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									                                                                 Peter Whalan
          To the Chair and Members
                                                                 742226
                      of the
                                                                 PJW/ED – R82/60

     HEALTH SCRUTINY SUB-COMMITTEE
                                                                 Email
                                                                 peter.whalan@newcastle-staffs.gov.uk


                                                                 11 July 2008




Dear Sir/Madam

A meeting of the HEALTH SCRUTINY SUB-COMMITTEE will be held in the COUNCIL
CHAMBER, CIVIC OFFICES, MERRIAL STREET, NEWCASTLE on WEDNESDAY,
23 JULY 2008 at 7.00pm.

                                    AGENDA

1.    Minutes of meeting held on 9 April 2008 (copy attached).
2.    To receive any declarations of interest in respect of items included on the
      agenda.
3.    To consider the report of the Executive Management Team (copy attached –
      white paper).
4.    To consider any business which is urgent within the meaning of Section 100B(4)
      of the Local Government Act 1972.

                                   Yours faithfully

                                   A CAMPBELL

                           Democratic Services Manager
                         NEWCASTLE-UNDER-LYME BOROUGH COUNCIL

                      EXECUTIVE MANAGEMENT TEAM‟S REPORT TO THE
                           HEALTH SCRUTINY SUB-COMMITTEE

                                              23 July 2008


1.   PATIENT EXPERIENCE AT UNIVERSITY HOSPITAL OF NORTH STAFFORDSHIRE

     Submitted by:         Scrutiny Officer

     Portfolio:            Safer and Stronger Communities

     Ward(s) affected:     All Wards


     Purpose of the Report

     To advise the Sub-Committee that representatives of the University Hospital of North Staffordshire
     (UHNS) will attend the meeting to update the committee on the patient experience in the Acute
     Assessment Unit.

     Recommendation

     That the Sub-Committee receive and constructively challenge the information to be
     presented by the representatives of the University Hospital of North Staffordshire.

     Reasons

     The Sub-Committee should seek to continually enhance its relationship with the local acute trust to
     ensure local health services and providers are transparent and accountable.

     1.     Background

     1.1    Val Doyle, Chief Operating Officer at the University Hospital of North Staffordshire, attended
            the last meeting of the Sub-Committee to discuss concerns associated with the day-to-day
            operation of the Accident and Emergency Department since its amalgamation with the
            Medical Assessment Unit to become the Acute Assessment Unit (AAU).

     1.2    The Sub-Committee had received the following representations from local residents in
            respect of patient and public experiences at the AAU:

            (i)     That many patients, the majority elderly in various forms of distress, were left in a
                    corridor for three or more hours on trolleys that brought them in from the ambulance.
            (ii)    That corridors were cold, overcrowded and uncomfortable.
            (iii)   That no seating was provided for those accompanying patients on stretchers.
            (iv)    That no indication was given of the expected length of the wait under such
                    unacceptable conditions.
            (v)     That the hospital and ambulance staff were doing their best to provide a good level
                    of service under unacceptable working conditions.




                                                   1
            (vi)     Whilst emergency cases were given priority, there appeared to be no initial process
                     to separate those who needed A&E treatment and those who should not have been
                     there.
            (vii)    That the whole area including the main reception was depressing, and that there was
                     litter on the floor.
            (viii)   That cleansing gel was not available at the initial point of entry, the outside doors.
                     Those accompanying a stretcher case need to go out of the direct path to apply gel.
            (ix)     That staff deserved better working conditions and that patients expect better
                     management and better facilities from one of the main points of entry to the hospital.

     1.3    The minutes of the previous meeting which are included within your agenda pack detail the
            response provided by Mrs Doyle on behalf of the University Hospital of North Staffordshire.
            It was agreed that Mrs Doyle be invited to this meeting of the sub-committee to outline the
            progress that has been made following the implementation of the new systems to reduce
            problems. It was noted that:

            (i)      All patients within the AAU would be treated within four hours of arrival.
            (ii)     Patient queues in corridors would no longer be acceptable and all patients would be
                     provided with appropriate blankets and pillows to address dignity issues.
                     Furthermore, additional rooms for patient assessment purposes were to be released.
            (iii)    Patients would be moved from the AAU within 30 minutes of their care being
                     completed.
            (iv)     Patients would not „boarded‟ in the AAU but, where applicable, moved to a ward with
                     a care plan once a decision to admit had been made.

            The committee may wish to use the above points to assist in their constructive challenge
            following the presentation of information by Mrs Doyle.




2.   ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2007-08

     Submitted by:          Scrutiny Officer

     Portfolio:             Safer and Stronger Communities

     Ward(s) affected:      All Wards


     Purpose of the Report

     To introduce the Annual Report of the Director of Public Health for 2007-08. (Appendix „A‟ – printed
     on cream paper).

     Recommendations

     (a)   That the Sub-Committee receive the Annual Report of the Director of Public Health.

     (b)   That the Sub-Committee constructively challenge any aspects of the report and identify
           any potential areas of work to be included in a work programme for the remainder of
           the municipal year.




                                                    2
     Reasons

     The Annual Report of the Director of Public Health identifies the big health issues for the primary
     care trust and the locality it serves: what they are, what the PCT has been doing, what more needs
     to be done, and what partner agencies need to do. This report provides a broad overview of the
     health issues facing the Borough and as such it is a key reference document for any planned
     activity on the part of the sub-committee.

     1.     Background

     1.1    Chapter One introduces the report. Chapter Two provides an overview of how the Director
            of Public Health has defined the big health issues for the PCT, and the variety of ways in
            which these issues can be tackled: procurement of services, provision of services and
            persuasion (working in partnership).

     1.2    The big health issues are described in Chapter Three, which gives a flavour of the work that
            has been done, and makes recommendations for what still needs to be done. Three areas
            for action are specified:

                     Reducing health inequalities.
                     Prevention of disease (smoking, obesity, high blood pressure, and alcohol).
                     Improving the quality of life for people long-term conditions (focussing on asthma,
                      chronic obstructive pulmonary disease, diabetes, coronary heart disease, chronic
                      kidney disease, and stroke and transient ischaemic attack).

            These areas complement and support three of the strategic themes from the PCT‟s Strategy
            „A Health Future‟: Staying Healthy, Supporting People with Health Problems, and Reducing
            Health Inequalities.

     1.3    An update on the topics highlighted in previous annual reports is given in Chapter Four
            where it is reported that good progress has been made in many areas, but more needs to
            be done. Chapter Five looks at key public health indicators: ways in which the changes in
            people‟s experience of health and improvements in health outcomes can be tracked.

     2.     List of Appendices

     2.1    The Annual Report of the Director of Public Health for North Staffordshire 2007-08.



3.   ISSUES FROM NHS NORTH STAFFORDSHIRE

     Submitted by:           Scrutiny Officer

     Portfolio:              Safer and Stronger Communities

     Ward(s) affected:       All Wards


     Purpose of the Report

     To advise the Sub-Committee that representatives of NHS North Staffordshire (formerly known as
     North Staffordshire Primary Care Trust) will attend the meeting to update the committee on various
     developments which have occurred since the last meeting and those which are ongoing.


                                                    3
     Recommendations

     That the Sub-Committee receive and constructively challenge the information to be
     presented by the representatives of NHS North Staffordshire.

     Reasons

     The Sub-Committee should seek to continually enhance its relationship with the local primary care
     trust to ensure local health services and providers are transparent and accountable.

     1.     Background

     1.4    The Chief Executive of NHS North Staffordshire, Mr Tony Bruce, has been invited to attend
            the meeting of the sub-committee to update Members on developments in primary care in
            the Newcastle locality of the primary care trust. Mr Bruce has been invited to provided an
            update on:

                     GP Led Health Centre in Newcastle-under-Lyme
                     Out of Hours Service Re-Provision
                     Urgent Care Strategy




4.   NHS NEXT STAGE REVIEW – FINAL REPORT BY LORD DARZI

     Submitted by:          Scrutiny Officer

     Portfolio:             Safer and Stronger Communities

     Ward(s) affected:      All Wards Indirectly


     Purpose of the Report

     To provide the sub-committee with a summary of the NHS Next Stage Review Final Report by Lord
     Darzi, Parliamentary Under Secretary at the Department of Health.

     Recommendations

     (a)    That the NHS Next Stage Review Final Report by Lord Darzi be noted.

     (b)    That the Sub-Committee invite representatives from the local health economy to
     highlight the changes arising from the review that will be realised locally in the near future.

     (c)    That Sub-Committee consider whether it wishes to respond to the consultation on
     the draft NHS Constitution.

     Reasons

     The sub-committee has monitored the progress of the „Our NHS, Our Future Review‟ conducted by
     Lord Darzi over the past twelve months. It is appropriate for the sub-committee to be appraised of
     the conclusions and recommendations arising from the review.



                                                   4
1.    Background

1.1   In July 2007 the Government commissioned the Lord Darzi of Denham, Parliamentary
      Under-Secretary at the Department of Health to undertake a wide-ranging review of the
                              TH
      NHS in time for the 60 anniversary of its establishment on 5 July 2008. The intention of
      the review was to given everyone the opportunity to shape the future vision for the NHS over
      the next decade by ensuring that it focuses on the things that really matter and meets both
      rising expectation and the challenges it will face over that time.

1.2   The sub-committee received update reports and the interim six-month report written by
      Lord Darzi at its meeting on 31 October 2007.

2.    Issues

2.1   The summary of the final report is attached at Appendix „B‟ (salmon paper). The immediate
      steps identified by the review are:

              Every primary care trust will commission comprehensive wellbeing and prevention
               services, in partnership with local authorities, with the services offered personalised
               to meet the specific needs of the local populations.
              A Coalition for Better Health, with a set of new voluntary agreements between the
               Government, private and third sector organisations on actions to improve health
               outcomes.
              Raised awareness of vascular risk assessment through a new „Reduce Your Risk‟
               campaign.
              Support for people to stay healthy at work.
              Supports GPs to help individuals and their families stay healthy.
              Extend choice of GP practice.
              Introduce a new right to choice in the first NHS Constitution.
              Ensure everyone with a long term condition has a personalised care plan.

              Pilot personal health budgets.

              Guarantee patients access to the most clinically cost effective drugs and treatments.

2.2   Following the publication of the Darzi Report a draft constitution has been prepared and is
      based on research into what matters to the public, patients and staff. The next step in the
      process is a public consultation, where everyone can have their say about what is in the
      constitution and how it will work. A guide to help Members understand the purpose of the
      constitution, explain the Government‟s plans and enable this sub-committee to respond to
      the consultation is attached immediately after Appendix „B‟ (also on salmon paper).

2.3   Representatives from the local health economy have been invited to attend this meeting and
      Members may wish to take advantage of the opportunity to enquire with them to what extent
      the recommendations and actions arising from the review will impact on local health services
      in the near future.

2.4   The Sub-Committee may wish to respond to this consultation which will form the basis of the
      next ten years of the NHS. This is a matter for the sub-committee. It should be noted that
      the consultation concludes on 17 October 2008 which is the week after the next scheduled
      meeting of the sub-committee on 8 October 2008. That provides a sufficient amount of time
      for Members to formulate a response between now and the next meeting before submitting




                                                5
            to the consultation before 17 October 2008. A number of questions can be found in the
            appended consultation document which can form the basis of the committee‟s response.

     3.     List of Appendices

     3.1    Summary Letter of the Review by Lord Darzi.

     3.2    Your Guide to the Proposed NHS Constitution.




5.   REVISED CODE OF JOINT WORKING ARRANGEMENTS HEALTH SCRUTINY

     Submitted by:         Scrutiny Officer

     Portfolio:            Customer Service and Transformation, Safer and Stronger Communities

     Ward(s) affected:     All Wards Indirectly


     Purpose of the Report

     To advise the Sub-Committee of the revised code of joint working arrangements for health scrutiny
     in Staffordshire.

     Recommendation

     That the Sub-Committee note the revised code of joint working arrangements for health
     scrutiny in Staffordshire.

     Reasons

     Members of the Sub-Committee should be aware that the Code of Joint Working Arrangements for
     Health Scrutiny provides the framework for health scrutiny activity at borough and district level.

     1.     Background

     1.1    This Sub-Committee is part of a county-wide joint working arrangement for undertaking
            health scrutiny. Since the establishment of this Sub-Committee in the 2002-2003 Municipal
            Year, the code of joint working arrangements has formed the basis of the relationship
            between the County Council‟s Staffordshire Health Scrutiny Committee and the local district
            and borough sub-committees.

     1.2    In view of the various changes to legislation and emerging local factors, the Staffordshire
            Health Scrutiny Committee and the Staffordshire Health Scrutiny Officer‟s Working Group
            revised the code of joint working arrangements. This revision took place earlier this year and
            was agreed by the Staffordshire Health Scrutiny Committee in February 2008. A copy of the
            revised code is attached at Appendix „C‟ (blue paper).

     2.     List of Appendices

            Staffordshire Health Scrutiny Committee – Code of Joint Working Arrangements – Health



                                                  6
6.   STAFFORDSHIRE HEALTH SCRUTINY COMMITTEE – REVIEW OF WORK UNDERTAKEN IN
     2007/08 MUNICIPAL YEAR

     Submitted by:        Scrutiny Officer

     Portfolio:           Not applicable

     Ward(s) affected:    All Wards Indirectly


     Purpose of the Report

     To introduce the review of the work undertaken by the Staffordshire Health Scrutiny Committee in
     the last municipal year.

     Recommendations

     (a)   That the activities of the Staffordshire Health Scrutiny Committee in the 2007/08
     Municipal Year be noted.

     (b)    That the Sub-Committee consider preparing a review of its work at the end of 2008/09
     Municipal Year to be included within the Council‟s Annual Report on Overview and Scrutiny
     Activity.

     Reasons

     In view of the joint working arrangements between the Staffordshire Health Scrutiny Committee and
     the Borough Council‟s Health Scrutiny Sub-Committee, it is important that Members are aware of
     the work that has been undertaken in the last year by the County Council in respect of health
     scrutiny.

     1.     Background

     1.1    The report attached at Appendix „D‟ (lavender paper) from the Staffordshire Health Scrutiny
            Committee outlines the work which that body has undertaken during the 2007/08 municipal
            year. It is useful for Members of this committee to have an appreciation of the work taking
            place at County level to support the improvement of health service provision through
            Overview and Scrutiny.

     1.2    In drawing this report to the attention of Members, the committee may wish to consider
            undertaking a similar exercise towards the end of this municipal year to demonstrate the
            value added by its activities. The Sub-Committee could choose to share this with partners
            across the local health economy, public and patient involvement groups and internally within
            the Council, through the Annual Report on Overview and Scrutiny. Members are
            recommended to consider these options as a potential means of improving engagement.

     2.     List of Appendices

            Staffordshire Health Scrutiny Committee – Review of Work Undertaken 2007/08.




                                                  7
7.   STANDARDS FOR BETTER HEALTH – FINAL DECLARATIONS OF NORTH STAFFORDSHIRE
     COMBINED HEALTHCARE TRUST AND UNIVERSITY HOSPITAL OF NORTH
     STAFFORDSHIRE

     Submitted by:         Scrutiny Officer

     Portfolio:            Safer and Stronger Communities

     Ward(s) affected:     All Wards Indirectly


     Purpose of the Report

     To advise the Sub-Committee of the final declarations made in respect of the Healthcare
     Commission‟s Standard for Better Health by North Staffordshire Combined Health Care Trust and
     the University Hospital of North Staffordshire.

     Recommendation

     That the information be received.

     1.     Background

     1.1    On 9 April 2008 the Sub-Committee received presentations from representatives of North
            Staffordshire Combined Healthcare Trust and the University Hospital of North Staffordshire
            in respect of their proposed declarations in accordance with the Healthcare Commission‟s
            Standards for Better Health. Following the presentations, the Sub-Committee agreed its
            third party commentaries in respect of both trusts. This report serves to complete the circle
            and provide Members with the final declarations by North Staffordshire Combined
            Healthcare Trust and the University Hospital of North Staffordshire. Copies of the
            declarations are attached as Appendix „E‟ (orange paper) and Appendix „F‟ (pink paper).

     2.     List of Appendices

            Final Declaration – North Staffordshire Combined Healthcare Trust.

            Final Declaration – University Hospital of North Staffordshire.




                                                   8
                            APPENDIX „A‟
                            (Cream paper)




ANNUAL REPORT
OF THE
DIRECTOR OF PUBLIC HEALTH



2007/08
Editorial Group
Author:       Dr Judith Bell


Contributors: Alison Pryce, Head of Health Intelligence

              Jackie Small, Head of Health Improvement

              Hil Moss, Local Strategic Partnership Project Officer
Contents

Chapter One:
Introduction ...........................................................................                           1

Chapter Two:
Defining the Big Health Issues for North Staffordshire PCT                                                         3
2.1 How do we define the big health issues and what are they? ...............                                      4
2.2 How do we tackle the big health issues?................................................                        6


Chapter Three:
What are the Big Health Issues for North Staffordshire PCT? 10
3.1 Health inequalities ...................................................................................       10
    3.1.1 Life expectancy ................................................................................        10
    3.1.2 Premature death ..............................................................................          11
    3.1.3 Deprivation .......................................................................................     12

3.2 Prevention of disease ..............................................................................          15
    3.2.1 Smoking ...........................................................................................     15
    3.2.2 Obesity .............................................................................................   16
    3.2.3 High blood pressure .........................................................................           18
    3.2.4 Alcohol .............................................................................................   21

3.3 Improving the quality of life for people with long-term conditions ......                                     24
     3.3.1 Asthma .............................................................................................   24
     3.3.2 Chronic obstructive pulmonary disease ............................................                     25
     3.3.3 Diabetes ...........................................................................................   27
     3.3.4 Coronary heart disease ....................................................................            29
     3.3.5 Chronic kidney disease ....................................................................            31
     3.3.6 Stroke and transient ischaemic attack ..............................................                   33


Chapter Four:
Progress with Last Year‟s Priorities ...................................                                          36

Chapter Five:
Key Public Health Indicators ...............................................                                      39

Glossary ................................................................................                         40
Chapter One:
Introduction
Real improvements in health and well-being only happen when everyone – individuals,
communities, services, researchers, government – work together.

Chapter Two gives an overview of how I have defined the big health issues for the PCT, and the
variety of ways in which these issues can be tackled.

Chapter Three describes the big health issues, gives a flavour of the work that has been done,
and makes recommendations for what still needs to be done.

Today the opportunity for a long and healthy life is still linked to your social circumstances and
your characteristics: where you live, what job you do, your race and your gender. The difference in
life expectancy of 9.7 years across the wards of the PCT is unacceptable. Joint working is crucial
to address the wider actions needed, which go beyond what NHS organisations on their own can
do.

