NOTES OF EVIDENCE

Meeting	Policy Commission for Care, Health and Housing
Ref	He.PC.22/11/06
Date	22 November 2006
Time	18.00hrs
Place	Committee Room 1, County Hall, Newport, Isle of Wight
Purpose of meeting	Formal public meeting
Attendance	Commission	Cllrs Erica Oulton (Chairman), Cllr Geoff Lumley, Roger Mazillius, Win McRobert, Cllr Margaret Webster, Colin West and David Whittaker Co-opted Members: Mr Robert Jones and Mr David White
	Cabinet	Cllr Dawn Cousins
	Secretariat	Cllr David Pugh
	Other Councillors	Cllr George Brown
	Officers	Ms Louise Biggs - Overview and Scrutiny (O&S) Team Ms Vanda Niemiec - Overview and Scrutiny (O&S) Team Ms Sarah Mitchell – Director of Adult and Community Services
	Stakeholders	Dr Paul Bingham – Director of Public Health, PCT Ms Elaine Garrett – Health Inequalities and Public Health Business Development Manager, PCT Ms Marj Ringer – Fall Prevention and Rehabilitation Coordinator, PCT Ms Tina Harris – Associate Director, Mental Health & Learning Disabilities Management Team, PCT Ms Sheila Paul – Chief Operating Officer, PCT Ms Helen Shields – Director of Commissioning, PCT Mr Stephen Ward – Project Manager, Transition Team, PCT
	Apologies	None
Agenda Items
1. To agree the notes of evidence arising at the meeting held on 25 October 2006	Notes agreed
2. Declarations of Interest.	None
3. To receive evidence on enquiry H1/06 (Continuing Care – Older People) from Dr Paul Bingham, Elaine Garrett and Marj Ringer	3.1 Most people receiving continuing care were older people. The two important public health issues to be considered in relation to continuing care were: 1. Nutrition. This was part of the ‘dignity in care’ programme and highlights the need for older people’s nutrition to be a key concern. A good hydration and nutritional intake were essential to maintain health and can assist recovery from illness, reduce the risk of osteoporosis and fractures, improve immunity, reduce the likelihood of a hospital admission and improve mobility. It was important that older people had suitable environments in which to eat. Companionship whilst eating was shown to lead to a higher intake of food. 2. Residential/nursing homes. The National Service Framework (NSF) for Older People states the need to reduce the risk of falls. Care homes were particularly important as 60% of falls occur within them, although training for care home staff has gone some way in reducing this risk. 3.2 There is a multi-agency ‘falls and fragility core group’ made up of many different teams from within the PCT and other organisations. 3.3 The post of ‘falls prevention and rehabilitation coordinator’ ends in December, but will hopefully be taken up by the osteoporosis nurse specialist. 3.4 Falls in older people were due to a number of interacting factors: medical conditions, poor mobility, poor eyesight, medication and environmental factors. The home is the most dangerous place for an older person. 3.5 Reaction-time decreases with age meaning that older people tend to sustain grater injuries form the result of a fall. 3.6 There is a high fear of falling again after one fall. This can result in the person self-restricting mobility, with a resulting loss of muscle strength and can lead to depression. 3.7 If an older person is admitted with a fracture as a result of osteoporosis, this should be picked up in hospital. If not it may be picked up by the osteoporosis nurse specialist or GP afterwards. 3.8 A patient suffering a fractured neck of femur has a 10% chance of dying within a month and a 30% chance of dying within a year. 3.9 Between January 2004 and January 2005 there were 162 women and 32 men who suffered a hip fracture. The figure for women is higher due to the higher level of osteoporosis in women. 3.10 3% of medical admissions were due to falls; 50% of acute orthopaedic admissions were due to falls 3.11 It was important to prevent and treat osteoporosis as this contributed to fall injuries. 3.12 Support was needed after discharge to prevent further falls, which were common after the first fall. 3.13 Falls were often a sign of unidentified and unmet healthcare needs in older people. 3.14 Interventions that can reduce the risk of a fall include falls risk assessment, a single assessment process for standard two of the Older Persons NSF. 3.15 The risk assessment included: a patients fall history, medications that they were taking (prescribed or otherwise), whether their medication caused dizziness, whether they had vision problems, whether they needed to rush to the toilet (due to medical conditions / medication), whether they had been diagnosed with stroke, dementia, Parkinson’s etc and mobility. 3.16 Training was carried out for residential and nursing home staff. This included how to carry out falls risk assessments and how to reduce risk of falling within the homes. This will not continue after the ‘falls prevention and rehabilitation coordinator ‘post ends. 3.17 Small changes in day-to-day living reduced the risk of falling. 3.18 There was a new in-patient falls policy which had resulted in a reduction of the number of falls in hospital wards. 3.19 Checking a patients walking aid has a significant effect on reducing the likelihood of a fall. 3.20 Hospital wards were required to record how many falls had occurred. Care homes do not always provide these figures.
4. To receive an update on the recovery plan (enquiry H6/05) from Sheila Paula and Helen Shields	4.1 The Recovery Plan figure for 06/07 is a saving of £14.8m is required. 4.2 There has been a deferral of the 02/03 deficit recovery of £3.7m 4.3 A further £9.0m has been identified with a further £2.1m to be found 4.4 A turn-around team were brought into the trust to challenge the Trust to find new ways of working, as so to aid financial recovery planning 4.5 The current consultation concerning the Farringford may be changing use but the service provided there will continue: patients will be transferred to different wards on the hospital and the ward staff will follow. No-0one will be made redundant but the wards receiving patients will require a different skills-mix. 4.6 The Farringford ward may be used for older people’s care; specifically those with dementia currently at Shackleton. 4.7 Bed census data has suggested that there were people in hospital when they need not be; the teams dealing with hospital discharge need to be strengthened.
5 To receive a presentation on the consultation paper by Stephen Ward and Tina Harris, entitled “Integration of the psychological therapy service with adult and community mental health teams”.	5.1 The Psychological Therapy Service (PTS) is currently based at the Gables in Newport. There were two adult community mental health teams: East Wight and West Wight. 5.2 The consultation paper aims to integrate the three teams, initially to be based in two current community mental health team locations in east and West Wight. 5.3 Current waiting times from referral to treatment exceeded the maximum 18 week wait. Some psychological therapies (psychodynamic psychotherapy) had a waiting time of over a year. 5.4 With the current staffing levels it is unlikely that the service can meet the 18 wee wait for psychodynamic psychotherapy. 5.5 The range of therapies currently provided could be reduced to allow shorter waiting times for other therapies. 5.6 The period of consultation could be extended as these changes were not required immediately. 5.7 It was highlighted that the changes were not based on a need to sell of any buildings, but were aimed at reducing waiting times for patients of the service. 5.8 The Patient forum highlighted that the some staff and patients were unhappy with the interim moving plans. 5.9 There are no plans within the proposal to reduce the number of staff in the PTS.
Actions	1. To circulate the ‘bed reconfiguration’ consultation document to policy commission members.		Sheila Paul / Louise Biggs