Health Overview Panel

 

7 December 2017

 

(7:30 pm 10:15 pm)

 

Councillor Rowena Bass (Chair)

Councillor Maria Netley (Vice Chair)

 

   Councillor Sushila Abraham

*  Councillor Geoff Austin

   Councillor Paul Bedforth

*  Councillor Mary Clark

   Councillor David Fraser

   Councillor Sheila Griffin

*  Councillor Shiraz Mirza

   Councillor Rachel Reid

 

Advisory Members

 

            Jane D'Souza, GP Advisory Member

            Kate Dudley, CEO, Kingston Carers' Network

            Grahame Snelling, Chair, Healthwatch Kingston

 

* Absent

 

Officer attendance:

 

RBK

Dr Helen Raison, Consultant in Public Health

Jane Bearman, Head of Operations Adult Social Care

 

Kingston Clinical Commissioning Group

Dr Phil Moore, Deputy Chair, KCCG

Fergus Keegan, Director of Quality & Engagement

 

South West London and St George’s Mental Health Trust

Gillian Moore, Head of Service Delivery Adult, Community and Older people

 

Kingston Hospital NHS Foundation Trust

Ann Radmore, Chief Executive

 

Healthwatch Kingston

Stephen Bitti, Manager

 

 

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21.         Questions

 

 

Mr Rob Robb from the Patient Participation Group at the Orchard Practice, Chessington, asked about the reduction in community beds from 35 to 25 in the move from Tolworth Hospital to Teddington Memorial Hospital and whether in view of winter flu there are any plans for Kingston Hospital to reduce the number of its beds.  The Chair pointed out that the community beds question had been discussed at the last meeting.  Fergus Keegan confirmed that the move of beds from Tolworth Hospital to Teddington Memorial Hospital has not yet taken place and this was likely to happen in the new financial year.  He confirmed there were no plans to reduce the number of beds at Kingston Hospital.

 

Mr Robb added that the South of the Borough Neighbourhood Committee was lobbying TfL to review transport in area to ensure there are better connections for the NHS and to help alleviate the need for parking at Kingston Hospital.  

 

James Giles asked about publicity arrangements for the new NHS complaints advocacy service and made a suggestion that details could be included on the RBK website.  Marian Morrison explained that publicity about the new provider (PohWer) had been discussed at a recent contract review and locally Kingston Voluntary Action had included details in their latest newsletter which was widely circulated.

 

 

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22.         Apologies for absence and attendance of substitute members

 

 

Apologies for absence were received from Councillors Geoff Austin, Mary Clark and Shiraz Mirza.  Councillor David Glasspool attended as substitute for Councillor Austin. 

 

Apologies were also received from Stephen Taylor, Director, Adult Social Care and Jane Bearman attended on his behalf.

 

 

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23.         Declarations of Interest

 

 

There were no declarations of interest.

 

 

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24.         Minutes

 

 

Agreed that:  The minutes of the meeting held on 12 October 2017 were confirmed as a correct record.

 

 

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25.         Adult Mental Health Services and progress with the Suicide Prevention and Self Harm plans

 

Appendix A

The Panel had agreed to consider progress with the Suicide Prevention and Self-Harm plans in response to a letter dated 4 April 2017 from Dr Sarah Wollaston, Chair of the Parliamentary Health Committee, to Chairs of Health Overview and Scrutiny Committees.  The Committee’s third progress report “Preventing suicide in England” was published in January 2017.  One of the recommendations was that “health overview and scrutiny committees should also be involved in ensuring effective implementation of local authorities’ plans.  This should be established as a key role of these committees”.

 

The officer report provided detailed information about two recent Kingston Strategies, firstly the Kingston Suicide Prevention strategy (launched in 2016) and secondly, the Thrive Kingston mental health strategy for adults and prevention for all ages (launched in 2017). The report also provided the context of these local strategies which include the NHS Five Year Forward View for mental health (2014) (FYFVMH), plus two Concordats for better mental health programme and for crisis care (Appendix 5). 

