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					  Wednesday 22nd July 2009                                       Est. 2004
             Voluntary Action Centre
                   Nottingham
                   Report


Attending: Glen Jarvis. Service User and Carer Involvement Officer. (CDP) - Chair
           Paula Torres-Silva - Partnership Development Team.- Minutes
Visiting:  Nick Davis – Worker, John Storer Clinic and User group/panel
              34 people who are or were engaged with the following services:
               10 Woman & 24 Men 4 New member s
              Health Shop                                   Park House
              Gate Mentoring                                Ex User x 3
              The Point - Compass                           Ken Wilde House
              John Storer Clinic- SMS                       Framework
              Making Waves                                  Double Impact
              John Storer service user panel                Wells Road Centre - SMS
              Rally & Aspire                                Shared Care
              NA/AA                                         HLG
              Studio House                                  Streetwise
              Patient Experience Group                      ADEPT
              NHCT Involvement Team

Report by:       Glen Jarvis                        CDP

ITEM                                                                                   ACTION

1.    Welcome and Introductions.
     1.1   The chair ran through the ground rules, purpose of the forum and house
           rules.
2.    Minutes of last meeting
      2.1 Glen read out a card from Maggy Topley, who is still away from work due
           to ill health. Members asked to convey that she has let no-one down and
           that the group appreciates the work she has done for many years and
           wishes her a swift recovery.
      2.2 Glen had received a letter from Harold Rosenberg, who was our guest
           speaker, thanking the forum for inviting him and sending his regards.
      2.3 Glen announced that a group is currently updating the Service User Guide
           (which this group invented) to include the mentoring services at Aspire,
           Gate and the prison. The pack will have a new front and back cover which
           people were invited to design. Today was the closing date and all the
           entries were on display for people to look at and vote on. The winners
           would be announced next time.
      2.4 Mark Garner had written to the group thanking them for their advice about
           the BBV leaflet last time.
3.    Matters Arising
      3.1 Glen announced that a group is currently updating the Service User Guide
            (which this group invented) to include the mentoring services at Aspire,
            Gate and the prison. The pack will have a new front and back cover which
            people were invited to design. Today was the closing date and all the
            entries were on display for people to look at and vote on. The winners
            would be announced next time.
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ITEM                                                                                                     ACTION



4.     Treatment Sytem Review Update and Charter
       4.1    Lucy Putland had sent apologies that she was unable to make the
          meeting but had sent a message to the group:
        “The CDP Board signed off on the final model in April 2009 and an implementation plan has
       been developed.
       Current progress against the implementation plan includes:
            Starting developments for Service A (new service for heroin and crack users) including
               establishing a project team, developing a draft service specification and agreeing a
               timetable for tendering
            Developing a mentoring and advocacy strategy to make recommendations for a local
               mentoring and advocacy model (due to be finished end of July)
            Developing a Drug Treatment System Charter (general principles for the new treatment
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               system) which has been approved by the JCG and is going to the CDP Board 27 July. It
               would be good if The Forum can also approve the charter.
            Ending drug specific assertive outreach services (Compass Centre Base will continue till
               an appropriate time to fit in with the model)
            Identifying options to deliver training for front line workers and communities
            Scoped direction of travel for Service C (Criminal Justice Treatment) in order to develop
               fully integrated criminal justice treatment team. Options are in negotiation
            The Service User Exec Panel has met twice and are proving effective in informing
               specific developments for the Treatment System Review, including Service A (new
               service for heroin and crack users), the Drug Treatment System Charter, and the
               mentoring and advocacy strategy.”

       4.2 Glen went through the Charter and explained that this will be the charter for
          the whole system as it is commissioned. There was lengthy discussion about
          each element of the charter, which had widespread support. There was a
          question about whether reference could be made to peer to peer support and
          guidance. (“under Service User Responsibilities add: To encourage and
          support peer to peer empowerment when and wherever possible). It was
          explained that this was the shorter version, which will go on display; the
          longer version is much more detailed. Glen pointed out that the anti stigma
          section had been taken from the work of Sally and Alix and included after
          Steve Spear had seen the workshop on this at the Dual Diagnosis
          Conference.
       4.3 Dentistry. The overview and scrutiny health committee is looking at
          dentistry and there is a questionnaire that people can complete if they want
          to. Sally highlighted that she had emailed in response to the call for
          information but had received no response. It would be useful if there was
          even an auto responder just so people knew that there contribution had
          arrived. There was some discussion about cosmetic work that some
          members had had done. It was important to highlight that some people are
          dismissive of such “cosmetic dentistry” but it is seen as being a huge boost to
          someone’s confidence and recovery, and hence a good investment. There
          were comments about prison dentistry needing improvement and the age old
          request for some kind of dentistry provision within treatment. Half a day at
          the clinic was suggested as a minimum to do emergency treatment.

