Monthly bulletin for volunteers and partners
March 2014 We can’t do this without you!
Welcome to the March 2014 edition of Healthwatch York’s regular monthly bulletins for volunteers and Partner Programme organisations.
Please let us have your feedback on this bulletin – what’s useful to you and what isn’t. If you have any ideas of what else should be included, do tell us.
Who’s who and who does what?
Focus groups – come and tell us what you need
As part of our work on Who’s Who and What’s What in Health and Social Care we are holding two (identical) focus groups to find out what you need to help you navigate your way through the health and social care system.
Wednesday 9th April, 5pm-7pm
Tuesday 15th April, 10am-12 noon
Both focus groups will take place at the Priory Street Centre. Tea, coffee (and biscuits!) will be available. Please come along to one of these sessions if you can.
You are invited to celebrate Healthwatch York’s 1st birthday!
On Tuesday April 1st Healthwatch York will be one year old and we’ve invited the Lord Mayor along to CVS to help us celebrate. We’d love it if as many of our volunteers and partners as possible could come along as well. Please join us from 10.30am in reception for
tea, coffee and a very special Healthwatch cake!
Office update – March at Healthwatch York
Our Spring newsletter will be published at the end of this month, together with our latest consultation survey. The survey asks what people think should be on our work plan from June 2014 until March 2015. It can be completed on paper or online. We need as many people as possible to complete a survey – please make sure you fill in yours. If you are able to take copies of the survey to meetings, events, coffee mornings etc please contact the office for further supplies. Completed surveys must be returned by May 30th.
As part of our work on discrimination against disabled people, we have organised a joint event with York Independent Living Network (YILN). The event will take place on Monday 12th May, from 9.30am to 1pm at the Priory Street Centre. At the event we want to hear about the experiences of disabled people in York. If you would like more information, please contact the office.
We’re pleased to announce that the organisation chosen to carry out the evaluation of the first year of Healthwatch York is Skyblue Research. Based in York, the Skyblue team is led by Research Manager Chris Charlton. Chris has already met some Healthwatch York volunteers at our recent meeting and he or his colleagues may be in touch with you over the next couple of months.
We have now arranged the dates for our volunteer meetings from April until December 2014. Please put the dates in your diary, and come along when you can.
Monday April 28th 4-6pm
Wednesday May 21st 10am-12 noon
Monday June 23rd 4-6pm
Monday July 28th 10am- 12 noon
Monday August 18th 4-6pm
Monday September 29th 10am-12 noon Monday October 27th 4-6pm
Monday November 24th 10am-12 noon
Monday December 22nd 4-6pm
The next volunteer induction sessions will take place on Monday April 14th 5-7pm (part 1) and Wednesday April 16th 5-7pm (part 2). Please can all volunteers who have not yet been to an induction let the staff team know if they can attend one or both of these dates?
All providers of NHS healthcare services produce Quality Accounts every year. These are reports to the public about the quality of services the organisation provides. The Quality Accounts include:
o priorities for improvement for the coming year o how these will be achieved, including arrangements for measuring, reporting on and monitoring progress o how the organisation has involved patients in determining the priorities for improvement.
Quality Accounts are completed in draft and shared with stakeholders, including local Healthwatch organisations, before they are published. This year, Leeds and York Partnership NHS Foundation Trust have offered to come and present their draft Quality Account to us in person. This will enable us to review the draft document and contribute a comment about them for publication. Trust staff will be attending a meeting with us on Tuesday April 29th from 10am to 12 noon. Any Healthwatch York volunteers and representatives of partner organisations who would like to attend would be very welcome.
The Centre for Health Economics at the University of York are currently working on a project which is looking at public views on health inequality. They are holding two one day Citizen Panel events, one on Saturday 26 April 2014 and the other on Saturday 3 May 2014. They are looking for members of the public to attend these events to give us their views on health inequality.
Both events are being held in the Ron Cooke Hub on Heslington East at the University of York and run from 9.30am - 3.00pm. Lunch and refreshments are provided and each participant will be given a one-off gift payment of £50.00 to thank them for their time.
Further details about the project can be found at:
http://www.york.ac.uk/che/research/equity/monitoring/
To book a place contact Ruth Helstrip on: 01904 321427 or e mail: [email protected]
Issues
The issues brought to Healthwatch York are vital to help us build a picture of what’s happening in health and social care in York. Members of the public do contact the office directly with their issues, but we also rely on our volunteers and partners to bring issues to us. When people are talking to you about their issues, please remember to note them and pass them on to us.