 

Thrive Kingston is the local strategy for local mental health services for the whole of the Kingston community and provides the local approach to the wider Thrive London strategy.  It was co-produced with over 200 people in the Kingston community including people with mental health conditions, their friends, carers and parents as well as health and social care professionals, commissioners and representatives of voluntary organisations (see Appendix 1).  An update on the progress with implementation of the strategy was presented in Appendix 2.

 

In relation to suicide there are approximately ten cases each year in Kingston and this can fluctuate slightly.  Due to the time taken for Coroners’ verdicts there is a time lag in the availability of confirmed data.  The suicide rate per 100k population in Kingston broadly follows the national average. (Across London there are 4 - 5 suicides per week).  Details of key performance indicators for suicide and related risk factors were presented in Appendix 3.

 

Dr Phil Moore, Deputy Chair of KCCG and Mental Health Clinical Lead, gave a presentation to the Panel explaining the Thrive Kingston strategy. He confirmed that this was in line with the national policy (FYFVMH) and provides a vision for mental health and wellbeing and a guide to shape the future provision setting out the policy for prevention, early intervention, self-care, treatment and recovery. 

 

The Thrive concept is international and developed in New York. Thrive London has six key aspirations:

·         A city where individuals and communities take the lead

·         A city free from mental health stigma and discrimination

·         A city that maximises the potential of children and young people

·         A city with a happy healthy and productive workforce

·         A city with services that are there when and where needed

·         A zero suicide city

 

Thrive Kingston has five key themes and Appendix 2 to the report expanded on these themes (pages A18 to A25):

·         Wellbeing and prevention

·         Early intervention

·         Community connection

·         Access to Services

·         Joined up Care

 

Priorities being progressed in 2017-18 are:

·         Early years, children and family, schools prevention

·         Workplace mental health

·         Directory of services

·         Development of primary care

·         Peer support networks

·         Triaging and single point of access

·         Roadmap of services and establishment of mental health and wellbeing hub

 

There are 200,000 people registered with Kingston GPs. Approximately 10% have common mental health problems (depression and/or anxiety) and 1% have a serious mental illness such as bipolar or schizophrenia.  Almost 10% of children and young people experience some form of mental health problem. 

 

Employment rates for people with mental health problems are less compared with people with other health conditions and are 31% below the general population.  Only 25% of people with mental health problems receive the treatment recommended by the evidence.  Dr Moore drew attention to the fact that periods of poor mental health are normal for most of us and only a small proportion are longer term.

 

Dr Helen Raison spoke about suicide prevention in Kingston.  This is led by Public Health but involves working jointly with health partners.

 

Dr Raison referred to the recent audit of coroners’ records which covered a four year period and looked at 38 deaths.  This has enabled Public Health to develop plans very specific to the population.  She explained that in Kingston the key age group for suicide is different from the national picture and there are more people in the 45 - 54 age group than elsewhere. Other factors are a higher numbers of men compared to women, being single, separated or widowed and having a long term physical condition or mental health problem. Economic difficulty is a factor in many Kingston cases and losing a job can lead to a range of issues.  The main methods used were hanging and poisoning.  Half of the people who take their life have recently seen a GP or mental health professional and the plan focuses on this element.

 

The suicide prevention strategy aims to minimise the number of suicides in Kingston and to better support those who are bereaved or affected by suicide.  Key areas are to:

·         Reduce risk of suicide in key high risk groups

·         Tailor approaches to improve mental health in specific groups

·         Support frontline staff

·         Promote suicide awareness and help seeking in the community

·         Provide effective local response to the aftermath of suicide

·         Reduce access to the means of suicide

·         Support research, data collection and monitoring

 

A multiagency suicide prevention group has been formed and 30 representatives (listed on page A12) are involved.  The suicide action plan for high risk groups was presented at Appendix 4 – Key Area 1 and has been cascaded to health and social care colleagues.  There is also a pathway to manage people in mental health crisis and information for relatives and carers who support people in distress.

