PAPER A

NOTES OF EVIDENCE

 

Meeting

Policy Commission for Care, Health and Housing

Ref

He.PC.25/04/07

Date   

 25 April 2007

Time

18.00hrs

Place

Committee Room 1, County Hall, Newport, Isle of Wight

Purpose of meeting

Formal public meeting

Attendance   

Commission

Erica Oulton (Chairman),  Geoff Lumley, Win McRobert,  Margaret Webster, Colin West and David Whittaker

 

Co-opted Members: Mr Robert Jones

Cabinet

Cllr Dawn Cousins

Secretariat

Cllr Alan Wells

Other Councillors

 

Officers

 

Ms Louise Biggs - Overview and Scrutiny (O&S) Team

 

Mrs Sarah Mitchell – Director of Community Services

 

Ms Claire Foreman – Head of Older Persons and people with a physical disability

 

Mrs Amanda Thomas – Committee Services

Invited Attendees

Mr Ed Macalister-Smith (IWPCT), Gillian Baker (IWPCT) and Dr Jenifer Smith (newly appointed Director of Public Health and Chief Medical Advisor  -  IWC/IWPCT)

Stakeholders

Mrs Nancy Ellacott

Apologies

Mr David White

Agenda Items

 

1. To agree the notes of evidence arising at the meeting held on 28 March 2007

The notes of the previous meeting were agreed.

2. Declarations of Interest.

None received.

3.  Directors Update

 

 

 

3.1      The Our Care, Our Health, Our Say White Paper Conference had been well attended by Members and health colleagues.   Dr Jenifer Smith the newly appointed Director of Public Health/Chief Medical Advisor (a joint post between the IWC and the IWPCT) was welcomed to the meeting.

 

3.2      Members were advised that the Council was taking the lead on Learning Disabilities and a briefing would be provided for Members on governance issues in due course. 

 

3.3      The information prescription pilot, which involved older people with mental health needs, was a self-help approach and information was available on the website.  The biggest issue was that there was no single information point.

 

3.4      The Committee noted that the voluntary agency Help and Care would be speaking to all hospital patients regardless of income.  End of year performance results were being produced and indicated that the Council had maintained performance on delayed transfers despite winter pressures. 

 

3.5      Packages of care for older people were reviewed and other care groups were consulted about their experience.  The Council’s performance was now up to 60%.  This approach enables regular reviews of funding and whether packages can be adjusted to better meet needs.

 

3.6      Help to live at home is another area where performance had improved.  This was due to the general commissioning strategy to support living at home rather than using residential care.

 

3.7      Self assessment for the Free Home Care Initiative had been introduced because it was less intrusive for clients.  Members noted that the system also helped with relieving pressure on staff time and was a good gauge of how people identify their own needs.  Staff had responded to the system extremely well and had identified some important background issues.  

 

3.8      Joint Commissioning with health colleagues was being progressed.  A meeting had been scheduled for the following week to look at a model for older people’s care and would explore how an integrated approach could work in practice.  The current joint commissioning with ICES and joint commissioning of nursing home beds had been very successful.

 

4. Financial Recovery Plan (presentation by Ed McAllister-Smith)

4.1     The IWPCT was getting close to resolving the financial issues for last year.  The accounts should be closed by 10 May 2007.  It was anticipated that there would be a small surplus at the end of the financial year.  A great deal of credit went to everyone for their hard work and support.

 

4.2      The overall budget position for this financial year was presented at the March Board meeting and the Local Development Plan (LDP) had been published.

 

4.3     The PCT had received an additional allocation of £20 million for this year, although the Island was still in equal bottom place for funding within the South Central Strategic Health Authority region. 

 

4.4     The LDP expected two kinds of investment and £10 million has gone to the provider arm with £10 million going to additionally commissioned services, some of which take place off Island.

 

4.5     The Committee was advised that NHS organisations had to demonstrate an efficiency gain each year of 2.5%, which equates to £6 million.  However, because the Island had a relatively small population with a relatively small hospital there was an ‘Island premium’ for maintaining a comprehensive range of services, which equated to approximately £4 million.  A total saving of approximately £10 million therefore had to be achieved.  A list of cost improvement programmes was currently being developed that would need to be applied over the year.

 

4.6     GP’s last year showed the best improvement of any PCT in the country for the Prescribing in Practice initiative and it was envisaged that this would continue.  There were a number of ways that this could be achieved: one was the length of stay in hospital and the second area was improving performance on delayed discharges from hospital. Some indications were that further improvement could be made by ensuring that discharge dates were strictly observed, which could save a significant number of beds in the hospital.  This would provide more ‘head-room’, or an opportunity for reducing the number of beds.

 

4.7     Every possible value was required for Intermediate Care and a programme was being developed for cost improvements, which would be presented  to the Board in June 2007. 

 

4.8     Additonal funding and budget information was available on the PCT website:  www.iow.nhs.uk.

 

4.9     Concerns were also raised about ‘social admissions’.  Members were advised that GP’s needed support for out-of-hours services, but that the joint approach for heath and care, particularly in pre-operation planning, needed improvement.  Members were further informed that discussions were taking place regarding merging and relocating the key discharge services within the hospital, which could make a real difference.

 

Continuing Care (presentation by Gillian Baker and Ed Macalister-Smith, IWPCT)

5.1     People meet this criteria if they have a primary need for healthcare.  NHS funding eligibility was based on assessed need, not dependent on diagnosis.  Assessments were undertaken jointly by a multi-disciplinary team.  Joint operational policies for continuing care were in place.

 

5.2     A joint continuing care funding panel had been established, and an appeals process was in place.  Some difficulties existed with border line cases and it was hoped that Government guidelines would help with this.  The SHA’s eligibility criteria was currently used for assessments.

 

5.3     Members were informed that joint training opportunities with the Council would be developed.

 

5.4     There were also concerns about service users being involved in developing the system.  If future responsibility was passed to local authorities, then the cost would effectively be passed to residents.  It was essential therefore that stakeholders be involved in the process.

 

5.5     The Committee was advised that regular assessments were undertaken in nursing homes, or by care managers to identify continuing care patients.

 

Actions

None

 

Meeting closed at 7.45 pm

 

 

 

*The next meeting would include speaking to providers of Continuing Care.