In Section 3.1, I describe how improvements to life expectancy have not been matched equally by
advances in healthy life expectancy. We are spending longer periods in poor health at the end of
our live. This burden is unequally distributed.

The „Staying Healthy‟ strand of the PCT Strategy aims to tackle just this, and help to advance
healthy life expectancy through major investments in:

   smoking cessation and tobacco control

   adult obesity

   childhood obesity

   improving life expectancy (cardiovascular disease screening programme)

   alcohol misuse

   children and families.

Inequalities are relevant at all stages of care, not just in relation to staying healthy. Deprivation is
associated with a poorer outcome for bowel cancer because people seek help later, making
treatment more difficult. People with mental health problems experience „downward social drift‟ as
they are increasingly disabled before they are in contact with services. Health equity audit is one
tool that can be used to assess rates compared with prevalence figures as shown in the joint
strategic needs assessment.

Prevention is undoubtedly better than cure. Smoking is the single greatest cause of preventable
disease and premature death in the UK. We need to take a different approach to encouraging the
people of North Staffordshire not to start smoking and to helping them to stop smoking. We are
planning significant investments in improving the access to, and range of, smoking cessation
services.

Obesity continues to be a growing problem, especially in children. Again, in taking the PCT‟S
strategy forward, we are planning to make considerable investments to tackle this.

High blood pressure, despite progress in prevention, detection, treatment and control, remains an
important public health problem for the PCT. We need to promote awareness of the condition, and
the relevant lifestyle changes, such as reducing salt intake and increasing physical activity.
The increasing problem of alcohol misuse has resulted in dramatic increases in the rates of
alcohol-related hospital admissions. Helping people to stop binge drinking is important, but we
must not lose sight of the dependent drinkers, many of whose lives would benefit from intensive
help. But this is not just about treatment, it‟s about availability and awareness.

Six long-term conditions have been highlighted, with a clear focus on cardiovascular disease.

Coronary heart disease, diabetes, chronic kidney disease and stroke between them cause a huge
amount of ill health and premature death. These diseases manifest themselves in very different
ways, but they share the same risk factors: high blood pressure, smoking, obesity, poor diet, and
lack of physical activity. Moreover, these diseases often serve as risk factors for each other. Our
understanding of the most effective approaches to prevention, risk assessment and management
of cardiovascular disease has developed considerably in recent years and we now need to turn
our knowledge into action.

An update on the topics highlighted in the previous annual reports is given in Chapter Four. Good
progress has been made in many areas, but more needs to be done.

Chapter Five looks at key public health indicators: ways in which we can track the changes in
people‟s experience of health and improvements in health outcomes. I hope that colleagues who
work in areas aligned with the local authorities boundaries, and colleagues in practice-based
commissioning, find this information useful.

Throughout the report, I have given examples of what we have been doing to improve health and
well-being – but with the clear recognition that more needs to be done. I am grateful for the
support and commitment of the many colleagues who have worked with us over the last year, and
look forward to building on this in the coming year.




Dr Judith Bell
Director of Public Health
North Staffordshire PCT
Chapter Two:
Defining the Big Health Issues for North Staffordshire PCT

          In this Chapter, I outline how I have identified the big health issues for the
          people of North Staffordshire PCT. I then give an overview of the ways in
          which I work with others to tackle these issues.

          In Chapter Three, I describe each of the big health issues, and make
          recommendations for what the NHS and partner organisations need to
          do.


How do we improve the health and well-being of the people of North Staffordshire PCT? By
preventing disease, prolonging life and actively promoting health and well-being.

My role as Director of Public Health is to provide public health leadership in partnership with others
to ensure that the needs of the local people are assessed – and addressed – through public health
programmes. In order to do this, we need an understanding of the population‟s health, its wider
determinants and a clear focus on identifying and tackling inequalities in health.
2.1 How do we define the big health issues and what are they?

Four specific criteria can be used to identify the big health issues in North Staffordshire PCT:

   the health issue places a large burden on society

   the health issue is distributed unfairly across the population (i.e. it does not affect all people in
    the same way, but affects minorities and disadvantaged individuals to a greater extent)

   there is evidence that preventative strategies could substantially reduce the burden of the
    health issue

   there is a strong evidence-base for high quality care for the health issue (which is not being
    consistently practiced).

Based on these criteria, there are three major health issues.

Health inequalities

While overall levels of health match the UK average, this conceals huge gaps in health experience
within our population: the difference in life expectancy across the PCT is almost 10 years. The
difference between us that more deprived PCTs is in the proportions of people at the lower end of
the scale.

The stark differences in health experience represent the big health issue for North Staffordshire
PCT. Tackling entrenched and enduring inequalities in health is a daunting challenge. Health
inequalities are widening, and will continue to do so unless we do things differently.

Preventing disease

We need a strong emphasis on prevention and early intervention if we are to improve people‟s
health. Prevention of ill-health begins by building good health and a healthy lifestyle from the
beginning of an individual‟s life. This means addressing not only the short-term consequences of
avoidable ill-health, but also the longer-term causes.

We need to target the areas where there is strong evidence that we can have an impact and
prevent disease development.

The big health issues (in terms of risk factors) for North Staffordshire PCT are:

   smoking

   obesity

   high blood pressure

   alcohol consumption.

Improving the quality of life for those with long-term conditions

The PCT also has large numbers of patients with long-term conditions. The big health issues (in
terms of high burden of disease, for which there is a strong evidence base for prevention of disease,
and improving quality of life) are:

   asthma / chronic obstructive pulmonary disease
   diabetes

   coronary heart disease

   chronic kidney disease

   stroke and transient ischaemic attack.
2.2 How do we tackle the big health issues?

There are a variety of ways in which we need to approach this: strategically, operationally, and in
partnership with other agencies.

The main methods for delivering improvements in health and well-being are:

   commissioning

   developing our health improvement function

   working in partnership

   national and local health agendas and associated targets.


2.2.1 Commissioning to improve health and well-being

Proficient local commissioning will help people to stay healthy and independent, and tackle health
inequalities. The Commissioning framework for health and well-being identifies eight steps to more
effective commissioning:


       1   Putting people at the centre of commissioning

       2   Understanding the needs of populations and individuals

       3   Sharing and using information more effectively

       4   Assuring high-quality providers for all services

       5   Recognising the interdependence between work, health and well-being

       6   Developing incentives for commissioning for health and well-being

       7   Local accountability

       8   Capability and leadership


Good commissioning depends on good information: information about communities that will help
commissioners and providers target health improvement resources to those who will most benefit
from them.

A key focus has been the production and promotion of joint strategic needs assessments (JSNAs).
Two JSNAs have been produced for Staffordshire: one of adults and one for children. Both JSNAs
were developed in collaboration with Staffordshire County Council, commissioning colleagues, and
other relevant partners.

I took the lead on the production of the JSNA for children, and the Director of Public Health for
South Staffordshire PCT took the lead on the production of the JSNA for adults.

Both of these reports have been actively promoted to commissioning colleagues within the PCT.
Fundamental to the development of the JSNA for children was the work undertaken by the
Children‟s Trust Commissioner for Staffordshire, in making sure that children and young people
were able to have their say.

Work, health and well-being

Public health also has a duty to ensure that the wider determinants of health are better understood
and inform commissioning decisions. There is a need to improve the health and well-being of
people in employment, and to help individuals improve their well-being through employment.

The NHS, as one of the world‟s largest public bodies, has a considerable opportunity to promote
positive change. It can set an example as a responsible employer by supporting staff who want to
stop smoking, ensuring that on-site catering promotes healthy food and drink choices, and by
promoting physical activity in the work place.

North Staffordshire PCT is the host organisation for the Staffordshire Condition Management
Programme, providing both corporate and clinical accountability. It is a valuable opportunity for
NHS organisations to offer added value to the care and treatment of patients of working age with
long-term health conditions. During the first year of service delivery, the programme has
evidenced improvements in all areas for service users.

Commissioning services from the voluntary sector

The Local Strategic Partnership (LSP) project officer works closely with commissioning colleagues
in the PCT to develop and support commissioning from the voluntary sector. Services are
commissioned taking into account the wider determinants of health, with a particular emphasis on
the inequalities within the PCT.

We also need to continue to support and develop the voluntary sector as service providers, to
encourage the development of innovative services especially for hard to reach groups.

Equity and access

We need to develop – and respond to – health equity audits.

We need to work closely with our commissioners, and service providers, to continue to improve
access and the quality of services for disadvantaged groups – particularly in relation to
preventative services.

We also need to ensure local community involvement continues to be an integral part of initiatives
to tackle health inequalities, to have a greater chance of having a long-term and sustainable
impact.


2.2.2 Developing our health improvement function

The new health improvement function is fully integrated within the Public Health Directorate with
its strong emphasis on reducing health inequalities, preventing disease and promoting health.

The structure has been based on a number of principles, including:

   the health improvement team should work closely with other staff in the PCT, particularly the
    commissioning teams, developing matrix type working to establish health improvement as an
    integrated element of the PCT function
   senior staff will need to have well developed influencing and partnership skills as well as ability
    to access and evaluate evidence (they will need to become key players in local partnership
    developments and in the delivery of the Local Area Agreement outcomes and Local Strategic
    Partnership delivery plans).
2.2.3 Working in partnership

Improving health and well-being is everyone‟s responsibility: individuals, communities, health
services, social services, and local and national government. Working in partnership is crucial,
based on a co-ordinated approach that addresses all the factors determining the public‟s health.

Examples include:
Staffordshire Strategic Partnership
Newcastle-under-Lyme Local Strategic Partnership
Staffordshire Moorlands Local Strategic Partnership
Community and Voluntary Services
Overview and Scrutiny Committees
Staffordshire Children‟s Trust Board
Staffordshire Safeguarding Children‟s Board
Newcastle Borough Children‟s Trust Board
Staffordshire Moorlands District Children‟s Trust Board
Staffordshire Healthy Schools Strategic Partnership Group
Staffordshire Teenage Pregnancy Partnership
Staffordshire Drug and Alcohol Action Team Partnership
Staffordshire Joint Commissioning Unit
Health Protection Agency
Northern Staffordshire Health Economy Pandemic Flu Planning Group
North Staffordshire Tuberculosis Network
Greater Midlands Cancer Network
University Hospital of North Staffordshire Clinical Interface Group
Darwin Training Consortium

Comprehensive Local Research Network Board

West Midlands Deanery, Postgraduate School of Public Health Board (Training
Executive Committee)



2.2.4 National and local health agendas and associated targets

There are many national and local policy drivers that are used to concentrate and co-ordinate
activities to improve health and well-being.

The government has identified national priorities for improving health. The NHS Improvement Plan
set out the Public Service Agreement (PSA) targets agreed between the Department of Health and
the Treasury, which include challenging public health targets.

The PSA targets from the NHS Operating Framework 2007/08 were based on four priority areas:
   improving the health of the population

   supporting people with long-term conditions

   access to services

   patient/user experience.

A full list of the PSA targets is on the PCT’s website.

The NHS Operating Framework for 2008/09 describes the priorities for the coming year. These
targets set out are in the form of ‘vital signs’, broken down into three tiers:

   national requirements
    (as set out in vital signs A targets, such as VSA14 which focuses on improving the quality of
    stroke care)

    national priorities for local delivery
    (as set out in vital sign B targets, such as VSB05 which focuses on reducing the number of
    smokers)

   local priorities
    (as set out in vital sign C targets, such as VSC26 which focuses on reducing hospital admissions
    for alcohol-related harm).

A full list of the vital signs targets is on the PCT’s website.

In order to identify local priorities, the PCT involved members of the Professional Executive
Committee, the Patient Public involvement Forum, members of the Practice Based Commissioning
clusters and both the Newcastle-under-Lyme and Staffordshire Moorlands LSPs along with input
from the Public Health Directorate.

In setting local priorities for action, the PCT will also be concentrating its efforts on long-term
conditions that I have identified as the big health issues for the PCT, namely:

   asthma / chronic obstructive pulmonary disease

   diabetes

   coronary heart disease

   chronic kidney disease

   stroke and transient ischaemic attack.

Setting explicit local targets will help us to monitor our progress in improving the health and quality
of life of people with these conditions.

In addition to the local vital sign C targets, there are the Local Area Agreement (LAA) targets
which are set and monitored by Staffordshire Strategic Partnership.
Chapter Three:
What are the Big Health Issues for North Staffordshire PCT?
3.1 Health inequalities

What are the health inequalities in North Staffordshire PCT?

The opportunity for a long and healthy life is linked to your characteristics (your gender and race)
and your social circumstances (where you live and the job that you do).

Differences in health experience are illustrated by the patterns in life expectancy and premature
death.

                              By 2010, increase life expectancy at birth in England
                                to 78.6 years for men and 82.5 years for women
                                   (PSA Priority I: targets PSA01 to PSA11)

                          By 2010, to reduce inequalities in health outcomes by 10%
                          as measured by infant mortality and life expectancy at birth
                                 (PSA Priority I: targets PSA06 and PSA07)

3.1.1 Life expectancy

People have been living longer over the past 20 years, but the extra years have not necessarily
been lived in good health. Life expectancy – and healthy life expectancy – both increased between
1981 and 2001, but with life expectancy increasing at a faster rate than healthy life expectancy.

The difference in life expectancy across the wards in North Staffordshire PCT is 9.7 years. The
difference in healthy life expectancy across the wards in North Staffordshire PCT is 18.7 years.

So we are living longer, but the time that we spend in less good health is getting longer too.

Variation in life expectancy and healthy life expectancy by ward

                                                     Lowest                                   Highest

Life expectancy

                        males              68.5          Town                        80.5          Cellarhead

                      females              75.7          Bradwell                    85.1          Westlands

                     persons               73.4          Leek North                  83.1          Dane

Healthy life expectancy

                        males              60.3          Holditch                    80.1          Westlands

                      females              66.5          Holditch                    77.4          Westlands

                     persons               63.3          Holditch                    76.7          Alton
Note: Healthy life expectancy estimates are not calculated for wards with the 2001 population estimates less than 1,000, and
therefore separate estimates for males and females have not been calculated for eight wards: Alton, Biddulph Moor, Biddulph South,
Dane, Hamps Valley, Horton, Ipstones, and Manifold.
Source: Life expectancy and healthy life expectancy at birth for males, females, and persons, 1999 to 2003
(experimental statistics), ONS, 2007 http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=12964
Nationally, three key interventions have been identified as having the potential to make the
greatest contribution to closing the life expectancy gap:

   reducing smoking in manual social groups

   preventing and managing other risks for coronary heart disease and cancer, such as poor diet
    and obesity, physical inactivity and high blood pressure through effective primary care
    (especially targeting the over-50s)

   improving housing quality by tackling cold and dampness, and reducing accidents at home and
    on the road.

The particular impact that improving housing quality and reducing accidents will have on the life
expectancy of our population is unclear. Locally, the most restrictive wider determinants of health
are employment and educational attainment.


3.1.2 Premature death

Saving Lives, Our Healthier Nation was the current comprehensive government plan focused on
the main killers: cancer, coronary heart disease and stroke, accidents, mental illness. It was an
action plan to reduce deaths from preventable illnesses, focussing on improving the health of
those worst off. The four targets were:

By the year 2010

   cancer: to reduce the death rate in people under 75 by at least a fifth

   coronary heart disease and stroke: to reduce the death rate in people under 75 by at least
    two fifths

   accidents: to reduce the death rate by at least a fifth and serious injury by at least a tenth

   mental illness: to reduce the death rate from suicide and undetermined injury by at least a
    fifth.

Statistics are produced separately for the PCT and local authority areas. The geography of North
Staffordshire PCT does not match exactly to the local authority areas of Newcastle-under-Lyme and
Staffordshire Moorlands, making direct monitoring of trends over time for the PCT problematic.
However, it is possible to compare recent death rates (2004 –2006 pooled) of the PCT with those of
England as a whole. This are summarised in the table next page.

At a local level, the very small numbers of infant deaths make it difficult to make any conclusive
judgements about this data.

Nationally, the following key short-term interventions have been identified as having the potential
to make the greatest contribution to closing the gap in infant mortality:

   improving the quality and accessibility of antenatal care and early years support in
    disadvantaged areas

   reducing smoking and improving nutrition in pregnancy and early years

   preventing teenage pregnancy and supporting teenage parents
 improving housing conditions for children in disadvantaged areas.
Premature death rates (directly standardised rate, 2004-06, pooled per 100,000 population)

                                     PCT          England

All causes
                                   315.4          309.6            not significantly different
(<75 years)

Cancer
                                   114.6          117.1            not significantly different
(<75 years)

Circulatory disease
                                    84.4           84.2            not significantly different
(<75 years)

Accidents
                                    19.7           15.9            PCT significantly higher
(all ages)

Suicide
and injury undetermined              5.8               8.3         PCT rate significantly lower
(all ages)

Source: NCHOD

Premature death rate (rate per 1,000 population, January 2003-December 2005)

                        Newcastle-     Staffordshire
                        under-Lyme      Moorlands        England
                            BC              DC

Infant mortality            5.6            3.1               5.1      not significantly different

Source: ONS

The premature death data appears to give a relatively positive picture of health in the PCT – in
direct conflict to the life expectancy and healthy life expectancy data. The premature death rates
represent the average for the PCT as a whole, and therefore hide the variation in health experience.

Clearly life expectancy and mortality are long-term outcomes, and we need ‘interim outcome
measures’ that can be tracked over shorter time periods to monitor progress (e.g. breast feeding,
smoking in pregnancy). However, we also need to be clear about measuring things that matter, and
not just what can be measured.


3.1.3 Deprivation

Deprivation in its widest sense lies at the heart of health inequalities. Although deprivation is
classically associated with larger towns and cities, the latest deprivation indices reveal pockets of
severe deprivation within Newcastle-under-Lyme.

Deprivation is relative, and the usual way to look at it is to focus on the top 10% most affected
areas. Areas are assessed against the following domains, which are combined to give an overall
score:

   income
   employment

   health and disability

   education, skills and training

   barriers to housing and services

   crime

   living environment.

In terms of overall deprivation, three super output areas (SOAs)* in the PCT are in England‟s 10%
most deprived. These are in three wards: Cross Health, Knutton and Silverdale, and Chesterton.

The issues across the PCT differ substantially: in Newcastle-under-Lyme key issues are
education, skills, and training, and health and disability, and in the more rural Staffordshire
Moorlands the challenges mainly relate to barriers to housing and services.

