100121 HOSC Minutes - Norfolk Health Overview & Scrutiny Committee

NORFOLK HEALTH OVERVIEW AND SCRUTINY COMMITTEE MINUTES OF THE MEETING HELD ON 21 JANUARY 2010 Present: Mr M R H Carttiss (Chairman), Norfolk County Council Michael Chenery of Horsbrugh Mr J Bracey Mr D Bradford Mrs J Chamberlin Mr S Dorrington Mr D Harrison Mr J Labouchere Dr N Legg Mrs B A McGoun Mr J Perry-Warnes Mrs S Weymouth Mr A J Wright Norfolk County Council Broadland District Council Norwich City Council Norfolk County Council Norfolk County Council Norfolk County Council Breckland District Council South Norfolk District Council North Norfolk District Council Norfolk County Council Great Yarmouth Borough Council Norfolk County Council Also Present: Jim Barker Anne Osborn Roger Hadingham David Stonehouse Tim O’Mullane Bob Mee Paul Steward Julie Cave Krishna Sethia Michele Nash Hilary Thompson Patrick Thompson Mary Ledgard David Russell Helen Lloyd Ellis Laywood Sandra Meaden Lyn Reynolds James Joyce Programme Manager (Unplanned Care), NHS Norfolk Director of Strategy, Planning and Performance, Norfolk and Norwich University Hospitals NHS Foundation Trust Commissioning Officer, Adult Social Services Deputy Chief Executive and Director of Finance, NHS Norfolk Head of Learning Difficulties Services, Adult Social Services Interim Director of Learning Difficulties, NHS Norfolk Consultant Project Manager for Changes to NHS Provided Respite Services for Adults with Learning Difficulties Director of Resources, Norfolk and Norwich University Hospitals NHS Foundation Trust Consultant Urologist, Norfolk and Norwich University Hospitals NHS Foundation Trust Chairman, Cromer Hospital Action Group County Councillor for Cromer Norfolk LINk Norfolk LINk Norfolk LINk Norfolk and Norwich University Hospitals NHS Foundation Trust Audit Commission Norfolk and Norwich University Hospitals NHS Foundation Trust East of England Ambulance Service Norfolk County Councillor Chris Humphris Maureen Orr Chris Walton Tim Shaw NHS Great Yarmouth and Waveney Scrutiny Support Manager (Health) Head of Democratic Services Committee Officer (For ease of reference, items are recorded in these minutes in the order in which they appear on the agenda This is not necessarily the order in which the items were considered at the meeting) Apologies for Absence 1.1 Apologies for absence were received from Mr P Hardy and Mr G Sandell Glossary of Terms and Abbreviations 2.1 Members received a glossary of the terms and abbreviations used in the agenda papers They also received on the table an explanation of the different medical procedures that were used in endoscopy (for use at item 7, when considering the report on the redevelopment of Cromer Hospital) Minutes 3.1 The minutes of the previous meeting held on 26 November 2009 were confirmed by the Committee and signed by the Chairman Declarations of Interest 4.1 Michael Chenery of Horsbrugh declared a personal interest in the item about the response to the draft dementia strategy because he had a substantive contract with the Norfolk and Waveney Mental Health NHS Foundation Trust and he was also a Mental Health Practitioner 4.2 Steve Dorrington declared a personal interest in the item about the draft dementia strategy consultation and the item about changes to NHS provided respite services for adults with learning difficulties because he was a care home provider 4.3 John Perry-Warnes declared a personal interest in the item about the redevelopment of Cromer Hospital because he was a Member of the Friends of Kelling Hospital Urgent Business 5.1 There were no items of urgent business Chairman’s Announcements 6.1 (a) Change of Membership The Chairman welcomed back to the Committee Mrs Jenny Chamberlin in place of Mrs Alison Thomas who had become Deputy Cabinet Member for Vulnerable Children 6.2 (b) Change of Agenda Order: Cromer Hospital Redevelopment The Committee agreed to a suggestion from the Chairman to consider urgent and emergency services in Norfolk as the first substantive item on this agenda and delay consideration of the item on Cromer Hospital redevelopment until after 11am when Krishna Sethia, Consultant Urologist at the Norfolk and Norwich University Hospitals NHS Foundation Trust would be able to attend the meeting The Chairman said that in the interests of all those who attended the Committee’s meetings it was important for Members to be able to consider items in the order in which they appeared on the agenda In future he would be unlikely to put forward changes in the agenda order after the papers had been published The agenda order was agreed with NHS witnesses at least some two weeks before the day of the meeting and that was the time for us to be advised if the proposed timing was inconvenient 6.3 (c) Meeting with Non-Executive Directors and Managers of NHS Norfolk It was noted that the date for the meeting with NHS Norfolk Non-Executive Directors and Managers had been changed from February 2010 to 29 March 2010 This meeting would be held in the Edwards Room at County Hall and details sent to Members in due course 6.4 (d) Norfolk LINk The Chairman said that Norfolk LINk had invited the Committee to appoint a Member to join one