Adult, Community Services and Health Overview and Scrutiny Panel
Tuesday 3 March 2009
ADULT, COMMUNITY SERVICES & HEALTH OVERVIEW & SCRUTINY PANEL
3 MARCH 2009
PRESENT: Councillors Mrs Endacott (Vice Chairman – in the Chair), Mrs Evans, Lenton, Majeed, Mrs Napier and Mrs Proctor.
Also Present: Councillors Baskerville and Mrs Yong: Mr C Hayton & Mrs E Barker (Heatherwood & Wexham Park Hospitals NHS Foundation Trust) Mrs C Finlay (Berkshire East PCT), Mrs Slinger and Mr G Nixon (Berkshire Healthcare NHS Foundation Trust) and Mrs S Holmes (Windsor, Ascot and Maidenhead LINk)
Officers: Mr Abrahamson, Mr A Brown, Mr Camp-Overy, Mr A Scott, Mr D Scott and Mr Taylor.
PART I
70/08 APOLOGIES FOR ABSENCE
An apology for absence was received from Councillor Meadowcroft.
71/08 DECLARATIONS OF INTEREST
Councillor Mrs Napier declared a Personal Interest in Agenda Item 6 – Safeguarding Adults – as her son was a vulnerable adult
Councillor Mrs Endacott declared a Personal Interest in Agenda Item 11 – Release of Service Users from Secure Accommodation – as she was a Governor for Berkshire Healthcare NHS Foundation Trust.
72/08 MINUTES
- RESOLVED: That the minutes of the meeting of the Panel held on 29 January 2009 be approved.
73/08 DEVELOPMENT OF ACUTE MEDICINE AND FUTURE PLANS FOR SERVICES AT HEATHERWOOD HOSPITAL - PROPOSALS FOR CONSULTATION
Mr Colin Hayton, Strategy Adviser for Heatherwood and Wexham Park Hospitals NHS Foundation Trust, reported upon proposed medium term changes that would include more local facilities and centralisation of some services. He advised that the changes were in line with the Right Care, Right Place proposals and Lord Darzi’s next stage review report “High Quality Care For All”, which had set out a 10 year blueprint for health services, including the quality of care to be provided in acute hospitals. He advised that the changes were also consistent with Berkshire East PCT’s Strategic Plan, which included objectives to provide changes and improvements to services in Heatherwood and Wexham Park Hospitals to meet current best practice, especially in areas of cardiac and stroke care and would also ensure that the Trust complied with the more recent and detailed Department of Health guidance and the European Working Time Directive for all junior doctors by August 2009.
Mr Hayton gave a presentation to the Panel on the changes being proposed by the Trust. He advised that, in order to improve the care of emergency medical admissions it was planned that all medical emergency admissions would be dealt with at Wexham Park Hospital, with only planned surgery being undertaken at Heatherwood Hospital. He explained the rationale for the change and commented upon the implications and benefits for both Heatherwood and Wexham Park Hospitals arising from the change.
Mr Hayton commented upon the range of services currently provided at Heatherwood that would not be affected by the proposed medicine changes. He also outlined new services that were planned for Heatherwood, which included Consultant Rapid Assessment Clinics, a Medical Investigations Day Unit, a Rehabilitation Ward led by nurses and rehabilitation staff for patients who may need 2 to 3 weeks rehabilitation before discharge, an ‘Intermediate Care’ Ward for elderly patients who may be waiting for assessment or for a nursing home bed, planned pacemaker implantation, more day and short stay surgery, £2million operating theatre improvements and a centralised pain clinic. He also commented upon changes necessary at Wexham Park hospital in order to provide sufficient Medical Assessment capacity.
Mr Hayton them responded to a number of questions raised by the Panel. He commented upon the possibility of additional space being provided for the GP practice at Heatherwood as part of the changes and referred to the discussions that had been held with the Ambulance Trust, which were re-assessing the routes to Wexham Park Hospital and other hospitals in the area to ensure that journey times were minimised. In the light of concerns expressed about the inevitable increase in journey times for some patients, it was suggested that the Ambulance Trust be invited to attend a future meeting to address the Panel on the issue of journey times. Mr Hayton also commented upon the plans to improve the physical environment of Heatherwood Hospital.
Members were advised that the changes would be the subject of formal consultation in the Spring through the issue of a formal consultation document, presentations to local public meetings and wide dissemination of the proposals to local groups for comment. The further report would be presented to the Panel at its next meeting on the consultation. The need to clearly explain the rationale behind those proposals in the consultation where services would be changing and where there were no realistic options, was stressed.
74/08 RIGHT CARE RIGHT PLACE
Members received a further update on the implementation of the proposals to modernise health services in East Berkshire arising from the Right Care Right Place consultation.
Details were provided on the number of births/bookings at midwife-led Maternity Unit at Heatherwood Hospital and the proposals to re-launch the Unit in April. In response to concerns raised about the transfer of expectant mothers to Wexham Park Hospital if they experienced difficulties with their delivery, Mrs Barker, Acting Chief Executive at Heatherwood & Wexham Park Hospitals NHS Foundation Trust, commented upon the procedures in place to deal with such eventualities and re-assured Members that the number of cases was very low. She explained that it was more appropriate to transfer the mother to a hospital that had all the necessary back-up services available rather than a doctor dealing with the matter at Heatherwood where specialist facilities and support were not available.