When we look at the seven individual domains that make up the overall deprivation score, a further
16 wards have SOAs that are in England’s 10% most derived. The most common domain is
education, skills and training group, affecting 10 of the 48 wards in the PCT.

From 2004 to 2007, there have been increases in deprivation in terms of education, skills and
training (with three new areas being identified) and barriers to housing and services (two new
areas). The biggest improvement was seen in a reduction in deprivation in terms of crime (a
decrease of two areas, both within Biddulph East).

Six wards contain SOAs which experience high levels of deprivation as measured by the barriers
to housing and services domain. These are in the rural wards of Dane, Hamps Valley, Horton,
Ipstones, Manifold, and Horton, and Loggerheads and Whitmore. This reflects the sparsely-
populated nature of these areas.

What are we doing?

   Reducing health inequalities is a fundamental ambition within the PCT Strategy, identified as
    being key to driving the delivery of improvements in health and well-being. The focus is on
    reducing unacceptable differences in life expectancy. We also need to concentrate on adding
    life to years as well as adding years to life.

   Actively promoting inequalities issues, and sharing data on life expectancy, healthy life
    expectancy and deprivation data widely: from Board papers to formal and informal
    presentations. This information is used to inform planning and commissioning decisions.

   Commissioning effective, accessible healthcare and working in partnership are the two
    fundamental levers. The LAA, Staffordshire Children‟s Trust, Newcastle-under-Lyme LSP and
    Staffordshire Moorlands LSP play a key role.



* SOAs are a new way to measure geographical areas. SOAs avoid the problems caused by the inconsistent and
unstable electoral ward geography, and are more consistent in terms of the numbers of people who live in the area.
What more needs to be done?

What more can the NHS do?

      Continue to work in partnership.
      Carry out further needs assessments where appropriate to identify the most important
       issues for our population.
      Ensure that commissioning decisions are made with a clear emphasis on reducing health
       inequalities.
      Promote fair access to care.
      Be a good corporate citizen and employer.

What more can our partners do?

      Continue to work to improve the wider determinants of health (housing, benefits, fuel
       poverty, transport, crime, employment).
      Ensure that commissioning decisions are made with a clear emphasis on reducing health
       inequalities.
      Promote fair access to services.
      Be a good corporate citizen and employer.
3.2 Prevention of disease


3.2.1 Smoking

Why is stopping smoking still important?

Smoking kills. It is the single greatest cause of preventable illness and premature death in the UK.
Smoking, more than any other identifiable factor, contributes to the gap in healthy life expectancy
between those most in need and those most advantaged.

Many children experiment with smoking, believing they will be able to stop when they want to. But
smoking is highly addictive and many will find themselves unable to give up. The younger people
start to smoke, the more likely they are to smoke for longer and to die from smoking.

National trends show a decrease in the numbers of smokers, although it is estimated that a
quarter of the population still smoke.

According to the General Household Survey in 2005, smoking prevalence in the West Midlands
was 22%, just below the national prevalence of 24%. The table below gives synthetic estimates for
smoking prevalences across the West Midlands.

Smoking prevalence estimates by PCT in the West Midlands (1998-2001)

    Shropshire and Staffordshire SHA                27%

    South Western Staffordshire                     23%

    East Staffordshire                              25%

    Shropshire County                               25%

    Staffordshire Moorlands                         25%

    Burntwood, Lichfield and Tamworth               27%

    Newcastle-under-Lyme                            28%

    Cannock Chase                                   29%

    Telford and Wrekin                              29%

    South Stoke                                     31%

    North Stoke                                     34%

Source: West Midlands Key Health Data 2006/07

Can we intervene effectively?

Yes. Without help, between 4-5% of people will successfully quit smoking. Using NHS Stop
Smoking services quadruples a smoker‟s chance of successfully quitting.

The most recent NHS Stop Smoking services success rate data (April to December 2007) show
that 49% of people using our service had successfully quit at 4 weeks. Only one PCT in the West
Midlands achieved a 4-week quit rate of over 50%.
So we need to look at increasing access to the service, and new ways of improving the 4-week
quit rate.

What are we doing?

   Helping people to stop smoking. North Staffordshire Stop Smoking Service was established in
    1999, and consists of a number of integrated cessation schemes delivered in a wide range of
    settings across both Stoke-on-Trent and North Staffordshire PCTs.

   Applying social marketing techniques to improve our smoking cessation services. This
    recognises the diversity within the target groups, and identifies the most appropriate way to
    communicate health messages to different populations.

   In taking the PCT’s Strategy forward, we are planning additional significant investments in
    improving the access to, and range of, smoking cessation services.


What more needs to be done?

What more can the NHS do?

       Support people who want to stop smoking (including helping employees who want to stop
        smoking).
       Ensure that our stop smoking services are as effective as possible.
       Target manual workers, pregnant women, young people as well as our disadvantaged
        communities to encourage smokers to stop.
       Ensure diversity in service provision (providing a range of services in a variety of settings).
       Train all front line staff to offer consistent brief advice on stopping smoking.
       Support smokefree homes (young children as especially vulnerable to passive smoking in
        homes).

What more can our partners do?

       Support employees who want to stop smoking.
       Continue to reduce the number of under-age smokers by identifying and prosecuting
        retailers who sell to children under 16 (and maximise the use of media by the publication of
        warnings, successful prosecutions and health information where appropriate).
       Continue to act on information concerning the location of cigarette vending machines on
        premises where children have access.
       Promote initiatives that tackle tobacco smuggling.
       Provide support to small- and medium-sized businesses to help them address the
        measures of the smokefree legislation.

What can the individual do?

       Give up smoking - contact the PCT‟s Stop Smoking Service.



3.2.2 Obesity

Data from North Staffordshire PCT GP disease registers (for patients aged 16 and older) shows
that as at 31 March 2007, 10.0% of patients were obese compared with 9.1% in England as a
whole.
Why does obesity matter?

Being overweight or obese can have a severe impact on an individual’s health, both are associated
with an increasing risk of diabetes, cancer, and heart and liver disease.

And the risks get worse the more overweight you become.

In recent years Britain has become a nation where overweight is the norm. The increase in
overweight and obesity, in both children and adults, is remarkable. By 2050, it is estimated that
60% of adult men, 50% of adult women and about 25% of all children under 16 could be obese.

Childhood obesity is closely linked with early onset of preventable disease, including diabetes. But
the consequences of obesity in childhood go further and include social stigma, discrimination and
prejudice linked to low self-image, low self-esteem and depression. Moreover, overweight
adolescents have a 70% chance of becoming overweight or obese adults.

During 2006/07, obesity in childhood was measured in two school years:

Reception Year (children aged 4 to 5)     PCT obesity rate = 12.4%, England obesity rate = 9.9%

Year Six (children aged 10 to 11)         PCT obesity rate = 18.8%, England obesity rate = 17.5%

Can we intervene effectively?

The current prevalence of obesity in the population has been at least 30 years in
the making. This will take time to reverse and it will be a considerable number of years before
reductions in the prevalence of obesity – and its associated diseases – are seen.

The evidence is very clear that policies aimed solely at individuals will be inadequate and that
significant effective action to prevent obesity at a population level is required.

What are we doing?

   Working in partnership, through the LAA.

   Monitoring the impact: the PCT has a well-established information system for monitoring
    school children‟s height and weight.

   Encouraging local schools to join up to the National Healthy Schools Programme, which
    includes action on physical activity and food.

   Exploring the potential of other organisations, such as „Sure Start‟, to address the issue of
    childhood obesity.

   Proactively promoting the PCT‟s exercise-on-prescription programme, „Go5‟.

   Running a range of initiatives, including „Walk to Water‟ and promoting free swimming during
    the school holidays, aimed at helping people to become more active.
What more needs to be done?

What more can the NHS do?

       Set an example as a responsible employer by ensuring that on-site catering promotes
        healthy food and drink choices, and by promoting physical activity in the work place.
       Increase access to exercise and healthy eating opportunities that fit easily into people‟s
        everyday lives, and support people‟s circumstances and preferences.
       Promote healthy infant feeding, including targeted provision of „positive parenting‟ advice
        and classes, and supporting families with family-based interventions.
       Promote and monitor use of the NICE guidelines for preventing overweight and obesity.

What more can our partners do?

       Local authorities can also set an example as employers, and should ensure that on-site
        catering promotes healthy food and drink choices, and promote physical activity in the work
        place.
       Improve access to well-maintained, safe, affordable, and convenient leisure and sports
        facilities.
       Through the LSPs, work to remove barriers to healthy eating by improving availability and
        access. Encourage local shops and supermarkets to promote healthy food and drink
        choices.
       Increase the range of healthy food choices (and make it more difficult to make unhealthy
        food choices) in schools. Increase the opportunity for physical exercise in schools.
        Encourage active travel to and from school.

What can the individual do?

       Eat healthily (reduce fat intake, increase intake of fruit and vegetables) and exercise
        regularly (at least 30 minutes a day on five or more days a week).



3.2.3 High blood pressure

Data from North Staffordshire PCT GP disease registers (for all patients) shows that as at 31
March 2007, 15.1% of patients had high blood pressure compared with 12.5% in England as a
whole.

Why does high blood pressure matter?

High blood pressure is the most important modifiable risk factor for stroke, plays a major role in
coronary heart disease, and is a key risk factor in diabetes and chronic kidney disease.

According to the World Health Organisation, the burden of disease attributable to a systolic blood
pressure of 115mgHg or above is:

   20% of all deaths in men and 24% of all deaths in women

   62% of strokes and 49% of coronary heart disease, and

   11% of disability adjusted life years.
Can we intervene effectively?

Yes. There are effective interventions to treat and control high blood pressure, but many people
with high blood pressure are not treated or receive inadequate treatment.

There are a number of lifestyle interventions that have been shown to be effective for primary
prevention of high blood pressure. These are:

   maintaining a normal body weight

   reducing salt intake

   taking regular physical exercise

   limiting daily alcohol consumption

   maintaining an adequate intake of dietary potassium

   having a diet rich in fruits and vegetables, and in low-fat dairy products with a reduced content
    of saturated and total fat.

Primary care management of hypertension varies across the PCT. This can be seen clearly in the
differences between GP practices in achieving the quality indicators for people with high blood
pressure.

Summary of achievement across the QOF hypertension quality indicators

QOF Indicator                                            Lowest to highest      Achievement
                                                           GP practice         across the PCT
                                                           achievement           as a whole
The percentage of patients with hypertension in
                                                          75.8% to 98.0%            93.2%
whom there is a record of the blood pressure in the
previous 9 months
The percentage of patients with hypertension in
                                                          46.3% to 92.7%            76.2%
whom the last blood pressure (measured in the
previous 9 months) is 150/90 or less
Source: QMAS data as at 31 March 2007

Several other quality indicators relate to the measurement and control of high blood pressure in
specific groups of patients. Again, there are significant variations between GP practices in the
proportions of eligible patients in whom blood pressure is regularly monitored and adequately
controlled.

We need to better understand what this quality indicator data is telling us, and work with low-
achieving GP practices to improve care for people with high blood pressure.
Summary of achievement across the QOF quality indicators related to the management of
hypertension

QOF Indicator                                                 Lowest to        Achievement
                                                               highest        across the PCT
                                                             GP practice        as a whole
                                                             achievement
The percentage of patients with diabetes who have a
                                                            89.5% to 100%          98.7%
record of the blood pressure in the previous 15 months
The percentage of patients with diabetes in whom
                                                            45.2% to 96.6%         76.0%
the last blood pressure is 145/85 or less
The percentage of patients with coronary heart
                                                            93.3% to 100%          98.1%
disease whose notes have a record of blood
pressure in the previous 15 months
The percentage of patients with coronary heart disease
                                                            65.2% to 97.2%         86.8%
in whom the last blood pressure reading (measured in
the previous 15 months) is 150/90 or less
The percentage of patients on the CKD register
                                                            90.3*% to 100%         98.1%
whose notes have a record of blood pressure in the
previous 15 months
The percentage of patients on the CKD register in
                                                            59.6*% to 100%         81.0%
whom the last blood pressure reading, measured in
the previous 15 months, is 140/85 or less
The percentage of patients with TIA or stroke who
                                                            85.2% to 100%          97.2%
have a record of blood pressure in the notes in the
preceding 15 months
The percentage of patients with a history of TIA or
                                                            57.3% to 100%          84.7%
stroke in whom the last blood pressure reading
(measured in the previous 15 months) is 150/90 or
less
* excluding practices with less than 30 eligible patients

Source: QMAS data as at 31 March 2007

What are we doing?

        As part of the primary care performance monitoring, QOF visits are made to outlier GP
         practices with low scores.


What more needs to be done?

What more can the NHS do?

        Increase access to exercise and healthy eating opportunities to help prevent high blood
         pressure in high-risk groups (people with blood pressure in the range 130-139/80-89mgHg
         i.e. those most likely to go on to develop high blood pressure, and those people who
         already have cardiovascular disease, diabetes, chronic kidney disease, or retinal disease).
        Improve the early identification of people with high blood pressure in high-risk groups
         (those patients at high overall risk of cardiovascular disease, or those with signs or
         symptoms of target organ damage that may be due to high blood pressure).
        Increase access to effective treatments to lower blood pressure, and promote patient
         adherence.
        Ensure better monitoring to help control high blood pressure, using a systematic method.
        Implement workplace health initiatives.
What more needs to be done? (continued)

What more can our partners do?

       Provide convenient facilities for a wide range of exercise opportunities (with a focus on
        men aged over 35 years of age).
       Increase the opportunities for physical activity in schools and increase the range of healthy
        food choices (particularly with regard to reduced salt intake) in schools. Encourage active
        travel to and from school.
       Implement workplace health initiatives.

What can the individual do?

       Eat healthily (reduce salt intake, increase fruit and vegetable intake), increase physical
        activity (at least 30 minutes a day on five or more days a week), drink alcohol sensibly.



3.2.4 Alcohol

Why does alcohol consumption matter?

Excessive alcohol consumption is known to lead to a range of health problems, including chronic
liver disease, alcoholic poisoning, alcohol-induced pancreatitis, and stomach cancer.

But it’s not just about the direct disease effects. Excessive alcohol consumption also has a negative
effect on communities. This can be seen in increasing anti-social behaviour, acts of violence,
accidents, crime, risky sexual activity (potentially leading to teenage pregnancies and
sexually transmitted infections), and truancy from school.

Over recent years, there has been a dramatic increase in the number of alcohol-related
admissions.

What are we doing?

   Commissioning community addiction services provided by Alcohol and Drug Services in
    Staffordshire (ADSiS) to support those people with less severe alcohol dependency to be
    managed in a home setting.

   Providing a new „brief intervention‟ service, aimed at people who misuse alcohol who are
    admitted to University Hospital North Staffordshire (specifically, the Accident and Emergency
    Department, the Primary Care Urgent Care Unit, the Acute Assessment Unit, the Minor Injuries
    Unit, the Short Stay Unit and the Surgical Assessment Unit.) This service has been
    commissioned jointly with Stoke-on-Trent PCT, and will be provided by ADSiS. „Brief
    interventions‟ services have been shown to be effective across a wide range of alcohol
    problems. They help individuals with hazardous and harmful drinking, bridging the gap
    between primary prevention efforts and more intensive treatment for persons with serious
    alcohol use disorders. The service will also provide an invaluable opportunity to identify and
    refer severe cases of alcohol dependence to specialized treatment.

   Through the LAA, a project has shown promising results in reducing reported drinking levels in
    school-age children.
Trend in the rate of alcohol-related admissions to hospital

                                          2,250


                                          2,000
     Rate of alcohol-related admissions




                                          1,750
          per 100,000 population




                                          1,500


                                          1,250


                                          1,000


                                           750
                                                                                     North Staffodshire PCT

                                           500                                       Newcastle-under-Lyme BC

                                                                                     Staffordshire Moorlands DC
                                           250
                                                                                     West Midlands
                                             0
                                                  2002/03   2003/04      2004/05         2005/06          2006/07

                                                                        Financial Year


Source: North West Public Health Observatory / The Information Centre for health and social care




What more needs to be done?

What more can the NHS do?

                             Closely monitor the brief interventions service at the University Hospital of North
                              Staffordshire.
                             Work with GPs to enhance the current screening and service provision for alcohol misuse.
                             Incorporate the lessons learned from a county-wide council project which successfully
                              reduced reported drinking levels in school-age children into local PCT plans.
                             Work with partners to support a wider campaign of education and awareness of the
                              possible negative consequences of alcohol misuse (including promoting sensible alcohol
                              consumption aimed at younger people).
                             Continue to work closely with the local Crime and Disorder Reduction Partnerships and
                              Staffordshire Drug and Alcohol Action Team to ensure an integrated approach to tackling
                              alcohol-related violence.
What more needs to be done? (continued)

What more can our partners do?

      Continue to reduce the number of under-age drinkers by identifying and prosecuting
       retailers who sell to children under 18 (and maximise the use of media by the publication of
       warnings, successful prosecutions and health information where appropriate).
      Continue to implement responsible licensing (including revoking the licences of problem
       premises).
      Work in schools to promote primary prevention measures.
      Strengthen partnership working to make drinker venues, and local communities, safer.
      Businesses that produce, promote and sell alcoholic drinks need to go beyond compliance
       with legal responsibilities, and should promote and encourage a wider social responsibility.
      Promote good practice in product development, advertising and packaging (including not
       targeting under-age drinkers, providing clear information about unit content, using safer
       materials).

What can the individual do?

      Drink alcohol responsibly.
       o Men – no more than 21 units per week (and no more than 4 units in any one day).
       o Women – no more than 14 units per week (and no more than 3 units in any one day).
       o Pregnant women or women trying to conceive – should avoid drinking alcohol. (If you
           do choose to drink, to minimise the risk to the baby, you should not drink more than 1
           to 2 units of alcohol once or twice a week and should not get drunk.)
3.3 Improving the quality of life for people with long-term conditions

3.3.1 Asthma

According to GP disease registers, asthma is the most common long-term condition in the PCT.
Data (for all patients) shows that as at 31 March 2007, 6.4% of patients were diagnosed as having
asthma compared with 5.8% in England as a whole.

People should have their asthma regularly reviewed to ensure that symptoms remain under
control. There is enormous variability between GP practices in the PCT in achieving the QOF
review quality indicator: the percentage of people with asthma who have had an asthma review in
the previous 15 months varies from 22.6% to 96.2%.

Experiencing an asthma attack that requires hospital treatment is frightening and distressing.
Improved primary care can reduce the need for emergency hospital care (it is estimated that 75%
of emergency admissions for asthma could be avoided).

