HEALTH OVERVIEW AND SCRUTINY PANEL

     MINUTES OF THE MEETING of the Health Overview and Scrutiny Panel held
     in the Guildhall, Portsmouth on Monday 1 December 2008 at 3.00 pm.


                         Councillors David Stephen Butler (Chairman)
                                     Margaret Foster
                                     Jacqui Hancock
                                     David Horne
                                     April Windebank

                                  Co-opted Members

                         Councillors Gwen Blackett
                                     Dorothy Denston
                                     Peter Edgar
                                     Vicky Weston

                                  Also in Attendance

                         Katie Benton, Scrutiny Support Officer,
                            Portsmouth City Council
                         Angela Dryer, Assistant Head of Adult Social Care,
                            Portsmouth City Council
                         Dr Paul Edmondson-Jones, Director of Public Health &
                            Well-Being, Portsmouth City Teaching Primary Care
                            Trust and Portsmouth City Council
                         Glen Hewlett, Director of Development & Estates,
                            Portsmouth Hospitals Trust
                         Tim Robinson, Head of Patient & Public Involvement,
                            Portsmouth Hospitals Trust

53   Apologies for Absence (AI 1)

     Councillors Keith Evans from Fareham and Anna McNair-Scott from
     Hampshire sent their apologies, as did Rob Watt, Head of Adult Social Care for
     Portsmouth City Council, who is on a secondment.

     The Panel were informed that Councillor Dennis Wright would in the future
     represent Hampshire County Council at the Portsmouth HOSP.

54   Declarations of Interest (AI 2)

     Councillor Peter Edgar declared a personal, but non-prejudicial interest, as he
     is a shareholder in a local taxi company.

     A warm welcome was then extended to all members, co-optees and
     contributors to the Health Overview and Scrutiny Panel, with special welcome
     given to Angela Dryer (representing Rob Watt as a representative from Adult
     Social Care) and Brian Rains (representative of the Portsmouth Local
     Involvement Network).

55   Minutes of Meeting held on 16 September 2008 (AI 3)

     RESOLVED that the minutes of the meeting held on 16 September 2008
     were confirmed as a correct record.

56   Matters Arising from the Previous Minutes

     There were no matters arising from the previous minutes.

57   Public Health Annual Report 2008 (AI 4)
                                      (TAKE IN REPORT)
     The Panel were informed:
      That the title for this year’s Public Health Annual Report is ‘Understanding
         the Gap in Life Expectancy’. This is because life expectancy is a
         fundamental indicator of health in a community and can easily be used as
         a comparator against other Local Authorities and Primary Care Trust
         (PCT) areas.
      That gaps in life expectancy are also related to targets for the Local
         Strategic Partnership, Local Area Agreements, CPA inspections,
         Portsmouth City Council corporate priorities and the City Primary Care
      That life expectancy and health inequalities have also been highlighted as
         2 of 10 outcomes the Primary Care Trust needs to improve as part of
         World Class Commissioning. The 2008 Public Health Annual Report aims
         to link these 10 World Class Commissioning outcomes together. The
         other 8 areas of interest include; infant mortality, cancer mortality, cardio
         vascular disease mortality, breast screening, cervical cancer screening,
         coronary obstructive pulmonary disease prevalence, diabetes controlled
         blood sugar and chronic heart disease controlled cholesterol.
      That life expectancy differs for males and females in Portsmouth, with
         males living to an average age of 76, and females to an average of 82 - a
         6 year difference - if born today.
      That this difference can be highlighted best by quintile graphs showing
         age expectancy from birth for the least and most deprived areas of
         Portsmouth: males have an average life expectancy of 80 and females 83
         (for least deprived) compared to males having a life expectancy of 72 and
         females a life expectancy of 78 (in the most deprived areas).
      That the largest cause of early death in Portsmouth is circulatory
         diseases, which accounts for nearly half of all early deaths within the City,
         compared to a third nationally.
      That although there has been improved detection of diseases such as
         breast and cervical cancer in Portsmouth, uptake of screening in areas of
         low social deprivation were much higher than those in areas of high social
         deprivation. As a result the lowest disease rates were found in areas with
         the highest screening take up and vice versa. The PCT therefore needs to
         ask itself if its services are located in the right areas.

