NHS Gloucestershire CEO Report PDF 143 KB

Gloucestershire Health, Community and Care
Overview and Scrutiny Committee
18 September 2012
NHS Gloucestershire - Chief Executive’s Report
1. Department of Health Consultations
1.1 The following Department of Health consultations may be of interest to
HCCOSC Members.
1.2 Consultation on new licensing regime for providers of NHS services
http://healthandcare.dh.gov.uk/consultation-licensing/
The issues covered by the proposals include:
• who will be required to hold a license from Monitor?
• how can providers challenge proposed changes to license conditions?
• what is the maximum fine that Monitor could impose for breach of
license conditions?
The closing date for responses is 22 October 2012.
1.3 Consultation on proposals for commissioners to deliver best value
http://www.dh.gov.uk/health/2012/08/consultation-commissioners/
Proposals for regulations to protect patients’ interests by ensuring that
commissioners always deliver best value are being consulted on by the
Department of Health.
The consultation sets out proposals for requirements to:
• ensure good procurement practice by commissioners including
requirements to act transparently, avoid discrimination and purchase
services from the providers best placed to meet patients’ needs;
• ensure that commissioners enable patients to exercise their rights to
choose as set out in the NHS Constitution;
• prohibit commissioners from taking actions that restrict competition
where this is against patients’ interests; and
• ensure that commissioners manage conflicts of interest and that
particular interests do not influence their decision-making.
The closing date for responses is 26 October 2012.
1.4 Consultation on joint strategic needs assessments and joint health and
wellbeing strategy guidance
http://www.dh.gov.uk/health/2012/07/consultation-jsna/
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The draft guidance, on which views are being sought, provides a framework for
NHS and local government to work together to undertake joint strategic needs
assessments(JSNA) and joint health and wellbeing strategies (JHWS). The
draft guidance:
• lays out duties that underpin JSNAs and JHWSs to be undertaken by
clinical commissioning groups and local authorities through health and
wellbeing boards from April 2013;
• explains how JSNAs and JHWSs will fit together with commissioning
plans in the health and care system; and
• sets out how the JSNA and JHWS process will enable the NHS and local
government to make real improvements to the health and wellbeing of
local people.
Views on the guidance should be fed back by 28 September 2012.
1.5 A full listing of all ‘live’ and ‘closed’ Department of Health consultations can be
accessed via the Department of Health website:
http://www.dh.gov.uk/en/Consultations/Liveconsultations/index.htm
This website also includes Government responses to closed consultations.
2. Early Years Specialist Service Update
2.1 Members of the HCCOSC will be aware of the joint work being undertaken with
Gloucestershire County Council under the auspices of the Joint Commissioning
Partnership for implementation of a jointly developed Strategic Commissioning
Framework for Children and Families in the Early Years.
2.2 Amongst other things this aligns the development and commissioning of
services for children in the early years against agreed high level outcomes and
other strategic imperatives which maximise the opportunities for improving
outcomes for children and families as well as bringing benefits to commissioner
and provider organisations. For example, Gloucestershire County Council has
recently made the decision to tender Gloucestershire’s Children’s Centres and
this will be done in a way which is complementary to the development of Health
Visiting Services. NHS Gloucestershire is also committed to implementing the
national target to increase the number of health visitors by 2015.
2.3 An additional important strand of the overall early years work is the
development of a specialist service for children under 5 who are experiencing
chronic neglect as a result of substance misuse, mental health or other needs
of their parents. This will take the form of a multi-disciplinary team made up of
social workers, health visitors, substance misuse and mental health workers
and a speech and language therapist to work intensively with children
and parents and incorporating a Family Drug and Alcohol Court and adapted
Family Nurse Partnership approach, both of which are designed to speed up
the achievement of improved outcomes and securing a more settled future for
the children involved.
2.4 NHS Gloucestershire has agreed to the secondment of four health visitors into
this new team (as a result of its own expansion programme for health visiting
services as described above) and GCC will be investing through other NHS and
county council provider services for the other components of the team, using
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the flexibilities of the Section 75 Agreement for commissioning services agreed
between the two organisations in 2010.
