NHS Services

LAY MEMBER’S HEADLINE FEEDBACK FROM THE NHS WANDSWORTH PROFESSIONAL EXECUTIVE COMMITTEE (PEC) MEETING WITH THE MANAGEMENT TEAM ON 13 JULY 2010

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.

Items for Discussion

Performance Area Presentation – Screening

Breast screening: The target is for 70% of women aged 53-70 to have received screening for the early detection of breast cancer over the last three years. In 2010/11, the target will be extended to include all women aged 47–73. 

Local performance was consistently underachieving (63%) compared to other sector PCTs (London average 65.1%; Islington 66% highest).  Issues of  venues, sites and times and list cleaning were being pursued to improve this.  Language issues are sighificant factor. A pictorial version of the invitation was being trialled.

There is significant patient opt out and also professional doubt about effectiveness in early detection and intervention for breast cancer.  This could be an example of chasing targets not in the patients’ best interest and spurious in terms of improving the health of the population.   Not part of current GP contract, so GPs less likely to be asked about it than cervical screening.  And patient information usually not transferred to EMIS patient records. 

General view that changes won’t take local performance up to 70%.  Breast screens done privately  (probably about 1%) not counted for the target as not quality assured. 

Cervical screening:  The 2010/11 target is for 80% of women aged 25-49 to have had a technically adequate smear within the last 3.5 years and 80% of women aged 50-64 to have had a technically adequate smear within the last 5 years.

Local performance (68% and 74.5% for the respective groups) improved by 2% this year, but consistent underperformance issues are the same as for breast screening.  Data reconciliation has revealed large inconsistencies in patient lists ( reflecting our highly mobile and diverse population).

For both types of screening, PEC agreed that there must be much more engagement with the target community to find out what kind of service they would use and where it should be offered.

My conclusion from this is that the NHS is underperforming because it is trying to promote uptake of a product that many customers don’t recognise as something they need and should want. Women called for screening are not “patients” and are unlikely to respond to top down services that take no account of language, culture, convenience and other consumer factors.  We do not know what kind of service women would like to have and until there is reliable user-led intelligence, it will not be possible to commission something more appropriate.  Tinkering with the existing model is futile and wastes resources.  Getting this right presents a big opportunity for the NHS, Wandsworth Council  and Third Sector bodies to work together in an engagement exercise with a public health objective. This fits the new White Paper’s approach to public health. It is astonishing that data collection at practice level is still so fragmented.  

Naitonal GP Survey – Practice Nurses

Wandsworth’s results for patient satisfaction with access to and services from nurses in general practice are getting worse.  PEC agreed the final version of a practice nurse developmehnt strategy aimed at improving the situation. This includes better performance measures than the national survey questions. Performance data is not understood in practices and by individual nurses in the practices and this must be remedied.   

Nursing outside of hospital remains disjointed and nurses employed by GPs are professionally isolated.  The new practice nurse strategy will help, but it cannot overcome a problem whose cause is inherent in the way these practitioners are employed by GPs as private businesses.  We need a primary care nursing service that is not just confined to GP practices.  In my view the practice nurse task model is a dinosaur and impedes innovation. An alterantive is to employ primary care nursing staff through Healthcare Federations as legal entities and not through individual practices and arrange professional development and leadership across Wandsworth. Another option to consider is the  “chambers” approach where nurse employees own their own business as a mutual society and contract services to practices (and to GP commissioning consortia in future).  That would require a solution to the NHS pensions issue but there are strong signals from government that this model would be supported.  

Quarter Four GP Survey Results

PEC discussed the access to primary care results.  London and all South West London sector PCTs are underperforming in most areas.  Wandsworth is poor in practice nurse and  out of hours areas.   Government has announced that the specific target of seeing a GP within 48 hours will be abolished.

