PAPER A2

NOTES OF EVIDENCE

Meeting		Policy Commission for Care Trust Delivery and Health Scrutiny
Ref		He.PC.24/8/05
Date		24 August 2005
Time		18.00hrs
Place		Committee Room 1, County Hall, Newport
Purpose of meeting		Formal public meeting
Attendance		Commission	Cllrs Erica Oulton (Chairman), Geoff Lumley, Roger Mazillius, Margaret Webster, Colin West, David Whittaker Co-opted Members Mrs Nancy Ellacott – Chairman, Primary Care Patient and Public Involvement Forum (PPIF) Mr Peter Pugh – Chairman, Healthcare PPIF
		Cabinet	Cllr Dawn Cousins
		Secretariat	Cllr David Pugh
		Officers	Ms Louise Biggs - Overview and Scrutiny (O&S) Team Mr Andrew Shorkey - O&S Team Ms April West - O&S Team
		Stake holders	Mr Brian Johnston, Risk Manager, Isle of Wight Healthcare NHS Trust (IWHNHST) Mr Yasin Rahim, Healthcare Commission (HC) Ms Jane Wilshaw, Director of Nursing, IWHNHST
		Apologies	Cllr Win McRobert
Agenda Items
1. To agree the notes of evidence of the meeting held on 27^th July (Paper A)		The notes of evidence were agreed subject to the following amendments: 1. It was noted that the entry referring to ‘Mr N Ellicott – Patient and Public Involvement Forum’ should read ‘Mrs N Ellicott – Chairman, Patient and Public Involvement Forum’. 2. With respect to Paper C it was noted that the completion date should read ’30 September 2005’. 3. The correct spelling of Mr Paul Hahn’s name was noted. 4. Evidence note ‘17’ under ‘Further discussions’ was amended to read: ‘A substantial partial impact assessment carried out by Ms S Weller indicated the need for the IWHNHST to carry out a full impact assessment on the whole health and social care system - the need for a whole systems approach to health planning is key to successful future planning of services for the Island.’ 5. The following addition would be included under ‘Further discussions’: ‘It was noted that housing was a priority under the previous administration and improvements were achieved as a result.’
2.a	To receive information and gain an understanding of the new ‘Healthcheck’ process of NHS Trust self-assessment against core standards, including how the Health Scrutiny committee can be involved in the process, from: Mr Brian Johnston	1. Governance, risk and assurance have been pulled together into one unit to service the Healthcare Trust and the Primary Care Trust. 2. The IWHNHST and the Isle of Wight Primary Care Trust (PCT) as two separate corporate bodies will make two separate declarations. 3. The O&S Committee and PPIF have an invitation not an obligation to comment on whether they feel the Health organisations are meeting the core standards. Comments can be positive as well as negative. 4. Although the declaration is a self-assessment the comments of the Local Authority and the local community are as important as those of the Health organisation in providing a balanced view. 5. The 24 core standards have been linked to a mechanism that enables the Trust Boards to be informed as to their current status. 6. The declaration document template will be made available on the HC website on 15 September 2005 for organisations to start inputting information. 7. The draft declaration is due at the end of October 2005 and will cover the six month period commencing 1 April 2005. The final declaration is due in April 2006 and will cover the 12 month period commencing 1 April 2005. 8. The Trusts will make their position clear on each of the 24 core standards but they will be incorporated into a single declaration which all members of the Board will sign. 9. If the IWHNHST or the PCT do not feel that they have achieved compliance with the 24 core standards they will submit an action plan specifying how they intend to achieve compliance. 10.The draft declaration will be available for O&S Committee and PPIF in early October 2005. 11.Although there is no clear steer at present the verbatim nature of the recording of comments by the PPIF and O&S Committee suggests that they will need to be received in writing. 12.The declaration will be cross checked by the HC against the views of the Strategic Health Authority, the PPIF and the O&S Committee. 13.The Health organisations are looking at wider and closer involvement with the O&S Committee and PPIF. Jane Wilshaw’s involvement with the Policy Commission in the future will help to develop this relationship.