In 2004, hospital admission rates for asthma showed considerable differences across the PCTs in
England. The England average rate was 100, and both the predecessor PCTs had rates below this
(Newcastle-under-Lyme = 98, Staffordshire Moorlands = 87).

Can we intervene effectively?

Yes. High quality routine care can make a real difference to the lives of people with asthma.
National guidelines state that people with asthma should expect:

   their condition to be adequately controlled by medication

   to have good symptom control

   not to need emergency treatment if appropriate routine care is given.

What are we doing?

   Including of the care of patients with asthma as a key local priority in the PCT‟s operational
    plan 2008/09.


What more needs to be done?

What more can the NHS do?

       Support people who want to stop smoking (including helping employees who want to stop
        smoking).
       Improve careful diagnosis, for adults and children (especially children, due to the long-term
        implications for both the child and health services).
       Reduce variation in access to high quality primary care to decrease unnecessary hospital
        admissions.
       Ensure that people with asthma are offered a written personal asthma plan.

What more can our partners do?

       Support employees who want to stop smoking.
       Continue to improve the quality of housing by tackling cold and dampness.
What more needs to be done? (continued)

What can the individual do?

       Make sure that they have a written personal asthma plan.
       Visit the GP or asthma nurse for regular reviews.



3.3.2 Chronic Obstructive Pulmonary Disease (COPD)

Data (for all patients) shows that as at 31 March 2007, 1.7% of patients were diagnosed as having
COPD compared with 1.4% in England as a whole.

COPD is very common, and it's getting more common, especially among women. It's possible to
have COPD without knowing you have it.

Nine out of ten people who have COPD are – or used to be – heavy smokers. Second-hand
smoke can also cause COPD. Giving up smoking reduces your risk of developing COPD. But
even after about 10 years of not smoking, 1 in 10 people who used to smoke will develop COPD.

Experiencing an acute exacerbation of COPD requiring hospital treatment is frightening and
distressing. For the patient, it may signal the beginning of the terminal phase of the illness. There
is increasing evidence that non-pharmacological interventions may prevent hospital admissions.

The premature death rate (pooled for 2004-06) for the PCT is similar to that for England as a
whole, but the rate in Newcastle-under-Lyme Borough Council (15.2 per 100,000 population) is
significantly higher than that for Staffordshire Moorlands District Council (8.7 per 100,000
population).

Can we intervene effectively?

Yes. High quality routine care can make a real difference to the lives of people with COPD.
There are national guidelines for the diagnosis and care of people with COPD.

Smoking cessation is the single most effective – and cost effective – intervention in most people to
reduce the risk of developing COPD.

Primary care management varies significantly across the PCT. There are marked differences
between GP practices in achieving the COPD quality indicators.

What are we doing?

   Helping people to stop smoking.

   Working with Stoke-on-Trent PCT and the University Hospital of North Staffordshire to develop
    an evidence-based local care pathway for people with COPD.

   Including the care of patients with COPD as a key local priority in the PCT‟s operational plan
    2008/09.
Summary of achievement across the QOF COPD quality indicators

QOF Indicator                                               Lowest to highest       Achievement
                                                              GP practice          across the PCT
                                                              achievement            as a whole
The percentage of all patients with COPD in whom
                                                             53.6*% to 100%             91.7%
diagnosis has been confirmed by spirometry
including reversibility testing
The percentage of patients with COPD with a record
                                                            25.0*% to 97.5*%            77.4%
of FeV1 in the previous 15 months
The percentage of patients with COPD receiving
                                                             29.7% to 100%              89.1%
inhaled treatment in whom there is a record that
inhaler technique has been checked in the previous
15 months
The percentage of patients with COPD who have
                                                             70.7*% to 100%             91.6%
had influenza immunisation in the preceding 1
September to 31 March
* excluding practices with less than 30 eligible patients

Source: QMAS data as at 31 March 2007




What more needs to be done?

What more can the NHS do?

        Support people who want to stop smoking.
        Work with GPs to ensure that COPD is recognised and diagnosed: it has been estimated
         that only 1 in 4 people with COPD are diagnosed.
        Improve access to spirometry.
        Improve the primary care of patients with COPD: reduce variation in inhaler technique
         checks and lung function monitoring across the GP practices within the PCT.
        Encourage the use of written personalised self-management plans.
        Review the requirements of implementing the new COPD care pathway. What services do
         we already have in place to support this? What services need to be developed? Which
         service gaps need to be filled first? How will we know that it‟s happening in practice (audit
         and monitoring)?

What more can our partners do?

        Support employees who want to stop smoking.
        Ensure that workplaces where exposure to harmful substances routine, or highly likely,
         provide employees with appropriate safety information, protective clothing and equipment.

What can the individual do?

        Give up smoking - contact the PCT‟s Stop Smoking Service.
        If you work in an industry where you could be exposed to harmful substances, be certain to
         follow safety advice to protect your lungs.
        Take regular exercise.
3.3.3 Diabetes

According to GP disease registers, diabetes is the second most common long-term condition in
the PCT. Data (for patients aged 17 and older) shows that as at 31 March 2007, 5.4% of patients
were diagnosed as having diabetes compared with 4.5% in England as a whole.

Diabetes causes significant illness and premature death, which can be reduced by effective
treatment and preventative measures. Over time, poorly controlled diabetes has widespread
adverse health effects:

   eye disease, leading to impaired vision and blindness

   kidney damage

   nerve damage, leading to loss of bladder and bowel control, loss of sensation in the feet
    (hence the likelihood of ulcers and amputation).

Nationally, the number of people developing Type 2 diabetes is rising. Of concern is the number of
young people being diagnoses with Type 2 diabetes – a condition previously associated with those
aged over 40 years of age.

There is significant variability between GP practices in the PCT in achieving the diabetes quality
indicators, most notably in inconsistency in achieving HbA1c control and blood pressure control.

Summary of achievement across the QOF diabetes quality indicators

QOF Indicator                                            Lowest to highest        Achievement
                                                           GP practice           across the PCT
                                                           achievement             as a whole
The percentage of patients with diabetes whose
                                                            71.8% to 100%             94.7%
notes record BMI in the previous 15 months
The percentage of diabetic patients who have a
                                                            83.5% to100%              97.1%
record of HbA1c or equivalent in the previous 15
months
The percentage of patients with diabetes in whom
                                                            53.8% to 89.3%            68.8%
the last HbA1c is 7.5 or less (or equivalent
test/reference range depending on local laboratory)
in the previous 15 months
The percentage of patients with diabetes in whom
                                                            82.1% to 97.1%            93.1%
the last HbA1c is 10 or less (or equivalent
test/reference range depending on local laboratory)
in the previous 15 months
The percentage of patients with diabetes who have a
                                                            62.2% to100%              87.3%
record of retinal screening in the previous 15 months
The percentage of patients with diabetes with a
                                                            23.0% to 99.8%            91.2%
record of the presence or absence of peripheral
pulses in the previous 15 months
The percentage of patients with diabetes with a
                                                            22.1% to 100%             90.8%
record of neuropathy testing in the previous 15
months
The percentage of patients with diabetes who have a
                                                            89.5% to 100%             98.7%
record of the blood pressure in the previous 15
months
The percentage of patients with diabetes in whom
                                                            45.2% to 96.6%            76.0%
the last blood pressure is 145/85 or less
Summary of achievement across the QOF diabetes quality indicators (continued)

QOF Indicator                                               Lowest to highest      Achievement
                                                              GP practice         across the PCT
                                                              achievement           as a whole
The percentage of patients with diabetes who have a
                                                             39.2% to 96.6%            86.5%
record of micro-albuminuria testing in the previous
15 months (exception reporting for patients with
proteinuria)
The percentage of patients with diabetes who have a
                                                             82.4% to 100%             96.9%
record of estimated glomerular filtration rate (eGFR)
or serum creatinine testing in the previous 15
months
The percentage of patients with diabetes with a
                                                             76.3*% to 100%            90.1%
diagnosis of proteinuria or micro-albuminuria who
are treated with ACE inhibitors (or A2 antagonists)
The percentage of patients with diabetes who have a
                                                             78.8% to 100%             96.1%
record of total cholesterol in the previous 15 months
The percentage of patients with diabetes whose last
                                                             64.9% to 93.3%            82.0%
measured total cholesterol within previous 15
months is 5 mmol/l or less
The percentage of patients with diabetes who have
                                                             75.4% to 100%             90.6%
had influenza immunisation in the preceding 1
September to 31 March
* excluding practices with less than 30 eligible patients

Source: QMAS data as at 31 March 2007

The premature death rate (pooled for 2004-06) for the PCT is similar to that for England as a
whole. However, 75% of deaths in people with diabetes are caused by cardiovascular disease.

Can we intervene effectively?

Yes. High quality routine care can make a real difference to the lives of people with diabetes. The
National Service Framework for Diabetes has clear standards for prevention of Type 2 diabetes,
early identification of diabetes, and empowering people with diabetes.

There is clear evidence that the majority (two thirds) of Type 2 diabetes can be prevented by
lifestyle and diet interventions.

What are we doing?

   Working with Stoke-on-Trent PCT and the University Hospital of North Staffordshire to develop
    an evidence-based local care pathway for people with diabetes.

   Planning a cardiovascular disease screening programme (described in section 3.3.4).

   Proactively promoting the PCT‟s exercise-on-prescription programme, „Go5‟.

   Including the care of patients with diabetes as a key local priority in the PCT‟s operational plan
    2008/09.
What more needs to be done?

What more can the NHS do?

      Support people who want to stop smoking (including helping employees who want to stop
       smoking).
      Improve early diagnosis and treatment.
      Improve early identification of people at risk (to intervene to prevent the development of
       diabetes).
      Review the requirements of implementing the new COPD care pathway. What services do
       we already have in place to support this? What services need to be developed? Which
       service gaps need to be filled first? How will we know that it‟s happening in practice (audit
       and monitoring)?

What more can our partners do?

      Support employees who want to stop smoking.
      Improve access to well-maintained, safe, affordable, and convenient leisure and sports
       facilities.
      Increase the range of healthy food choices (and make it more difficult to make unhealthy
       food choices) in schools. Increase the opportunity for physical exercise in schools.
       Encourage active travel to and from school.

What can the individual do?

      Give up smoking - contact the PCT‟s Stop Smoking Service.
      Eat healthily (reduce fat intake, eat at least two portions of fish per week - one of which
       should be an oily fish, increase intake of fruit and vegetables).
      Exercise regularly (at least 30 minutes a day on five or more days a week).
      Drink alcohol sensibly (within the recommended limits).



3.3.4 Coronary Heart Disease (CHD)

According to GP disease registers, CHD is the third most common long-term condition in the PCT.
Data (for all patients) shows that as at 31 March 2007, 4.4% of patients were diagnosed as having
CHD compared with 3.5% in England as a whole.

CHD is the most common cause of premature death in the UK. It is a key public health priority
because it is common, frequently fatal, and largely preventable.

Primary care management varies across the PCT. There are significant differences between GP
practices in the PCT in achieving the CHD quality of care indicators, notably control of cholesterol
levels and blood pressure, and use of beta blockers for secondary prevention.

Can we intervene effectively?

Yes. High quality routine care can make a real difference to the lives of people with CHD. The
National Service Framework for CHD has clear standards for improved prevention, diagnosis,
treatment and rehabilitation, and goals to secure fair access to high quality services.
Summary of achievement across the QOF CHD quality indicators

QOF Indicator                                               Lowest to highest     Achievement
                                                              GP practice        across the PCT
                                                              achievement          as a whole
The percentage of patients with coronary heart
                                                             93.3% to 100%            98.1%
disease whose notes have a record of blood
pressure in the previous 15 months
The percentage of patients with coronary heart
                                                             65.2% to 97.2%           86.8%
disease in whom the last blood pressure reading
(measured in the previous 15 months) is 150/90 or
less
The percentage of patients with coronary heart
                                                             57.0% to 100%            94.9%
disease whose notes have a record of total
cholesterol in the previous 15 months
The percentage of patients with coronary heart
                                                             44.6% to 94.2%           82.6%
disease whose last measured total cholesterol
(measured in the previous 15 months) is 5 mmol/l or
less
The percentage of patients with coronary heart
                                                             75.9% to 99.6*%          94.8%
disease with a record in the previous 15 months that
aspirin, an alternative anti-platelet therapy, or an
anti-coagulant is being taken (unless a
contraindication or side-effects are recorded)
The percentage of patients with coronary heart
                                                             49.4% to 97.3*%          76.3%
disease who are currently treated with a beta blocker
(unless a contraindication or side-effects are
recorded)
The percentage of patients with a history of
                                                             82.5*% to 100%           90.4%
myocardial infarction (diagnosed after 1 April 2003)
who are currently treated with an ACE inhibitor or
Angiotensin II antagonist
The percentage of patients with coronary heart
                                                             61.5% to 99.1%           92.0%
disease who have a record of influenza
immunisation in the preceding 1 September to 31
March
* excluding practices with less than 30 eligible patients

Source: QMAS data as at 31 March 2007

What are we doing?

    We are in the process of commissioning a cardiovascular disease screening programme. The
     broad scope of the programme is:
    o primary prevention (reduction of risk factors for cardiovascular disease in the population)
    o identification of those at high risk of CHD, chronic kidney disease, stroke, transient
        ischaemic attack, or diabetes (so that interventions can be made to prevent disease
        development)
    o identification of those already with CHD, chronic kidney disease, stroke, transient
        ischaemic attack, or diabetes (so that these conditions can be managed appropriately).

   Including the care of patients with CHD as a key local priority in the PCT‟s operational plan
    2008/09.
What more needs to be done?

What more can the NHS do?

      Support people who want to stop smoking (including helping employees who want to stop
       smoking).
      Set an example as a responsible employer by ensuring that on-site catering promotes
       healthy food and drink choices, and by promoting physical activity in the work place.
      Improve early diagnosis and treatment.
      Improve the primary care of people with CHD: reduce variability in the management and
       control of risk factors, and in the prescribing of medication for secondary prevention.
      Improve early identification of people at risk (to intervene to prevent the development of
       CHD).

What more can our partners do?

      Support employees who want to stop smoking.
      Local authorities can also set an example as employers, and should ensure that on-site
       catering promotes healthy food and drink choices, and promote physical activity in the work
       place.
      Improve access to well-maintained, safe, affordable, and convenient leisure and sports
       facilities.

What can the individual do?

      Give up smoking - contact the PCT‟s Stop Smoking Service.
      Eat healthily (reduce fat intake, eat at least two portions of fish per week - one of which
       should be an oily fish, increase intake of fruit and vegetables).
      Exercise regularly (at least 30 minutes a day on five or more days a week).
      Drink alcohol sensibly (within the recommended limits)



3.3.5 Chronic Kidney Disease (CKD)

According to GP disease registers, CKD is the fourth most common long-term condition in the
PCT. Data (for patients aged 18 and older) shows that as at 31 March 2007, 3.9% of patients were
diagnosed as having diabetes compared with 3.0% in England as a whole.

CKD is the broad term for all types of kidney disease that slowly destroys the kidneys over months
or years. If not treated, early CKD can progress to more severe forms of the disease, including
renal failure. The numbers of people requiring dialysis or transplantation is rising rapidly, and is not
expected to reach a steady state for another 25 years.

There is considerable variability between GP practices in the PCT in achieving the CKD quality
indicators, notably in the management of high blood pressure. Practices have been working hard
to establish CKD registers - which in most cases have more than doubled in size this year. So
although the percentage figures may appear low, more patients overall have been assessed.
Summary of achievement across the QOF CKD quality indicators

QOF Indicator                                               Lowest to highest      Achievement
                                                              GP practice         across the PCT
                                                              achievement           as a whole
The percentage of patients on the CKD register
                                                             90.3*% to 100%            98.1%
whose notes have a record of blood pressure in the
previous 15 months
The percentage of patients on the CKD register in
                                                             59.6*% to 100%            81.0%
whom the last blood pressure reading, measured in
the previous 15 months, is 140/85 or less
The percentage of patients on the CKD register with
                                                             61.9*% to 100%            84.7%
hypertension who are treated with an angiotensin
converting enzyme inhibitor (ACE-I) or angiotensin
receptor blocker (ARB) (unless a contraindication or
side effects are recorded)
* excluding practices with less than 30 eligible patients

Source: QMAS data as at 31 March 2007

The premature death rate (pooled for 2004-06) for the PCT is similar to that for England as a
whole. However, CKD patients have an increased risk of cardiovascular disease that accounts for
40-50% of all deaths in CKD.

Can we intervene effectively?

Yes. High quality routine care can make a real difference to the lives of people with CKD.
The National Service Framework for Renal Services has clear standards to raise the quality of
care provided for people with kidney disease, increase their choice, and minimise the impact of
their disease.

What are we doing?

   Planning a cardiovascular disease screening programme (described in section 3.3.4).

   Including of the care of patients with CKD as a key local priority in the PCT‟s operational plan
    2008/09.


What more needs to be done?

What more can the NHS do?

        Support people who want to stop smoking (including helping employees who want to stop
         smoking).
        Set an example as a responsible employer by ensuring that on-site catering promotes
         healthy food and drink choices, and by promoting physical activity in the work place.
        Increase early identification of people with CKD to maximise the opportunity to prevent or
         slow disease progression.
        Improve the primary care of patients with CKD: reduce the variation in blood pressure
         management.
What more needs to be done? (continued)

What more can our partners do?

      Support employees who want to stop smoking.
      Local authorities can also set an example as employers, and should ensure that on-site
       catering promotes healthy food and drink choices, and promote physical activity in the work
       place.
      Improve access to well-maintained, safe, affordable, and convenient leisure and sports
       facilities.

What can the individual do?

      Give up smoking – contact the PCT‟s Stop Smoking Service.
      Eat healthily (reduce fat intake, eat at least two portions of fish per week – one of which
       should be an oily fish, increase intake of fruit and vegetables).
      Exercise regularly (at least 30 minutes a day on five or more days a week).
      Drink alcohol sensibly (within the recommended limits)



3.3.6 Stroke and transient ischaemic attack (TIA)

According to GP disease registers, stroke and TIA are the sixth most common long-term condition
in the PCT. Data (for all patients) shows that as at 31 March 2007, 2.2% of patients were
diagnosed as having had a stroke or TIA compared with 1.6% in England as a whole.

Stroke, the brain equivalent of heart attack, is one of the top three causes of death in England –
and the leading cause of adult disability. Because the brain controls everything that we do, feel,
think and remember, damage to the brain affects these abilities.

The most important treatable conditions linked to stroke are: high blood pressure, smoking, heart
disease, diabetes, and TIA. In the four weeks following a TIA („mini stroke‟) the risk of a stroke is
around 20%.