 5.    Harm Reduction Strategy Group Feedback.
       5.1 The new leaflet is complete and is already being distributed. Very positive
           feedback. Next one is on harm reduction and alcohol. A sub group is being
           set up and volunteers are welcome. Poly drug use is a huge issue.
           Discussions around this, coca ethylene, and needle exchange in the forum.
           Positive bnews about training in the city being made available and OD

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        training for workers being essential. There was a discussion around
        naloxone use. A bid had been made for a pilot with carers in Nottingham but
        we had been unsuccessful this time. The health shop training that we have
        every year will be after the next forum. Glen will be taking names at that
        meeting and it is hoped that we will have a good response from members.
     Glen read out an email from Mark Garner: Harm reduction lead at the CDP. “I
     met with the PCT today. They have acquired some extra funding to be used to increase
     needle exchange stock given out within pharmacy exchange schemes. This is not at
     present a permanent allocation so it may not be renewed each year. We have therefore
     decided that we need to record any benefits that this might have on clients using
     pharmacy NX as a way of justifying the continuation of funding in the future. We may
     therefore roll out a client questionnaire within pharmacy NX in the future. If so it would
     be good if users of the service will help with completing this.
     We have agreed that this should be spent on providing sterile water and steri cups with
     filters at all pharmacy exchanges. This will hopefully be in place from October time (ish).
     We agreed that we would like your forums to help spread the word when this is
     available.
     We also agreed that we would need to provide training for pharmacy staff around this
     equipment and the advice they should give out with it. This will be dealt with at the next
     pharmacy staff training event"
     5.2 Forum members are encouraged to respond to this. There was a request for
         VIT C to be added to the list. In discussion about discarded needles a
         member suggested using Smart Water on needles to identify who hasn’t
         returned them. This sparked a lively discussion around the application and
         usefulness of Smart Water for such a purpose, which Glen asked for
         permission to not include in the minutes!! There was also a suggestion to
         look into dissolvable needles, similar to fishing hooks?

6.   Shared Care Update
     6.1   Our two reps from the Shared Care Monitoring Group reported that the
           group had not met since the last forum. The group is quarterly. There were
           some general discussions around previous issues and members were
           encouraged to speak to john or Mathew if they had any ideas or issues. It
           was emphasised that they are not advocates and can not get involved with
           individual complaints but they can take more strategic and policy concerns
           back to the group.

7.   Exec Panel feedback.
     7.1 The EXEC Panel is a small, variable group of service users drawn from all
          forums to meet with the commissioners on an informal basis to discuss
          issues in more depth, usually about the treatment system review.
          Feedback was given about the most recent meeting where service “A” had
          been discussed and the proposed delivery model. Suggestions had been
          made by the group.

8.   John Storer Panel feedback and Nick Davis
     8.1 More ideas are needed for the next issue of the newsletter/magazine.
         Anyone with stories, poems, pictures etc are encouraged to submit them at
         the clinic, to a panel member, at the involvement centre or to glen. A
         massive thanks to Darren for putting it all together. A huge round of
         applause was given for such a great achievement. There was a request for
         an article and information on shared care. Nick was involved in a
         discussion around the success of the panel in the last year. Issues have
         been raised and dealt with, without the need to involve this forum. Sally
         and Alix working at the trust has been a huge achievement and Darren’s

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           story has been inspirational since he became involved. He has shown that
           this is a great route into involvement and a real benefit to recovery.
     8.2   Members from other services said that they would like panels in their
           services too. There was discussion around this and the JS Panel members
           recommended that they set one up as the benefits are great. Eg less
           hostility, more partnership work etc. There was encouragement for
           everyone to get as involved as possible in their services, especially as half
           of the forum seats are now reserved for such people and this is very much
           the direction of travel.
     8.3   Glen thanked everyone for their positive engagement in the panel over the
           past year and ended by pointing out that another thing to note was that
           Nick had become the first clinic worker to be invited to attend and
           participate in a whole forum meeting, not just as a guest speaker.