Because of the importance of providing information to patients to enable informed choices, PEC agreed that this information should be put on the PCT website in a clear and accessible way relating to individual practices.  This would enable people to choose a GP practice or switch from a poorly performing one.  PEC also agreed that the PCT should ask patients if this was the kind of data they wanted, what will they do with it,  whether it helped them make choices and whether they would recommend others to use it.    

 Implementing Coalition Government Policy

The Chief Executive provided information based on a recent briefing with NHS London and London PCT CEOs.  The following issues were highlighted:

The mismatch between having to achieve management savings quickly compared to the requirements of the legislative timetable to have changes completed by 2013 is a serious complicating factor and will make the PCT’s job more difficult in managing change and retaining its skilled staff to enable the transition to GP commissioning and closer work with the Council.

Commissioning consortia will be statutory organisations with an accountable officer (CEO) and geographical responsibilities.  Consortia will be in shadow form from from 4/11.  No mention of Boards in the accountable structure (consortia CEOs will be accountable upwards to the NHS CEO in England).  

Re-negotiation of GP contact will be simultaneous with setting up of consortia.  Providers will take most assets with them required for provision of services (et Queen Mary’s Hospital, health centres);  only assets requried for commissioning would remain with GP consortia.

The NHS Commissioning Board from 2012 will commission all primary care and maternity care.  GP consortia will not commission GP (primary)  care, for obvious conflict of interest reasons, but would take an interest in quality and effectiveness (how this would happen has not yet been specified).  Some SHAs will turn into offices of the NHS Board by 2012.  

Public health,  wellbeing and health improvement – will essentially transfer to local government  as a core cabinet level responsibility to be integrated with social care. In London this could mean the Mayor taking control of them.  Directors of Public Health would be employed by Councils not the NHS.  Overview and scrutiny arrangements will change.  London would have a public health focus.

Healthwatch nationally and locally would relate to the Care Quality Commission and absorb the LINk.  Local Healthwatch would be Council funded and accountable.   See the diagram at the end of this report.

Monitor would become the universal healthcare economic regulator.  All NHS Trusts would have to become Foundation Trusts or merge with viable FTs. Private patient income cap will be removed.  Social enterprise and employee ownership models are being heavily promoted and incentivised.

Independent health care sector will play a role mainly in market testing rather than mainlyin service provision.  

Key documents for the White Paper Liberating the NHS launched on 12/7are grouped on the Department of Health website and are essential reading www.dh.gov.uk/en/Healthcare/LiberatingtheNHS/index.htm 

 David Nicholson, CEO of NHS England, letter to CEOs of NHS organisations 13 July outlining stages and pace of transition www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117406.pdf  stresses  four key change principles: subsidiarity, co-production,    clinical ownership and leadership, and system alignment.  The message is the need to understand the NHS as a system of services linked by common principles of access, equity and quality, not a monolithic organisation of buildings and 1m+ employees.

NHS England Governance Model in White Paper Liberating the NHS July 2010

 Next Meeting of the NHS Wandsworth Board: Wednesday 28^th July 2010 in the Richmond Room, Queen Mary’s Hospital, commencing at 09h30.

 Next Meeting of the PEC: 09h30 on Tuesday, 14^th September 2010.

Tune in tomorrow, 22nd July, at 10.30am to the Number 10 website to see the Health Secretary Andrew Lansley field questions on NHS reforms.

And to get you in the mood, see this link to the Secretary of State’s testimony before the Health Select Committee yesterday, 20th July.

MAC share their views on Andrew Lansley’s Health White Paper…

Liberating the NHS the new Health White Paper on “equity and excellence” could turn out to be, in Chris Ham’s prophetic words today, the “biggest organisational upheaval in the health service, probably, since its inception”.  This is about England only of course: the contrast with the other three countries in these islands will now be even starker.

Shaping the new order

Speaking in the Commons this afternoon as the document was published, Secretary of State for Health Andrew Lansley said his objectives were putting patients right at the heart of their care, putting clinicians at the heart of decisions about services and achieving health outcomes comparable of our neighbours.

