. The PCTs have to make
judgements on the timing of closure and opening of services and this does include double
running where feasible. PCTs have to make this part of their financial plans. This will be a
challenge.

25.9 The Committee asked for evidence that shifting hospital care into the community
is reducing demand on hospital resources. Mr Yeo said that considerable steps forward
had been made in the way hospital services were managed particularly in Accident and
Emergency and bed management. Demand on services is not increasing as much now
although there has not been a decrease in demand. The future will aim to provide care
around the patient and make sure people use the right services and that they are
accessible. PCTs are working with the acute hospital on this e.g. single point telephone
access, single accident and emergency/PCT reception area which directs patients to
appropriate care.

25.10 The Committee asked for evidence on what consultation had been undertaken
with GPs about Fit for the Future. Mr Yeo said that communications structures are still
being established but there is strong involvement with GPs although there is no single
voice of GP opinion.

25.11 The Committee asked how much influence the weighted capitation formula had on
decisions about services in East Sussex. Mr Yeo said the government sets the target for
financial allocation for East Sussex. Many health authorities across the country claim that
the formula does not give sufficient weighting to local factors. However, East Sussex
currently gets an allocation in excess of our weighted capitation target and this means the

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county will, against the national average, have slightly lower growth in our financial
resources year on year.

25.12 On behalf of the Committee the Chairman expressed thanks to Nick Yeo,
Councillor Barnes and Dr Diana Grice for their contributions to the discussion.

25.13 RESOLVED – to

          (1) ensure that the Fit for the Future proposals take account of the local view and
              are reasonable and rational and acceptable to the people of East Sussex;

          (2) seek evidence that the public’s confidence in the health service is being
              restored following the damage caused by public statements on the single
              siting of obstetrics from the Medical Director of East Sussex Hospitals NHS
              Trust;

          (3) seek evidence that will convince the Committee of the merits of Fit for the
              Future proposals;

          (4) request a written reply from Nick Yeo outlining the use of self-diagnosis
              machines in GP surgeries and summarising the strengths and weaknesses.

26.       CHOOSE AND BOOK

26.1      The Committee considered a report by the Director of Law and Personnel.

26.2 Terri Agnew, Choose and Book Programme Manager East Sussex Area was
present and after a brief presentation answered questions.

26.3      The Committee was advised that:

      •   Currently there are 600 referrals per week across East Sussex. This compares
          with 80/90 a week in September 2006. Hastings and Rother PCT is now in the top
          5 performing PCTs in South East Coast SHA area. It is only in the last two months
          that a full range of services has been able to be offered to GPs.

      •   Only six surgeries are affected by technical problems and these should be
          resolved by December 2006/January 2007.

      •   East Sussex Hospitals NHS Trust has taken orthopaedics ‘off menu’ which means
          it will not accept Choose and Book referrals for this speciality. Alternatives are
          available to GPs with other providers, including the private sector. The number of
          orthopaedic referrals is significant and therefore this step taken by ESHT is of
          concern.

      •   The Choose and Book team is liaising with GPs and trying to improve capacity as
          well as looking at demand management schemes.

      •   GPs find the system slow and it does not meet all their needs. For example,
          Choose and Book cannot be used to book appointments with named consultants.
          The best alternative is for GPs to direct patients to specific clinics where they
          know that a particular consultant will see the patient.

      •   There are no financial inducements available for hospital trusts to support Choose
          and Book although Choose and Book has funded two people in East Sussex
          Hospitals NHS Trust for the last two and half years to work on the system.


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      •   The Choose and Book programme management team will be in place until March
          2007. The objective is to ensure that the system is fully integrated into the
          mainstream working practices of GPs, PCTs and hospital trusts by this date.

26.4 On behalf of the Committee the Chairman expressed thanks to Terri Agnew for
her report to the Committee.

26.5      RESOLVED – to

          (1) note the improvement in the performance of the Choose and Book system;

          (2) note the greater confidence of the Choose and Book programme management
              team;

          (3) receive a further update on Choose and Book in June 2007.

27.       NHS DENTISTRY

27.1      The Committee considered a report by the Director of Law and Personnel.

27.2 Jane Hewitt, Dental Services Development Manager, and Andrew Demetriades,
Director, East Sussex Downs and Weald PCT, were present and after a presentation by
Jane Hewitt, answered questions. Copies of the slides are available as part of the
document.