The following issues have been logged with Healthwatch York since the last monthly bulletin:
A mother who took her young child to A & E at York Hospital reported that signage (a white board) showing all clinics waiting in the same area is unhelpful, and can be confusing. Also, there are so many seats in this area it is difficult to get in and out without climbing over people/ banging into them or making them move.
A woman who fell in a GP’s waiting room was unable to get up, even with help of her carer and staff. There was no equipment to help lift her in the surgery, so an ambulance was called. There were no blankets or pillows in the surgery to make her comfortable while waiting for the ambulance.
Daughter with support needs of her own has power of attorney for her mother who has been in York Hospital for some months. She is currently trying to find a suitable care home with nursing to get her mother discharged as soon as possible. She reports lack of support and understanding from both hospital staff and City of York Council staff in finding a suitable care home.
A patient who has mental health conditions and also has a chronic pain condition reports that her GP referred her to the Community Mental Health Team (CMHT) who sent her back without seeing her as ‘pain clinic more appropriate’. Pain clinic felt they weren't most appropriate, so referred the patient back to the GP for referral to CMHT. She now feels she cannot manage without support but has been told by her GP they are not hopeful she will be seen. A care home manager reports that residents who are wheelchair users are spending a lot of money on taxis because wheelchair taxis are so expensive. A wheelchair user who has a bus pass reports that a large proportion of her money is being spent on taxis because bus drivers often don't allow her to get on the bus because the wheelchair space is taken up by buggies. Several buses go by without being able to take the wheelchair. She has to pay £30 to visit the dentist in a taxi.
Partner news
During March we welcomed York People First to our partner programme. Here is the full list of our current partners:
Age UK
Alzheimer's Society
CANDI (Children and Inclusion)
IDAS (Independent Domestic Abuse Services)
Independent Living Scheme
MS Society - York & District Branch
National Osteoporosis Society: York Support Group
Friends of St Nicholas Fields
Get Cycling
North Yorkshire &York Neurological Alliance
Mysathenia Gravis York Branch
Priory Street Nursery
Royal Voluntary Service - Leeds & York Hub
Volunteering York Wilberforce Trust
York Independent Living Network (YILN)
York Older Peoples Assembly (YOPA)
York & District Citizens Advice Bureau (CAB)
York & District Pain Management Support Group
York Advocacy
York Carers Centre
York Carers' Forum
York Lesbian Gay Bisexual & Transgender (LGBT) Forum
York People First
York Rheumatoid Arthritis Support Group
York Wheels
Young Carers Revolution
YUMI (York Unifying Multicultural Initiative)
Key dates for April 2014
Details of meetings and events can be found on the events calendar on the Healthwatch York website. Healthwatch York meetings/events are colour coded in red. Details of other organisations meetings/events which are open to the public are colour coded in green.
Paper copies of the calendar are available for anyone who does not have access to the internet.
Meeting reports
Healthwatch York staff and volunteer representatives attend a variety of meetings every month.
These are the reports from some of the meetings held during March:
Representatives’ Report/Feedback Name of Representative: Polly Griffith
Title of the meeting: YorOK
Date the meeting took place: 03/03/14
Date of next meeting: 12/05/14
Purpose of the meeting (Please give short summary):
A gathering of everyone who has responsibility for Children's Welfare in any way across York. A strategic overview to ensure the CYC and the NHS are fulfilling their obligations and that all groups are working well together to meet the needs of children from pre-birth to 25 years old.
Main areas of discussion:
This is a very wide-ranging meeting as you can imagine from its remit so I find it difficult to report in detail. Minutes and papers are available in a timely manner on the YorOK Board website (google YorOK Board) for anyone who is interested. Catherine Surtees also attends and she has put out a very interesting and comprehensive email for CVS colleagues about issues and new reports which can be sent to HW members. Let me know.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):
A discussion about how what happens at this meeting relates to what others are doing to ensure we are joined up and not missing something important. Also, feedback from other members as to what I should (if anything) raise at the meeting.
As far as I know, Healthwatch is not yet a recognised member of this group. There is no problem of my attending and they are very welcoming, but we might make more of an impression, especially if we do have issues to raise, if we were formally invited.
