AGENDA ITEM
Dignity and Respect 3 in Health and Social Care Services for Older People Working Party
Minutes of the Meeting held on 9 October 2008
The Meeting commenced at 9.35am and concluded at 12.20pm
P resent:
Councillor Mrs Lewis – Chairman Councillor Bulteel – Vice Chairman
Bournemouth Borough Council:
Councillor Russell
Borough of Poole
Councillors Mrs Long and Meachin
Bournemouth and Poole Teaching Primary Care Trust:
Angela Schofield, Heather Craven and Ken Hockey
Older People’s Strategy Group Representatives
Angie Warren (Poole Older People’s Strategy Group Representative)
In attendance
Barry Bull: Development Officer, Help and Care Louise Bate: LINks Support Officer, Help and Care Eileen Dunnachie: Service Director - Adult & Community Support, Bournemouth Borough Council Joy Reynolds: Associate Director Strategic Planning, Bournemouth and Poole Teaching Primary Care Trust Liz Baron: Principal Overview and Scrutiny Support Officer, Legal & Democratic Services, Borough of Poole
Expert witnesses:
Carole Cusack: Primary Care Commissioning Manager, Bournemouth and Poole Teaching Primary Care Trust - 1 - Sarah Elliott: Director of Service Provision, Bournemouth and Poole Teaching Primary Care Trust
Members of the public present: 0
1. APOLOGIES FOR ABSENCE
Apologies for absence were received from Councillor Mrs Rey (Bournemouth Borough Council), Councillor Mrs Lavender (Borough of Poole) and Patricia Casserley (Bournemouth Older People’s Strategy Group Representative).
2. DECLARATIONS OF INTEREST
None declared.
3. MINUTES
In confirming the Minutes the Chairman and the Working Party concurred that an excellent job had been done by Liz Baron in preparing a set of Minutes which were a clear, concise and true reflection of the last Meeting.
RESOLVED that the Minutes of the last Meeting held on 18 September 2008, having been previously circulated, be taken as read, confirmed as a true record and signed by the Chairman.
Matters arising:
(i) The United Nations Principles of Older Persons
The Chairman reported that the Health Scrutiny Committee of Bournemouth Borough Council had formally recommended that Council adopt the United Nations Principles of Older People at its meeting held on 8 October 2008.
The Vice Chairman reported that the recommendation would be considered by Poole Borough Council at its meeting to be held on 21 October.
The Chairman of the Bournemouth and Poole Teaching Primary Care Trust reported that the Primary Care Trust Board had formally adopted the United Nations Principles of Older Persons at its Meeting held on 24 September 2008.
4. GP AND OTHER PRIMARY CARE SERVICES – COMMISSIONING FOR QUALITY
- 2 - Members of the Working Party received a presentation from Carole Cusack, Primary Care Commissioning Manager (Bournemouth and Poole Teaching Primary Care Trust) on how the PCT commissioned for quality from GP and other primary care services, including general dental practitioners, pharmacists and optometrists.
Members received a detailed Powerpoint Presentation (slides appended to these Minutes – Appendix A) which drew out the following points:
The quality of General Medical Practitioner (GMP) services locally was measured against a quality and outcomes framework which covered 20 clinical domains, including coronary heart disease, heart failure, COPD and diabetes etc (full list of services appended).
Within each clinical domain, the PCT measured seven specific areas, covering between one and 16 measures of quality, in order to assess the standard of services in each local general medical practice. This included measuring standards and performance in ‘safety’, ‘clinical and cost effectiveness’, ‘governance’, ‘patient focus’, ‘accessible and responsive care’, ‘care environment and amenities’ and ‘public health’.
Standards for ‘patient focus’ contained specific equality standards, including a requirement that patients would not be discriminated against on any grounds, including for reasons of age, gender, sexuality, religion, ethnic background etc;
The PCT conducted site visits to each of the 44 GMPs in Poole and Bournemouth annually in order to assess quality of services; practices identified as in need of improvement were given specific targeted support by the PCT, including training. In response to a query from the Chairman it was clarified that PCT Officers did not always gather feedback from patients when they conducted site visits to surgeries.
