Feedback & Consultations

Wandsworth  Council has now approved a full response to the Wandsworth LINk Hospital Discharge Report.  The response is a joint one on behalf of all the local health and social care agencies.  Almost all of the LINK’s proposals in the original report have been agreed and plans put in place to ensure the changes take place.  The exception is the issue of who should coordinate discharges which take place at weekends.  The LINk will continue to encourage local hospitals to discharge patients in a planned way at weekends if the patient is ready to go home and any community service needed is in place.  The full Council response is attached.

Council Response to LINk Hospital Discharge Report

Wandsworth LINk has been hearing reports about long waiting times at St George’s, one lady arrived at 9.30 and was number 80 in the queue and by lunchtime she was  number 47.

Have you recently attended a St George’s clinic? And if so did you have a similar experience?  How long did you have to wait? what was the waiting are a like and how did you find the staff attitude?

Please let LINk know so we can get your experiences heard by the people at St George’s who make the decisions. The LINk Executive is meeting with David Astley St George’s CEO and Peter Jenkinson Trust Secretary on Thursday 24 th March

Dear colleague,

We wanted to update you on progress we are making in south west London towards implementing transitional arrangements as we move towards the plans described in the Health and Social Care Bill, following consultation on the White Paper “Liberating the NHS; Equity and Excellence” last year.

In November 2010, the PCTs in south west London agreed to work together more closely to manage the transition from PCT-led commissioning to GP and Local Authority Commissioning, and also make significant management cost savings.  Although individual PCTs will remain as statutory organisations, we will now operate as one management team across south west London to share resources, roles and functions. We will continue with a strong borough focus and work closely with GPs and Local Authorities. This will take effect from 28 February 2011.

As you know, Ann Radmore was appointed as Sector Chief Executive in January and will become the accountable officer for all five PCTs in the cluster, subject to the approval of the five Boards: Croydon, Kingston, Richmond, Sutton & Merton and Wandsworth.  The appointment process for a single chair for all five PCTs is also underway. 

We are also now able to announce the new South West London management team. 

South West London Team

• Bill Gillespie, Director of Strategy and Performance
• Jonathan Hildebrand, Director of Public Health
• Jill Robinson, Director of Finance
• Dominic Conlin, Managing Director of the Acute Commissioning Unit
• Amanda Philpott, Managing Director for Croydon
• Penny Taylor, Managing Director for Merton
• Dominic Wright, Managing Director for Richmond 
• Graham Mackenzie, Managing Director for Wandsworth
• David Smith, Director of Health and Adult Services for Kingston

(Joint appointment with the Royal Borough of Kingston-upon-Thames)

• Simon Currie, Interim Managing Director for Sutton, for four weeks whilst a substantive post holder is selected. 
• Charlotte Gawne, Director of Communications and Corporate Affairs
• Jocelyn Fisher, Director of HR, OD and Workforce

The remaining director posts to be appointed are Medical Director and Director of Transition. 

The key role for the Managing Directors will be to lead the local work for the borough and a small team of commissioners focusing on the needs of the borough’s population, working closely with their local authority and GP clinical leaders.  They will also form part of the management team for south west London. 

We would like to take this opportunity to thank the Chief Executives from each PCT for their hard work and dedication over the past years to improve the health and health services of local people in South West London.

Arrangements for the governance of how these arrangements will work will go to our public PCT Board meetings in February. Please contact Ann’s office or your PCT if you would like a copy of the Governance Proposals.

These director level appointments are an important step towards making this transition. The coming period in the NHS in south west London will be challenging – all parts of the NHS system are changing.  We are confident that this new team can successfully lead us through this process.

This is the first phase in these changes and unfortunately the overall management cost reduction will mean redundancies for a number of our managerial and administrative staff.  Staff consultation for the majority of our staff ended in January 2011 and an appointments process will follow.

We have been briefing staff frequently throughout this process and working closely with our union representatives to ensure staff are supported throughout this process.  The new structure will be in place by April 2011, and I know all our staff would appreciate your patience and support as we continue through this difficult time.

Kind regards,

Ann Radmore, Chief Executive, and Sian Bates, Chair, of the NHS in South West London

8 February 2011  BBC article

NHS shake-up ‘risks diluting patient power’By Nick Triggle Health reporter, BBC News GP consortia should be up and running by 2013

Patients risk having less of a say in the running of the NHS in England under the proposed shake-up, eight leading health charities say.

GPs are being given control of much of the NHS budget under the changes laid before Parliament last month.