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback Name of Sian Balsom Representative: Title of the meeting: Joint Strategic Needs Assessment (JSNA) steering group Date of meeting: 4 March 2014 Date of next meeting: 1 April 2014
Purpose of the meeting (please give short summary):
Main areas of discussion: Website - Site testing – starting in April, then 28 April invite some of testers in to meet with developers and discuss things face to face. Launch 30 April. Will be releasing deep dive areas in phases. Poverty work first – uploaded by 16th May. Mental health next, uploaded by 13th June. Frail elderly by 18th July, with work finished 4 weeks before publication, review completed 2 weeks before go live on web. Dates may slip. Young persons deep dive will be last released, by 19th September. Refresh work - issues around resourcing the report writing and checking. No public health consultant to undertake this whilst Martin is off sick.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback
Name of Sian Balsom Representative: Title of the meeting: Joint Strategic Needs Assessment (JSNA) Mental Health deep dive Date of meeting: 6 March 2014 Date of next meeting: 1 April 2014
Purpose of the meeting (please give short summary):
Main areas of discussion Linda Westlake – Commissioning for Value toolkit. Benchmarking indicators for CCGs with 10 nearest neighbours (based on deprivation levels, rural v urban, population type etc). Will circulate completed version to us all within the week. Looking at Mental Health indicators. No primary care indicators in bottom quintile. 5 of 17 indicators in secondary care in bottom quintile. E.g. excess deaths in under 75s with severe mental ill health. To benchmark at the average, would need 3 fewer deaths per year. Challenges around interpreting the data in a meaningful way.
Other data areas – have got some meaningful data from Voluntary and Community Sector (VCS), but not as much as had hoped. Important to look at Mind mapping exercise too. Catherine McGovern provided info on provision – excellent piece of work collating details. New JSNA website 30 April, phased release of deep dives monthly after. poverty end May, then mental health by end June (final draft end May). Nick to send round timescales and dates. Testing over weekend 25th April then face to face feedback day 28 April. Beverley Geary – psychiatric liaison. Joint project between York Hospital, Vale of York CCG and Leeds and York Partnership Trust. 2 options – raid model or Bootham based model. Will develop business case to be agreed at project board. 3 way meeting director to director in May. Assuming will run with a preferred option from that meeting. Willingness from all parties to proceed. Evidence for the options needs including, then direction of travel into Health and Wellbeing Board strategy.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?): Ask at Adult Safeguarding Board (ASB) – do we collectively review suicide information to identify system issues? Not just looking into individual circumstances but covering system concerns.
Speak to Catherine re Sarah Douglas, York College provider forum for counselling organisations. Has she had any contact? Links with mental health forum?
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback
Name of Representative: Lesley Pratt
Title of the meeting: Vale Of York Clinical Commissioning Group Governing Body Date the meeting took place: 6 March 2014
Date of next meeting: 3 April 2014
Purpose of the meeting (please give short summary): Report & update events to board.
Main areas of discussion:
Dr Mark Hayes confirmed that the place of safety (section 136) opened at Bootham Hospital on 3 February 2014.
The Prime Minister Challenge of £50 million was to be released in nine blocks and the Vale of York had put in two bids.
It was suggested that there should be an evaluation of all public engagements events and these should reported back to the Governing Body.
Work with York Hospital is on going to understand and manage the reasons for the increase in infections. It was confirmed that next year’s target will be lower.
Concern was raised over the service offered to children between 16 and 18.
The Out of Hours (OOH) Service is showing as Red on the dashboard and it was suggested training be included as part of the next procurement.
The OOH service needs to be strong and use local GPs. Questions were asked if there was a national programme for OOH services but nobody was aware of one. It was suggested that perhaps this could be included on the Post Graduate course at the University.
A question was asked if this service included an advanced nursing practitioner. We were advised that procurement was based on an outcome basis and that this could not be insisted on but it could be a recommendation. It was also suggested that the contract should be for 5 years.
We were advised that the Better Care Plan had been forwarded in draft using the template provided but the template was not helpful and it was hoped that after re drafting Vale of York would achieve Amber. It was agreed that this was a good opportunity to look at how Health & Social Care could work together.
Concern was raised over the introduction of 7 day working and the cost of offering this service.
It was suggested that the plan should show how the new services would affect the patient and the Kenneth system was suggested as a guide.
A question was asked if there was a plan B and we were advised there was not.
The Board requested that the data provided should be more up to date.
The situation in A&E is improving and the attendance figure has gone down and staffing had improved.
The Board were advised that ESIST were visiting in April to look at the system in A&E.
It was agreed that the CCG should be present on the boards concerning the Ambulance Service and not rely on just being represented.
It was suggested to help with problems over discharge the use of the voluntary sector could be used to avoid the long waits for ambulances.
Work is going on into looking into why there has been an increase in the number of falls at York Hospital.
Work is going on into safeguarding and Lucy Botting is to bring a report to the next meeting.
Meetings are planned with Leeds Partnership following the CQC report on Bootham Hospital & Lime Trees. A plan of action has been set up.