27.3      The Committee were advised that:

      •   The PCT and dentists are still embedding new contract changes.
      •   Generally there is a match between provision and need.
      •   Higher number of dentists accepting NHS patients.
      •   Contract disputes reduced or resolved.
      •   The new NHS contracts have no major long term impact on Emergency Dental
          Services after the initial surge.
      •   There has been no major impact in localities of rejected contracts.
      •   There is a potential charge deficit risk to the PCT.
      •   Overall underperformance on annual activity.
      •   Deficit resulting from lower than expected patient charges estimated to be £1
          million.
      •   Urgent care provision was under review.

27.4 On behalf of the Committee the Chairman expressed thanks to Jane Hewitt and
Andrew Demetriades for the presentation and contribution to the discussion.

27.5      RESOLVED – to

          (1) monitor progress of the new dental contract and receive an update report in
              November 2007.

28.       PROPOSED CHANGES TO THE COMMUNITY DENTAL SERVICES

28.1 The Committee considered a background report by the Director of Law and
Personnel.

28.2 Phil Hamlin, Acting Clinical Director for Community Dental Services and
Emergency Dental Services, East Sussex Downs and Weald PCT, was present and after
a brief presentation answered questions. The Committee was advised that:


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      •   The proposal is for Community Dental Services clinics based in Crowborough and
          Heathfield to close and those patients transferred to enhanced Uckfield and
          Hailsham clinics. This is phase two of a programme to streamline services to
          concentrate activity in fewer clinics so that the use of space and staffing can be
          maximised to the advantage of patients and the service.

      •   Benefits highlighted

             Improved waiting times (After 12 months: Heathfield from10 to 8 weeks and
             Crowborough from 24 to 17 weeks.)
             Service quality improved
             No reduction in budget which means the savings can provide better services
             No reductions in staff, indeed improved staff efficiency
             No impact on Emergency Dental Services clinics in Hailsham, Lewes and
             Hastings.

      •   Some patients will have longer journeys. The PCT plans to undertake individual
          consultation with the 190 patients who currently use the Crowborough service and
          130 who use the service in Heathfield. Individuals (and any carers) will be
          consulted on their travel plans.
      •   Home visits are an alternative option. Urgent cases are usually seen within a
          week but non-urgent case may have to wait up to 10 weeks.

      •   Patients with HIV are treated in a general dental practice. Patients with AIDS can
          be referred to Community Dental Services clinics because of their severe medical
          problems.

28.3 On behalf of the Committee the Chairman expressed thanks to Phil Hamlin for his
briefing and contribution to the discussion.

28.4      RESOLVED - to

          (1) endorse the proposals subject to the service consulting with all the affected
              patients and resolving the additional transport requirements as envisaged;

          (2) maintain a watching brief on appointment waiting times for CDS patients which
              the Committee considers to be poor even with the anticipated improvements;

          (3) receive an update report in November 2007.

29.       CHILDREN’S SERVICES REVIEW OF YOUNG CARERS

29.1 The Committee considered a report by the Director of Law and Personnel. John
Tovey, Joint Head, Children’s Services Commissioning Unit; Sandy Thomas, Policy and
Planning Manager, Disabled Children, Children’s Services; Liz Fenton, Chief Executive,
Care for the Carers; Mary Law, Young Persons’ Services Manager, Care for the Carers,
were present and, after a presentation by Sandy Thomas, answered questions. Copies of
the slides are available as part of the document.

29.2      The Committee were advised that:

      •   Care for the Carers support the direction of travel set out in the young carers’
          development and improvement plan. The organisation would like to provide a
          wider ranging service to all young carers but resources are limited which means it
          can only work with around 120 young carers identified as those most in need.
          These young carers are often in the ‘hard to reach’ category and there is a need
          for more creativity in overcoming this.

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      •   Schools are key in helping identify young carers in need. Schools receive
          guidance on what behaviour to look for. The Common Assessment Framework
          will be rolled out in April 2007 and this should help identify pupils with caring
          responsibilities. There is also Children’s Index – the information sharing system
          which allows organisations to see who else is working with a child.