2.b	Mr Yasin Rahim	14.The statutory duty of the HC would be to reduce the burden of health investigations on healthcare service providers and to assess the provision of healthcare including public health in order to make a difference to health service users in accordance with Government standards. 15.It was recognised that until the factors that prevent performance were identified service improvement could not be achieved. This would be addressed by building partnerships with local agencies, the voluntary sector and service providers to gain an understanding of how of local issues impact upon local service delivery. By co-ordinating activities with other regulatory bodies a significant administrative burden that consumes front-line healthcare resources would also be lifted. The star-rating performance monitoring system was being disbanded and a new Annual Health check tool was being introduced. 16.There are in excess of 800 personnel at the HC. 17.In July 2004 24 core standards were introduced that healthcare organisations were informed they had to meet by the date of introduction. The core standards along with developmental standards, national targets and improvement reviews would be used to compile the annual review and performance rating. The emphasis however would be on local self-assessment assurance. 18.The ‘Healthcare organisations’ referred to in Paper B (p.3) would not include Social Services. 19.Whereas the role of the Strategic Health Authority was performance management that of the Health Commission was assurance. 20.Health organisations would now be responsible for assuring their own services in partnership with O&S committees and PPIF. Regulators in other places have not yet explored this way of working and consequently until a complete picture of the complexities of the local healthcare economy could be developed the weighting of the role of the Healthcare Commission as a regulator and/or a performance improver cannot be determined. 21.The commission will intercede with random and risk based sampling when dissonance becomes apparent between self assurance indicators and national standards. Thereafter an intelligent conversation will take place between the HC and the Health organisation to determine the nature of the problem and how it can be remedied. 22.The 2007 Social care inspection and the HC merger is driving joined up thinking between the two organisations. Consequently, the social services performance framework will feed into the annual health check. 23.Draft declarations are to be submitted by health organisations by the 31 October 2005. There is a facility on the declaration for the verbatim comments of the O&S Committee and the PPIF with regard to the 24 core standards. If no comments are made this will not negatively reflect on the organisation. 24.A Health organisation failing to meet the 24 core standards in the first six months and meeting the standards in the second six months cannot declare that they have met the standards for the year in question. 25.Protection of vulnerable adults will be part of the improvement reviews planned by the HC. 26.Reviews of community and mental health services will start to be rolled out in February 2006. 27.It is recognised and has been pointed out to the Department of Health that certain core standards are duplicated in some areas. 28.The annual picture will be much more robust than that provided by the star-rating system. 29.There are approximately 2000 data items used to cross check whether or not Trusts are appropriately assured and meeting assurance indicators including qualitative data from GP surveys and patient feedback. 30.Under the former system a 3 Star rated Health organisation could apply for Foundation Trust status, at present no decision has been taken as to the new qualification criteria. 31.Health organisations are responsible to service users. If standards are not met by the cuts required by the Strategic Health Authority the HC can report the issue directly to Parliament. 32.Use of finances is a key core standard.
3.	Further discussions	33.A communications process is required to enable the Policy Commission, the PPIF and the Health organisations to work together more effectively. 34.According to the PPIFs Trusts are looking forward to the new process as a positive challenge. 35.The IWHNHST welcome the new self-assessment method. 36.Reciprocity is required with respect to invitations to meetings if a successful working partnership is to be developed. 37.An initiative in 2003 involving Elected Members attending the joint meeting of the Boards in 2003 worked very well and could be re-established.
Actions		1. Comments on the achievement of the 24 core standards by the IWHNHST and the PCT for inclusion in the draft declaration to be included on agenda for September meeting. 2. Feedback to be given to Mr Yasin Rahim on his presentation.	O&S Team O&S Team to seek views and feed back as requested.