A private medical practice which had recently launched services in the Poole area was not monitored by the PCT but was accountable to the General Medical Council and the Healthcare Commission;
A staff appraisal scheme was used to assess the quality of GMP staff performance and a mentoring scheme / additional training were provided wherever appropriate. The PCT’s approach emphasised the importance of peer supervision as well as managerial supervision in order to encourage quality service from its staff;
Patient feedback on the standard of GMP services was gathered by means of an anonymous Patient Experience Questionnaire which contained specific questions on how patients rated the quality of care provided, how effectively they felt issues of dignity and respect were being addressed and how accessible they felt services to be. It was agreed that a copy of this data, together with a synopsis of the main findings, would be passed to the Working Party for further information.
- 3 - Practices were required to convene a formal meeting with either the PCT or with an associated patient group in order to discuss the results of the Patient Experience Questionnaire and develop an Action Plan on the basis of the results;
GMPs were being encouraged to develop links with external social groups / organisations in order to enhance their service to patients; in addition, a number of directed, local and national enhanced services were being provided through GMPs including extended access, citizens advice and homeless services. New directed enhanced services to be provided included services for heart failure, alcohol, learning disabilities, osteoporosis and ethnicity;
Access and extended opening hours had emerged as a key area of concern for patients (based on a random sample of patients), as a result of which extended hours had been negotiated in most local practices. Information on new opening hours would be published in individual surgeries / on the PCT website and a media release was currently being prepared to inform the wider public. As part of these innovations, four GMPs were to shortly pilot whole day opening on Saturdays;
GMPs were supporting practice based commissioning by which specific services were being provided in the localities where they were most needed. Eg. medicines management, osteoporosis services etc.
the introduction of new contracts for general dental practitioners from 1 April 2006 meant the PCT was now working more closely with dental practitioners who were expected to participate in the new clinical governance programme. The PCT was aware of concerns that some older people were being turned away for expensive forms of treatment, including denture fittings. Clauses in the new dental contracts issued by the PCT included a specific requirement that patients would not be discriminated against on any grounds, including age;
A comprehensive oral health assessment was currently being undertaken in Poole and Bournemouth;
In response to a query on how the PCT could ensure that people with specific difficulties (including hearing, sight and learning difficulties) could be adequately understood and treated, it was clarified that the three-yearly inspection process would pick up on any difficulties experienced by patients and Action Plans were issues to Practices every Quarter. In addition, since 1 July 2008, all dental nurses were required to be registered with the General Dental Council, the terms of which included them undertaking specific training on how to care for people with special needs;
The Community Dental Service provided oral health services for people with disabilities, and offered home visits or visits to care homes, where appropriate. Patients were referred to the service via professional referral or could self-refer to the service if appropriate. The service was currently being expanded to provide a base in Bournemouth.
- 4 - The Working Group explored how the PCT had recently taken over training for GP receptionists, offering comprehensive 6 weekly courses which included training on dealing with patients with special needs. It was hoped that the PCT would roll out similar training for dental receptionists and there was an aspiration that practices would pay particular attention to ‘dignity and respect’ in their induction processes;
The PCT was issuing new contracts for optometry services and additional services aimed at the elderly were shortly coming on line.
The Chairman thanked Carole Cusack for her interesting and informative presentation.
In considering the evidence presented to the Working Party it was RECOMMENDED that
(i) the PCT be requested to provide the Working Party with a copy of the recent Patient Experience Questionnaire data, including specific data on how effectively patients felt issues of dignity and respect were being addressed, together with a synopsis of the main findings; and
(ii) that the Working Party formulate recommendations to the PCT on how to include dignity and respect in its receptionist training packs and induction programmes.