A review of all the medicines used at York Hospital is in the process of being set up.
It was suggested that the inclusion of more lay people on the CCG committees would be helpful. This was thought to be a good idea and will be looked into. Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):
Offer help & assistance in promoting the use of lay people on the CCGs committees
Do you feel that this meeting was useful?
Yes x No
Representatives’ Report/Feedback
Name of Siân Balsom Representative: Title of the meeting: Health and Wellbeing Event – Vale of York CCG & CYC Date of meeting: 10 March 2014 Date of next meeting: tbc
Purpose of the meeting (please give short summary): To update people about what is happening in health and social care in York, and to give them an opportunity to share their views.
Main areas of discussion: Integrating care in York - Paul Edmondson-Jones (PEJ) See Kings Fund ‘Sam's story’ online here; http://www.kingsfund.org.uk/audio-video/joined-care-sams-story
What we know - high spend in some areas, compared with other local authority areas. Made some progress in terms of changing delivery, but currently in difficult financial times. Will be unable to just make efficiency savings to keep things going with current funding and increased demand - need for real change, fundamental shift in model of care. Working through rewiring public services programme.
Challenges & drivers for change - changing demographic, care & support bill changes ( probably most fundamental piece of legislation in our lifetimes - prevention integration, personalisation, quality, safety and safeguarding), integration with health, rising cost of care, complexity of cases, Dilnot review, more customers, budgetary constraints. Clear direction in order to respond to these challenges.
Currently 5-6% of spend on preventative services. Need this to shift - to enable pre-threshold intervention. Prevention and early intervention, Information and self care. How do we enable people to help themselves, how do we shift the balance.
Who are our stakeholders? Residents - at heart of what we do. Not just about organisations. Health. VCS. Public health. Private and independent sectors. All as equal partners. Need to work together if this is going to work. One of few HWB boards that involves providers around the table. Clear commitment to mutual, cooperative approach to problem solving.
We must be outcome focused, not process driven.
Mark Hayes - CCG and NHS perspective CCG spend - acute £215m, mental health £39m, community £29m, primary care - prescribing etc - £49m.
We only have so much money. If we invest more in the hospital to enable it to meet current demands, and continue to do this, we will starve community, mental health and primary care services of their funds. Better care fund - min 3% CCG funds into pooled budget with council. Can put in more. Represents a shift in emphasis. 5% reduction in acute hospital funding = 9% growth in mental health, community and primary care. Canterbury, New Zealand - diagram of integrated care system. Hope to emulate this work.
Better care fund - no new money. Redeploy existing funds. Challenges - must have a better impact than current use of funding, must protect social care services but not spending, 24/7 care. Wheel of care - Person at centre. With family, carers, community. Then - Single contact point. Then existing providers - hospitals, care homes, voluntary services, community health and social care, primary care, plus proactive care. Around the edge, whole raft of interventions.
Questions - how do we involve GPs in change? Priory Medical Group presentation may address this. Importance of accessible information. Role of Healthwatch York in involving people. No nationally led communications on better care fund - being left to each area. Trialling some multi disciplinary team work in Priory Med, Selby, and Pocklington.
Martin Eades. Priory Medical group - 53,500 patients across York. Work with lots of care homes, nursing homes. Many with chronic diseases, long term conditions. Many with lifestyle issues. Many who cannot easily get out of the house. Current situation - fragmented service provision, with poor communication across services - politically, financially, clinically. Limited awareness of each other. Pressure to do more with less - financial and political. No technology platform to share data. Patients tell their story multiple times. At the moment, the patient is not at the centre. Priory Medical believe each journey is unique to the patient, as all patients are unique. Patients want seamless care. Safer consistent care. Better use of technology. Good information for self care. With good support. More remote care and monitoring. Want to put the patient at the centre.
How do we get there? If it works do more, if it doesn't stop doing it. Patient safety essential. But don't be afraid to take risks. Break the rules. Make sure we find resources for the stuff that does work. Try things in small chunks, and then scale up if they work.
Key to success - communication, cooperation, coordination, control. Scale ability - Focusing first on 500 patients. Believe can make a difference it them now. Then if it works, take to 1,100 high risk patients. If that works, 2,000 frail elderly patients. Two way contract with patients. Patients will need to be on board to make this work.
Summing up - thinking through journey of integration, partly driven by finance and politics but also, more importantly because it makes things better for people.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?): Action for HWY - need to make contact with Martin Eades Priory Medical Group re activities, with CYC and Garry Jones. Check out week long drop in at Lavender Grove - this week. Email Jan Neary York Housing Association - re engaging with GPs around housing and health issues.