2.5 It is intended that the service will be operational by October 2012 and will run
for 3 years initially with funding for the third year dependent upon successful
evaluation in year 2. Further information on the early years work generally and
this service in particular is available at:
http://www.gloucestershire.gov.uk/extra/eystrategy
3. IVF Commissioning Policy Update
3.1 The Gloucestershire and Swindon PCT Cluster, through the Clinical
Commissioning Group Shadow Boards, recently adopted a new, NICE
compliant policy for the provision of IVF treatment, which allows for three cycles
of treatment. Further work has been going on with providers and other
stakeholders to implement this policy by 1st October 2012. In the course of this
work, issues relating to surrogacy still require clarification.
3.2 Surrogacy is a complex legal and ethical issue, and it has been decided to
exclude surrogacy from the agreed IVF policy and include a statement in the
policy to that effect, adopting a policy for surrogacy as an intervention not
normally funded.
4. Emergency care pathway – September 2012 update
4.1 In July 2012, HCCOSC members received a detailed report through the NHSG
Chief Executive Report regarding the Emergency Care Intensive Support Team
Review of Urgent and Emergency Care in Gloucestershire. HCCOSC members
requested regular updates against actions, which can be found below:
5. Telehealth
• Performance have been maintained above the target of 95% since May
2012 despite high levels of attendances (10,625 in July an increase of
389 compared to July 2011)
• Changes to the rostering of staff have reduced the number of vacant
shifts and hence the reliance on locums.
• The Gloucestershire Royal Hospital helipad reopened on 12 July, 2012
• Signs have been installed at Cheltenham General and Gloucestershire
Royal Hospitals, stating "save the emergency department for real
emergencies". A new web page, which displays live waiting times for the
county's emergency departments and minor injury units, has gone live
on the GHNHSFT website. http://www.gloshospitals.nhs.uk/en/Wards-
and-Departments/Departments/Accident-and-Emergency-
Department/AE-Waits/
5.1 88% of the 305 patients receiving telehealth services in Gloucestershire would
recommend the service to their friends and families, and 85% rate the service
as either excellent or good. These are the findings from an anonymous survey
of telehealth patients recently carried out by NHS Gloucestershire. The survey
also revealed that patients find telehealth reassuring as it makes them less
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anxious about their condition and gives them peace of mind and confidence to
manage their condition better, without having to make a trip to see their GP.
5.2 NHS Gloucestershire launched its telehealth programme in June 2011 in a bid
to support the growing number of people living with long term conditions in the
county, which is around 6,000 of the county’s population of approximately
600,000 people. Telehealth can support these patients, giving them a greater
understanding and awareness of their condition and the reassurance they need
to help them manage it more effectively.
5.3 Telehealth enables patients’ vital signs such as weight, blood pressure and
oxygen levels to be monitored from their own homes easily, securely and
safely. The results are viewed on a daily basis by a triage team who work
closely with clinicians to ensure timely and appropriate referral and support is
provided as required.
5.4 The telehealth programme is backed by the findings of a recent national study,
the Whole System Demonstrator programme, which found that telehealth is
associated with lower mortality rates (45%) and fewer hospital admissions
(11%, with a 20.6% reduction in emergency admissions).
5.5 Most of the county’s 85 GP practices are now referring patients they believe will
benefit from telehealth, which can improve quality of life and result in fewer
hospital admissions.
6. Maintaining Quality During The Transition
6.1 In March 2011 the National Quality Board (NQB) published its report:
Maintaining and improving quality during the transition: safety, effectiveness,
and experience. The report sets out the requirement to develop a legacy
handover document to ensure that organisational memory on quality issues
was not lost during PCT and SHA clustering and the ongoing transition
process. This led to the development of the NHS Gloucestershire and NHS
Swindon Cluster Legacy document, which was presented to Board in
November 2011.