Part of the reasoning was that it would help empower patients, but the groups, including the British Heart Foundation, said it could weaken their involvement.

 The government insisted the changes would give patients “real clout”.

The intervention by the health charities – in a letter published in the Times – follows widespread criticism of the reforms by health unions and MPs last month when the bill paving the way for the changes was published.

Accountability

Managers working for primary care trusts (PCTs) are currently responsible for planning and buying local services, but GPs working together in consortia would take on responsibility for this from 2013 under the reforms.

Pilots are already starting and once the process is complete, two tiers of management – PCTs and the 10 regional health authorities – will be scrapped.

The letter, which was also signed by the Alzheimer’s Society and mental health charity Rethink, questioned the powers and resources being given to the local Health Watch bodies, which will be set up across the country to represent patient interests in the new NHS structure.

“If we don’t do this well and thoroughly we could end up with patient and public involvement weaker than it is and no-one really wants that” 

End Quote Andrew Chidgey Alzheimer’s Society

It states: “If the new NHS is to properly serve patients and the public, this democratic deficit must be addressed and the voices of patients heard by those making crucial decisions affecting their lives.”

The letter also said the proposed scrutiny arrangements – local authorities are being put in charge of monitoring GP consortia – meant the lines of accountability were “too weak”.

Andrew Chidgey, of the Alzheimer’s Society, told the BBC the issues needed addressing now that the bill was working its way through Parliament.

“If we don’t do this well and thoroughly we could end up with patient and public involvement weaker than it is and no-one really wants that.”

The eight signatories to the letter are the Alzheimer’s Society, Asthma UK, Breakthrough Breast Cancer, Diabetes UK, National Voices, Rethink, the British Hearth Foundation and the Stroke Association.

Their criticisms represent a new area of concern about the changes.

A Department of Health spokeswoman said the letter raised “constructive” points, adding: “We will work together to ensure the bill, which is in its early stages, delivers the reality of improved patient involvement.”

However, she disputed the suggestion that patient power could be diluted, citing the ability of Health Watch to trigger official NHS inspections.

Last month, the House of Commons’ health committee said the plans had taken the NHS by surprise and could threaten its ability to make savings.

Meanwhile, in another letter, also published in the Times, six health unions, including the British Medical Association, warned of their “extreme concerns” that greater commercial competition in the NHS would end up undermining care.

The NHS Confederation, which represents managers, has also suggested hospitals may have to close.

Pathfinder bid for the GP Commissioning group.

 Wandsworth LINk supports the ‘pathfinder’ bid by local GPs and the Wandsworth PCT. If successful, this would enable the new NHS reforms in the NHS White paper to be trialled in Wandsworth so that GPs can take the lead in Commisioning health services.

 Jeremy Ambache asked, on behalf of Wandsworth LINk, if the concept of patient representation and a strong ‘patient voice’ can be included within the bid. Also, it was suggested that this will include full patient participation in all the Commissioning groups of the new emerging organization.

On 17th January Wandsworth LINk held elections for 4 of the 12 Executive Committee places. There was a rush of of people wanting to cast their votes and tensions were running high on the night. A total of 54  people cast their vote and the outcome of the vote was extremely tight. There was a tie for the fourth position, and according to LINk procedure, a show of hands from LINk members present at the meeting was taken for the two tied candidates. Roger Appleton received 17 votes and Joy Miller 13, meaning that Roger Appleton was re-elected to the LINk Executive.

  Candidate                                       

Jeremy Ambache -  45

Roger Appleton -32

Joy Miller -  32

Abdul-raheem Saalwu - 7

Jenny Weinstein - 54

Barbara Willerton - 50

It seems fitting that the person to receive the highest votes has also been nominated as the new LINk Chair, congratulations to Jenny Weinstein.

 Under the current agreement the elected candidate will serve for 3 years until January 2014.

THE PCT MANAGEMENT TEAM ON 11 JANUARY 2011

These headlines are for rapid briefing purposes about the lay/user issues arising in the meeting. It is not a full report from the meeting.

PEC and PCT Board papers are available on the NHS Wandsworth website: www.wandsworth.nhs.uk   contact Sandra Allingham on 020 8812 7740 or e-mail sandra.allingham@wpct.nhs.uk

The contents of this briefing note are for information only and are solely the responsibility of Andrew Craig, PEC Lay Member, including errors and omissions. They do not necessarily represent the views of the PEC or NHS Wandsworth.