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback Name of Ann Harper Representative: Title of the meeting: Lavender Grove Practice, Priory Medical Group Open Forum Date of meeting: 11 March 2014 Date of next meeting:
Purpose of the meeting (please give short summary): An open week featuring discussions of aspects of health care provision, hosted by Priory Medical group. Main areas of discussion: Services for elderly people, residential home care, admission and discharge from hospitals. Comms between hospitals/wards, GPs and residential homes. Provision of specialist equipment in nursing homes. Labelling of drugs from pharmacy. White Knights Charity – picks up and delivers prescriptions. Number of ECPs (emergency care practitioners) in area. Mortality rate following admission to hospital from nursing home = 17% within 3 days. Sometimes better to treat in the home. Training for nursing home staff, to include hospital based tutorials? Dare for dementia patients. District nursing.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback
Name of Siân Balsom Representative: Title of the meeting: Health Overview and Scrutiny Committee (HOSC) Date of meeting: 12 March 2014 Date of next meeting:
Purpose of the meeting (please give short summary): City of York Council scrutiny committee covering Health
Main areas of discussion: Matters arising Paul Doughty(PD) noted that the HOSC can scrutinise the Health and Wellbeing Board.. Looking forward to welcoming Tracey Simpson Laing to HOSC to begin this relationship.
Public participation John Yates - NHS111. Is it working, and how many calls have been misdirected? Numbers to be clarified. Jeremy Jones - homelessness. Arclight was in at the creation of the PMS. Now room stands empty. Bespoke medical service for the homeless is important. Re provision of service June 2012 unrepresentative and flawed, real reason for it being decommissioned was funding. Following decommission of other PMS elsewhere, a number of successful social enterprises were set up to provide this service. Patient cost of PMS was £1,000. In Watford, patient price is not far off that. Serious decline in GP appointments. Loss of consistency of care, of prescribing, communication between services. Paul Edmondson-Jones (PEJ) - re provision now throughout GP practices. What has been done over last 6 months health needs assessment gypsies and travellers and homeless people. Now need to look at what this tells us for their health needs. Currently not able to take this forward as main people involved have been off sick for 6-8 weeks.
Agenda item 4 - third quarter CYC finance and monitoring report. PD - CQC concerns around quality of provision. Do CYC pick these up before CQC inspections? PEJ confirmed there are homes where CYC is taking action to improve provision. Tina Funnell (TF) - Better info from CQC now. Will add to that with our own information. PD - issue of setting unachievable budgets. PEJ - very difficult to bring in every budget line on budget. Some of the savings take time to bring in, some may involve market testing, some we do not fulfil the level of savings anticipated, but in other areas savings are greater. Difficult due to fluctuating demand. PD - public health surplus. Given number of times we've spoken of prevention and lack of resource surprised to see it. PEJ - handed over a number of existing contracts, no exact science in how budget calculated. No way of splitting activity in detail. Spent this year working through understanding of how funding will be spent in future. Issues around e.g. Sexual health services - commissioned on a basis of paying for each person who comes through the door. Current prevention spend only 4-5% of funding, need to shift. SW - we know we have more customers with greater demand, yet we are not filling vacant posts. Why hold contingencies when we have real needs to meet now? PEJ - looks as if way activity splits on sexual health, more 50/50 than 25/75. Oral health possibly overfunded compared with North Yorkshire. So need some contingency. Sexual health contract a big problem. We also have to pay for anyone who uses services elsewhere. Eg people who travel to Leeds, and this charge will not be known till March / April. Issue with rising demand, vacant posts, always a judgment issue, will only do this where safe to do so. Much more likely to hold vacant management post than front line one.
How do we monitor this more creatively? Used to get a quarterly finance and performance report. Might want to look at issues - delayed transfer of care, which is a health and social care system issue, IAPT which has a significant waiting list and needs looking at, and information sharing, significant issue across organisations about info sharing, and Multi- agency safeguarding approach. Whilst finance info useful no assurance people are okay.