Public awareness of the symptoms and impact of stroke – and how strokes can be prevented – is
very low.

There is significant variability between GP practices in the PCT in achieving the stroke quality
indicators, notably in the management of cholesterol levels and high blood pressure.

Summary of achievement across the QOF stroke quality indicators

QOF Indicator                                             Lowest to highest        Achievement
                                                            GP practice           across the PCT
                                                            achievement             as a whole
The percentage of patients with TIA or stroke who
                                                            85.2% to 100%              97.2%
have a record of blood pressure in the notes in the
preceding 15 months
The percentage of patients with a history of TIA or
                                                           57.3% to 96.4*%             84.7%
stroke in whom the last blood pressure reading
(measured in the previous 15 months) is 150/90 or
less
Summary of achievement across the QOF stroke quality indicators (continued)

QOF Indicator                                               Lowest to highest      Achievement
                                                              GP practice         across the PCT
                                                              achievement           as a whole
The percentage of patients with TIA or stroke who
                                                             50.0% to 100%              92.3%
have a record of total cholesterol in the last 15
months
The percentage of patients with TIA or stroke whose
                                                             40.5% to 90.7%             77.2%
last measured total cholesterol (measured in the
previous 15 months) is 5 mmol/l or less
The percentage of patients with a stroke shown to
                                                             87.7% to 100%              94.5%
be non-haemorrhagic, or a history of TIA, who have
a record that an anti-platelet agent (aspirin,
clopidogrel, dipyridamole or a combination), or an
anti-coagulant is being taken (unless a
contraindication or side-effects are recorded)
The percentage of patients with TIA or stroke who
                                                             67.4% to 100%              89.3%
have had influenza immunisation in the preceding 1
September to 31 March
* excluding practices with less than 30 eligible patients

Source: QMAS data as at 31 March 2007

The premature death rate (pooled for 2004-06) for the PCT is similar to that for England as a
whole.

Can we intervene effectively?

Yes. Many strokes are preventable and developments over the last ten years have shown that fast
and effective acute treatment of stroke, along with high quality rehabilitation, can significantly
reduce death and disability.

What are we doing?

   The PCT supports a health economy-wide local stroke register which is a key resource in
    monitoring local health outcomes.

   Planning a cardiovascular disease screening programme (described in section 3.3.4).

   Including of the care of patients with stroke and TIA as a key local priority in the PCT‟s
    operational plan 2008/09.
What more needs to be done?

What more can the NHS do?

      Improve public awareness
      Primary prevention: work with primary care to ensure that the identification and
       management of high blood pressure is a priority.
      Support people who want to stop smoking (including helping employees who want to stop
       smoking).
      Set an example as a responsible employer by ensuring that on-site catering promotes
       healthy food and drink choices, and by promoting physical activity in the work place.
      Improve the primary care of stroke and TIA patients: reduce variations in the management
       of cholesterol levels and high blood pressure.
      Ensure high quality rehabilitation and co-ordinated post-acute support for patients and
       carers.
      Implement the National Stroke Strategy.


What more can our partners do?

      Support employees who want to stop smoking.
      Local authorities can also set an example as employers, and should ensure that on-site
       catering promotes healthy food and drink choices, and promote physical activity in the work
       place.
      Improve access to well-maintained, safe, affordable, and convenient leisure and sports
       facilities.
      Improve support to stroke survivors and carers.

What can the individual do?

      Know what your blood pressure should be, and get your blood pressure checked regularly.
      Give up smoking - contact the PCT‟s Stop Smoking Service.
      Eat healthily (reduce fat intake, eat at least two portions of fish per week - one of which
       should be an oily fish, increase intake of fruit and vegetables).
      Exercise regularly (at least 30 minutes a day on five or more days a week).
      Drink alcohol sensibly (within the recommended limits)
      Don‟t ignore a TIA – see your doctor as soon as possible.
Chapter Four:
Progress with Last Year’s Priorities

           In this Chapter, I give an update on the key issues highlighted in
           previous annual reports.



                           What are we doing?                    What more needs to be done?

Health inequalities        described in Chapter Three            described in Chapter Three

Smoking, chronic           Smoking and chronic obstructive       Smoking and chronic obstructive
obstructive pulmonary      pulmonary disease:                    pulmonary disease:
disease and lung cancer    described in Chapter Three            described in Chapter Three

                           Lung cancer:                          Lung and other cancers:

                              Helping people to stop              Working with researchers at
                               smoking.                             Keele University to get a
                                                                    better understanding of why
                              Working closely with the             people with symptoms of
                               University Hospital of North         cancer wait before going to
                               Staffordshire to improve             their GP, and what can be
                               access to cancer services in         done to encourage people to
                               order to meet the national           act earlier.
                               waiting times targets. The
                               lung cancer pathway was a
                               particular problem, and work
                               was undertaken to speed up
                               access to diagnostics prior to
                               attending the clinic.

                              Working with the Greater
                               Midlands Cancer Network and
                               the University Hospital of
                               North Staffordshire, to
                               improve treatment outcomes.

Obesity                    described in Chapter Three            described in Chapter Three

Alcohol consumption        described in Chapter Three            described in Chapter Three
                 What are we doing?                    What more needs to be done?

Infant feeding      Employing dedicated Infant           Promote antenatal education
                     Feeding Co-ordinators:                and support.
                     have had a significant impact
                     on the number of mums                Set up maternity services which
                     continuing to breastfeed at 6         allow for the time needed to
                     weeks and 3 months.                   encourage new mums to
                                                           breastfeed by truly informing
                    Implementing an Infant                them of the benefits and risks
                     Feeding Policy, and a number          associated with the various
                     of supportive projects such           feeding options, and supporting
                     Breast Feeding Cafés.                 them through the first weeks of
                                                           their child‟s life. Maternity
                                                           services can play a pivotal role
                                                           on educating, preparing and
                                                           supporting women.

                                                          Ensure that there is sufficient
                                                           ongoing support, and learn
                                                           from the Infant Feeding Co-
                                                           ordinators‟ successes.

                                                          Better data collection
                                                           systems.

Sexual health       Working closely with the              Provide more sexual health
                     University Hospital of North          services in the community
                     Staffordshire and Stoke-on-           (this will be achieved as part
                     Trent PCT to improve the              of the implementation of our
                     services at the GUM Clinic.           local sexual health plan).
                     These improvements have
                     included the re-organisation of      Continue raising public
                     opening hours, reducing               awareness about the
                     unnecessary activity,                 seriousness of sexual health
                     increasing user involvement,          issues.
                     and the subsequent move to
                     open access.

                    Working with Staffordshire
                     Teenage Pregnancy
                     Partnership Board.

                    The Teenage Pregnancy
                     Team for North Staffordshire:
                     a programme of activities and
                     actions in place that are
                     developed in partnership with
                     young people, their parents
                     and carers that covers both
                     prevention and support.
                     Projects include „Clinic-in-a-
                     box‟, and „Sexplain‟ (a website
                     with the information on sexual
                     health and HIV, contraception,
                     pregnancy and sexuality).
                      What are we doing?                  What more needs to be done?

Admission avoidance      Developing of a Primary Care       Find new ways to improve the
and proactive case        Urgent Care Unit, with Stoke-       quality of life of people with
management                on-Trent PCT, initially on a        long-term conditions
                          weekend only basis.                 (including reducing
                                                              emergency admissions)
                         Including of emergency
                          admissions as a key local          Implement the most
                          priority in the PCT‟s               appropriate local model of
                          operational plan 2008/09.           care to implement, by formally
                                                              evaluating the current
                                                              proactive care and the
                                                              interventionist approach
                                                              models.

                                                             Planned extension of the
                                                              Primary Care Urgent Care
                                                              Unit to seven days a week.

Pharmaceutical           All pharmacies within North        Explore further ways in which
public health             Staffordshire PCT provide           community pharmacies can
                          essential services to support       support the „Staying Healthy‟
                          public health.                      strand of the PCT Strategy.

                         Five pharmacies form part of
                          the North Staffordshire Stop
                          Smoking Service.

Global warming           North Staffordshire NHS            Seek external advice
                          Estates Agency have                 regarding additional steps that
                          developed proposals to              the PCT can take to make a
                          reduce the level of primary         positive difference and reduce
                          care energy consumption and         its carbon footprint and focus
                          improve energy efficiency           on the wider picture beyond
                          performance.                        that of estates (for example,
                                                              the development of green
                                                              travel plans).

                                                             Consider signing up to the
                                                              Climate Change Declaration
                                                              for Staffordshire, led by the
                                                              County Council.
Chapter Five:
Key Public Health Indicators
       Good quality data and information is needed to inform priorities and
       commissioning. We also need robust indicators to monitor progress with
       improving health and well-being. This Chapter gives an overview of the key
       public health indicators available on the PCT’s website.

The indicators summarised in the table below is available on the PCT‟s website. However, if you
have any problems accessing the data, please contact the Public Health Directorate and we will be
happy to provide a paper copy.

Wherever possible, the data is presented in a number of ways, in order to increase the usefulness
of this information for colleagues who work in areas aligned with the local authorities boundaries,
and colleagues in practice-based commissioning.

Please note that the geographical boundary of North Staffordshire PCT does not exactly match the
combined areas of Newcastle-under-Lyme Borough Council and Staffordshire Moorlands District
Council. Three wards within Staffordshire Moorlands District Council (Bagnall & Stanley, Brown
Edge & Endon, and Caverswall) are the responsibility of Stoke-on-Trent PCT.

                                                                                 Commissioning
                                                 PCT          Local authority
                                                                                    cluster

Demographics                                                                           
(age, gender, ethnicity)                                                               (not all
                                                                                     indicators)

Risk factors and lifestyle behaviours                                                  
(smoking prevalence, obesity, high                                 (not all            (not all
blood pressure, alcohol indicators,                              indicators)         indicators)
teenage pregnancy, breastfeeding
initiation)

Disease prevalence                                                                     
(asthma, atrial fibrillation, cancer,
coronary heart disease, chronic kidney
disease, chronic obstructive pulmonary
disease, dementia, diabetes, heart
failure, hypothyroidism, epilepsy, mental
health (psychotic disorders), stroke and
transient ischaemic attack)

Life expectancy                                                                        

Healthy life expectancy                                                                

Premature death                                                                        
(all causes, accidents, cancer,
circulatory disease, suicide and
undetermined injury, infant deaths)

Deprivation                                                                            
Glossary

Children‟s Trusts               Children‟s Trusts are organisational arrangements which bring
                                together strategic planners from relevant sectors to identify
                                where children and young people need outcomes to be
                                improved in a local area and plan services accordingly.
Commissioning                   Commissioning is the process of securing and managing
                                appropriate healthcare services for relevant populations at value
                                for money for taxpayers. It is composed of three phases:
                                1) Understanding, segmenting and anticipating the needs of
                                    local communities and individual patients, and planning and
                                    prioritising accordingly.
                                2) Defining services to meet these and contracting them from
                                    the most appropriate providers.
                                3) Monitoring provision and managing contracts, to
                                    continuously improve outcomes for patients and local
                                    communities.
Healthy Schools programme       A programme, overseen by the Department of Health and the
                                Department for Education and Skills, which encourages schools
                                to contribute to the improvement of children‟s health and well-
                                being. To become a Healthy School, schools must meet certain
                                criteria in four core areas: personal, social and health
                                education, healthy eating, physical activity and emotional health
                                and well-being.
Joint Strategic Needs           JSNA describes a process that identifies current and
Assessment                      future health and wellbeing needs in light of existing services,
(JSNA)                          and informs future service planning taking into account
                                evidence of effectiveness.
Local Area Agreements           The LAA is an agreement that sets out the priorities for a local
(LAAs)                          area in certain policy fields as agreed between central
                                government (represented by the Government Office), and a
                                local area, represented by the local authority and Local
                                Strategic Partnership and other partners at local level. The
                                agreement is made up of outcomes, indicators and targets
                                aimed at delivering a better quality of life for people through
                                improving performance on a range of national and local
                                priorities.
Local Strategic Partnerships    A Local Strategic Partnership is a body made up of
(LSPs)                          organisations from across a specific area, working together to
                                improve the quality of life for local people in the area.
                                An LSP involves people from local authorities, the emergency
                                services, the health service, education, social care, community
                                groups, local businesses and voluntary organisations.
                                The aim of an LSP is to ensure that the partner organisations
                                work effectively together across all of their activities to bring
                                about improvements in local communities.
Long-term conditions            Conditions (for example, diabetes and asthma) that cannot, at
                                present, be cured but whose progress can be managed and
                                influenced by medication and other therapies.
National Institute for Health   The independent organisation responsible for providing national
and Clinical Excellence         guidance on the promotion of good health and the prevention
(NICE)                          and treatment of ill-health.
Primary prevention         Primary prevention aims to avoid the development of a disease
                           or condition.
Public Service Agreement   An agreement between each government department and HM
(PSA)                      Treasury which specifies how public funds will be used to
                           ensure value for money.
Quality and Outcomes       The QOF is part of the contract PCTs have with GPs. It is a
Framework (QOF)            voluntary annual reward and incentive programme for all GP
                           surgeries in England, detailing practice achievement results.

                           The QOF contains four main components, known as domains.
                           Each domain consists of a set of measures of achievement,
                           known as indicators, against which practices score points
                           according to their level of achievement.
Secondary prevention       Secondary prevention aims to limit the progression and effect of
                           a disease at as early a stage as possible. It includes further
                           primary prevention.
APPENDIX ‘B’
(Salmon paper)
                                                                           APPENDIX „C‟
                                                                            (Blue paper)

                   STAFFORDSHIRE HEALTH SCRUTINY COMMITTEE

                      Code of Joint Working Arrangements - Health

1.    Definitions
1.1   In this code the following words and phrases shall have the following meanings:



SHSC:               Staffordshire Health Scrutiny Committee
                    .
Health:             the Strategic Health Authority via the Chief Executive
                    and any NHS Trust, including Foundation Trusts, operating in or
                    providing services in/to Staffordshire again via the Chief Executives
                    and other NHS health organisations which fall within the scope of the
                    Regulations.

The Regulations:    Local Authority (Overview and Scrutiny Committees Health Scrutiny
                    Functions) Regulations 2002 as exemplified by the Department of
                    Health Overview and Scrutiny of Health Guidance May 2003 (to
                    include a reference to or any amendment or re-enactment).

Officers Group:     that group whose membership and terms of reference are currently
                    detailed in the Terms of Reference, Appendix 2.


2.    Background

2.1   The Health and Social Care Act 2001 (“the Act”) confers upon local authorities with
      social services functions powers to undertake scrutiny of health matters as detailed
      in the Local Authority (Overview and Scrutiny Committees Health Scrutiny
      Functions) Regulations 2002 (“the Regulations”).

2.2   The County Council currently has responsibility for social services functions and, for
      the benefit of the inhabitants of Staffordshire, (excluding Stoke on Trent) the
      County Council and the 8 District/Borough Councils have agreed to operate joint
      working arrangements. There is in existence a Code of Joint Working
      Arrangements, which explains the broad arrangements for the scrutiny of Health
      within Staffordshire, between the Staffordshire Health Scrutiny Committee and the
      District/Borough Council local scrutiny arrangements. See Appendix 1.

2.3   It will be noted from Appendix 1, that in summary the SHSC is intended to deal with
      matters that have a Staffordshire wide theme, whilst the local District/Borough
      scrutiny arrangements are intended to deal with matters that have a local theme. A
      dedicated health scrutiny committee does not necessarily discharge District/
      Borough scrutiny arrangements. Currently, the District/Borough arrangements are
      based on their areas. An Officers Group on which all the District/Boroughs are
      represented and Health, support the SHSC. See Appendix 2, the Group‟s current
      terms of reference.

2.4   The SHSC has adopted the practice of its members taking a special interest in one
      of the Health Trusts as defined in paragraph 1.1 above. The list of special interests

                                                                    February 2008 revision
      will be maintained by the County Council and notified to the Trusts from time to
      time.

2.5   This code has been developed to provide a framework for the working
      arrangements between SHSC, and Health and unless other local arrangements
      have been determined also provides a framework for the working arrangements
      between the District/Borough Council local scrutiny arrangements and Health.

2.6   The spirit of this code is to facilitate effective and proper scrutiny of matters within
      the Regulations. For the avoidance of doubt the SHSC recognises and accepts
      that the health of local residents is dependent on a number of factors, not just the
      quality of health services provided by National Health Services organisations, but
      also on the quality of other services. The intended outcome of health scrutiny
      activity is the reduction of health inequalities and to promote and support health
      improvement of the people of Staffordshire.

2.7   It is accepted that this document will need amending from time to time.

3.    Keeping Health Informed

3.1   SHSC and the local District/Borough Councils will endeavour to:

      (a) forward to Health non confidential agenda/minutes of the SHSC and of the local
           District/Borough health scrutiny arrangements;

      (b) forward to Health any Health Scrutiny Bulletins that are produced;

      (c) forward to Health any proposals for items of scrutiny, giving an opportunity for
           Health to comment;

      (d) forward to Health any draft/final reports on topics actually scrutinised, in the
          case of drafts giving an opportunity for comment;

      (e) with reasonable notice advise Health of any request for attendance at the
          authority discharging the scrutiny arrangement, with reason(s) why attendance
          is asked for;

      (f) for as long as it is determined appropriate by the SHSC, make available to
          health, membership for three health representatives on its Officers Group;

      (g) answer any reasonable request from Health in relation to scrutiny activity.

4.    Assistance from Health

4.1   Health will comply with the Regulations and the provisions of the NHS Act (2006)
      as amended by the Local Government and Public Involvement in Health Act (2007).

4.2   When information within the Regulations has been requested, Health will comply
      within a reasonable time-scale. Where information requested, is not available in a
      ready or easily convertible format, Health will advise of such and advise what other
      information is available or what arrangements can be made to facilitate the
      provision of the required information. SHSC and the District/Boroughs appreciate

                                                                     February 2008 revision
      the workload of Health organisations and will ensure that requests for information
      are only made if such information is relevant and necessary to the topic being
      reviewed or relevant and necessary for discharge of the arrangements under the
      Regulations.

4.3   If requested, Health will make appropriate arrangements with the SHSC and/or
      District/Borough councils for the passing on of information that is already in the
      public domain or should/can be made available to local authorities. Without
      prejudice to the generality of this paragraph, Health will endeavour to ensure that
      members with special interests (see paragraph 2.4) are kept informed on a regular
      basis of matters pertaining to the Regulations.

4.4   Whilst it is acknowledged that the Regulations provide for attendance of Health at
      local authorities discharging health scrutiny arrangements, every effort in exercising
      this request will be made to limit unnecessary attendance, and where appropriate
      written responses from Health that address the question, will be adequate.