 

A range of questions were asked by members of the Panel:

 

In response to a question about actions being taken with employers to support workers experiencing mental health problems and alleviate crisis, Dr Moore responded that the NHS was working with large employers in London and there was also work with local employers in Kingston.  He added that there is a strong economic case to help support people in work and avoid absence. There is also an approach to provide individual work placements to support return to work in the longer term.  The Trust helps employers with devising plans for supporting and returning to work and a primary care project funded by the lottery provides individual placement support.  NHS E is developing further plans to increase support.

 

The Fulham Football Foundation has developed a project for people with serious and enduring mental health problems to get involved in exercise, help in writing CVs and getting back into employment.  The Healthy Work Place charter focuses on wellness issues and stress.

 

The Chair suggested that linking with the local Chamber of Commerce on wellbeing at work may help with educating local businesses and the Vice Chair drew attention to work in progress as the Chamber of Commerce has recognised that people working from home can experience social isolation and is looking at ways to support people.  One initiative is the Canbury Coffee morning for lone workers.

 

It was pointed out that social isolation can be both a cause and an effect of mental health issues and Kate Dudley spoke about feedback KCN had received from carers. There seemed to be a lack of consistency in primary care about when to refer for secondary care support and she questioned the threshold for referrals.  She also pointed out that there was evidence to suggest that carers were not listened to and outlined a case where the GP did not visit promptly which led to the patient being treated at Kingston Hospital for self-harming.  

 

It was noted that people who seriously self harm are generally admitted to hospital and a joint protocol includes follow up care.  However, Dr Helen Raison did point out that there were some gaps in the pathway.  This will be taken forward in the New Year and Dr Raison invited Kate Dudley to participate in this.

 

Self harm in children and young people in London is also being looked and early evidence suggest that there is an improvement where there is follow up by texts and other messages to check that people are OK.  However the levels of self harming is high in young people aged 16 to 24 years and locally there is work in schools is being progressed.  Training initiatives are being developed to improve GPs skills. 

 

Gillian Moore, Head of Service Delivery (SWLSTG), confirmed that there was a South West London project with psychiatric liaison service in A&Es to provide follow up.  This is about enabling people to access help and support rather than expecting them to initiate this themselves.

 

A member commented that the report made hard reading and she asked whether enough was being done for people who don’t recognise they have a problem and are not accessing services. Dr Moore pointed out that there is substantial evidence that friends and families of people who take their own life are at greater risk of suicide and that this area needs more discussion.

 

Dr Helen Raison drew attention to the need also to change the culture and enable openness and discussion about mental health as stigma of it is part of the issue.   Also in about half of cases where people take their own life they will have seen their GP or another health professional in the previous week.

 

It was noted that Camden and Islington Mental Health NHS Foundation Trust C&I attended the Panel in January this year and spoke about the primary care mental health services.  It was also noted that work is progressing with the student population and also around stigma progress.

 

A member commented on the wider implications for family and employers of people who take their own life. 

 

Dr Phil Moore provided details of GP training.  19 local GPs had been trained to advanced diploma level in Mental Health.  There is also a mental health learning set which continues the training and enables access to supervision and support.  People generally respond well if they receive both medication and talking treatment and he confirmed that there was a good service in Kingston.  GPs are encouraged to refer to the local service which is also open to people who self-refer.  Reference was made to   www.good-thinking.uk which provides an online service to Londoners on a range of mental health-related topics including sleeping. 

 

A request was made for information be provided to members and it was agreed that the new Counselling in Kingston directory would be circulated.

 

A member enquired about the relevant contact centre training and it was confirmed that there was an awareness of this need and steps would be taken in the near future.   (Weblink: https://www.kingston.gov.uk/downloads/download/739/directory_of_counselling_services_in_kingston)

 

In response to a question from Dr D’Souza about the implementation of the mental health strategy Dr Moore confirmed that work was progressing across the country but it is hampered by budget problems.  Claire Murdoch, National Mental Health Director at NHS England is leading the Five Year Forward View for Mental Health and she is pushing for investment.  He added that he was working with her and there is CCG oversight to measure mental health investment per weighted population to target investment. There is evidence that by investing in mental health savings can be made in other areas.   He confirmed that progress was being made in Kingston and achievements made.  