of Norfolk LINk’s regular meetings of its Older People with Mental Health Problems Working Group The Committee nominated Shirley Weymouth to attend the Norfolk LINk Working Group and Michael Chenery of Horsbrugh to be her named substitute Cromer Hospital Redevelopment 7.1 The Committee received a suggested approach from Maureen Orr, Scrutiny Support Manager (Health), to a report from the Norfolk and Norwich University Hospitals NHS Foundation Trust that set out the results of its consultation on plans to redevelop Cromer Hospital and the recommendations that were due to go to its Board on 22 January 2010 The Committee also received additional information from Norfolk LINk (that had been sent to Members in advance of the meeting) that set out Norfolk LINk’s comments on the redevelopment proposals and the public consultation exercise 7.2 The Committee received evidence from the following witnesses: Julie Cave, Director of Resources, Norfolk and Norwich University Hospitals NHS FT Krishna Sethia, Consultant Urologist, Norfolk and Norwich University Hospitals NHS FT Michele Nash, Chairman, Cromer Hospital Action Group Hilary Thompson, County Councillor for Cromer John Perry-Warnes, Committee Member and County Councillor for Holt Patrick Thompson, Norfolk LINk 7.3 In hearing from the witnesses and in answer to Members’ questions, the Committee noted the following:  The witnesses said that development work at Cromer hospital was due to start on site by the beginning of July 2010 and finish in 2012  The Cromer Hospital project made maximum benefit out of the generous legacies left to Cromer hospital by Sagle Bernstein and Phyllis Cox The NNUH had agreed to commit the £15m legacy to the development of the new hospital and had set aside a small contingency reserve It would cost an additional £3m from the NHS to provide endoscopy at Cromer and this was too expensive for the NHS to include within the budget for the Cromer hospital project  The service model for the new Cromer hospital was aimed at providing mainly “high volume, high frequency services that had a low clinical risk” Such services excluded general anaesthetic surgery and endoscopy which were being relocated at the NNUH  To provide an acute endoscopy unit at Cromer Hospital would require 700 square metres in order to meet hygiene requirements and the decontamination regulations  A new MRI scanner at Cromer hospital would deal with up to 4,000 patients a year  The 18 week treatment time target applied at Cromer Hospital as it did elsewhere  The witnesses said the NNUH would be able to cope with the additional numbers of patients transferring from Cromer Hospital  Members pointed out that there were potential transport difficulties for patients who currently attended Cromer Hospital who would have to attend the NNUH some 25 miles away  Some Members said those living in Cromer were fortunate to have a new hospital being build in their area because nothing similar existed for those living in the south of the county, and for whom a 25 mile journey to the NNUH was usual  In response to a question from John Perry-Warnes, local County Councillor for Holt and a Member of the Committee, Krishna Sethia, Consultant Urologist, NNUH, said that there were no known difficulties with clinicians having to travel daily to Norwich  Michele Nash, Chairman of the Cromer Hospital Action Group, said that whilst some people were disappointed with some aspects of the redevelopment plan, most people she had spoken with had broadly supported what was being proposed It might be possible for funds to be raised locally for keeping endoscopy at Cromer Detailed discussions with the NNUH about the types of services that could be provided in the hospital were continuing These discussions included the possibility of a GP practice being sited within the hospital grounds 7.4  Hilary Thompson, the local County Councillor for Cromer, said that the public consultation about the proposed new hospital had been generally well received in the locality although disappointment remained that there would be on endoscopy unit She said that it was important there was no delay in the implementation of the project There was a danger that any delay in approval could result in the loss of some services, given the poor state of public finances  Patrick Thompson, Norfolk LINk, said that Members of Norfolk LINk had visited a GP surgery where endoscopy was performed He said that Norfolk LINk remained concerned about the lack of detail concerning the facilities that would be provided in the new building The Committee agreed that – (a) The NNUH consultation with the Committee had been adequate (b) The NNUH proposals were in the interests of the local Health Service The Committee requested the NNUH continue to work closely with the Cromer Hospital Action Group and the NNUH respond favourably if, in the years ahead, local fundraisers were able to raise enough money to support an endoscopy service at the hospital that met all the relevant healthcare standards Response to the Draft Dementia Strategy Consultation 8.1 The Committee received a report from Maureen Orr, Scrutiny Support Manager (Health), that asked Members to agree a