4.5   Any request to Health in relation to this code will be by a duly authorised
      officer/member of the authority, whose names shall be notified to health from time
      to time.

4.6   Health will consult with the Scrutiny arrangements where decisions are going to be
      made which affect the commissioning of services for people of Staffordshire by
      reference to the numbers of people who could be affected and/or the significance
      of the service, for example specialist services. In order to satisfy this paragraph,
      the scrutiny arrangements operating in Staffordshire would welcome being an
      addition to Health‟s consultation distribution lists. If there is doubt about a decision
      that may or may not fall under this paragraph, Health should speak, in the first
      instance, direct with the SHSC Health Scrutiny and Performance Manager.

4.7   Without prejudice to the generality of paragraph 4.6, Health will particularly consult
      with the appropriate scrutiny arrangement on matters, which constitute a substantial
      variation and/or substantial development. In deciding whether or not a matter falls
      within this heading Health will have regard to the Guidance which specifies possible
      substantial variations and/or developments when they fall under one or more of the
      following:

      (a) changes in accessibility of services – for example the creation of a new GP
          and/or dental practice;

      (b) impact of proposal on the wider community – exercising some flexibilities under
          Foundation Status;

      (c) patients affected – closing facilities or parts of, eg Saturday surgeries, relocation
          of services;


      (d) methods of service delivery – new arrangements for out of hours services.




                                                                      February 2008 revision
                                      Substantial variation or
                                     substantial development




                                       Contact Staffordshire
                                       County Council Health
                                Scrutiny and Performance Manager
                          Local issues                           Countywide issues

               Borough District Council(s)                            SHSC




                                             Consultation




      Examples of countywide substantial variations/developments

4.8   It is not envisaged that Health will consult on contractor changes, minor
      amendments to service regulations or matters which are internal issues.

5.    Information Sharing/Data Protection/Confidentiality

5.1   For the purposes of this code information will be shared provided such is within the
      law. Further, for the purposes of facilitating this paragraph, but not limited to,
      co-operating organisations will sign up to the Staffordshire Police, Information
      Sharing Protocol for Crime and Disorder purposes.

6.    General Working Principles

6.1   Generally, unless this code provides a specific provision, then the health scrutiny
      activity in Staffordshire will be carried out on the basis of the following general
      working principles:

      (a) Co-operation – the organisations involved are willing to share knowledge,
          respond to requests for information, initiatives and reports as appropriate.


      (b) Accountability - the process of health scrutiny will be open and transparent,
          except where the principles of confidentiality apply.


      (c) Accessibility – scrutiny activity will, for each piece of work, actively seek to
          identify interested parties and stakeholders and to involve them where
          appropriate in the overview on scrutiny process.



                                                                      February 2008 revision
                                                                                  Appendix 1
                       Staffordshire Health Scrutiny Committee

              Code of Joint Working Arrangements – Local Authorities

1.    Background

1.1   The Health and Social Care Act 2001 (“the Act”) confers upon local authorities with
      social services functions powers to undertake scrutiny of health matters as detailed
      in the Local Authority (Overview and Scrutiny Committees Health Scrutiny
      Functions) Regulations 2002 (“the Regulations”).

1.2   The County Council currently has responsibility for social services functions and, for
      the benefit of the inhabitants of Staffordshire, (excluding Stoke on Trent) the
      County Council and the 8 District/Borough Councils have agreed to operate joint
      working arrangements.

1.3   This code has been developed to provide a framework for the joint working
      arrangements.

1.4   This document may need amending from time to time.

2.    Scope of Overview and Scrutiny Activity

2.1   The areas of activity that may form the basis for possible overview and scrutiny flow
      from the Regulations. The broad scope is detailed at paragraph 2(1) “An overview
      and scrutiny committee may review and scrutinise any matter relating to the
      planning, provision and operation of health services in the area of its local
      authority.” (“scrutiny activity”).

2.2   All parties accept and agree that scrutiny activity is not a complaints mechanism.
      Accordingly matters which are referred/determined for consideration by the scrutiny
      process, shall properly fall within its scope and overview. Whether or not this will
      be the case will depend on the individual circumstances.

2.3   In Staffordshire scrutiny activity will be based on three levels of responsibility. The
      level of responsibility will determine where a specific scrutiny activity may be dealt
      with:

      (a)    The County Council may lead on matters that can best be dealt with at a
             county level.
      (b)    For some matters the County Council may ask a lead District/Borough
             Council to carry out the scrutiny, and this may be singly or jointly with other
             District/Borough Councils
      (c)    Those matters best dealt with by District and Borough Councils.




                                                                      February 2008 revision
2.4   In order to discharge the levels of responsibility:

      (a)    The County Council scrutiny activity – will be undertaken by the
             Staffordshire Health Scrutiny Committee. Its initial membership is 8 County
             Councillors whose appointment takes account of political balance and 8
             District/Borough Councillors (one from each of the District/Borough areas
             within the County of Staffordshire), nominated annually. Since this will
             constitute 8 separate appointments, political balance is not an issue. The
             Staffordshire Health Scrutiny Committee will be administrated by the County
             Council and operate in accordance with the County Council‟s Constitution,
             Committee procedure and rules. The Chair and Vice Chair will be appointed
             by the County Council. All Members will be required to sign the Code of
             Conduct for Members. Guidance for all Members may be sought from the
             Clerk to the Committee or the Health Scrutiny and Performance Manager.
             The Health Scrutiny and Performance Manager will ensure that there is
             opportunity for appropriate links with officers of all the District/Borough
             Councils. For this purpose an officer group has been formed and has its
             own terms of reference (see Appendix 2).

      (b)    County Council appointment of lead District/Borough – the Staffordshire
             Health Scrutiny Committee, will determine any scrutiny activity which falls
             under this heading, the terms of reference, and ask a lead District/Borough
             (with their agreement). The terms of reference will determine if appropriate,
             which organisations‟ Constitution will be adhered to during the process. This
             approach could, for example, be taken because a particular District/Borough
             wishes to undertake the specific scrutiny activity due to local interest. This
             approach may involve more than one District/Borough, but in such a case it
             is accepted that only one will be the nominated lead.

      (c)    District and Borough scrutiny activity – this will be undertaken by the
             appropriate scrutiny arrangement set up locally. In all cases one County
             Councillor will be appointed to each Committee designated for the purpose
             and they will be voting members for those matters which relate to health
             scrutiny activity. Appointments will be by the County Council on a yearly
             basis. As a Member of the relevant District/Borough Council Committee all
             County Councillors will be bound by the Constitution and rules of procedure
             etc of that Committee.




                                                                   February 2008 revision
County Level Scrutiny Activity

2.5   The Staffordshire Health Scrutiny Committee may deal with:

      (a)    Matters pertaining to the West Midlands Strategic Health Authority and West
             Midlands Ambulance Service NHS Trust (in conjunction with the health
             overview and scrutiny committees of the relevant Councils within the region).

      (b)    Matters pertaining to the North Staffordshire Combined Healthcare NHS
             Trust and the South Staffordshire and Shropshire Healthcare NHS
             Foundation Trust.

      (c)    Social Services and Health Authorities interface.

      (d)    Responding to reports from Patient and Public Involvement Forums until the
             end of March 2008. Thereafter responding to reports from Local
             Involvement Network/s, which affect services that relate to more than one
             District/Borough, other than where a District/Borough has agreed to take the
             lead.

      (e)    Health related consultations, commissioning, and services that relate to
             more than one District/Borough other than where a District/Borough is
             nominated to take a lead role.

      (f)    Other scrutiny activity which has been agreed by the Staffordshire Health
             Scrutiny Committee and all the relevant District/Borough Councils to be dealt
             with by the Staffordshire Health Scrutiny Committee.

County Appointment of lead District/Borough Scrutiny Activity

2.6   Matters which, fall under this heading will be determined by agreement at the
      relevant time. See paragraph 2.4(b) above.

District/Borough Scrutiny Activity

2.7   District/Borough scrutiny activity may deal with:

      (a)    Services, which contribute towards health improvement within their area.

      (b)    Matters which have been agreed by the Staffordshire Health Scrutiny
             Committee and the relevant District/Borough.

      (c)    Local National Health Service Bodies.

      (d)    District/Borough services that interface with planning for and provision of
             health services. For example, but not exclusively, housing, leisure and
             environmental health service.

      (e)    Voluntary sector services where they are provided from or within the
             District/Borough area.

      (f)    Local partnerships, eg health improvement partnerships.

                                                                    February 2008 revision
Choosing the Topics

2.8   It is recognised that the final choice of topics for health scrutiny is that of the
      appropriate Committee, but in order to avoid duplication/overload the following
      principles are accepted:

      (a)    That the Committees will develop their approach to involving interested
             parties and the public in the preparation of their annual work programmes,
             including one another.

      (b)    The Staffordshire Health Scrutiny Committee is currently the most
             appropriate committee to advise on choice of topics for health scrutiny
             across Staffordshire. Accordingly, each District/Borough Councillor member
             will undertake this role when attending the Staffordshire Health Scrutiny
             Committee and each appropriate District/Borough Councillor and County
             Council member will undertake this role when attending the more local
             Committee designated to deal with health scrutiny activity.

      (c)    It is accepted that a degree of flexibility within work programmes is required
             to adapt to unforeseen issues arising. However, following Staffordshire
             Health Scrutiny Committee approval to its annual work programme for
             scrutiny activity there shall not be deviation from the programme unless
             there is a clear and urgent need. Whether or not a matter is clear and
             urgent will be determined by the Staffordshire Health Scrutiny Committee in
             consultation with the Chairman.

(See Appendix 3 for Staffordshire Health Scrutiny Committee Criteria for Selecting
Topics.)

Maintaining Links

      (d)    Whilst undertaking scrutiny activity arrangements for the purpose of keeping
             each other up-to-date about progress and final recommendations,
             District/Borough Councillors and County Councillors will be the prime link.
             However, in addition, arrangements will be facilitated to ensure that the
             Staffordshire Health Scrutiny and Performance Manager regularly receives
             copies of all committee reports/minutes in relation to health scrutiny, so that
             an item may appear in the County Council‟s Health Scrutiny and
             Performance Manager‟s regular report to Staffordshire Health Scrutiny
             Committee. Members of the officer group will assume this responsibility on
             behalf of their Councillor.

      (e)    For the avoidance of doubt, final draft reports and final reports will also be
             shared under paragraph 2.9(d) above. In the case of draft reports this will be
             timed to facilitate comments. Final reports and recommendations will take
             account of paragraph 3 of the Regulations. It will be the responsibility of the
             Committee producing the final report to take follow-up action.

      (f)    Calling health representatives to any committee will be the responsibility of
             the Chair of that Committee. In so doing it is accepted by all chairs that such
             will be conducted with courtesy and following appropriate enquires to avoid

                                                                      February 2008 revision
            duplication of requests. Each Chair will also particularly be bound by
            paragraphs 5 and 6 of the Regulations.

      (g)   In addition to committee papers, any County Council Health Scrutiny Bulletin
            will be sent to all Officer Group members and District/Borough Councillor
            members of the Staffordshire Health Scrutiny Committee. The Staffordshire
            Health Scrutiny process provides for questions to be asked as a standard
            agenda item. All members agree to co-operate in the discharge of this
            arrangement.

      (h)   All Councils accept and agree to appropriate officers meeting in accordance
            with the Staffordshire Health Officers Group Terms of Reference. (See
            Appendix 2).

Resources

      (i)   The Staffordshire Health Scrutiny Committee will be administered by the
            County Council, currently there is approximately one and a half full-time
            equivalent staff for this purpose.

      (j)   The resource for the local health scrutiny arrangement will be a matter for
            the appropriate District/Borough Council.

      (k)   Notwithstanding (i) and (j) above, all parties agree to contribute a small
            annual sum towards the cost of joint training for Councillors and the Officers
            Group. Such sum to be determined each year by the Staffordshire Health
            Scrutiny Committee, failing agreement to be not more than £250.

3.    General Working Principles

3.1   Generally, unless this code provides a specific provision, then the health scrutiny
      activity in Staffordshire will be carried out on the basis of the following general
      working principles:

      (a)   Scope of Health Scrutiny – recognising that the health of local residents is
            dependent on a number of factors, not just the quality of health services
            provided by National Health Service organisations, but also on the quality of
            other services. The intended outcome of health scrutiny activity is the
            improvement of the health of the people of Staffordshire.

      (b)   Co-operation – the authorities involved must be willing to share knowledge,
            respond to requests for information, initiatives and reports as appropriate.

      (c)   Accountability – the process of health scrutiny will be open and
            transparent.

      (d)   Accessibility – scrutiny activity will, for each piece of work, actively seek to
            identify interested parties and to involve them where appropriate in the
            overview and scrutiny process.




                                                                     February 2008 revision
                                                                            Apppendix 2

                               Brief Terms of Reference


                            Health Scrutiny Officers Group

1. Introduction

1.1 The Health Scrutiny Officers Group („HSOG‟) has been formed to support the
Staffordshire Health Scrutiny Committee („SHSC‟) and District and Borough Scrutiny
arrangement.

1.2 The SHSC is a member committee while the HSOG is an officer group.

1.3 The function of health scrutiny began early 2002.

2. Membership

2.1 The membership of the HSOG will be as follows:

  Organisation                                    Number of Members

  Cannock Chase Council                           1
  East Staffordshire Borough Council              1
  Lichfield District Council                      1
  Newcastle-under-Lyme Borough Council            1
  South Staffordshire District Council            1
  Stafford Borough Council                        1
  Staffordshire Moorlands District Council        1
  Tamworth Borough Council                        1
  Staffordshire County Council                    1 (plus non-voting Support
                                                  Officer)
  Patient and Public Involvement Forums           1 review on establishment of
                                                  Local Involvement Network/s
  Health agencies as appropriate                  3: 1 - Strategic Health
                                                     2 - North and South
                                                     Staffordshire Primary Care
                                                  Trusts

2.2 By agreement the HSOG may invite other advisers/members to its Group on an
ongoing or ad hoc basis.

2.3 The County Council Health Scrutiny and Performance Manager will be an adviser to
the HSOG.

3. Terms of Reference

3.1 The main aim of the HSOG is to support the SHSC in achieving its aims and
objectives as detailed in its terms of reference.

3.2 Without prejudice to paragraph 3.1 the HSOG may:
                                                                  February 2008 revision
    (a) discuss, agree and put forward for approval items of business for the SHSC
    Agenda;

    (b) determine the process of involving interested parties to enable the SHSC to
    finalise scrutiny topics;

    (c) discuss and report on matters of note for the SHSC (generally via instruction to
    the Health Scrutiny and Performance Manager) and in particular discuss and
    report on an appropriate mechanism for member involvement in the scrutiny
    process;

    (d) establish an appropriate mechanism to determine links between the
    Staffordshire Scrutiny process and local scrutiny arrangements;

    (e) be the link with their own organisation and member to keep such informed,
    seek views etc;

    (f) co-operate with each other, where possible, for the furtherance of scrutiny of
    health in Staffordshire.

4. Operational Methods

4.1 Meetings – the HSOG will meet as frequently as needed to achieve the terms of
reference. Meetings will be organised and administered by the County Council.

4.2 Decisions – will be by consensus of agreement, failing such there shall be a vote.
Simple majority will carry the vote. Any member not satisfied with the outcome of such
may register a dispute. Registration of a dispute will hold the decision suspended and the
matter shall be referred to the SHSC for determination, or any other process agreed by
HSOG/SHSC to be appropriate. For the avoidance of doubt, advisers may not vote with
the exception of the County Council Health Scrutiny and Performance Manager.

4.3 Agenda Items – for the HSOG will be determined by the County Council Health
Scrutiny and Performance Manager. Other members may request appropriate items be
included on the agenda by reasonable notice.

Substitution – officers may send substitutes who will have the same voting rights.

Sub-Group(s) – by agreement the HSOG may set up sub-groups on an ongoing or ad
hoc basis.

Chairing – the County Council Health Scrutiny and Performance Manager will chair the
meetings and where possible produce an updating report for the HSOG.

5. Review and Change

5.1 The content of this document may be reviewed and changed at any time by the
agreement of the HSOG.




                                                                     February 2008 revision
                                                                               Appendix 3

                        Staffordshire Health Scrutiny Committee

                     Criteria for Selecting Topics for Health Scrutiny

1. The topic is relevant to addressing health inequalities in Staffordshire.

2. The topic is not being researched similarly by another person/organisation.
Undertaking work on this topic would not, therefore, represent duplication.

3. The scrutiny programme should strive to co-ordinate existing review and
inspection processes in the health service and local government.

4. The topic is a matter of public interest. The topic should be relevant to local
people. There may be tension between the determinants of health and what local
people think are the most important factors affecting their health e.g. smoking.

5. The County/District/Borough Council with responsibility for scrutiny can
scrutinise this topic within existing resources and that provision can be made for
the input and support of relevant NHS bodies, to support a partnership approach
where and as appropriate*.

6. In selecting topics for scrutiny, the benefits of choosing topics that will result in
an early recommendation(s) and cross-cutting topics being scrutinised, are
considered.

7. The topic is not over-ambitious and can realistically achieve a result that is going
to have an impact in terms of health improvement in Staffordshire.

8. The topic is timely. Where scrutiny needs to fit into other timetables e.g. budget
deadlines or reporting processes the findings can be fed in to fit in with existing
timetables.

Note: The scrutiny programme should be flexible enough to respond to the need for
unplanned work, as and when it arises, and the topics chosen should link to local
government/health service priorities and improvement agenda and feature in the
key relevant business plan such as the Community Strategy or Local Area
Agreement for Staffordshire.

* within the context of the relevant legislation/regulations/guidance.


NB The choice of topics remains discretionary within the scope of the Health and
Social Care Act 2001 which confers upon local authorities with social services
functions powers to undertake scrutiny of health matters as detailed in the Local
Authority (Overview and Scrutiny Committees Health Scrutiny Functions)
Regulations 2002.




                                                                    February 2008 revision
Local Government and Public Involvement in Health Act 2007 - The Committee will
follow any process established for determining whether to consider any topics
raised by Local Involvement Networks or through Councillor Call for Action.

                                                      (Reviewed February 2008)




                                                          February 2008 revision
                                                                             APPENDIX „D‟
                                                                          (Lavender paper)

                                                                  Item No. 11 on Agenda
  Local Members‟ Interest
           N/A


           Staffordshire Health Scrutiny Committee - 28 April 2008

                            Review of Work Undertaken 2007/08

Recommendation

1. That the Staffordshire Health Scrutiny Committee review the work that they have
undertaken during 2007/08.


Report of Scrutiny and Performance Manager


Part A

What is the Scrutiny Committee being asked to do and why?