 

Councillor Mary Clark’s two written questions were asked on her behalf. In response to a question about Police custody arrangements Dr Phil Moore confirmed that people detained under Section 136 are not detained in police cells but are transferred to the S 136 Suite at Springfield Hospital or an alternative place of safety, of which there are several across London. Police cells are used only in very exception circumstances.

 

In response to Councillor Mary Clark’s question about whether there are any plans for further Crisis cafes in addition to those in Tooting and Wimbledon, Dr Phil Moore replied that these two cafes had been set up as pilots and it is possible that Kingston may have one in the future operated by the voluntary sector.  Gillian Moore confirmed that there was good attendance at the two cafes by people from Kingston.

 

Mr Robb made a request for carers to be enabled to contribute in client consultations and suggested that patient confidentiality prevents this.  Dr Phil Moore advised that the recent mental health act review had highlighted awareness of the issues for carers and the Data Protection Act should not act as a barrier to involving carers.

 

Recommendations were made to strengthen the health-in-all policies approach by ensuring that all reports to committees include a new section on health implications and also by for example introducing health impact assessments (which include mental health) on all major new strategies and developments.

 

Agreed that:

 

1.    The Counselling Services in Kingston booklet is circulated to all members;

 

2.    The Panel recommends to the Health and Wellbeing Board that the council takes a health-in-all policies approach by introducing health impact assessments on all new policies and strategies; and

 

3.    Committee reports include a new section on health implications.

 

 

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26.         Update from Kingston Hospital NHS Foundation Trust and progress with the CQC Inspection recommendations

 

Appendix B

Kingston Hospital submitted a report to the Panel to update on the following areas:  performance, fire safety, car parking, progress against the areas identified by the Care Quality Commission – the 7 “must do” (of which 6 have been addressed) and 42 “should do” items (39 now addressed/being progressed). The remaining “must do” item concerning system improvements to monitoring equipment maintenance and safety checks is being progressed and an automated tracking system will be in place in mid-December.

 

The three outstanding “should do” items require significant capital investment which has not been identified so far and the CQC is aware of this:

 

·       Consider how the environment and facilities in the ITU/CCU could be improved.

·       Review maternity service bed capacity in order to address the increasing activity

·       Review the environment of the chapel and multi-faith facilities

 

Ann Radmore, Chief Executive attended the meeting, gave a presentation and answered a number of questions.

 

The Trust has continued to perform well on cancer targets and the referral to treatment target (RTT) and has been exceeding the national targets for each.  It is achieving well on digital development and is the 4th hospital in England to achieve HIMSS level 6.  The Hospital also performed well on the Family and Friends Test – 95% of people would recommend the hospital to others.

 

Ann Radmore stated that performance in A&E in October was 92.6% seen within 4 hours, just below the national target of 95%.  She explained that the Trust does achieve the 95% standard about twice a week. The capacity in the emergency department’s Major and Resuscitation area is being increased to create a further 7 spaces and the new urgent treatment centre (UTC) opened on 27 November.

 

The “Red Bag” Scheme piloted in Sutton has now been introduced in nursing homes in Kingston and Richmond enabling patients admitted to hospital to take their red bag with them.  This contains important information on a resident’s health and a number of essential belongings which also aid discharge.

 

Ann Radmore confirmed that progress has been made on the provision of seven day services and extended consultant physician care is available on wards across the week with two consultants at weekends.  This is aiding the ability to make discharges at the weekend.

 

Implementation of the fire safety plan is progressing especially with regards to increasing compartmentalisation within the hospital buildings.  Significant investment will be needed to undertake these works, however two wards in Esher Wing have been completed.  It is expected that the changes will be completed in the next 18 months.  Mock evacuations /training exercises had taken place jointly with the London Fire Service. During discussion it was suggested that there was a need for more Fire notices directing people where to go.

 

Car parking at the hospital is being reviewed to explore whether it would be possible to increase the amount of onsite parking but currently several spaces have been temporarily lost due to the UTC and A&E extension works but 12 spaces will be lost permanently due to the larger UTC footprint.  CP Plus will be operating the hospital car parking from 22 January 2018.