We are to have an outcomes framework identifying what the health service should achieve and it will be up to the professionals (in collaboration with the public and patients if Lansley is serious about “no decision about me without me”) to say how it should be achieved in each part of the country.

Some of the other highlights of the new order include:

• A payments system that acts as a driver for quality, safety and integrated care not just a reward for activity (very welcome)
• Decision making as close to patients a possible, including patients with long term conditions having budgets (we hope for health AND social care combined) to make real choices about their care.
• Real, local accountability: Local Authorities will agree local strategies to integrate NHS, public health and social care together.  (fine, assuming councillors rise to the challenge and there isn’t likely to be extra money for cash-strapped authorities)
• Consortia will commission NHS services in line with the local health plan agreed with the local Council; this is how GPs will lead bottom up redesign of services:“GPs are senior professionals in public service and paid well for that.” No opting out.
• Patient choice over treatment options, including the consultant-led team that treats them, based on a torrent of information to guide informed choices
• Choice of GP practice and  power to control our own patient records. (no practice boundaries)
• Patient voices will be heard and acted upon by Healthwatch as a national body working through local healthwatch incorporating the current LINks (across health and social care which is essential)
• An English NHS “liberated from command and control”, including all NHS Trusts to be Foundation Trusts with power in the hands of their employees and users: “Our ambition is to create the largest and most vibrant social enterprise sector in the world.” (could help with getting assets off the government’s balance sheet and sort the pensions issue too)
• Any willing provider in the health care marketplace, provided they deliver to NHS standards and prices
• A more powerful Monitor as economic regulator and CQC as the guardian of safety and quality standards
• The NHS Commissioning Board holding the national GP contract, managing performance, allocating resources to commissioning consortia and leading specialised commissioning (big job all of that, any applicants on the horizon?)

Liberation is a double edged sword

MAC’s initial reaction to all of this – our deeper thoughts are for later –  is that what Mr Lansley is proposing  - and the devil will be in the detail of the coming consultations and the autumn Health Bill – could certainly be “liberating” both in an innovative but also in a chaotic sense (think Pandora’s box)  - and probably at the same time.  The phrase “constructive discomfort” comes to mind.

But there’s a catch. The NHS in England must save recurrently some £20bn by 2014 - “every penny saved will be a penny reinvested for the benefit of patient care” Mr Lansley said. That takes many steady eyes and hands on the job and some well placed voices are wondering if now is the right time to pursue wholesale root and branch change which will be very distracting in our largest and most expensive public service? Managers fashioning lifeboats for themselves may have concerns other than achieving efficiency savings.

Cromwellian thoroughness and speed

The reforms to commissioning and accountability aim to be Cromwellian in thoroughness and speed.  Andrew Lansley seems to be taking Tony Blair’s approach further and faster than anyone thought possible, but the difference is there seems to be a map this time.  Our modern day “major generals” (aka Strategic Health Authorities)  are being marched off to the Tower awaiting termination  - or as Mr Lansley termed it “disempowerment of bureaucracies” – by 2012, to be followed by PCTs by April 2013.

As we move towards then, will the crowd be shouting “behold the heads of tyrants” as we breath the free and pure air of GP commissioning, or will we just be too distracted to care?  And will there be anyone left in PCT land by then to turn off the lights, cancel the milk and put the cat out?

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2 Responses to “Liberation root and branch style”