Matters Arising

COPD and Pulmonary Rehabilitation Needs Assessment

Both of these related areas are being targeted for service redesign. The report stated that “patient and public Involvement is key to these projects and a patient group will be established to work with the clinicians to develop the proposals.” The PEC recommended that an “invest to save” model be used, reflecting the importance of COPD to the QIPP programme.

I asked that user engagement begin before the formulation of proposals – reflecting the government’s commitment to “nothing about us without us” – so that it would be clear that the redesign of the pathway reflected service users’ contributions. The national literature on patient views on these services should be used to test out local views.  Having one patient on the working group was tokenism and inadequate and must be reconsidered.

Items for Discussion

Teenage Pregnancy Performance Update

This subject is really about young people’s sexual health and wellbeing, not just teenage pregnancy.  Funding streams were coming to an end and there was a need to integrate activity with the local authority to get the right reach into the target group.  There was good evidence of service user input to this work.  Reliable data showed Wandsworth pregnancy rates falling, but the overall rate remained above the London and national averages. The rate of conceptions in young women under 18 was still the 10^th highest in London and 43^rd highest in England. 

Wards with the highest numbers of under 18 conception rates are: Queenstown; Nightingale; Latchmere with rates nearly three times that in low rate wards.  Numbers of conceptions are highest in Latchmere, Queenstown, Roehampton and Furzedown.  Black and minority ethnic groups had much higher probability of pregnancy than the white population and this had to be addressed in terms of vulnerability and aspirations from an equality point of view.  The emergency contraception pathway and access to it was not clear enough to young people.  A text service had been used for this, but it had been discontinued.   

I supported the integration with the local authority approach for strategy and funding and hoped that the action plan would be considered by the new Health and Well Being Board led by the Council at an early point.   This subject should be part of the Joint Strategic Needs Assessment.  Any communications method that increased awareness and access to emergency contraception had to be used with this target group.  We needed to understand why comparison boroughs like Westminster and Hammersmith and Fulham had achieved greater success than we had in Wandsworth.

Breastfeeding Update

Evidence was that breast feeding initiation rates were high immediately post birth, but in the 6-8 week period after that things broke down, especially for some groups of white mothers. The target for 2010/11 is that 75.7% of infants are recorded as being partially or totally breastfed by the GP practice at the 6-8 week check. Mothers from black and ethnic minority groups were much more likely to continue breast feeding. Locally, we were only just meeting this target and the evidence suggested performance was slipping as mothers were reporting not being advised by health visitors about breast feeding.   PEC agreed that this had to be a mainstream service and must not be left to a specialist.  The outcomes in the contract had to be tightened, including financial penalties for not meeting breastfeeding targets, rather than funding found for a specialist post.  

I expressed strong concern if the so-called “universal service” provided by midwives and health visitors locally seemed – on the basis of this report at least – to be failing where adherence to breast feeding was concerned. This is such a crucial issue that it cannot be left to a specialist to pick up the pieces.  The Health and Well Being Board should consider this as a public health priority and the message to Community Services Wandsworth needed to be strong that performance had to improve.

Items for Approval

TB Needs Assessment and Action Plan

Tuberculosis is a significant public health problem in Wandsworth, with the highest TB mortality rate in SW London and the biggest incidence (new cases per year) 29/100,000. Most cases occur in non-UK born ethnic minorities from sub-Saharan Africa (particularly Somalia) and the Indian sub-continent (India, Pakistan and Bangladesh).  This is reflected in the considerable geographical variation in incidence that is seen within the borough, with the highest rates occurring in Tooting, Earlsfield, Graveney, Roehampton, Furzedown and Latchmere.   

Drug resistance is an emerging problem within Wandsworth with 13% of culture-confirmed cases resistant to at least one anti-tuberculosis drug and 3.5% resistant to more than one drug in 2008. The problem is compounded by considerable stigma around TB in minority ethnic populations, which results in late presentation and poor treatment rates.  Against this, local providers are meeting local and national metrics for finding and treating cases. Universal BCG vaccination about to start.  Wandsworth Prison is included in the action plan as TB is a significant problem in that facility.

PEC agreed the action plan and recommended it to the Board

Reports for Information

Cancer Diagnosis Audit

This is another area where late presentation and delays in treatment make the problem much worse than it should be in terms of survival rates.  An audit across the sector showed: 46% of patients diagnosed with cancer had been referred via the two week wait rule (ie 56% FAILED to be referred within the required time; 47% of the audit patients were referred to secondary care after one visit to the GP surgery, ie for 53% it took MORE than one visit and in some cases many more.