6.2 The NQB has now published further guidance on the handover process:
Maintaining Quality During the Transition: Preparing for handover. This new
guidance builds on lessons learnt during the PCT and SHA clustering process
and sets out new handover requirements designed to ensure that any risk to
quality during the transition is reduced, and that business continuity is
maintained. This forms just one part of the wider transitional arrangements
required to implement the changes set out in the Health and Social Care Act
2012.
6.3 The report sets out a requirement for Directors of Nursing and Medical
Directors to lead on the development of a Quality Handover Document that can
be used to support the transition. PCT Clusters were required to develop a plan
for how this Handover Document would be produced, and to submit this to the
SHA by 23rd June 2012. Work is now underway to produce the first draft of the
Quality Handover Document, which will need to be submitted to the SHA by
28th September 2012. The draft Document will be shared with HCCOSC and
LINk members of the NHS Gloucestershire Reference Group for comment. The
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final version of the Quality Handover Document will be presented to Board in
March 2013 for final sign off, before being shared with successor organisations.
7. Annual Report on the progress of implementation of The NHS
Constitution in NHS Gloucestershire and NHS Swindon Cluster
7.1 The results of the fourth Audit report on implementation of The NHS
Constitution carried out by NHS South showed NHS Gloucestershire and NHS
Swindon Cluster rated overall as compliant or ‘Green’. The Audit covered the
following organisations:
• NHS Gloucestershire
• NHS Swindon
• Gloucestershire Hospitals NHS Foundation Trust
• Great Western Hospital NHS Foundation Trust
• 2Gether NHS Foundation Trust
• Great Western Ambulance NHS Trust
7.2 Published on 4 July 2012, The Report on the effect of The NHS Constitution
informs efforts to embed fully the Constitution throughout the NHS.
7.3 The report sought to clarify the effect of the NHS Constitution on those who use
NHS services and who work in the NHS. It considered whether, and to what
extent, the Constitution has made a difference to patients, staff, carers and the
public, and examined the degree to which it is succeeding in its aims.
7.4 The report showed that three years on from the launch of the Constitution, the
NHS remains true to its fundamental principles and values as expressed in the
NHS Constitution. However, public awareness of the Constitution remains
generally low and there is little evidence that patients use it as a means of
exercising their rights. Staff awareness of the NHS Constitution is significantly
higher than among the public but still few feel well informed about it.
7.5 The Health and Social Care Act 2012 has strengthened the legal foundation for
the NHS Constitution: the NHS Commissioning Board and clinical
commissioning groups will have clear duties to promote the NHS Constitution.
7.6 The Department of Health will hold the NHS Commissioning Board to account
for meeting its legal duty to promote the Constitution. It will also hold the Board
to account for delivering on the Rights and Pledges contained within it.
7.7 The Future Forum will now consider how the Constitution can be strengthened
and reinforced for the future, in terms of both content and awareness.
7.8 The NHS Future Forum will present its advice to the Government in the
autumn. Following this, there will be a public consultation on any changes to
strengthen the Constitution so that patients, staff and the public have the
chance to have their say. The Report can be found at:
https://www.wp.dh.gov.uk/publications/files/2012/07/report-on-the-effect-nhsconstitution-0407-2.pdf
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8. Prison Inpatient Services at HMP Gloucester
8.1 The aim of prison health care is to give prisoners access to the same range and
quality of health care services that are available to people living in the
community. Historically there have been insufficient facilities for inpatients
within prison establishments. Beds were used for:
• Social care for older, disabled and/or vulnerable people where the prison
lacked alternative facilities
• Care for those waiting for mental health Act (S47/48) transfers to
external mental health facilities
• Observation for those deemed to be at risk of self-harm
• End of life care
• Transfers of challenging prisoners from segregation units
• Accommodation for cleaners and/or lodgers with no healthcare needs.
8.2 The Regional Offender Health Team has led a drive over the past nine years to
reduce inpatient beds within the prisons in the South West with the aim of
ultimately closing them while ensuring prisoners in need of health care are
treated in the most appropriate setting. This policy is supported by an impact
assessment.