Caroline Millar says: July 13, 2010 at 10:19 amI have real concerns about GP commissioning not relieved in any way by watching the debate on Newsnight yesterday where the panel of around ten people contained no-one who represented the patient voice – although of course several GPs who were utterly convinced that they knew better than anyone what patients needed and wanted. We have to stop this persistent conflation of what GPs think is good for their patients with what patients themselves want. They are not necessarily the same thing. How do GPs know what patients want/think/experience? How many GP practices have patient groups – and where they exist do they make a difference? Every time you ask patients what they want they come back with the same issues. Two of the biggest issues are evening opening and rude receptionists yet somehow nothing ever seems to get done about these particular wants. So with the GPs in charge will patients necessarily be better off than they are now? It certainly is by no means a foregone conclusion!Peter Westland says: July 13, 2010 at 2:25 pmwell it is early days but it would be nice to know whether they mean “commissioning” or “procurement” and at what level in this “new” two tier arrangement the “commissioning” will be done….ie the analysis, horizon scanning, planning services for the future3. This will no doubt be placed with the “top” brainbox end of a consortium…with people imported from PCT’s and SHA’s OR that lot will be abandoned in favour of intellectuals from the USA or even Price Waterhouse. Whatever…it will look a bit like a PCT except it will not have the usual governance by retired captains of industry, accountants and estate agents….or will it. Also I can’t make out how the accountability will work. And Finally …Public Health to Local Authorities….some of us have argued for this for 20 years…but how will this now relate to the new NHS. Plenty of work for you Andrew and colleagues….

We need your ideas!

Have you had a stroke?

Have you cared for someone who’s had a stroke?

Do you live in South London?

Join us on Wednesday 28th July to tell us how we can improve stroke services in South London.

If you have been affected by stroke within the past two years, please join us on Wednesday 28th July from 12:00-4:30pm to help shape future stroke services.

The SLCSN will host a workshop for stroke survivors and their carers in South London (near Waterloo station)to get their views on what support patients need following a stroke. These ideas will be used to influence future service changes.

During the meeting:

• You’ll be asked for your views on what support patients would like six months after a stroke
• Leading clinicians will update you on the latest developments in stroke treatment
• You’ll have the chance to meet other patients and carers to share experiences
• You’ll be able to find out how the SLCSN is working to improve care in the region

If you’d like to join us or have questions, please contact us on

people@slcsn.nhs.uk or 0208 812 5950.

(Please note space is limited so you must contact us to reserve your place. )

The venue has disabled access and a hearing loop. Communication support will be available.

This is a free event and lunch will be provided.

This event will be held at:

Coin Street Neighbourhood Centre

108 Stamford Street

London SE1 9NH

www.coinstreet.org

LAY MEMBER’S HEADLINE FEEDBACK FROM THE NHS WANDSWORTH PROFESSIONAL EXECUTIVE COMMITTEE (PEC) MEETING WITH THE MANAGEMENT TEAM ON 13 APRIL 2010

Self-Referral Physiotherapy Service Update

The PEC has been supportive of self-referral to physiotherapy.  A successful pilot is running in West Wandsworth (through Queen Mary’s) and a pilot is soon to start in Central Wandsworth (through Wandsworth  Medical Centre at the top of Garrett Lane).   Self referral will be a recognised referral route and will be imbedded into the referral pathway.  There will be a further report on developments in 3 to 4 months.

I welcomed this development, having raised the issue some months ago about self-referral to therapists.  We need to understand the user feedback/evidence  in the West Wandsworth pilot.   This is a good focus for  shifting services, if the community service is robust enough and seeing the right people and changing user behaviour about where they might choose to go and what services they can access. 

Ethical Framework for Priority Setting

This is a draft framework to facilitate the decision making process around priorities, especially in a time of financial restraint and competing demands for funding.  The NHS Constitution has been referenced in compiling it and it reflects the legal and ethical duties of the PCT.   PEC welcomed this tool and it was agreed that when it was fully fledged, it would be used to revisit earlier decisions made about funding obesity (bariatric) surgery and funding for fertility (IVF).    There is an aspiration to share this process with Local Authority councillors (Health OSC in particular) and officers. It can support the new LCCBs (Local Clinical Commissioning Boards).  The June meeting will consider an amended version including weightings for value for money, feasibility and service fit. 

I welcomed this approach to decision making and support sharing the process in a public seminar.  Planned differences in services are acceptable – even desirable – when they reflect evidence based decisions about health needs of the local populations.