Agenda item 5 - NHS 111 - Dr Nigel Wells, GP Lead for 111 at VoYCCG. Taking about 4,000 calls per month across VoY area. About a third triaged back into primary care, either in or out of hours. Service seemed to cope well over winter, business continuity plans functioned. Lucky to have had relatively mild winter. SW - how are general public being told about 111? What has Yorkshire Ambulance Service (YAS) done to communicate it? NW - this is the only way you can access Out of Hours (OOH) service. If you phone your GP out of hours you will be asked to call 111. Call not redirected as call has to be free. SW - what qualifications and training do call handlers have? NW - accredited pathways run by call handlers. Clinical advisors only get involved where needed. Originally mainly nurses and doctors, but now involving dental nurses and other specialists. TF - make sure NHS 111 call handlers direct to OOH at A&E not emergency services. Must make it easy, can't have 6 calls to get someone into the right service NW - in other areas, 111 can book patients direct into services, provides a better, more seamless service, Vale of York CCG would want to look at this. Gerard - can we have feedback data? What measures do you have in place to deal with mental health problems? NW - yes. This goes to regional governance committees. Continually looked at and worked upon. Dealing with mental health through 111 is a challenge, can take a lot of a clinical advisers time, and not always clear what services are available to people. PD - is it proving more effective than NHS direct? Is it keeping people away from A&E. NW - direct was never set up to be the 1 number people call, so cannot compare. But think it is working as a clinical triage tool. Complaints and incidents very low. Most are provider to provider feedback, e.g. Someone directed to wrong place, why did that happen?
Agenda item 6 - urgent care and winter pressures - Becky Case from previous item - 111 service here has one of lowest conveyance rates in the country, so believe they are redirecting people appropriately. Lots of work going on between OOH provider and A&E. Winter pressures – the government allocated some money to areas facing challenges coping with winter pressures. £2m across York trust area (including Scarborough). Urgent Care Working Group (UCWG) tasked with splitting and allocating this to schemes aiming to reduce pressure on A&E. Number of schemes reviewed, discussed, and measured. Some continued funding, number of new schemes, such as emergency care practitioners which will be continued as has been successful. Getting monthly reports on progress. Has improved performance on 4 hour waiting at A&E. Report on RATS team received today, who were extended into evenings. Real impact for a patient, taken out of state and into Archways quickly rather than being in hospital overnight. Will use learning from the scheme to consider plans for next year. MP - really good demonstration of partnership working. Shows we can do good things.
Agenda item 7 – York Hospital Trust Francis report update - Mike Proctor - really difficult to measure care and compassion. Need to demonstrate that we really celebrate and value how we do it, not just what we do. Nurses were angels, and now we're considered to be devils. Neither is right. We are human. So focusing on enabling good nursing care. SW - good you've pulled out areas where you are actually doing things. Pleased to see care and compassion back on the agenda. Nursing has become about meeting targets, and this isn't enough, so good to see care and compassion throughout the report. MP - important to celebrate success and address where things go wrong. SW - healthcare assistants are the rock in hospitals. Good to see their training is included. Are you continuing with a professional progression route for HCAs? MP - yes, important to recruit into nursing from people with life experience not just good A-levels. Also ward leadership vital. Difference made by fantastic ward sisters. Knowing when to hold someone's hand doesn't come with an A-level.
April meeting, full agenda, focusing on HWB / partnerships, CQC reports, and personalisation report.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?): Actions Call Jeremy re homelessness health Raise 111 publicity with Healthwatch England.
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback Name of Representative: Polly Griffith
Title of the meeting: York Hospitals Foundation Trust Governors' Meeting Date the meeting took place: 12/03/14
Date of next meeting: 11/06/14
Purpose of the meeting (Please give short summary):
York Hospital (YH) Governors meet 4 times a year to report to each other on sub-committee activities as well as to hear from the Senior Team at YH and other presentations.
Main areas of discussion:
This time, Patrick Crowley (PC), Chief Executive of YH, reported.
1) Finances: Not great, but much better than many other hospitals. Across England, 40 foundation trusts are in serious financial trouble.
2) Performance: Although things are generally positive there are some worries. The trust failed to meet its 18 weeks waiting target, mainly due to increased activity. PC made the strategic decision to do that in order to ensure good patient care. He has called in an Intensive Support Team from the NHS to review York's systems to ensure they are not missing something that would improve the situation and has been reassured York in a difficult situation. PC is also worried about Scarborough's Breast cancer service. On the other hand, he is confident of meeting the A&E target of getting 95% of patients through in 4 hours.
3) Whitby&Scarborough: Long discussion about changes there. Whitby probably to close next year though nothing as yet sure; Bridlington has become an orthopedic centre for Scarborough. Going well.
4) Matron Restructure: Have been changing and strengthening the role of matrons across both sites. Have now reappointed 1 matron per directorate across both sites, with a remit of excellence of care for patients and a positive ward atmosphere while admin responsibility is reduced. They have also placed the successful candidates in clinical areas new to them so they can look around with “fresh eyes”. Working to integrate the unsuccessful candidates to other roles and not to lose them.