response to a draft joint commissioning strategy from NHS Norfolk, NHS Great Yarmouth and Waveney and Norfolk County Council’s Adult Social Services Department, entitled “Living Well with Dementia: Transforming the Quality and Experience of Dementia Care for the People of Norfolk” 8.2 The Committee received evidence from the following witnesses: Roger Hadingham, Commissioning Officer, Adult Social Services David Stonehouse, Deputy Chief Executive and Director of Finance, NHS Norfolk 8.3 During discussion, it was suggested that the joint commissioners should be asked to respond in writing to the Committee’s comments and questions that could be found at paragraph 2.2 of the report It was also suggested that the response of the joint commissioners should be shared with Members of the Committee 8.4 The Committee endorsed the response at paragraph 2.2 of the report, subject to the addition of a comment seeking information from the joint commissioners about those who would diagnose dementia Proposed Changes to NHS Provided Respite Services for Adults with Learning Difficulties: Mill Close, Aylsham and Park View, King’s Lynn 9.1 The Committee received a suggested approach from Maureen Orr, Scrutiny Support Manager (Health), to a report from the Pooled Fund Commissioners (NHS Norfolk, NHS Great Yarmouth and Waveney and Norfolk County Council) on proposals to discontinue NHS provided respite care for adults with learning difficulties at Mill Close, Aylsham and Park View, King’s Lynn 9.2 The Committee received evidence from the following witnesses: Tim O’Mullane, Head of Learning Difficulties Services, Adult Social Services Bob Mee, Interim Director of Learning Difficulties, NHS Norfolk Paul Steward, Consultant Project Manager 9.3 It was noted that the Committee had previously examined the proposed changes in respite services for adults with learning difficulties at its meeting in September 2009 and that Members were due to receive a full consultation report about the proposals in March 2010 It was pointed out that this report would include detailed proposals on alternatives to the current NHS provided respite service, and explain the likely financial implications of each of the proposals for all parties 9.4 It was pointed out that those living in the east of the county and currently receiving respite care at Mill Close would have their respite care re-provided with those moving from Lothingland to a new facility at Pinewoods at Repps with Bastwick The existing facilities would not close until the planned care was operational, in around June 2010 9.5 The Committee noted the progress report The Committee agreed that parent/carer representatives should be invited to the March 2010 meeting when the Pooled Fund Commissioners would present their full consultation report The Committee asked for the report to include information on how charges were to be introduced for parent/carer representatives, and the overall cost implications for the NHS, Adult Social Services and the individuals concerned 10 Urgent and Emergency Services in Norfolk 10.1 The Committee received a suggested approach from Maureen Orr, Scrutiny Support Manager (Health), to a report from NHS Norfolk about urgent and emergency health service strategies in light of the rise in emergency admissions to hospital 10.2 The Committee received evidence from the following witnesses: Jim Barker, Programme Manager (Unplanned Care), NHS Norfolk Anne Osborn, Director of Strategy, Planning and Performance, Norfolk and Norwich University Hospitals NHS FT 10.3 It was noted that Dr Bryan Heap, Medical Director and Chairman of Unplanned Care Programme Board, NHS Norfolk, had intended to attend the meeting but had given his apologies due to illness The Committee agreed to consider the rise in emergency admissions to hospital at this meeting in Dr Heap’s absence, and examine the measures that the NHS was taking to address the current situation at the March 2010 meeting when Dr Heap would be able to respond to any questions from Members 10.4 In hearing from the witnesses and in answer to Members’ questions, the Committee noted the following: 10.5  It was pointed out that there had been a 16% rise in medical emergency admissions and an 11% rise in A&E attendances at the NNUH in the past year and that there had been a rise in demand for emergency services at the Queen Elizabeth Hospital and the James Paget Hospital, but not to the same extent  The rise in emergency admissions was attributed to an increase in selfreferrals, inadequacies in the provision of primary care, particularly out-ofhours services, and a perceived difficulty in obtaining GP appointments, particularly amongst migrants living in the west of the county who were unfamiliar with the working of the NHS  It was pointed out that there was a strong relationship between the NHS and migrant workers in the Great Yarmouth area and there could be lessons to be learned from this in the NHS Norfolk area  Emergency admissions increased pressures on the four-hour waiting target  An Emergency Care Intensive Support Team had been set up to look at care pathways and to make best practice recommendations for reducing demand on hospital