5. ENSURING DIGNITY IN COMMUNITY HEALTH SERVICES
Members of the Working Party received a presentation from Sarah Elliott, Director of Service Provision, (Bournemouth and Poole Teaching Primary Care Trust) on how the PCT delivered Community Health Services in a way which respected service users’ dignity.
Members received a detailed Powerpoint Presentation (slides appended to these Minutes – Appendix B) which drew out the following points:
The PCT provided a total of 35 community health services, delivered daily, from 65 locations across Dorset (full list of services appended to the Minutes for information). Many services were delivered in partnership with the local authority;
A number of service-wide actions had been taken in order to ensure that ‘dignity’ was at the heart of the PCT’s service delivery. This included a stated commitment to dignity, respect and kindness and a commitment to the UN Principles of Older People.
The working party considered examples of service specific actions (home based care) which illustrated how the PCT was providing dignity and respect for service users. Examples included a focus on the individual to maximise health and independence (especially for care delivered through the Poole Intermediate Care Service (PICS) / Bournemouth Community and Rehabilitation Team (CART)), an
- 5 - instruction to the District Nursing Team to switch off their mobile phones when giving personal treatment and practical improvements to address shortfalls in the continence service. In addition, assessments for patients using the Broadwaters service were now held in the patient’s own room in order to help preserve patient confidentiality;
The PCT could also demonstrate how practical improvements had been made to its clinic based services in order to provide greater dignity and respect for patients. This included establishing and using a patient’s preferred mode of address in the Audiology Waiting Room; improvements to Podiatry facilities in order to safeguard patient privacy; and improved patient information in dietetics to aid personal decision making;
Questions:
In response to questions the following issues were considered:
It was debated whether the PCT should adopt a ‘blanket policy’ on how to address patients or whether efforts should be made to ensure that staff established at the outset of treatment how each individual patient wished to be addressed. In considering these options, PCT Officers suggested that the sheer volume of patients could make the latter option problematic;
The confidentiality and quality of the PCT’s Patient Satisfaction Questionnaires was maintained by ensuring that questionnaires were anonymous and returned via a stamped addressed envelope. Patients requiring assistance in completing the questionnaires were offered assistance from voluntary organisations;
The PCT was an active participant in partnership working and had recently worked with Dorset Fire Authority to ensure that fire safety messages were being communicated to vulnerable patients via health professionals and care workers; In considering the importance of collaborative working, it was recommended that Officers from all relevant bodies develop a form which could be used by personnel working with vulnerable patients and which would contain information and advice from all partners in one single reference point; there was some discussion on whether current prescription pads could be extended to cover such additional information;
The Working Party considered anecdotal evidence suggesting some patients using the continence service were not being allocated as many incontinence pads as previously, and that they were being advised to purchase additional pads out of their carer’s allowances. In response it was stated that the PCT monitored how many pads a patient used in a one-month period and that each individual’s needs were reviewed on a three-monthly basis. Where appropriate, this review included the PCT making checks with the patient’s family or carer(s). There had been no recent policy changes involving the continence service, and the PCT was making efforts to ensure that the service was tailored as far as possible to the needs of the individual. Members of the Working Party recommended that the PCT give more
- 6 - attention to publicising and clarifying information for service users, carers and family members on the continence service, which Members agreed, could be confusing.
RECOMMENDED that
(i) Officers from all relevant partnership bodies (Primary Care Trust, Local Authority, Fire, Police etc) consider developing a form which could be used by personnel working with vulnerable patients and which would contain information and advice from all partners in one single reference point; and
(ii) that the PCT gives more attention to publicising and clarifying information for service users, carers and families on the continence service.