      •   Recently, hospitals have adopted a new protocol which means they now have to
          look much more widely at a patient’s needs. This includes any carer involvement.
          There is also an awareness raising programme underway with GPs.

      •   The number of young carers might be higher than the estimates which are based
          on the 2001 census figures. Indeed, young carers sometimes do not see
          themselves as carers.

      •   A Young Carers Strategy Group is being set up to take forward the work. This
          group includes school representation.

      •   Joint protocols between Adult’s Services and Children’s Services would benefit
          from complete revision. There is a need for a seamless service.

29.3 On behalf of the Committee the Chairman expressed thanks to John Tovey,
Sandy Thomas, Liz Fenton and Mary Law for the presentation and contribution to the
discussion.

29.4      RESOLVED - to

          (1) endorse the satisfactory progress on implementation of recommendations of
              Children’s Services’ review of young carers. The Committee is enormously
              encouraged to see the issues being addressed.

          (2) continue to monitor progress and receive an update report in November 2007.

30.       HOSC WORK PROGRAMME 2006/2007

30.1      The Committee considered the HOSC work programme.

30.2      RESOLVED to

          (1) Continue lobbying the South East Coast SHA and the Department of Health to
              ensure that local involvement networks (LINks) have the right to inspect
              hospitals and other NHS institutions. The Committee could put forward its own
              proposals on how to work with LINks.

          (2) Receive an update report in June 2007 on the impact of the reconfiguration of
              ambulance services in the South East and the transport issues affecting the
              ambulance service arising from any proposals under Fit for the Future.

          (3) Note the improving position on delayed transfers of care in East Sussex and to
              thank the staff in Health and Adult Social care for their considerable
              contributions which have resulted in the reduction of cases attributed to them.
              An update report will be presented to the Committee in March 2007.

          (4) Note progress on the Best Care Best Place joint review with West Sussex
              County Council and Brighton and Hove City Council.

          (5) Note the lack of progress with burns services consultation that was initiated in
              August 2005 by Kent and Medway Strategic Health Authority.

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31.    INDIVIDUAL HOSC MEMBER ACTIVITY

31.1 Councillor O’Keeffe and Councillor Healy reported that the Adult Social Care
Scrutiny Committee is reviewing preventative services and seeking views and examples
of areas to investigate e.g. Telecare, prevention of falls.

31.2 Councillor Healy attended a recent board meeting of East Sussex Downs and
Weald PCT and suggested that HOSC members would benefit from observing health
board meetings on a rota basis. The meetings provide a valuable insight into Health
issues and the workings of health trusts.

31.3 Councillors Lacey, Howson, Taylor and Mr Chapman attending the Health Summit
on 29 November 2006 in Brighton and expressed reservations about the lack of any
apparent sense of purpose for the event; they were equally concerned that there was still
no picture of the alternatives to be considered in Fit for the Future plans. They expressed
distaste about the rumoured high cost of the event.

31.4 Councillor Angel was experiencing serious communication difficulties surrounding
the arrangements for ambulance PPI Forum meetings and as a consequence missed a
recent meeting; these reflected the problems experienced by Cllr O’Keeffe from whom
she had taken over the link role.

31.5 Councillor Taylor reported that the East Sussex Downs and Weald PPI Forum is
focusing on dentistry and wheelchair access.

31.6 Councillor Martin highlighted the former chairman of Hastings and Rother PPI
Forum’s concerns on the future of patient and public involvement.

31.7 Councillor Lacey reported that he had been interviewed about HOSC work on
Rocket FM and Eastbourne Youth Radio.

31.8 Councillor Lacey reported that the South East HOSCs Chairmen are meeting with
the Chief Executive of South East Coast SHA, PCT and Centre for Public Scrutiny
representatives on 6 December 2006 to discuss various issues surrounding the Fit for the
Future Plans.

31.9   RESOLVED - to

       (1) Affirm that East Sussex HOSC is opposed to the formation of any region wide
           joint health overview and scrutiny committees to consider Fit for the Future
           proposals. This is because it is not appropriate (on grounds of local
           accountability) nor feasible (because of the sheer volume of evidence) for East
           Sussex representatives to be able to consider properly the detailed arguments
           for health service changes in other counties, and vice versa.




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