       2. The Committee are asked to review the work that they have undertaken during
2007/08. Such a review offers the opportunity for the Committee to assess their ways of
working, what they have achieved and the outcomes of their work. Members may wish to
highlight both positive aspects and areas for development. Members‟ views will shape the
support that is provided to the overview and scrutiny function to enable continuous
improvement in performance.


Part B

Background

3. The Staffordshire Health Scrutiny Committee are responsible for scrutinising the
planning, provision and operation of health services in Staffordshire County Council‟s
area, in accordance with regulations under the Health and Social Care Act 2001 and
subsequent guidance. In Staffordshire there is a fully devolved and inclusive model of
health overview and scrutiny. Members of Staffordshire Health Scrutiny Committee
concentrate on scrutinising issues that cover the whole or large parts of Staffordshire.
The District and Borough Councils in Staffordshire have a health overview and scrutiny
committee, or equivalent, and their Members focus on scrutinising issues of local concern
within their area. In addition, health overview and scrutiny committees are consulted on
“substantial variations and developments” and respond to national, regional and local
consultations on health matters.

4. This year has been notable for the level of consultation with health overview and
scrutiny on key business planning documents, following significant organisational change
in the previous year. The relationships with local health trusts have matured, as has the
operation of the devolved arrangements for health overview and scrutiny. The Committee
has developed the arrangements for receiving feedback on the outcome of consultation
and previous scrutiny work so that all parties can refine the process to ensuring that health
overview and scrutiny fulfils its remit.

5. In 2007/08, the Committee have undertaken the work set out in the following
paragraphs. Where appropriate, the paragraphs that describe outcomes also indicate
whether there is likely to be further scrutiny on a matter. This is intended to help the
Committee by highlighting matters that they may wish to bring forward when, after the
annual Council meeting in May 2008, they consider their Work Programme for 2008/09.


Holding the Cabinet to account

Updates on Health Issues

6. During the year, the Committee have received some Updates on Health Issues. These
reports are intended to highlight the recent issues considered by the Cabinet, give an
overview of significant developments and identify the future key decisions that are relevant
to the remit of the Committee. Questions, comments and views are invited from Members
of the Committee and they are able to ask about scrutiny involvement in the future key
decisions.

7. Topics covered in Updates have included: Medium Term Financial Strategy – investing
in social care and health; Exercise Winter Willow (preparedness of statutory agencies to
respond to an influenza pandemic); Big Lottery Wellbeing Fund; dementia; Strategy for
Healthier Communities and Partnership Agreements; Social Care and Health Directorate
district-based management arrangements; the Changing Lives programme; charges for
service users; Health, Safety and Welfare Policy; community projects; Health Impact
Assessment; drugs and alcohol; and joint appointments of Directors of Public Health.

Questions (Appendix 2 of the County Council‟s Constitution)

8. The Members of the Committee have not used the provision for questions to Cabinet
Members in 2007/08. However, the provision for this Committee extends to questions to
local health Trusts and in March 2008, questions were submitted to West Midlands
Ambulance Service NHS Trust on ambulance response times in Staffordshire and to Mid
Staffordshire NHS Foundation Trust on mortality rates. Replies were obtained from the
Trusts.

Triangulation meetings

9. Regular meetings have been held between the Chair and Vice-Chair of the Committee,
the Leader of the Council and the Deputy Corporate Director, Community Services.
These meetings provide for discussion about the work of the Committee to help make
sure that overview and scrutiny Members, Cabinet Members and directorate officers are
working effectively together to contribute to the County Council‟s and partners‟ shared aim
of reducing health inequalities.
Scrutiny Review

National matters with implications for Staffordshire:

The Transition from Patient and Public Involvement Forums to Local Involvement
Networks

10. The Local Government and Public Involvement in Health Act 2007 made provision for
Local Involvement Networks (LINks) to replace Patient and Public Involvement Forums
from 1 April 2008. The intention behind LINks is for local communities to have more say
in the way in which the whole health and social care system is designed and works. The
County Council was responsible for procuring a host organisation to support the work and
activities of a LINk for Staffordshire.

The Committee have maintained an overview of national and local developments in the
transition from Forums to LINks and have undertaken the following scrutiny activity.

a) In June 2007, the Committee used a day of the support that they get from the Centre
for Public Scrutiny for a seminar on the transition from Forums to LINks. The seminar was
well attended by County and District/Borough scrutiny Members and officers, and
representatives of Forums in Staffordshire and their support organisation. They reflected
on their experience of Forum working arrangements, received the current information
available on the transition; and anticipated future LINks working arrangements. In
addition, in July 2007, the Committee considered a presentation from Jacqui Nother-Smith
and Charles OKell, Senior Forum Co-ordinators, on the activity of the Forums in the
county over the previous twelve months. The Forums had worked with local health Trusts
to contribute to health service development and, through inspection and follow up activity,
performance management.

   Outcome: The Committee acknowledged the significant contribution of the Forums to
   the development of health services. The key points arising from the seminar were
   forwarded to the Leader of the Council. As a result, an advisory group was established
   to help the County Council prepare for the process of procuring a host organisation.

b) The Committee scrutinised the County Council‟s approach to procuring a host
organisation to help ensure that value for money was achieved in this procurement
process. This included how the evaluation of the bids would take account the cost of the
host and the value that it could bring to the delivery and work of the LINks; ensuring that a
decision was reached on best value principles. The Chairman was involved in the
evaluation of the bids.

   Outcome: The County Council‟s approach to this procurement process, which included
   European advertisement and comprehensive pre-qualification questionnaires, was
   held as good practice by other authorities. The County Council was one of the first
   local authorities to appoint a host organisation.

c) The Committee responded to the Department of Health consultation on the draft
regulations for LINks, covering: the duties of service providers in regard to LINks requests
for information, reports and recommendations, and requests for entry; and LINks‟ referrals
to overview and scrutiny committees.
   Outcome: Following the consultation, regulations and guidance on various aspects of
   LINKs‟ operation are being issued by the Department of Health.

d) In March 2008, the Committee used a further day of support from the Centre for Public
Scrutiny for a seminar to explore: developing overview and scrutiny and LINks‟ Work
Programmes; and developing the relationship with regulatory bodies. Councillors and
officers working in health and social care scrutiny at County and District/Borough level
attended, as did representatives of commissioners and regulators of health and social
care services. They anticipated opportunities for working together to ensure that overview
and scrutiny, and patient and public involvement, contribute effectively to improved care
services delivery and outcomes. They also discussed what arrangements might be
required to support working together, including learning from current good practice.

   Outcome: The notes of the seminar will be shared with the host organisation, relevant
   health, local authority and regulatory body representatives with a view to developing
   Work Programmes and relationships, in the context of their shared interest in improved
   care services delivery and outcomes.

Practice Based Commissioning

11. In November 2007, representatives of North and South Staffordshire Primary Care
Trusts (PCTs) attended a Committee meeting to provide Members with an overview of the
development of practice based commissioning in Staffordshire. Practice based
commissioning is about GP practices having a budget with which to commission services,
meaning that doctors and nurses are more involved in decisions about services. The
benefits are intended to be a greater variety of services which are responsive to patient
need, providing greater choice and convenience.

   Outcome: The Committee‟s relationship with commissioners of health services is key
   to fulfilling their remit, so it is important that they understand these devolved
   commissioning arrangements. Members were particularly interested in the governance
   arrangements, communicating with the public and the „buy in‟ from GPs. The
   Committee may wish to follow up whether the intended benefits of practice based
   commissioning are realised.


Regional matters with implications for Staffordshire:

West Midlands Regional Assembly: “Healthy Choices? You Decide” Consultation on
Developing a West Midlands Regional Health and Wellbeing Strategy

12. The Committee considered a presentation by the Chairman of the Regional Health
Partnership, in June 2007, on the draft Health and Wellbeing Strategy for the West
Midlands. Members focused on how the Strategy was intended to link the health agenda
with other partnership agenda and regional strategies. A Sub-Group of Committee
Members met to consider in detail the questions in the consultation document.

   Outcome: The Committee‟s comments, which were about: emphasising certain
   priorities; target setting; and some specific developments that Members would like to
   see, contributed to the Council‟s response to the consultation. The Committee may
   wish to follow up on the implementation of the Strategy.
West Midlands Strategic Health Authority Consultation: Strategic Framework
“Investing for Health”

13. In July 2007, the Committee considered a presentation by the Programme Specialist
from NHS West Midlands on their Strategic Framework for improving health and health
services, which was the subject of consultation. Members concentrated on how the
proposed priorities and projects would meet the health challenges identified. A Sub-
Group of Committee Members met to consider in detail the questions in the consultation
document.

   Outcome: The Committee‟s comments, which were about: partnership working;
   investing in prevention of ill health; organisational learning; communications;
   technological advances; community engagement; sustainable services; and mental
   health, contributed to the County Council‟s response to the consultation. The final
   version of “Investing for Health” has recently been received and the Committee may
   wish to follow up on the associated programmes of work.

   One of the issues raised during the Committee‟s considerations was providing
   information and advice to people to help them manage their own health. This
   prompted contact with the County Council‟s Library and Information Services to find
   out about their role in providing such information.

Cross-cutting matters:

Audiology

14. The Chairman was contacted by the Chief Executive of the Royal National Institute for
the Deaf (RNID) who highlighted the issue of long waiting times for audiology assessment
and services. In October 2007, the Committee considered a report containing information
from North and South Staffordshire PCTs about how this matter was being addressed.

   Outcome: Additional capacity was being provided, which was bringing down waiting
   times. The Chairman responded to the RNID giving feedback on the outcome of the
   Committee‟s enquiries. The Committee have expressed the intention to monitor future
   progress in regard to audiology assessment and services.

Hospital Discharge and Emergency Readmissions

15. The Committee followed up a question asked by a Member of the Healthier
Communities and Older People Scrutiny and Performance Panel by exploring, in
November 2007, the subject of avoiding inappropriate discharges from hospital. This
included looking at information on emergency readmissions to hospital and information
from the acute hospital and primary care Trusts in the county about the performance
management arrangements in regard to discharge policy and practice.

   Outcome: The Committee discussed whether they should make any further enquiries
   on this subject. Members decided that they were most interested in what action was
   being taken to ensure that appropriate social care services are available to those who
   needed them on discharge from hospital, particularly to home. They referred this
   subject to the Healthier Communities and Older People Scrutiny and Performance
   Panel with a request that they consider reviewing this subject as part of their Work
   Programme. The Panel have since considered a report from the Social Care and
   Health Directorate on the emerging challenges, plans and progress in relation to
   discharges from hospital, including a project to develop, in partnership, all elements of
   the customer journey relating to discharge. The Panel have resolved to monitor the
   implementation of the project, in the context of the multi-agency approach to discharge
   management.

Learning Disability Services

16. The Committee have an interest, from a health perspective, in the development of
services for people with learning disabilities. In furtherance of this interest, in April 2007
with the former Social Care Scrutiny and Performance Panel, the Committee considered
the commissioning strategy for Learning Disability services and were updated on progress
in regard to the Learning Disability Action Plan. The Committee have also undertaken the
following activity.

a) Learning Disability Respite Care - For some time, the Committee pursued consultation
on the transfer of responsibility for commissioning some learning disability services from
South Staffordshire PCT to the County Council, with the implication that there should also
be consultation on future service delivery. The Committee considered a report, in
September 2007, which covered the need to alter services (involving changes in
commissioning and provision) and the strategy to develop short break services. This was
in the context of the County Council‟s strategy for modernising services for adults with
learning disabilities. South Staffordshire and Shropshire Healthcare NHS Foundation
Trust (who provided some current services) supplied additional information to assist the
Committee. Members were assured that the County Council had effective leadership
arrangements in place to deliver the strategy. The Committee asked the PCT and County
Council to work together to undertake the necessary consultation, in accordance with the
Cabinet Office Guidelines for Consultations and West Midlands Strategic Health Authority
guidance.

In October 2007, the Committee were presented with proposals for the consultation to
take place between January and March 2008.            The Committee supported the
arrangements for consultation but expressed some concern about the timetable for the
consultation process. The Chairman wrote to the Chairs and Chief Executives of the PCT
and South Staffordshire and Shropshire Healthcare NHS Foundation Trust and also the
Corporate Director and Cabinet Member for Social Care and Health to ensure the highest
level commitment to this consultation process.

   Outcome: The consultation on the future of residential short breaks (respite care)
   provision for people with learning disabilities in South Staffordshire is taking place and
   features on the agenda for the Committee‟s April 2008 meeting.

b) NHS Campus Reprovision Programme for People with Learning Disabilities – The
Committee have maintained an overview of this Programme. It is a Government
requirement that services termed as NHS Campus sites (homes where care is provided by
the NHS) be reprovided by April 2010. In October 2007, Members were informed of the
number of Campus placements in Staffordshire and Stoke-on-Trent and the project
management arrangements put in place for the reprovision, including the necessary
assessment and consultation processes. In March 2008, Members were updated on
progress with the project, associated funding and anticipated outcomes.
   Outcome: The Committee may wish to maintain an overview of progress with this
   Programme until its completion.

Local Health Trust matters:

17. Following the model of triangulation meetings, the County and District/Borough health
overview and scrutiny committees seek regular informal meetings (together and
separately, as appropriate) with the local health Trusts in the county to: discuss the role
and contribution of overview and scrutiny; develop effective working relationships; discuss
emerging issues; shape Work Programmes (including consultation); and follow up on the
outcomes of previous scrutiny activity. Regular meetings have been held with the majority
of the relevant Trusts during the year. This year, the Committee has also been in contact
with Stoke-on-Trent PCT, Royal Wolverhampton Hospitals NHS Trust and Walsall
Hospitals NHS Trust, to find out about developments, as Staffordshire residents access
services provided by these Trusts.

18. The main contact between the Staffordshire Health Scrutiny Committee and local
health Trusts is set out below. In addition, Members of the Committee are allocated a
Special Interest in the work of a local health Trust. Members pursue this interest in
different ways. There is a facility for Member to report back on their contact with the Trust,
such as attendance at Trust Board meetings.

19. All contact with Trusts, which may also include visits to familiarise Members with
services, is reflected in the contribution of overview and scrutiny to each Trust‟s Annual
Health Check declaration. Annual Health Checks are the Healthcare Commission‟s
system for assessing the performance of NHS Trusts. Health Trusts are required to make
a self assessment and to supplement this with comments from overview and scrutiny
committees and other stakeholders. The County and District/Borough health overview
and scrutiny committees‟ contributions to the 2007/08 Annual Health Check were supplied
to the relevant Trusts at the beginning of April 2008.

North Staffordshire PCT

20. a) In April 2007, the Committee received presentations on the public health annual
reports for the areas of the county covered by the PCT. These included the key public
health issues of: obesity and infant feeding; sexually transmitted diseases; respiratory
disease and tobacco; alcohol; and health inequalities. Members learned about the
progress in these areas and what more needed to be done. Looking ahead, other
important areas were emergency hospital admissions, community pharmacies and
responding to climate change.

   Outcome: These presentations, and subsequent advice from the jointly appointed
   Director of Public Health for North Staffordshire, helped shape the Committee‟s Work
   Programme.

b) In Autumn 2007, following prior discussion of service developments and consultation
requirements with overview and scrutiny, the Trust issued consultations on:

      Proposals to develop a specialist centre for people with organic
       mental health needs (dementia) for North Staffordshire and Stoke-on-
       Trent (together with Stoke-on-Trent PCT and involving services
       provided by North Staffordshire Combined Healthcare NHS Trust
      North Staffordshire Service Review and Improvement in Urgent Care.

The Committee delegated the response to these consultations and to a letter from the
Trust seeking views on their Principle and Values, to the overview and scrutiny
committees or equivalent of Staffordshire Moorlands District Council and Newcastle-
under-Lyme Borough Council.

   Outcome: The Trust gave formal feedback to the Committee on the outcomes of these
   consultations in December 2007. A Primary Care Urgent Care Team, based within the
   Adult Assessment Unit by Accident and Emergency at University Hospital North
   Staffordshire, opened on 5 January 2008. A specialist centre for people with dementia
   is being developed. Members were informed of various actions to be undertaken to
   respond to the issues raised in consultation. The Committee may wish to follow up on
   progress with these developments.

c) In December 2007, the PCT sought the Committee‟s views on their five-year Strategy
for improving health and healthcare services for the people served by the PCT. The
themes of the strategy were: staying healthy; health management; at times of crisis;
specialist care; and reducing health inequalities. Members asked in particular about
prioritising spending, investment in preventative services and co-ordination with other NHS
and non-NHS partners.

   Outcome: The Committee anticipate further opportunity to comment on the
   engagement and consultation associated with the Strategy and the prioritisation
   process.

South Staffordshire PCT

21. a) In June 2007, the views of the Committee were sought on the Trust‟s Strategic
Plan, presented to them by the Director of Commissioning and Redesign. The themes of
the plan included: improving child health; increasing life expectancy; quicker, high-quality
health care; treating patients closer to home; improving care for patients with chronic
conditions; patients in control of their health; working together; and improving end of life
care. Following concern expressed by Members about the short timescale for comments
and the incompleteness of the document, the Trust extended the deadline for comments
and issued an updated version of the Plan for scrutiny. A Sub-Group of the Committee
considered the Plan in detail and the Committee‟s views were submitted to the Trust.

   Outcome: The Committee‟s response covered various subjects including: prevention
   and early intervention; engaging with scrutiny; patient and public involvement; the role
   of carers; mental health; cancer in regard to life expectancy; end of life care; NHS
   dentistry; GP booking systems; patient choice; partnership working; and infection
   control. The Committee may wish to follow up on the delivery of the Plan.

b) In November 2007, the views of the Committee were sought on the Trust‟s Consultation
Document and Action Plan and Work Programme for their Patient and Public Involvement
(PPI) Strategy 2007-10. A Sub-Group of the Committee considered the documents in
detail and the Committee‟s response was submitted to the Trust.

   Outcome: The Committee‟s response covered: the relationship with LINks; taking
   account of other PCT‟s patient and public involvement strategies; communicating and
   co-ordinating consultation activity; monitoring patient satisfaction; partnership working;
   engagement and feedback/reporting; carers; workforce development; and working with
   the Committee. The Committee have stated that they look forward to working with the
   Trust in respect of the implementation of the Strategy.

c) The Committee have maintained an overview of the Trust‟s work in the area of palliative
care, following a review which had taken place after previous scrutiny enquiries, namely
the preparation of a strategy to respond to the need to change the model of service
provision, including crisis response. The Committee received a written update on the
associated project plan in September 2007 and then a presentation on the emerging
themes from the Director of Quality and Performance at South Staffordshire PCT at their
meeting in December 2007. Members‟ scrutiny covered: funding; information provision;
care packages; drugs; and children‟s hospices, which are the subject of a separate piece
of work.