8.3 HMP Gloucester had been successful in reducing the number of prisoners
staying inappropriately in the Assessment and Treatment Unit (ATU) (inpatient
unit) in line with regional policy. There was a successful reduction of beds from
11 (in 2006) to eight (2010) and down to five (2011). The decision to reduce
these beds has previously been discussed with the HCCOSC. During 2011/12
bed occupancy remained stable at around 8.2%. This was achieved by close
working between the Governor, Healthcare and Prison staff.
8.4 There was always an intention to close the remaining beds and following a
recent recommendation from the Regional Offender Health Team, a local
agreement was made to action this. This decision was strengthened by findings
from a ‘Her Majesties Inspectorate of Prisons’ (HMIP) inspection to HMP
Gloucester in July 2012. As a result of this, the Prison Governor decided to
close the remaining healthcare beds. The vulnerable persons Unit (VPU) and
the Segregation Unit have also been closed to provide better regimes for the
whole the prison population in HMP Gloucester.
8.5 Those prisoners who would have accessed prison inpatient beds are now either
treated by nursing and prison staff on the Wings, or are sent to other facilities,
which can provide more suitable accommodation for their needs.
8.6 Nursing staff who had worked in the ATU on night duty have been relocated to
the new ‘first night’ centre, where they can better perform mental health and
physical health observations. This arrangement has been fully supported by the
Regional Lead for Prisons and the Offender Health Team. There are plans to
utilise the ATU to develop services, such as health improvement, therapeutic
activities and day care, which require a solid partnership approach. The impact
of the closure of the remaining beds is being monitored through the Prison
Health Partnership Board, which drives quality improvements in prison health
care.
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9. 15 Steps Challenge in for inpatient services – mental health services
9.1 The NHS Institute for Innovation and Improvement has launched a toolkit to
help NHS organisations to gain a better understanding of how patients feel
about the care provided. The 15 Steps Challenge encourages patients and
staff to work together to identify improvements which may enhance the patient
experience, highlighting what is working well and what might be done to
increase patient confidence. The 15 Steps Challenge is in its draft format for
mental health settings.
9.2 2gether NHS Foundation Trust has been invited to participate in the pilot
process and is now actively involved in this work
10. Emotional Wellbeing Health Promotion taster sessions with Seldom
Heard communities
10.1 Emotional Wellbeing Health Promotion taster sessions have been delivered by
2gether NHS Foundation Trust to various communities including the Chinese
Parents and Children’s Association, Asian Carers, Pharmacy staff in BME
communities. The sessions have been well received and regarded as helpful.
Some participants have chosen to undertake further in-depth sessions of emotional
well being.
11. Awareness activities for people with learning disabilities
11.1 NHS Gloucestershire, Gloucestershire Voices and Gloucestershire County Council
and 2gether NHS Foundation Trust held the fourth Big Health Check day at the
National Star College, Ullenwood in May 2012. The event was attended by over
100 people who either had a learning disability or cared for someone with a
learning disability.
11.2 The day focused on health and wellbeing and participants had the opportunity to
find out more about local services and get involved in interactive sessions covering
topics like exercise, pharmacy and oral health care.
11.3 Gloucestershire Voices performed a short play called ‘Listen to me’. This was a
light hearted but thought provoking play about a visit to a hospital for someone with
learning disabilities and focused on what could go wrong and how this could be
done better. The play was filmed and will be used as a training tool for ‘Health
Inequalities Awareness training’ in the community and hospitals.
11.4 Attendees were also able to have a look around an ambulance and talk to
paramedics as well as visit a health booth, which was run by learning disability
nurses.
12. Health and Wellbeing Strategy and Strategy for Care
This is covered under a separate item on the HCCOSC Agenda.
13. Gloucestershire Care Services
This is covered under a separate item on the HCCOSC Agenda.
Jan Stubbings, Chief Executive, NHS Gloucestershire
September 2012
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