5) Local Integration: Working with Vale of York CCG on “Better Care Fund” striving to get services into the community as alternatives to hospital based care. He has been encouraging the CCG to look at a Community Hub model which has been successful in the United States – urged Mark Hayes to go visit and now he too is enthusiastic. The CCG is now thinking to develop 3 models of the Community Hub concept and see which works best.
6) Staff: Peta Hayward has resigned. PC feels she has made a significant improvement to how things work at YH and she will be missed. In consideration about how to replace her.
7) Mental Health: Mike Proctor is taking the lead to ensure YH works as well as possible with Leeds&York MH Trust.
Helen Mackman has stepped down as lead governor and been replaced by Margaret Jackson. There will be an election for new governors in the autumn.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):
Not at the moment.
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback Name of Ann Harper (AH) Representative: Title of the meeting: Burnholme School CYC Public Engagement Date of meeting: 15 March Date of next meeting:
Purpose of the meeting (please give short summary): Public engagement event involving redevelopment of Burnholme site.
Main areas of discussion: Stalls etc. AH distributed leaflets and directories. Contact made with Barry Bothamley of National Pensioners Conference. He’ll contact the office. 2 issues reported.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):
Be aware of Barry Bothamley
Log issues.
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback
Name of Dorothy Murphy Representative: Title of the meeting: YOPA Election Forum Date of meeting: 17 March 2014 Date of next meeting: 17 May 2014
Purpose of the meeting (please give short summary): The Older People’s Assembly is not political but it was felt that the members of the assembly should be informed by representatives of the main political parties concerning the European Elections to be held in May 2014.
Main areas of discussion: What the benefits of being in the EU particularly for older people are. What are the implications of a possible withdrawal from the EU.
Over 60 members attended A very lively meeting
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?): HWY needs no response to the meeting byt future meetings still need to be attended.
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback Name of Sian Balsom Representative: Title of the meeting: Urgent Care Working Group Date of meeting: 20 March 2014 Date of next meeting: 17 April 2014
Purpose of the meeting (please give short summary):
Main areas of discussion: Winter planning - norovirus escalation plan would be really helpful. Going to be progressed. Plans to start winter planning earlier in 2014. Positives – communication has been better. Planning event in April with Area Team. ‘wash up’ session. North Yorkshire and Humber wide event. The Area Team are managing the invitations. Correspondence, meetings and events - regional event in Leeds focused on delayed transfer of care (DTOC). Was a comparison of hospitals by size, and York was top of the list – a bigger issue than other comparable areas. Issues over how it is reported. Some CCGs use private organisations to deliver step down care who don’t have to report in, but we use NHS organisations which do. Procurement of out of hours GP services. Number of events in April for interested providers.
Due to changes in the way the CCG is providing funding to the hospital, there is now a pot of funding that can be used elsewhere in the urgent care system. So need to identify what this funding will be used for. Urgent Care Working Group (UCWG) should sign off plans for its use. Will need to think about this with sight of Better Care Fund and what that funds, to make sure we have full strategic oversight.
York Teaching Hospital Strategy – Acute Care Review Brought as a discussion document. Spoke about the need to look at this as whole system issue – links with Better Care Fund but driver not through acute care but from community across. Offered support of healthwatch volunteers to be involved in discussions around urgent care generally and A&E in particular. How does it link with CCG strategic plan?
Developed in light of Keogh review. Need to untangle internal provider requirements from system stuff through the Collaborative Transformation Board (CTB), collaborative improvement board, or other areas. Need to make sure we align our expectations in terms of where patients will be seen in future. Will the strategy encourage people to attend A&E? If they will be seen within an hour it will be very convenient for people.
Dashboard Presenting information that gives us a clear idea of where the pressures in the system are. Becky to progress through Commissioning Support Unit (CSU).
NHS 111 – Easter plans Will be using the winter plans.
Better Care Fund (BCF) Working hard to refresh the initial submission in time for the Health and Wellbeing Board.
Winter Pressures Monies Will send an update after end March. Schemes now falling into different camps.
1. BCF – hospice at home and Emergency Care Practitioners (ECPs) continuing. End of Life team funding will stop at the end of March 2. Hospital – continuing single point of access Phlebotomy scheme – Trust taking this forward as part of service imorovement plans. Emergency Department (ED) extra staff – no ongoing funding, but looking at how to continue some of this work without finance
3. Schemes ending pending review of data but keen to look at ways to maintain – Patient transport by Age UK York – but want to look at the data and understand impact. Arclight scheme RATS team
But will be looking at what can be done with these.