   Outcome: The Trust Board have approved the strategy. The Committee have stated
   their wish to receive a copy and be updated on its implementation in due course.

d) The Committee have maintained an overview in regard to the GP Out of Hours service,
writing to the Trust in September 2007, in regard to the tendering process for this service,
about maintaining the service level. In January 2008, the Trust‟s Head of Primary Care
Commissioning presented to the Committee on the new arrangements for the service.
Discussion covered: the tender process and contracted provider; participation of GP
practices; staffing matters; service location and provision; waiting times; information
provision; and performance management arrangements.

   Outcome: The Committee will receive a first quarter update in regard to the new
   provider arrangements and then further performance information in due course.

e) In March 2008, the Head of Primary Care Commissioning gave the Committee an oral
update on Equitable Access to Primary Medical Services in South Staffordshire (in relation
to the „Darzi Health Centre‟) which provided the opportunity for Members to ask questions
and comment on what consultation and engagement would be undertaken.

   Outcome: The Committee anticipate further opportunity to comment on the types of
   services to be provided from the Health Centre.

Burton Hospitals NHS Trust

22. In June 2007, the Trust presented to the Committee on their proposal to become an
NHS Foundation Trust. Members‟ enquiries covered: the Trust‟s key aims; their financial
position; the proposals for membership and governance arrangements; and patient
choice. A Sub-Group of the Committee considered the consultation document in detail
and the County Council‟s response was submitted to the Trust.

   Outcome: The Committee‟s response covered: service development; partnership
   working; attracting and retaining members; governance arrangements and
   communications. An update from the Trust on the progress of their application for
   Foundation Trust status features of the agenda for the Committee‟s April 2008
   meeting.

Heart of England NHS Foundation Trust (re. Good Hope Hospital)
23. At the end of 2006/07, the Committee responded to consultation on the merger of
Good Hope Hospital NHS Trust with Heart of England NHS Foundation Trust.

   Outcome: The merger took place. There has been no contact between the Committee
   and the latter Trust during 2007/08. However, Lichfield District Health (Overview and
   Scrutiny) Panel have had contact and contributed to the Trust‟s Annual Health Check
   declaration.

Mid Staffordshire NHS Foundation Trust

24. a) At the beginning of 2007/08, the Committee responded to the Trust‟s consultation
on their application for Foundation Trust status. Their comments covered; the wording of
the Trust‟s priorities; the hospital name; membership and governance matters; and
communications.

   Outcome: In June 2007, the Committee learned that the results of the consultation in
   respect of the Trust‟s Foundation Hospital Trust application were available on the
   Trust‟s website. In summary, the Trust had received overwhelming support for their
   application and had made some changes to their proposals following the consultation:
   the name for the Trust would be Mid Staffordshire NHS Foundation Trust; and there
   would be one additional appointed governor (for South Staffordshire District Council)
   and one more public governor to represent surrounding areas. The Trust picked up
   the Chairman‟s suggestion of articulating their intention to be “the cleanest place in
   town”.

b) The Trust made the Chairman aware of the Healthcare Commission investigation of
their mortality rates, in particular their systems for monitoring mortality rates relating to
emergency admissions.

   Outcome: Some Members of the Committee are taking part in related Healthcare
   Commission interviews.

University Hospital of North Staffordshire NHS Trust

25. There have been no formal Committee agenda items from the Trust during this year
but, as well as regular meetings and visits, Members have attended a joint meeting with
Patient and Public Involvement Forums and a Clinical Governance day.

   Outcome: This contact has enabled Members to maintain an overview of the Trust‟s
   delivery of their service and financial plans.

North Staffordshire Combined Healthcare NHS Trust

26. There have been no formal Committee agenda items from the Trust during this year
but discussion about service developments in north Staffordshire included services
provided by the Trust.

   Outcome: Communication from the Trust has enabled the Committee to maintain an
   overview in respect of their application for Foundation status. In January 2008,
   informal meetings were reinitiated.

South Staffordshire and Shropshire Healthcare NHS Foundation Trust
27. Following correspondence and initial feedback in January 2008, in February 2008 the
Trust enabled the Committee to follow up on previous scrutiny activity through the Chief
Operating Officer reporting on the results of their internal review of their community Child
and Adolescent Mental Heath Service (CAMHS). The recommendations arising from the
review were focused on the administrative and clinical management of the service and the
clinical models of care, aimed at ensuring equality of access to services and consistent
best practice. Members enquired about the arrangements for: implementing the
recommendations; decision making about clinical models; and managing performance,
particularly with regard to waiting times for assessment and services. They also asked
about the cost and service implications of out of county services for young people with
autistic spectrum disorders.

   Outcome: The Committee have asked to consider the implementation plan arising from
   the review, once this has been to the Trust Board, and for some example patient
   journeys to help Members understand the nature of the service.

      The Committee have stated their wish to maintain an overview of strategic
   developments across the county in regard to the various tiers of the CAMHS and have
   asked South Staffordshire PCT about their commissioning intentions with regard to
   services for people with autistic spectrum disorders.

West Midlands Ambulance Service NHS Trust

28. a) The Committee maintained an overview of progress with the merger of Staffordshire
Ambulance Service Trust with West Midlands Ambulance Service NHS Trust, with
updates provided by representatives of the Staffordshire Ambulance Service NHS Trust in
March and August 2007. These covered the: process; benefits; financial position; locality
and performance management arrangements; and the position on Community First
Responders.

   Outcome: The Committee encouraged Staffordshire Ambulance Services NHS Trust to
   take a robust approach to their communications and public relations in respect of the
   merger, to reassure Staffordshire residents.

b) In August 2007, the Committee had the opportunity to comment on the draft Strategic
Framework for the West Midlands Ambulance Service NHS Trust, which outlined the
direction for the Trust for the five year period commencing April 2007 (this had been
reissued in response to concerns expressed, about a lack of awareness of the document,
at a regional meeting of health overview and scrutiny Chairs and Officers in June 2007).

   Outcome: The Committee‟s response covered: leadership; affordability;
   commissioning; Foundation Trust status; stakeholders; urgent care; infection control;
   call connection; training; vehicle maintenance and condition; and reference to the
   Community First Responders scheme. The Committee may wish to follow up on the
   work associated with the Framework.

c) In September 2007, the Chief Operating Officer and the Trust‟s Head of
Communications presented the Emergency Operations Centre (EOC) consultation. The
aims of the proposal, to move from five to three Centres, include: better patient care;
increased resilience; and increased ability to deal with a major incident. Our scrutiny
included the use of the latest technology, including digital radio, and achieving the best
possible performance in regard to response and ambulance despatch times. The
Committee responded to the Trust, supporting the proposals on the understanding that
they were informed of the results of the independent review also taking place and could
reconsider their response in the light of the review. In December 2007, the Trust‟s Locality
Director reported on the outcome of the consultation and the review, at which point the
Committee confirmed their response.

   Outcome: There will be three Centres in the region. The Committee may wish to
   follow up on the implementation of this set up and the arrangements for managing
   performance. Members plan to visit two of the Centres.

d) The Healthcare Commission has recently published the report on its investigation of the
Staffordshire Ambulance Service NHS Trust.

   Outcome: A representative of West Midlands Ambulance Service NHS Trust will attend
   the Committee‟s April 2008 meeting to explain how the Trust is responding to the
   report.

Burton Independent Treatment Centre

29. Health Scrutiny Chairmen from the County Council, Stoke-on-Trent City Council,
Derbyshire and Leicestershire County Councils and East Staffordshire Borough Council
reviewed the management and operation of Burton Independent Treatment Centre,
following some adverse media coverage. The Centre, which covers the Midlands area, is
a purpose built health care facility and offers a range of specialities and provides services
for outpatients along with day surgery procedures. Meetings were held in July and
October 2007. Members met, and received information from, the owner and from South
Staffordshire PCT (one of the commissioners of services at the Centre). Members have
also visited the Centre.

   Outcome: Since the involvement of health overview and scrutiny began, there has
   been significant improvement in the management and operation of services provided
   at the Centre. The Chairmen of the Staffordshire and Derbyshire Health Scrutiny
   Committees made this joint statement: “We find improvement in patient care
   encouraging and we offer our assurance that we will continue to monitor provision at
   the Treatment Centre to ensure that progress is maintained and earlier fears
   alleviated.” However, concerns have been raised about contractual matters and the
   Chairman is pursuing the development of Terms of Reference for further scrutiny.

County Council matters:

30. The County Council has established arrangements for scrutiny Members to contribute
to the preparation of the Council‟s business plans, in advance of the consideration of
these plans by Cabinet and full Council. In February 2008, the Committee commented on
the Healthier Communities & Older People and Children & Young People Thematic
Improvement Plans, with particular reference to whether the priorities and intended
outcomes that were outlined in the Plans were clear and understandable and whether the
Plans formed a robust basis for monitoring progress and performance in these thematic
areas during 2008/09.

   Outcome: The Committee‟s comments, which included reference to the very elderly,
   vulnerable people, performance indicators, monitoring arrangements and focusing on
   outcomes, were taken into account on in finalising the Thematic Improvement Plans.
   Members have asked for a copy of the Joint Strategic Needs Assessment.

District/Borough Council matters:

31. The District and Borough Councils represented on the Committee continue to provide
reports to ensure that the Committee have a complete picture of health overview and
scrutiny activity in the county, which helps with the co-ordination of work and sharing good
practice.

32. The Committee welcome the presentation of the outcome of reviews conducted by the
District/Borough health overview and scrutiny committees. In April 2007, Staffordshire
Moorlands District Council presented their review on Substance Misuse. In December
2007, East Staffordshire Borough Council presented the report of the Joint Review by
East Staffordshire Borough Council and Patient and Public Involvement in Health Forums,
Burton Hospitals and South Staffordshire PCT into Hospital Discharge Policy and Practice
at Burton Hospital.

   Outcome: The Committee look at these reports to see whether there are any learning
   points, or recommendations with wider applicability, to be shared. The Hospital
   Discharge report was shared with the Healthier Communities and Older People
   Scrutiny and Performance Panel, as it was relevant to the Committee‟s referral to them
   of this subject.



Scrutiny Working Group activity:

33. There have been various Scrutiny Working Groups in operation during the year that
have involved Committee Members.

Take Up of School Meals in Primary Schools In Staffordshire

34. A Working Group of Members of the Committee and the former Children and Lifelong
Learning Scrutiny and Performance Panel investigated the take up of school meals in
primary schools in Staffordshire, against a picture of falling take up. They submitted their
final report to the Committee in November 2007. The report contained recommendations
aimed at increasing the take up of schools meals, providing some ideas as to how
improvements may be made - to support the School Meals Service, assist the schools and
benefit children. The report was endorsed by both the Committee and the Children and
Young People Scrutiny and Performance Panel and submitted to the Cabinet Member,
Children and Young People, for response.

   Outcome: The Executive Response to the Review was considered by the Committee in
   March 2008. They were pleased to note that the majority of the recommendations
   were supported. The Committee will monitor the implementation of the agreed
   recommendations.

35. The Committee has been represented on three cross-cutting Working Groups
established by the County Council‟s Corporate Policy Scrutiny and Performance
Committee: Budget Scrutiny Working Group; Climate Change Scrutiny Working Group;
and Performance Management Scrutiny Working Group. The work of these Groups will
be covered in the Corporate Policy Scrutiny and Performance Committee‟s Review of
Work Undertaken 2007/08.


36. Various topics for review have been given preliminary consideration during the year.
On the basis of advice from the Directors of Public Health for North and South
Staffordshire, the topic of sexual health has been prioritised and the draft scope circulated
to Members and submitted to the Directors for comment. This review will take account of
the scrutiny of the Teenage Pregnancy Partnership undertaken by the Partnerships
Scrutiny and Performance Panel.

Chairman‟s correspondence:

Cardiac Risk in the Young (CRY)

37. CRY works closely with a number of MPs to try and improve awareness of sudden
cardiac deaths in young people. County Councillor Mick Clarke requested the
Committee‟s support in lobbying government to introduce heart screening for young
footballers, following the death of a local Wolstanton teenager.

   Outcome: The Chair investigated this matter and, in November 2007, responded to Cllr
   Clarke on the basis of uncertainty about the case for screening but general support for
   the efforts of CRY to raise awareness of cardiac risk in the young and to support those
   affected by the sudden death of a child or young adult. .

Decriminalised Parking Feedback

38. As a result of a question by County Councillor Mark Winnington to full Council in
December 2007, the subject of the impact of the decriminalised parking initiative on
healthcare professionals was referred to the Committee. If there were problems, the
possibility of a Health Emergency Badge Scheme could be considered. Mindful that this
would be at a cost to the PCTs, the Chairman wrote to the Chief Executives of North and
South Staffordshire Primary Care Trusts asking what impact, if any, this initiative has had
on their staff. South Staffs PCT had looked into this issue and not found evidence of any
problems and North Staffs PCT had reported a minor issue in Cheadle. As a result of the
question, other issues around the blue badge scheme were raised. The Chairman will
provide a response to Councillor Winnington when this has been followed up.

Other activity by Members:

39. Members have engaged in the following activity to share information and best practice
and support the development of the health overview and scrutiny function.

40. In April 2007, a day of support from the Centre for Public Scrutiny was used for a
seminar to discuss health scrutiny and links with the media. The County Council‟s
External Communications Manager was among the Members and officers who attended
from the County and District/Borough Councils. The seminar was intended to help
Members and officers: become more aware of the way in which links with the local media
can support the work of health and overview scrutiny committees; decide next steps
towards a proactive approach to engaging the public through the media; and contribute to
the development of a communications strategy for scrutiny. Feed back from the seminar
was very positive.
    Outcome: Various communications actions were included in the 2007/08 Scrutiny and
    Performance Team Development Plan and the subject will feature on the programme
    for the next Scrutiny Development Forum on 24 April 2008.

41. The Committee was represented at the Sustainable Development and Health in the
West Midlands Conference, Telford in May 2007.

42. Some Members of the Committee visited Staffordshire University Faculty of Health in
September 2007. Dr Hilary Jones, Dean, Faculty of Health, arranged a series of
interesting presentations by staff and a tour of the building.

43. The Chairman attended the Centre for Public Scrutiny 5 th Annual Conference in June
2007. He has also participated actively in meetings of the West Midlands Regional Health
Scrutiny Chairs Group held in June and September 2007 and January 2008. Subjects
covered at the meetings include: the Regional Health and Wellbeing Strategy; the West
Midlands Strategic Health Authority‟s Strategic Framework and West Midlands Ambulance
Service NHS Trust consultations. With the assistance of Legal Services, the Chairman
and the Scrutiny and Performance Manager are leading on the development of Terms of
Reference for the Group. The Chairman and Scrutiny and Performance Manager also
attended the Centre for Public Scrutiny event on Scrutinising Specialist Services in
October 2007. The aim of the seminar was to build the process of developing effective
relationships between specialised commissioning groups and overview and scrutiny
committees.

44. The Vice-Chairman and the Scrutiny and Performance Manager met with the
Healthcare Commission in London in February 2008 to discuss the development of the
Annual Health Check process and third party contributions. This has resulted in contact
from Dr Foster Intelligence about participation in the development of a benchmarking
system for PCTs.

Support matters:

45. The Scrutiny and Performance Manager‟s reports to the Committee ensure
accountability for this role and that of the Scrutiny and Performance Support Officer and
provide a way of reporting to the Committee on:

   matters or events arising to be drawn to their attention;
   discussions/correspondence with NHS Trusts or other organisations;
   referral of matters between the county‟s health scrutiny committees;
   progress on Scrutiny Reviews;
   progress on actions undertaken in respect of matters that do not require a full report or
    Scrutiny Review process such as those being addressed through correspondence;
   development of the Work Programme;
   work undertaken relating to Members‟ special interests;
   use of the Centre for Public Scrutiny health scrutiny support programme; and
   Member development.

46. Matters covered in these reports not mentioned elsewhere include: NHS dentistry,
result of Healthcare Commission assessments of local health trusts; NHS Framework for
Continuing Care; and CAMHS Tier 4.
47. The Scrutiny and Performance Manager continues to look for opportunities which
might benefit the Committee such as participation in South Staffordshire and Shropshire
Healthcare NHS Foundation Trust‟s Choice Innovations Project to explore ways in which
the Trust can develop „choice‟ for service users involving staff, service users and partners.

48. The Health Scrutiny Officers‟ Group continues to meet on a quarterly basis to support
the operation of the devolved arrangements for health overview and scrutiny.

49. Equalities Implications - The work of the Committee is intended to contribute to the
County Council‟s corporate objective of healthier communities and older people and to
reducing health inequalities in Staffordshire.

50. Legal Implications - The Committee are updated as necessary on any matters
affecting their operation that relate to legislation, regulations, and the County Council‟s
Constitution. The Constitution has been amended to show that the Committee may, within
the scope of its allocated roles and responsibilities, respond independently to health
related consultations from Government and external agencies. In February 2008, the
Committee considered a Law and Governance report and endorsed updated Codes of
Joint Working with Local Authorities and Health (with the Terms of Reference for the
Health Scrutiny Officers‟ Group and the Criteria for selecting topic for scrutiny).

51. Resource and Value for Money Implications - The review of work provides a means
of evaluating the effectiveness and efficiency of the Committee.

52. Risk Implications - Not conducting a review of work undertaken would mean that the
opportunity to gauge the effectiveness and efficiency of the Committee and plan for
improvement would be lost.
Contact Officers

Name:              Tina Randall, Scrutiny and Performance Manager
Telephone No.:     01785 27 6148
Address/e-mail:    tina.randall@staffordshire.gov.uk

Name:              Sarah Garner, Scrutiny and Performance Support Officer
Telephone No.:     01785 27 6144
Address/e-mail:    sarah.garner@staffordshire.gov.uk


List of Appendices/Background papers

Scrutiny and Performance Manager‟s reports to, and minutes of, the meetings of the
Staffordshire Health Scrutiny Committee held on:

      28 March 2007
      30 April 2007
      12 June 2007
      19 July 2007
      14 August 2007
      11 September 2007
      15 October 2007
      15 November 2007
      13 December 2007
      14 January 2008
      5 February 2008
      31 March 2008.
 APPENDIX „E‟
(Orange paper)
APPENDIX „F‟
 (Pink paper)

								
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