 

Other achievements include:

 

·       Clinical research has been driven forward and the Trust is now seen as having made the greatest improvement in England.  The Trust will report in April and May on its quality goals achievements.

·       The Trust has more than 600 volunteers working in every part of the hospital who make a great contribution.

·       The Trust is at the forefront of adopting digital technology and seeing the benefits in way care is provided to patients.

·       Radiology department is being developed and new CT and MRI scanning will be on site next year.

 

A question was asked about the additional funds which were being made available for hospitals as announced in the recent budget and what was happening locally.  Ann Radmore stated that capital money has been allocated to the four regions but as yet there are no descriptions about how this should be allocated and for what purpose.  Longer-term investment has also been announced and this may be allocated via CCGs

 

£350m has been allocated for winter and bids have been invited.  The Delivery Board for Kingston, Richmond and East Elmbridge has identified three areas for funding and is awaiting a response: 

·       community team for rapid response at weekend

·       physician and GP in A&E to reduce admissions

·       additional staffing at weekends to increase the number of discharges at weekends including discharge co-ordinator, occupational therapist and social worker

 

Several questions were asked about Parking at the hospital especially concerning reports of disabled parking in Galsworthy Road on double yellow lines leading to potentially dangerous situations.  Ann Radmore replied that there were 32 disabled spaces on site and these were not used to capacity. She added that a new provider will be taking over in January and the hospital want a system which is more appropriate for elderly people.  Members requested that the hospital investigates the under use of disabled spaces and reasons for those choosing to park in Galsworthy Road.  It was suggested that leaflets could be placed on car windscreens to find out the reasons for parking in the street and other views and Ann Radmore agreed to undertake this.  It was confirmed that the Trust did provide parking concessions for relatives of people who were in intensive care.

 

In response to a question from the gallery Ann Radmore explained that security do check periodically that cars parked in disabled bays do have blue badges.

 

In response to the suggestion that the Hospital’s respiratory lung function test equipment is very dated, Ann Radmore explained that the capital programme is considered by the Board annually.  Clinical directors are invited to identify needs and bring forward business plans but there are never sufficient funds to meet all requests.  She agreed to ask about where this equipment was placed in the list of priorities.

 

In response to a question about delayed transfers of care (DTOC) Ann Radmore explained that a lot of effort has been invested in last 18 months by both health and social care partners in Kingston, Richmond and Surrey to ensure swifter placements.   There are occasions where there are no delayed discharges for social care reasons and at other times there can be 1-3 delays.

 

In response to a question from the Chair, concerning the CQC’s identification in the June 2016 report of A&E leadership as being problematic, Ann Radmore explained that at the time of the inspection in January 2016 the clinical director was very new into post.  Several changes have been made since that time including around clinical and nursing management. Leadership is now more rigorous and this is resulting in an improvement in performance and management of the department.

 

In response to a question about Maternity services and whether any expectant mums are ever turn away Ann Radmore stated that 5,500 babies are delivered at the hospital annually and none have been turned away so far.  Recent maternity service developments at West Middlesex have reduced the pressure in that area.  She added that today expectations are different and the hospital wants to be able to provide services in a more discrete way.  For example currently the Post-natal Ward is not close to the maternity unit.

 

The changes to paperless systems were welcomed and a question was asked about next steps.  Ann Radmore referred to the national programme which was aiming to be paperless by 2021.  She added that there were some challenges about technology particularly where wards were not designed for this and there were log in complexities when step away.  However the Trust was making very good progress.

 

Mr Robb in the gallery asked whether there was good IT compatibility with other systems and Ann Radmore replied that technology is more cloud based and this has helped with compatibility and there is better integration with hospitals, social care, mental health and GPs.  However it is important to exercise care with patient information.

 

Agreed that:

 

1.    the information provided is noted; and

 

2.    The Trust undertakes an investigation into disabled parking and the apparent increasing trend for disabled people to park in Galsworthy Road rather than the hospital car park.