Cancer Prevention Action Plan

Cancer and CVD (cardiovascular disease) are the two main causes of death locally.  The mortality rate for cancer is rising and as currently set, the local target (reflecting previous unmet targets) to reduce cancer deaths is not achievable.  Wandsworth is the worst performer in the sector for cancer deaths in people under 75.  Smoking is the greatest cause of cancer locally and the PCT is not doing enough to achieve stop smoking targets.  Reducing smoking  would be the most cost effective thing the local NHS could do to reduce deahs and make savings from smoking-related problems.  Performance on colorectal cancer was also cause for concern locally and there was unsatisfactory uptake of the national bowel cancer screening initiative. Other key areas of activity in the cancern prevention plan included:

• raising awareness and needs assessment
• smoking cessation
• obesity control
• increasing physical activity
• alcohol reduction,
• cancer screening – breast, cervical and bowel
• sun protection and early detection of skin cancer
• HPV vaccination.

Obviously the public’s awareness and willingness to come forward for screening and when symptoms are suspected or detected is essential for success in any prevention programme.   Steps have been taken to address gaps in the PCT’s understanding of how local people understand cancer, eg about skin cancer risks and testicular cancer in younger men. Social marketing aimed at high risk groups is the main tool used to discover user-focused views and a tendering exercise to appoint a company to undertake this work is nearing completion.  

GP Performers List Update

PEC discussed the issue of strengthening language competency for GPs, including those providing out of hours services, and other health care professionals.  The General Medical Council registration procedure did not offer sufficient assurance and as EU/EEA qualified doctors were not required to demonstrate competency in English, it was up to local processes to do this. The PCT’s letter to applicants for the Performers List had been strengthened about language proficiency and the Primary Care Support Service was putting in place a language test. Patients have a right to assume that a doctor who comes to see them at home is competent in English. There was a problem with locums who were not on the Performers List who come from agencies.  The PCT’s out of hours contract (currently with Harmoni) would also be strengthened as part of the current rewriting of the specification prior to re-tendering.  Local GPs using agencies for locums will be advised only to use agencies that require standards of English testing.  The same would be applied to nurses and therapists employed through agencies.  PEC agreed it was essential to assure the public on this issue.

I support this move and would encourage any patient or carer who has had an unsatisfactory experience with a clinician having poor command of English, whatever the setting,  to tell the PCT about this.  

Other Business

It was announced that contracts had been terminated with the folowing three GPs and that they had ceased to trade.  Patients of these practices had been informed and been offered allocations to other practices. 

Dr Daud Khan  87 Northcote Road; Dr Mohamed Sultan and Dr Jawed Ali   138-140  Mitcham Road

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

Next Meeting of the NHS Wandsworth Board: 

Balham Park Surgery, 236 Balham High Road,  not the Town Hall, starting at 09h30 on Wednesday 28^th April.

Next Meeting of the PEC: 09h30 on Tuesday, 11^th May 2010.

Last night at the open meeting at South Thames College each of the Battersea parliamentary candidates from the three main political parties were asked their view of the current proposed polyclinic hub services for Battersea.

Jane Ellison (Conservative) felt that the current “portacabin” solution in Grant Road was a far cry from what was promised by NHS Wandsworth after the expensive consultation in 2008.  She still felt that a replacement hub on the NHS-owned Bolingbroke Hospital site would have been the best solution.

Martin Linton (Labour) pointed out that the “portacabin” solution was only temporary whilst the permanent base for the GP health centre under the arches was prepared.  He also reiterated NHS Wandsworth commitment to achieving the comprehensive hub on the Grant Road site: a promise made by NHS Wandsworth after referral of their current plans to the Council’s Health Committee by Wandsworth LINk.

Layla Moran (Liberal Democrat) saw the long-term solution being the creation of local health boards which would take over the running of local health services.  Local people would then be able to determine what happened in their own area.