   That ward breakdowns showed hotspots of smoking prevalence in
     Portsmouth, with higher smoking citizen percentages leading to some of
     the highest lung cancer rates in the country.
 That the key recommendations the Director of Public Health and Well-
     being is making to Portsmouth City Council, the Local Strategic
     Partnership and Portsmouth City Teaching Primary Care Trust is to
     reduce the prevalence of smoking, to reduce obesity by tackling the
     causes of chronic heart disease and the causes of obesity in children, to
     increase anti-hypertensive and statin therapy in order to reduce
     cholesterol, to improve screening and immunisation uptake and to further
     improve local services for diabetes.
In response to questions the Panel heard:
   That the gap of infant mortality rate between males and females is not
     individual to Portsmouth, this is found nationally - infant mortality is
     naturally higher in males. However, compared to the rest of the early
     death figures, infant mortality makes up a very small percentage.
   That the higher rates of infant mortality are found in younger mothers
     from areas of high social deprivation.
   That the PCT is able to break down wards into hotspots of activity. For
     example, St. Jude and St. Thomas wards have areas of both high and
     low social deprivation - these can be broken down into hotspot areas of
     50 to 100 houses.
   That the low numbers of take up in breast cancer screening in areas of
     high social deprivation are probably due to lack of education and
     awareness, and restricted access to services.
   That the PCT has one mobile and one fixed breast screening unit, one of
     which is based at Royal Hospital Haslar, and the other moves throughout
     the Portsmouth area.
   That the breast screening unit will be moving back to Queen Alexandra
     Hospital once Royal Hospital Haslar closes in June of 2009.
   That the PCT can provide information comparing today’s public health
     figures to those from 10 to 20 years ago, but that the Panel should be
     aware that boundaries have changed over time and so fluctuations in
     figures may be found.
   That the PCT and Portsmouth City Council have large networks and
     organisations that it works with in order to put its recommendations into
     practice; including a vascular prevention team, an education team and a
     pool of doctors.
   That Portsmouth does have an early intervention team and children’s
     programme, which is focused on education. These teams aim to capture
     the attention of children whilst they’re young, and also to educate parents.
   That the PCT recognises that for early intervention to work children must
     be involved in an education process from birth, as currently children who
     have reached the age of 5 have a 12-13% chance of being obese, which
     rises to 20% during teenage years. By these ages it is then too late to
     start education programmes, and instead the need is to work on reducing
     the obesity itself.
   That the PCT has a new scheme to write to parents alerting them if their
     children are measured as obese during routine medicals at the start of the
     school term, in order to emphasise the need for earlier treatment.

       That Portsmouth has seen a reduction in the number of MMR
         immunisations, largely due to the triple vaccine issue, as some parents
         believe there is a link between the vaccine and autism. This is mostly
         seen in areas of low social deprivation, as it is these parents that tend to
         be more likely to listen to medical concerns. However, the PCT is working
         on an education programme in order to assure parents that there is no link
         between the MMR jab and autism.
      That there have only been one or two cases of measles in the Portsmouth
         area, with the city currently having zero measle clusters. However, as the
         immunity in the community decreases, so the risk of measles increases,
         especially as some children cannot have this vaccine for medical reasons,
         and are therefore reliant on the children around them being immune.
      That Portsmouth City Teaching Primary Care Trust are trying hard to
         reach out to black and minority ethnic groups and the migrant community.
         All travelling patients, whether migrant or immigrant, are offered the same
         services as residents in Portsmouth, but it can be very difficult to locate
         these groups, communicate to them in a way they find easy to
         comprehend, and assess the services these communities need.
     RESOLVED that the Panel asks Dr Edmondson-Jones to update them on
     the progress of the work being completed relating to the
     recommendations (as set out in his Public Health Annual Report 2008) in
     six months’ time.

58   Scrutiny Reviews
     The Panel then heard from Katie Benton, Scrutiny Support Officer for
     Portsmouth City Council, who outlined the project brief for the Hyperbaric
     Chamber Scrutiny Review and the Scrutiny Topics - HOSP procedure. (AI 5.1
     and 5.2)
                           (TAKE IN PROJECT BRIEF)

     RESOLVED (1) that the Hyperbaric Chamber Scrutiny Review remains a
     Portsmouth City Council review with input from the co-opted Hampshire
     and Gosport members;
                   (2) That the Hyperbaric Chamber Scrutiny review project
     brief is agreed;
                   (3) That a letter be sent out to all members and co-optees
     asking for a suitable date for a dedicated Hyperbaric Chamber Scrutiny
     Review day.

59   Update on Items Previously Considered by the Panel (AI 6)
                                   (TAKE IN REPORTS)
     Angela Dryer, Assistant Head of Adult Social Care for Portsmouth City Council,
     presented the Items of Interest - Adult Social Care.
     The Panel were informed:
      That Portsmouth Hospitals Trust and Portsmouth City Council were
         working together to reduce the fines and waiting times for delays to
         transfers of care.
      That the main issue they needed to resolve was the lack of nursing
         dementia beds available in Portsmouth, although this isn’t just an issue in
         the City - it is being seen nationally.