 

 

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27.         Update on preparations for the winter demand

 

 

Fergus Keegan, Director of Quality and Engagement at Kingston and Richmond CCGs gave a detailed presentation on the preparations for winter. 

 

This year’s winter plan builds on work of last year and is aligned with the DH, PHE and NHSE’s third national integrated “stay well this winter” campaign.  The presentation gave information on relevant statistics, the focus for Stay Well this Winter, the local communications plan, primary care access and the role of the A&E Delivery Board which is chaired by Ann Radmore.

 

The national campaign brief is “to ensure that people who are most at-risk of preventable emergency admission to hospital are aware of and, where possible, are motivated to take actions that may avoid admission this winter”.  The campaign seeks to educate at-risk groups about the actions they can take to stay healthy (C2DE adults aged 65+, people with long term conditions and carers and to improve the update of flu vaccine.

 

Key statistics in the past year:

 

·         Emergency admissions via A&E at Kingston Hospital – increased by 12.2%

·         Ambulance journeys (KCCG patients) - increased by 3.7%

·         A&E attendances (all) at Kingston) Hospital - increased by 0.55%

·         A&E attendances (KCCG patients – increased by 1.1%

 

·         RBK Delayed Transfers of Care – reduced by 63% comparing Sept 17 with Sept 16

 

·         Flu immunisation 65+ for KCCG (Sept 16 to Jan 17) 66.1% and for year to date 61.4%

·         People registered with Kingston GPs – 209,409 – increased by 2.4% (includes small numbers of people from outside Kingston)

·         GP appointments over past year – 811,522

·         Extended Primary care hub appointments April – Sept 17 – 14,942

·         (this increases GP appointment capacity by 3.6% over a year)

 

In terms of overall A&E attendances:

 

·         Total A&E attendances at Kingston Hospital (Oct 16 – Sept 17)   117,198

·         65% (65,202) patients from other CCGs

·         44% (51,996) patients from KCCG

 

·         22,805 KCCG patients (30%) attended another A&E

 

Fergus Keegan stated that Kingston has not seen the same level of growth in A&E attendances compared with other hospitals but a higher proportion of over 85s need to stay in hospital and they have greater health needs. Kingston Hospital has a clinical decision unit which provides a safe area for people who need to stay longer than 4 hours.  This enables more time for observations and prevents people being sent home in the middle of the night.

 

Partnership working in Kingston and notably RBK’s adult social care team have enabled 63% reduction in delayed transfers of care compared to previous 12 months and Kingston is the 2nd best in London.

 

Flu vaccinations for Kingston’s NHS staff now stands at 71% (at 6 December 2017).  This is an improvement on last year and has exceeded the target. 

 

Fergus Keegan drew attention to the additional capacity that has been provided in primary care particularly at the primary care hubs.  All together an additional 58K appointments are being provide plus a further 23K - 24K community nursing appointments.  For every A&E attendance there are 11 appointments elsewhere.  People attending A&E inappropriately are redirected to other services eg their GP, pharmacy or one of the GP hubs.

 

In relation to the communications plan there are small changes compared to last year’s.  Local promotional material is being linked to the national campaign and the aim is to encourage 1M people across the country to use local pharmacies rather than A&E.  Fergus Keegan emphasised that the aim is not about preventing emergency treatment but encouraging people to use it appropriately and to take steps to keep well, keep warm, take up flu vaccination, ensure stocks of food and encourage people to keep an eye on elderly neighbours.  

 

There are three stages to the communications plan, firstly (October) to raise awareness of flu vaccination, secondly (January/February) to continue to raise awareness of flu, encourage people to use pharmacies for advice especially about long term conditions and to use the 111 service, and thirdly (February to March) targeting parents of children under 5 to stock up on medications such as Calpol.

 

London is one of three regional areas selected to deliver a 111 awareness campaign.

 

Communication platforms include film clips for websites, social media, posters and leaflets, stakeholder communications and communications in GP practices.