Members were advised that the Minor Injuries Unit at St Mark’s Hospital, Maidenhead was currently seeing 700 patients a month and that it was hoped that the Unit would be fully staffed within the next few months. It was re-iterated that the evaluation criteria upon which the success of the Unit would be judged did not contain specific cost or patient number targets, although the affordability of the Unit would be considered when the review of the pilot was undertaken. In the light of the concerns expressed about the closing time of the Unit, Members were advised that the PCT had advised the provider of its view that patients should be received until 5.00pm, not treated until 5.00pm. Members requested confirmation from the provider that they were complying with that requirement.
With regard to the Bracknell Healthspace, Members were advised that discussions were still ongoing with two potential providers and that it was hoped that the PCT would be in a position to announce the preferred partner by the end of March.
Members were advised that, as the procurement of the proposed new GP-Led Health Centre at Upton Hospital had failed to secure a viable bid, the service would be the subject to another procurement exercise, which was likely to take nine months as the scheme would be subject to a re-scoping exercise. As the new service was therefore not expected to start until early 2010, interim arrangements for the continuation of the current services were currently under discussion.
75/08 RELEASE OF SERVICE USERS FROM SECURE ACCOMMODATION
(The Panel agreed to consider this item in the public part of the meeting as no personal or confidential information would be disclosed).
Members received a presentation from Mr Gary Nixon, Director of Operations for Berkshire Healthcare NHS Foundation Trust, on NHS Secure Mental Health Services. He referred to the range of Hospital Services that were provided, outlined the admission routes into Hospital Services and commented upon the discharge arrangements and the specific responsibilities of the various health care professionals.
Mr Dixon and Mrs Slinger, Chief Executive of Berkshire Healthcare NHS Foundation Trust, then responded to a number of questions/comments, in particular about the after care and supervision provided for service users following their release from a secure unit. Members were advised that people discharged from secure accommodation were subject to a care plan and conditions, which would not change unless agreed by their Care Manager. It was stressed that, in order to provide safeguards to the public, a good quality risk assessment was key to any discharge and, whilst the current system could never be fool proof, it was close. It was confirmed that people could be subject to drug tests as part of their supervision order and stressed that Adult and Social Care professionals had the power to take appropriate action and would override a patient’s right to confidentiality if information came to light that raised concern about the health of a person in care/under supervision.
76/08 SAFEGUARDING ADULTS
Members considered the report that was due to be submitted to Cabinet on 26 March 2008 on the proposals to significantly increase the profile around adult safeguarding in the light of an increase in national emphasis and the development of new policy procedures. Members were advised that the Council had a responsibility to ensure that there were effective multi-arrangements in place to safeguard and protect vulnerable adults from all forms of abuse and to intervene when concerns of possible abuse were raised.
The report proposed the establishment of a Safeguarding Adults Partnership Board within the Royal Borough, with the appointment an Independent Chair, and the establishment of a Safeguarding Vulnerable Adults Manager within Adult Social Services who would also be the responsible officer for carrying out the co-ordination of Deprivation of Liberty work. There would also be improved knowledge and practice of safeguarding of adults across all partners and care providers/givers and extensive publicity and training within the Royal Borough and with partner agencies in the independent and voluntary sector.
Arising from the discussion, the Panel endorsed the report and welcomed the fact that the proposals would bring safeguarding of adults to a level that currently existed for children. The Panel were also of the opinion that the appointment of the Safeguarding Vulnerable Adults Manager post and the Independent Chair of the Safeguarding Board should be filled without delay and recommended that the posts be advertised immediately after Cabinet had approved their establishment.
- RESOLVED: That the report be recommended to Cabinet, subject to the inclusion of the comments outlined above.
77/08 SERVICE MONITORING REPORT
The Panel received and noted the latest service monitoring report for activity within the Adult, Community and Health Services during the period to 31 January 2009. It was noted that the Adult Social Care budget showed an underspend of £352k, a net decrease in expenditure of £133k on the reported underspend last month of £219k and that the increased demand on Housing Services had resulted in an increased budget pressure of £50k.
In response to concerns expressed about the staffing levels and resources available within the Housing Policy Unit to enable the Council to respond expeditiously to the likely increase in demand arising from the current economic crisis, the Officers advised that additional funding would be made available as required from the £1.2M economic contingency fund, which had been set up to address any areas of concern/pressure arising from the economic crisis. In the light of the lead in time that would be required to recruit suitably qualified housing officers, the need to keep the situation under constant review was stressed. It was proposed that the concerns outlined above, together with appropriate comment, be reported in the following months Service Monitoring Report to Cabinet.
78/08 WORK PROGRAMME
Members noted the items that had been identified for submission to the next meeting.
79/08 LOCAL GOVERNMENT ACT 1972 – EXCLUSION OF THE PUBLIC
- RESOLVED: That under Section 100(A)(4) of the Local Government Act 1972, the public be excluded from the remainder of the meeting whilst discussion takes place on items 10 and 13 on the grounds that they involve the likely disclosure of exempt information as defined in Paragraphs 2 and 3 of part I of Schedule 12A of the Act.