   That Portsmouth City Council has a dedicated social worker supervising
     transitional beds that patients from Portsmouth Hospitals Trust can be
     transferred to for a limited period whilst waiting for nursing home
 That the fees for delayed transfers of care had decreased in September
     and October but had increased quite significantly in November - up to
     £5,300 – though this is due to an unexpected increase of hospital
     admissions due to winter pressures, which is likely to increase over the
     Christmas period. However, Portsmouth City Council and Portsmouth
     Hospitals Trust are working together to put staff into Out of Hours and into
     the Independent Living Service over the Christmas period in order to
     reduce admissions over this time.
In response to questions the Panel heard:
 That due to budgetary restraints the amount of care that patients are able
     to receive has decreased slightly, as currently only those who have
     substantial or critical needs receive personal care support, whereas
     previously those patients with moderate needs could claim. Domiciliary
     care i.e. cleaning, is no longer provided
 That the Primary Care Trust, Portsmouth Hospitals Trust and Portsmouth
     City Council are working together on a falls pathway that aims to
     streamline the support given to elderly people.
 That Portsmouth City Council does carry out their own inspections of in-
     house care homes. This is done monthly. Also if a nursing or residential
     home is given a poor rating by the Commission for Social Care Inspection,
     Portsmouth City Council will also complete their own inspection and carry
     out risk assessments to see if patients need to be removed from that
 That the Council now has its own safeguarding team, which is receiving
     four times the amount of alerts than it received at the same time last year.
     The team’s official launch is in January 2009. There has been an increase
     in the number of safeguarding alerts which have come from staff working
     within nursing or residential care homes.
Timothy Robinson, Head of Patient and Public Involvement at Portsmouth
Hospitals Trust and Glen Hewlett, Director of Planning and Development at
Portsmouth Hospitals Trust then presented the next item, ‘Car parking at
Portsmouth Hospitals Trust’.
In response to questions the Panel heard:
 That PHT were did not currently possess the accurate breakdowns of
     revenue from parking towards clinical uses, maintenance, security etc, but
     would send figures to members.
 That the Hampshire Action Team will be meeting on 15 December in
     Winchester to discuss access to the Queen Alexandra Hospital site from
     June of next year.
 That Portsmouth Hospitals Trust and First Bus have been meeting
     regularly to discuss changes to the hospital with the most recent meeting
     being on 4 November.
 That the main access to QA hospital will become Southampton Road,
     rather than from Southwick Hill Road as current. The Cavell Drive access
     will then be shut off and only accessible to emergency vehicles, cyclists,
     pedestrians and public services.
 That a new drop off zone will be created outside the hospital with a u-turn
     area available for cars to exit swiftly after.

        That the hospital site will be colour coded to enable patients to find
          appropriate car parking and department areas quicker.
      That the largest vehicle traffic times seem to be on Tuesday mornings and
          afternoons and Thursday afternoons. This is thought to be due to clashing
          outpatient clinic times, and work is being done to rectify this.
      That car parking charges have not been raised since 2004.
      That the park and ride scheme for staff has taken a lot of pressure off the
          traffic problems at QA hospital and should be commended.
     RESOLVED that the annual income figure from public parking on the
     Queen Alexandra and St Mary’s Hospital sites should be broken down to
     show where this money is spent, i.e. security and maintenance, and
     clinical, etc, and forwarded to Members of the Health Overview &
     Scrutiny Panel.

60   Possible Substantial Changes to Services, Quarterly Letters and Annual
     Reports (AI 7)
                                     (TAKE IN LETTER)
     Timothy Robinson, Head of Patient and Public Involvement from Portsmouth
     Hospitals Trust verbally presented PHT’s quarterly letter to the Panel.
     The Panel heard:
      That up to October 2008 MRSI cases were up to 12 from a trajectory of
          21, and cases of Clostridium difficile were up to 122 from a trajectory of
      That the work on the Totton Dialysis Unit was almost complete and will be
          finished by Monday 8th December, ahead of schedule. Two complaints
          have been received about this but had been dealt with efficiently.
      That the ‘Stop the Bugs’ Infection Campaign had received a top gold
          award from a PR award ceremony, and is also being rolled out to
          Hampshire Partnership Trust due to its large success in Portsmouth City.
     In response to questions the Panel heard:
      That one of the main issues Portsmouth Hospitals Trust faces is in trying
          to educate patients, staff and visitors to use the hand gel facilities.
      That there are issues with staff and contractors smoking outside the
          hospital building. Unfortunately, this is outside of the Hospital Trust’s
          powers, as this area is not covered by legislation.
      That automated speakers have been installed outside of the hospital
          entrance in order to remind smokers that it is not a permitted smoking
      That the team arranging the opening of the new hospital are due to visit
          the team behind the Terminal 5 opening, in order to learn the lessons from
          the opening of that facility.
      That Gosport War Memorial hospital is now the largest community
          hospital in the country.
61   Date of Next Meeting (AI 8)
     The next meeting is scheduled for Monday 26 January at 2.00 pm in
     Conference Room A, Core 2, Floor 2 Portsmouth City Council.

           The meeting closed at 16.25


To top