services  A social marketing “Choose Well” campaign had been launched by NHS Norfolk to ensure people attended the right kind of health service for their treatment and did not go to A&E departments unnecessarily  Patients with minor ailments who went to the A&E department were being encouraged to see their GP or pharmacist instead This approach to managing attendance at A&E was being piloted at the Queen Elizabeth Hospital The pilot was in its infancy and it was hoped to roll it out across Norfolk in due course  The initiative taken in setting up the Walk-in Centre at Timberhill in Norwich was meant to ease the pressures on the A&E department at the NNUH  It was important people only accessed emergency help or treatment if it was indeed an emergency Various other NHS services such as GP surgeries and NHS Direct were available so that people could choose the right service for their ailment  It was considered important for information about how people could access NHS services to go out in different languages and be made available in places where migrant workers were most likely to read it This was not necessarily in GP practices  Patrick Thompson, Norfolk LINk, spoke about the importance of A&E services being “user friendly” and more easily understood by the public The Committee asked for representatives of NHS Norfolk and NHS Great Yarmouth and the NHS hospital acute trusts to give a further report at a later meeting 11 Appointment to Great Yarmouth and Waveney Joint Health Scrutiny Committee 11.1 The Committee received a report that sought approval to fill a vacancy for a Conservative Member on the Great Yarmouth and Waveney Joint Health Scrutiny Committee in place of Mrs A Thomas 11.2 The Committee agreed to appoint Michael Chenery of Horsbrugh to fill that vacancy 12 Information for the Care Quality Commission 12.1 The Committee received a report by Maureen Orr, Scrutiny Support Manager (Health), that sought approval to a method for providing information to the Care Quality Commission 12.2 Steve Dorrington reported on a meeting that he and Members from local authorities across the south east had attended with representatives from the Care Quality Commission to consider how the Care Quality Commission would regulate all health and social care services in England, whether they were provided by the NHS, local authorities or private companies He said that the Care Quality Commission had suggested each Health Overview and Scrutiny Committee should appoint a Member Champion for Care Quality issues 12.3 The Committee agreed to accept an invitation from Norfolk LINk to join it in a workday with the Care Quality Commission, to be held locally 12.4 The Committee also agreed that – (a) In-depth scrutiny reports approved by the Committee should be routinely copied to the Care Quality Commission for information (b) At the request of the Care Quality Commission, persistent issues that were not being resolved locally would be brought to it’s attention (It was, however, noted that by the time such issues became “persistent” the Committee was more than likely to be following other routes of redress) 13 Regional Joint Health Scrutiny Committees 13.1 The Committee received a report from Maureen Orr, Scrutiny Support Manager (Health), that asked the Committee to waive the requirement for political proportionality on regional and sub-regional Joint Health Scrutiny Committees which were formed on a task and finish basis 13.2 It was agreed that – (a) Other authorities participating in future regional and sub-regional Joint Health Scrutiny Committees may waive rules on political balance when appointing Members to Joint Committees (b) The Committee’s own appointments to Joint Committees will be according to the political balance of Norfolk County Council, unless the Council approves otherwise 14 Forward Work Programme 14.1 The Committee agreed the Forward Work Programme that was set out in the report subject to the following amendments: (a) NHS Norfolk and NHS Great Yarmouth and Waveney consultation on Continuing Healthcare Policy to be received at the March 2010 meeting (b) “Urgent and emergency care” to be added to the March 2010 agenda (c) “How we manage death and dying“ to be postponed from March 2010 to the 15 April 2010 meeting The meeting concluded at 13.15pm CHAIRMAN If you need these minutes in large print, audio, Braille, alternative format or in a different language please contact Tim Shaw on 0344 8008020 or 0344 8008011 (textphone) and we will our best to help T:\Democratic Services\Committee Team\Committees\Norfolk Health Overview & Scrutiny Committee\Minutes\Final\ NHOSC Mins 100121 ... we will our best to help T:Democratic Services Committee TeamCommittees Norfolk Health Overview & Scrutiny Committee Minutes Final NHOSC Mins 100121 ... regional and sub-regional Joint Health Scrutiny Committees may waive rules on political balance when appointing Members to Joint Committees (b) The Committee? ??s own appointments to Joint Committees... Joint Health Scrutiny Committee 11.1 The Committee received a report that sought approval to fill a vacancy for a Conservative Member on the Great Yarmouth and Waveney Joint Health Scrutiny Committee