9.   Emergency Department feedback
     9.1    Following on from the concerns raised by the Dual Diagnosis Forum with
        the Overview and Scrutiny Committee, and issues that have arisen ever
        since, someone from the Emergency Department had contacted Glen
        recently regarding the recommendation that the committee of councillors had
        made for them to contact the forums to look at the issues raised.
     9.2 Rather than ask the staff to come round each forum Glen had suggested
        that they attend an exec panel meeting, which is made up of representatives
        of all 3 forums. This meeting took place last week. Four staff members had
        attended. An associate Director of Nottingham University Hospitals Trust,
        Matron of ED, someone from Transport and a nurse. They met with 5 forum
        members, Glen and Lucy Putland from the CDP.
     9.3 The issues were explained in full. Basically there were the issues around
        discharge policy, lending money for transport and the general way that
        clients are treated.
     9.4 Examples were given where clients had been discharged or sent away in
        the early hours with no means of getting home and no offer of transportation.
        This had included one person having to walk to Bingham, along the A52 and
        3 people with deep vein thrombosis having to walk home across the City.
        One member present gave an example of inconsistency where he had gone
        on one occasion and was given a taxi home when he was ok, then recently
        he had gone in with a head injury and serious DVT and was told to walk
        back to Radcliffe on Trent. There were some examples of people being
        given cash with an IOU from the finance office or medication on credit.
     9.5 The staff confirmed that transport is available 24 hours a day based on a
        medical assessment of need, or people on benefit can claim any monies
        spent back later. They were unaware of any kind of IOU scheme in progress.
        They were concerned that there seemed to be some inconsistencies in
        approach.
     9.6 We made it clear that we were not suggesting a free taxi service for
        everyone, as this would likely bankrupt the trust within weeks, and we did not
        pretend that there was a simple solution to this, especially when the ED
        comes under immense strain at times from a deluge of alcohol related
        incidents, including abuse and violence. Nor are members claiming that they
        are all completely innocent in this equation. The concern raised is that there
        seems to be some very obvious cases where the policy has not been
        administered satisfactorily and that clients may well have been put at risk.
        There was a further concern that it could appear sometimes that individuals
        may be making moral or social assessments rather than medical ones. At
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          the very least there was a need to look at what the policies are, how they are
          administered and what steps are carried out to assure consistency of
          approach. We do not pretend to have any magic answers, nor do we expect
          any, but it is useful to start a dialogue and raise awareness.
       9.7 Glen informed the group that he had met the week before with Katie
          Moore, who does Public and Patient Involvement (PPI) for the hospitals and
          identified where the forums can feed into their mechanisms and where
          members would be welcome to be involved personally on a series of groups.
       9.8 Glen agreed to feed back to Overview and Scrutiny that the meeting had
          taken place and that we had been visited by all the relevant staff from the
          hospital, at all levels. Members agreed to try and obtain an IOU slip for the
          staff to look at (Glen now has one for medication dispensed when a patient
          had no money). The staff agreed to look at the issues within the department,
          talk to relevant staff and to feed back to the committee. Glen will report to
          Katie Moore and start to send forum minutes to her to feed into the PPI
          process in future.
       9.9 Members were impressed that we had received a full delegation from ED
          and that they appeared to be taking the issue seriously. The meeting had
          been very fruitful and it was hoped that some better understanding may
          come from it. Sally and Alix are to deliver anti stigma training at QMC.
          Anyone interested should speak to Sally or Alix

10.   Any other business
      None


      Date and time of the next meeting
       The date of the next meeting is:
                                                   th
        WEDNESDAY 30 September
                2009
           Meeting 10.00am-1.00pm. Lunch 1-2pm at the Voluntary Action Centre,
                             7 Mansfield Road, Nottingham.
      The forum is so busy now people must pre book a place. There are no
      places available on the day. Booking opens one week before the meeting.
      I.e. on Wednesday before.
      Anyone attending for the first time is welcome to contact Glen Jarvis on
      0115 9156377 to confirm their attendance and request peer support if
      required. Reimbursement payments are made at 1pm after the business of
      the meeting. No early payments will be made.
      The meeting starts at 10am prompt.
      glen.jarvis@nottinghamcity.gov.uk
      Mobile 07932 805 706 (flash it to get call back. You might need to do a
      couple as they stack up on a Wednesday and Glen has a crap council
      phone!)
      You can get a key worker to phone for you, but you must get your place
      confirmed. Leaving a message does not get you a place!




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                              In partnership…Get involved
Note: Forum minutes and the details of the alcohol and drug forums are available
from the fantastic Partnership Development Team website:

 “If you use local Health or Social Care services in Greater Nottingham
 or if you are a carer for someone who does, you can help change the
                way services are planned and developed.”
                             www.pdteam.org.uk
                    Information on services in Nottingham is available at:
                     www.referrersguide.com and www.talktofrank.com
                                 www.nottinghamcdp.com

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