 

Kingston and Richmond have extended primary care services to provide GP and nurse appointments 8am to 8pm seven days a week.  In Kingston these are located at Kingston Health Centre, Surbiton Health Centre and the Merritt Health Centre in Chessington (Richmond’s are at Teddington Memorial Hospital and Essex House in Barnes). The Kingston services are currently operating at 70% capacity and at weekends between 30-40%.

 

Walk-in centres are available at Teddington Memorial Hospital and Queen Mary Hospital, Roehampton avoiding attendance at A&E.

 

There has been good planning for this winter and a programme of work has been developed by the A&E Delivery Board with improvements made on last year.  A focus is to better manage the peaks as effectively as possible. It is anticipated that this will be a tough winter and it will be challenging especially for the over 85 group of patients.  

 

In response to a question Fergus Keegan confirmed that more work is needed to address people who are regarded as frequent users of the A&E service. 

 

A question was asked about the new GP app service.  This is available for people who work in London Zones 1 to 3 and this is a paid for service rather than being free to the patient under the NHS.  Whilst it is advertised as offering the opportunity of being able to speak to a NHS GP, this service is an adjunct to the GP’s NHS role. 

 

Dr Phil Moore added that concerns about this service had been raised at the Primary Care Committee and he was aware that many representations are being made but not by KCCG.  

 

Dr D’Souza asked for further details about Kingston Hospital’s Clinical Decision Unit.  Fergus Keegan explained that the national 4 hour target is appropriate for most but there are occasions where a hospital may need more time to diagnose, or determine the next step for treatment.  The CDU provides beds and single sex and is under the supervision of the A&E team.

 

Mr Robb (in the gallery) suggested that the Merritt Centre was not open as long as the other two and would it be possible to extend this to 8am to 8pm.  Fergus Keegan pointed to the need to ensure affordability and added that weekend services are underused especially on Sunday (only 30-40% capacity) and the services is provided by just a small pool of GPs to provide. 

 

Agreed that:

 

The information provided is noted.

 

 

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28.         Minutes of the Health and Wellbeing Board

 

Appendix C

The minutes of the Health and Wellbeing Board held on 14 September included the following items:

 

·         Update on the South West London Sustainability and Transformation Partnership

·         Child Death Overview panel Annual Report 2016-17

·         May of London’s Health Inequalities Strategy Consultation

·         London Crisis programme – health based place of safety

 

AGREED that:  The minutes of the Health and Wellbeing Board held on 14 September 2017 were noted.

 

 

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29.         Urgent Items authorised by the Chair - Referral from Healthwatch Kingston:  Services for people with Emotionally Unstable Personality Disorder

 

 

Healthwatch Kingston had submitted a formal written request under statutory powers to the Chair of the Health Overview Panel to consider the specialised provision for people with complex Emotionally Unstable Personality Disorder (EUPD) in Kingston.  The letter explained that a number of questions about provision of these services had been made to the Kingston Clinical Commissioning Group (KCCG) but the responses had been unsatisfactory.  Currently Kingston residents have no access to specialist services for EUPD unlike other nearby boroughs. Instead a primary care based personality disorder (PD) service is being commissioned. The letter appended information about the engagement with KCCG and South West London and St George’s Mental Health Trust (SWLSTG), the NICE treatment guidelines for EUPD [including Dialectical Behaviour Therapy (DBT) and Mentalisation-based Therapy (MBT)], and the prevalence of both PD and EUPD in Kingston.  It is estimated that there are 536 people in Kingston with EUPD

 

Grahame Snelling, Chair of Healthwatch, Kingston introduced the request.  He stated that this was an important topic and Healthwatch were seeking to draw attention to the inequity in service provision for residents of Kingston with this condition compared to those in other boroughs.  Whilst several representations to KCCG had been made Healthwatch were not satisfied with the responses received so far.  Healthwatch were seeking answers to the following four questions:

 

·       We would like to understand the rationale for the provision of PD services for residents in Kingston and in particular, more complex EUPD.

·       “Thrive Kingston” is a 5-year strategy (we are currently approaching the end of year 1) and we would like to know when provision for Kingston residents with complex EUPD will be addressed in the remaining 5 years of the strategy.