The median average total pathway was shortest in breast cancer cases (27 days) followed by lung cancer cases which took an average of 27 days in total.  Colorectal cancer cases took 54 days on average whilst prostate cancer cases took longest of all at 64 days.  The biggest reason for the variance was patient delay, see below.

GPs participating in the audit identified that there had been 146 (22%) avoidable delays out of 704 cases.  Of these:

45 cases (31%) were due to the patient delaying presentation, investigation or hospital referral, 

34 cases (23%) were delayed due to the GP not initially thinking about diagnosis,

27 cases (18%) were delayed after referral to secondary care,

16 cases (11%) could have been referred earlier using the two week rule

14 cases  (9%)  were delayed due to communication problems between primary and secondary care and

10 cases (7%) were delayed due to other causes.

PEC agreed the action plan of the Cancer Network and recommended it to the Board.  The February PEC will receive a report based on interviews with the public analysing views about signs and symptoms of common cancers.

Open Space

I raised two issues

Comparative GP practice performance data.

Despite promising to produce it since July last year, the PCT has not delivered comparative GP practice performance data accessible to the public to facilitate choice and changes of GP practice. Work to make this suitable for the website was done by the comms department but never materialised.  Government has confirmed it is proceeding in the forthcoming HSC Bill with abolition of practice boundaries, so user friendly comparative information to enable choices and changes is essential.  It is not acceptable to the public to say that NHS London is doing this work – there is no sign of it on their website –  so the PCTs do not have to.   

PEC agreed that a “balanced score card” showing comparative performance of all Wandsworth GP practices by name will be completed in the next 4 weeks and put up on the PCT website.

Hospital discharge.  

Wandsworth LINk published its hospital discharge study in mid December based on patient and carer interviews.  This is important user-focused intelligence, so how will the existing and future commissioners take account of it?

Next Meeting of the NHS Wandsworth Board: Wednesday 26^th  January 2011 in the Richmond/Barnes Room at Queen Mary’s Hospital, London SW15.

Next Meeting of the PEC: 09h30 on Tuesday, 8^th February 2011.  I have given my apologies and there will be no Lay Member’s report from this meeting.

Wandsworth LINk’s Enter and View Team have just published their interim report on their visit to Springfield hospital. The team visited Springfield Hospital with a view to talking to some patients with Mental Health problems who were near to discharge. The team were hoping to test whether the discharge was safe, how involved in the process patients and their carers had felt, whether they were uneasy or confident about the plan, and whether they would like any other form of help which had not been planned.

Following consulation with providers regarding this initial report, the team will carry out an additional visit and produce a full report shortly.

To read the Enter and View interim report click here

The papers for next week’s LINk Executive Meeting are now available on the LINk Minutes page of the website.

Monday 17th January’s meeting looks to be pretty action packed, with Elections to the LINk Executive prior to the meeting from 5- 6pm, the business meeting from 6-7pm and a two presentations at 7.30pm. Dr Jeremy Gray will be giving an update on Government plans for GP commissioning and Jenny Weinstein, Wandsworth LINk Vice Chair, will be presenting on future plans for Health Watch.

In addition to this everyone is invited to make suggestions on what issues they think the LINk should focus on in 2011.

The meeting will be taking place at Tooting Leisure Centre and there will be refreshments available. We look forward to seeing you there!

Now that all the festivities are over its time to get back to business. As I hope you’ve all seen, LINk has completed its Hospital Discharge Project and with the Elections to the Executive committee taking place on Monday 17^th January, it’s time to decide on LINk’s priorities for 2011. 

We would like to invite all our members to make suggestions as to what LINk should focus their attentions on this year. Once the priorities have been decided, we will be establishing working groups for each priority, and asking any members who would like to join, one or all of the groups, to do so.

Some of the suggestions we have received so far for LINk priorities include, Employment Support in Mental Health Services and Patient Representation in GP surgeries. Please do let us know the topics which are of most importance to you and which you think LINk should be working on. This is your LINk and we want to make sure it represents your views.

Please let us have your views either via telephone, email or post, ideally by next Monday, so they can be discussed at the Executive meeting. Dr Jeremy Gray will be giving an update on Government plans for GP commissioning and Jenny Weinstein, Wandsworth LINk Vice Chair, will be presenting on future plans for Health Watch.

We look forward to hearing from you.