Roger Appleton

Chair Wandsworth LINk

Co-Creating Health initiative Self-Management Programme for Depression

The Self-Management Programme for Depression is part of the Co-Creating Health initiative, a three year project set up by The Health Foundation, www.health.org.uk, that aims to embed support for people living with long term conditions into the core of what the NHS and its clinicians do on a daily basis – the initiative is being run in partnership by South West London & St George’s Mental Health Trust and NHS Wandsworth.

The Self Management Programme (SMP) provides an opportunity for individuals to build skills and confidence in managing day to day life with depression.  The programme runs over seven weeks with one 3-hour group session weekly, is free and open to anyone living in Wandsworth who experiences depression. 

Daytime and evening programmes are run at various locations throughout the borough of Wandsworth.

Quotes from past participants

”Throughout the course, I found my confidence building and my hope starting to revive”

“I found the peer support useful, as well as learning the techniques”

“This programme gives respect and dignity to the experience and impact depression has on the individual”

For further info about the programme and initiative can be found at www.swlstg-tr.nhs.uk/cocreatinghealth – there are also testimonials from people who have attended the programme and further details about the course structure and content on the website.

If you would like any more information about the initiative please do not hesitate to contact Hannah Nettle, cc’d into this email – Hannah is taking over as project manager for the initiative from 12^th April.

Andrew Craig, PEC Lay Representative, has produced a feedback briefing from the PCT’s Professional Executive Committee Meeting held with the PCT Management Team on 16^th March 2010.    

• Dental Mystery Shopping
• St. Georges Hospital A&E  GP referrals
• Minor Oral Surgery update
• Out of hours Services

To read his report please click here March 2010 Lay Member PEC Feedback

Your comments on these and other lay issues in connection with PEC discussions are very welcome and Andrew will feed them into the next PEC meeting or other appropriate channel at the PCT.  

Why is the LINk is referring the NHS Wandsworth decision on the Battersea polyclinic hub to the Council’s Health Overview and Scrutiny Committee? 

 Wandsworth LINk has now sent Wandsworth Council its reasons for referring the recent NHS Wandsworth decision to create a split-site polyclinic hub for Battersea, to its health Overview and Scrutiny Committee for further analysis. 

Wandsworth LINk considers the new plan to be a substantial change from the previous one and should therefore be exposed to public consultation.  The split-site service will inconvenience patients, sometimes requiring attendances at both sites to deal with a single problem.  The availability of capital finance is being given as the recent for the change of plan.  There was a solution for this in 2008.  Is that solution not available today?  For the full reasons for referral please see attached note.  The Committee will be held in public at Wandsworth Town Hall at 7.30 pm on Tuesday 16th February.

Why are Wandsworth LINk referring the NHS Wandsworth Polyclinic decision to the Health Overview and Scrutiny Committee

Keep your child safe from swine flu this winter

All children over six months and under five years of age in Wandsworth are now being offered the swine flu vaccine.  The under fives are most at risk from swine flu and more likely to need hospital care than any other age group.

GPs across Wandsworth are offering the vaccine and parents of eligible children will be contacted directly by their GP.

Local GP Tom Coffey said: “Even if your child is healthy, it’s extremely important to get them vaccinated again swine flu.  Children can easily catch and pass on the swine flu virus and unfortunately we’ve seen higher rates of hospitalisation in the under fives.”

“It’s impossible to know if you’re child has already had swine flu unless they’ve had a positive laboratory test for the virus.  Our advice to parents is therefore, don’t take a chance, the swine flu vaccination will keep your child safe this winter.”

The under fives are the latest group to be offered the swine flu vaccine.  The vaccine is already being offered to

• Adults and children between six months and 65 years of age in the current seasonal flu vaccine clinical ‘at risk’ groups. e.g. who have a long-term health condition, including chronic lung disease and heart disease;
• Pregnant women;
• People who live in the same house as someone whose immune system is compromised by disease or treatment, and
• People aged 65 and over in the current seasonal flu vaccine clinical “at risk” groups.

For more information on swine flu, visit  www.nhs.uk or call the Swine Flu Information Line on 0800 1 513 513.