·       What provision will be made for people with complex EUPD until new arrangements are in place?

·       Would the Health Overview Panel consider the link between this and suicide prevention?

 

Grahame Snelling added that the report considered for the earlier item on Mental Health Services and progression with the suicide and self-harm plans explained the ambitions of the Thrive Kingston strategy and Healthwatch had hoped this group will be represented in that documented in more detail.

 

Dr Phil Moore began by stating that we do not have a perfect Personality Disorder service in Kingston.  He agreed that the prevalence in Kingston of people with EUPD was of the order of 500. Kingston has a number of services in primary care, primary care step-up support and SUN. The CCG recognises that this group of people is not well-served with current services.  The CCG is therefore planning to undertake a three months’ demand and capacity review and expects to be in a position to report in April/May 2018 to enable plans to be made for the future. 

 

In relation to the current service provision, the Serenity Integrated Mentoring Project takes people with the greatest need and who are the most chaotic.  Police and other professionals undertake regular mentoring for these clients and the approach is based on project developed in the Isle of Wight.

 

Stephen Bitti, Manager, Healthwatch emphasised that the key concern is that these 500 people are not provided for currently and every other SWL CCG has commissioned this as part of the complex needs service at SWLSTG.  He asked for details of what further steps would be provided to this group prior to the outcome of this review?

 

Gillian Moore, Head of Service Delivery (SWLSTG) agreed that those in Kingston with the highest need are not catered for, but was supportive of the comments made earlier by Dr Moore about the other support and interventions which are available to local clients.  She added, however, that whilst the structured clinical management in the clinical support teams can provide more support for people with PD, this will not resolve issues and that psychotherapy and other therapies (DBT and MBT) are needed.  People can be admitted to hospital but this was not an optimal treatment and the Trust wished to manage behaviours in a different way. Dr Moore pointed out that a psychology based service is also important to supporting this group. 

 

Stephen Bitti asked again about what can be offered at this point in time.  He pointed out that this group was at a higher risk of suicide and self-harming behaviours and he was keen that this year’s commissioning cycle opportunity is not missed.  He asked whether any “spot purchasing” is undertaken and Dr Moore confirmed that this did occur.  Dr Moore added that it would be possible to make some changes in year.

 

Kate Dudley (Kingston Carers’ Network) stated that DBT therapy had been available in the past and asked why the decision had been taken to remove this offer, adding that the feedback pointed to the effectiveness of this therapy and good long term results. Gillian Moore confirmed that the expertise is still provided by the Trust but not for Kingston residents.  Clinicians recognise the efficacy of this treatment and would welcome the return this provision for Kingston clients.  

 

It was questioned whether, in view of the strong arguments put forward, this service provision could be addressed within the commissioning intentions for 2018/19.  Dr Moore pointed out that the CCG was undertaking a review of EUPD services and the outcome was not expected until the Spring.  The Chair requested that the CCG reports back to the Panel in March 2018 on an interim basis and the Chair of Healthwatch requested a formal response from the CCG to the four questions raised in the letter early in the New Year.

 

AGREED that: 

 

1.    KCCG reports back on an interim basis on the demand and capacity review of the provision of services for EUPD to the meeting on 28 March 2018; and

 

2.    KCCG responds formally to Healthwatch early in the New Year.   

 

 

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30.         Work Programme

 

Appendix D

Agreed that: 

 

1.    The work programme as amended was noted;

 

2.    The items for the meeting on 28 March 2018 are:

 

·       Main item – Progress with the Locality and Wellbeing Teams

·       Transport for children and young people with learning disabilities

·       Update on the Sustainability and Transformation Partnership

·       Interim Update on KCCG’s demand and capacity review of services for Emotionally Unstable personality Disorder; and

 

3.    The following members were appointed to the working group to develop the items:  Councillors Bass, Netley and Clark, and Kate Dudley (Kingston Carers’ Network) and Stephen Bitti (Healthwatch Kingston).

 

 

 

 

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Signed…………………………………………………….Date…………………

Chair

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