4. CCG looking at cellulitis / community IV, and frequent flyers work.
Successful VCS schemes in Scarborough – dial a ride and 2 workers from Mind supporting in A&E, with follow up at home.
Winter Pressures Communications Number of press releases have gone out. Had some questions from public.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback
Name of Representative: Polly Griffith
Title of the meeting: Maternity Services Liason Committee (MSLC) Date the meeting took place: 25/03/14
Date of next meeting: 24/06/14
Purpose of the meeting (Please give short summary):
To bring together clinical staff and users + user reps to monitor the delivery of maternity services in order to ensure they are the best possible.
Main areas of discussion:
Recent change of antenatal classes from face to face groups with a midwife teacher to on-line videos. This has been an issue since the idea was introduced last autumn. The videos are in place (see York Hospital website) and have gone live from this month. There will be an evaluation after 6 months with staff ready to make changes if/as necessary, possibly to the point of going back to classes (that's not sure). Watch this space. Delivery of homebirths much improved now that Virginia Hatton is paying attention!
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?): Not at the moment. Please let me know if there are any comments/complaints re antenatal classes directly to HW.
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback Name of Representative: Lesley Pratt Title of the meeting: York Training Hospital Trust Board Meeting
Date the meeting took place: 26 March 2014
Date of next meeting: 30 April 2014
Purpose of the meeting (Please give short summary): Update Board and accept reports.
Main areas of discussion:
Open & Honest Care Programme
The aim of this programme is to support organisations to become more transparent and consistent in publishing safety, experience & improvement data with the aim of improving care, practice & culture. It was decided that a ‘dry run’ should be done before rolling out the programme.
Patient Experience
There has been a redefining of the role of the Matron as it was thought not enough time was being spent on the nursing side. As a result the number of Matrons has been reduced and a corporate nursing team has been set up.
The work of the patient experience team has also been looked at and it has been decided that they should be involved in other issues and not just deal with complaints.
Falls
Work is going on to see why there has been an increase in the number of falls recorded. C.Diff
The number of recorded cases has increased from 43 to 65 and as a result of this the hospital has incurred a fine of £1.1 million. There has however been no cases reported in the last 21 days.
Friends & Family test
The number of people completing these forms in the ED dept has been a problem and ways of improving this are being looked into.
End of Life Care
New DNR forms are being issued soon.
Following the withdrawal of the Liverpool Care Programme we were assured that York Hospital involve the family and patient in every step of their journey. A presentation will be made at the next meeting explaining how this will put into practice.
Following recent press coverage over the way some hospitals deal with the death of unborn babies we were assured that York Hospital give support to the families and offered them the choice of either burial or cremation.
The Board were also advised that the CVS were holding an event in May concerning End of Life and that perhaps the Hospital should be involved.
Data sharing
Following the Caldacott report it was highlighted that most patients do not know what information is shared and that care should be taken when dealing with sensitive data.
Volunteers
The involvement of volunteers is proving worthwhile and should be encouraged.
Acute Strategy Update
The improvements to the ED department and joining with the short stay ward should improve the services offered. More staff are to be recruited and 7 day working should also help.
Community Hubs Talks are going on with the various CCGs over how the hospital will fit in with the setting up of the hubs.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):
Board papers and reports are available on the Hospital web site.
Do you feel that this meeting was useful?
Yes No
Representatives’ Report/Feedback Name of Sian Balsom Representative: Title of the meeting: Collaborative Transformation Board Date of meeting: 27 March 2014 Date of next meeting: 1 May 2014
Purpose of the meeting (please give short summary): Main areas of discussion: Better Care Fund Submission is a public document – going to HWB on 2nd April for sign off. Tried to improve the language within it. More finance information in it. Shows spend against each scheme – doesn’t currently include nationally mandated funding for implementation of the care bill. YTH working with voluntary sector in Selby to develop a hub around Selby Memorial Hospital. Priory hub – looking at working with care homes, 500 patients already based in care homes. So looking at reducing UTIs, chest infections, falls, end of life plans. If this work can be shown to reduce admissions, will start to extend into the community. Suggested link with Leeds and York’s care home support team. Pocklington scheme sits across two local authorities so will be a good way of testing whole system change. Fourth scheme potentially around 13 practices working together. These span city centre, Ryedale and Easingwold so another cross authority project working with NYCC.
Discussion around geographical coverage of the Collaborative Transformation Board – this meeting brings in representation from East Riding and NYCC, to cover Vale of York footprint.
Partnership boards – still a piece of work ongoing around future of PBs. Will be picking this up towards end of April.
Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):
Do you feel that this meeting was useful? Yes No