6. INITIATIVES TO IMPROVE SERVICES FOR OLDER PEOPLE
Members received a presentation from Sarah Elliott, Director of Service Provision, (Bournemouth and Poole Teaching Primary Care Trust) on initiatives to improve services for older people. The presentation drew out the following points: (slides appended to these Minutes at Appendix C for information)
National initiatives helping to shape the PCTs services for older people included Age Concern’s ‘Hungry to be Heard’ (dietetics service); the British Geriatric Society’s ‘Behind Closed Doors’ (focusing on ensuring dignity in toileting arrangements for older people in hospital settings and care homes) and Essence of Care – Privacy and Dignity standards;
The Working Party agreed to shape recommendations relating to continence issues; specifically assurances would be sought that assistance was given to older service users to use toilets in hospitals and care homes; that regulations relating to the use of bed pans were clearly assimilated into practice; and that organisations were aware of the essence of the ‘Behind Closed Doors’ campaign;
New services which championed the dignity agenda were outlined including the dementia care pathway, stroke rehabilitation pathway and palliative care – Gold Standards Framework for home based care at the end of life. New services would typically be tailored to the individual, and there would be additional funding for speech and language therapy as part of the stroke rehabilitation pathway;
Dementia care was a priority for PCT investment;
In response to a query from Cllr Meachin as to whether local health and social services offered bereavement support services, it was explained that the PCT had employed a Bereavement Facilitator and that District Nurses and GPs were encouraged to offer a degree of bereavement support and to link service users with
- 7 - faith communities and voluntary organisations. In addition, the PCT had invited the local Chaplain to contribute to the work of the end of life group;
It was acknowledged that BME Groups would have different religious and cultural needs relating to end of life care;
Adult Protection issues were discussed, including the procedures / practices in place to ensure that all relevant agencies learned lessons from any adult protection issues in the community. It was agreed that the Working Party should give consideration to the governance arrangements in place for reporting / reviewing adult protection issues.
RECOMMENDED that
(i) the Working Party shapes recommendations on continence issues to health and social care providers; specifically the Working Party will seek assurances that assistance is given to older service users to use toilets in hospitals and care homes; that regulations relating to the use of bed pans are clearly assimilated into practice; and that organisations are aware of the essence of the ‘Behind Closed Doors’ campaign; and
(ii) the Working Party gives consideration to the governance arrangements in place for reporting / reviewing adult protection issues.
7. SUMMARY AND CONCLUSIONS
Actions arising from the Meeting were summarised as follows:
(i) PCT to provide a copy of the recent Patient Experience Questionnaire data, including specific data on how effectively patients feel issues of dignity and respect are being addressed, together with a synopsis of the main findings;
(ii) Working Party to formulate recommendations to the PCT on how to include dignity and respect in its receptionist training packs and induction programmes.
(iii) Consideration be given to developing a form which can be used by personnel working with vulnerable patients and which will contain information and advice from all partners (Health, Local Authority, fire and police) in one single reference point;
(iv) PCT to be requested to publicise and clarify information on the continence service. Working Party to shape recommendations on continence issues to both health and social care providers. This will include seeking assurances that assistance is given to older service users to use toilets in hospitals and care homes; that regulations
- 8 - relating to the use of bed pans are clearly assimilated into practice; and that organisations are aware of the essence of the ‘Behind Closed Doors’ campaign; and
(v) the Working Party considers governance arrangements in place for reporting / reviewing adult protection cases.
Additional recommendations were made as follows:
(vi) It was recommended that a clear understanding of the dignity and respect agenda is built into core selection criteria, training and development for health and social services personnel.
(vii) GPs to be invited to give evidence to the Working Party during Phase 2 of the inquiry. Invitations to be arranged through the PCT Professional Executive Committee.
8. DATE OF THE NEXT MEETING
AGREED that the next Meeting of the Dignity and Respect in Health and Social Care Services for Older People Working Party would take place on Thursday 13 November 2008 at 9.30am in the Council Chamber, Borough of Poole.
The purpose of the meeting will be to gather evidence from Carers, including training and education for carers on dignity and respect.
CHAIRMAN
- 9 -