MINUTES OF A MEETING OF THE ADULT AND COMMUNITY SERVICES SELECT COMMITTEE HELD AT COUNTY HALL, NEWPORT, ISLE OF WIGHT ON TUESDAY, 26 OCTOBER 2004 COMMENCING AT 9.30 AM

 

Present :

 

Mr I R Stephens (Chairman), Mr J R Adams, Mrs B D Clough, Mrs D Gardiner Mr J F Howe, Mr R G Mazillius, Mr V J Morey, Mrs E Oulton, Mr D G Williams

 

Portfolio Holder :

 

Mr G S Kendall

 

Also Present (non voting) :

 

Mr A C Bartlett, Mr M J Cunningham, Mr R A Sutton

 

 

27.              MINUTES

 

The Minutes of the meeting held on 16 September 2004 were confirmed.

 

28.              DECLARATIONS OF INTEREST

 

Mr G S Kendall declared an interest as a Non Executive Director of the Primary Care Trust.

 

29.              UPDATE ON THE HOMECARE TASK GROUP

 

Members were given an update by the Lead member, Mr D Williams, on the current homecare provision and the tendering process that had been undertaken.  There had been 23 applications for tender packs 8 had been returned and 5 were shortlisted.  2 organisations had been awarded contracts, Wight Homecare who would service the west and north of the Island and Two Counties who would service the south and east.  Two Counties were also training providers.  The costs for the change had been anticipated and would be met from within existing budgets.

 

The Portfolio Holder thanked the Task Group for their work.  Members were advised that there may be difficulties towards the end of the existing contract but if that was the case it would be managed.  Members asked if any jobs would be lost and were told they would not.

 

Members believed that a robust system should be in place to provide intensive homecare by April 2005.

 

The Select Committee asked that the fiscal implications to the package be explored during the budget process.  Members also believed that a section should be included within the Quarterly Performance Management Report showing the new and old costs for providers.

 

ACTION TO BE TAKEN BY THE LEAD MEMBER OF THE HOMECARE TASK GROUP :

 

The Select Committee monitor the progress of Homecare provision through the Lead Member of the Task Group with a view to receiving an update in 6 months, either formally or informally.

ACTION TO BE TAKEN BY THE PORTFOLIO HOLDER AND THE HEAD OF CORPORATE POLICY AND COMMUNICATIONS :

 

That a section be included in the Quarterly Performance Management Report showing the new and old costs for providers.

 

30.              UPDATE ON THE ISLE OF WIGHT COUNCIL’S RESPONSE TO THE HEALTHCARE STRATEGY AND BEYOND HEALTHFIT

 

The Chairman welcomed Mr R Samuel of the Hampshire and Isle of Wight Strategic Health Authority (SHA), Mr G Elderfield of the Isle of Wight Healthcare NHS Trust (NHS) and Mr D Crawley of the Isle of Wight Primary Care Trust (PCT) to the meeting.

 

Mr Samuel advised the Select Committee that views had been sought on the discussion document forming the Strategic Framework.  There were 4 localities within the area with the Isle of Wight being one.  There was some discussion with reference to Locality Agreements and how to take forward their implementation within each locality.  A meeting was to be held on 10 November 2004 whereby an explanation of Locality Agreements would be given the SHA wanted to ensure everyone was aware of and understood the next steps.

 

Mr Elderfield indicated that a meeting of the Cross Solent Forum had recently been held with the Chief Executives and Medical Directors of Portsmouth and Southampton.  The meeting had been held on the Island so as to give the officers an idea of what Island patients regularly had to experience when going for treatment on the mainland.

 

The Select Committee wanted an assurance that any deficit incurred by the PCT would not be passed on to the Isle of Wight Council Tax Payers.  Mr Elderfield indicated that from the Healthcare perspective its financial targets had been met.  A recovery plan was in place and was on track for the first 6 months.  A saving of £5½m had been made and there was a commitment to meet its financial targets for this financial year.  The Isle of Wight Council tax payers would not bear the burden of any failed financial health target.  It was anticipated that by April 2006 the new organisation would start life with no deficits.  There was a need for radical changes to make the service fit for the future.

 

Members asked where the Island stood in relation to the reduction of health inequalities and were advised that a health equity audit was being carried out by the Director of Public Health, Dr Paul Bingham on the Island with targets being set locally.  Mr Samuel indicated that he would provide Councillors with a complete breakdown of where the Isle of Wight stood with regard to inequalities.

 

There was some discussion with regard to the amount of money spent on prescribing drugs; the cost was approximately £25m per annum which equated to roughly £½m per week.  Work with GPs was ongoing to ensure that any waste was kept to a minimum.  The latest figures for drug inflation for August 2004 was 7% for the Island and 9½% nationally.

 

ACTION TO BE TAKEN BY THE STRATEGIC HEALTH AUTHORITY :

 

The Strategic Health Authority provide detailed information of health deprivation and inequalities in respect of the Isle of Wight in comparison to other local health localities.

(a)               Transfer of Care and Older People

 

Councillor Mazillius believed that the Island had a very good service in respect of care for older people.

 

Members asked for an update on the proposed closure of a further 60 – 80 beds at St Mary’s by April 2005 to achieve the £2.7m saving.  Mr Elderfield advised the Select Committee that there were no plans to close beds this year and the next planned closures were to be in 2005/06.  A bed census had been undertaken in March 2004 with another one planned for November 2004.  The bed census played an important part in helping with the provision of multi disciplinary services, delayed discharge had been virtually nil since its inception.

 

Independent partners wanted to work with the PCT and several schemes were being investigated which included the development of Evercare.  The 2nd stage of the development had looked at the intermediate care bed capacity which had been a success and it was hoped to increase the numbers of those beds.

 

Mr Samuel said the NHS faced their own challenges and advised there had been a change in terms of leadership to take forward change to April 2006.  Two teams had been established and were being led by Mr G Elderfield and Mr D Crawley.  Members asked how the decision of who should lead the teams was arrived at and were told that it was a decision by the Transitional Steering Group, on which the Council held equal representation.

 

ACTION TO BE TAKEN BY COUNCILLOR DAVID WILLIAMS AS THE LEAD MEMBER OF THE HOMECARE TASK GROUP :

 

The Lead Member of the Homecare Task Group continue to monitor progress of the Homecare market.

 

(b)               Surgery and Emergency Services

 

Councillor Williams asked for an update on the performance of NHS Direct and IDOC as during the consultation concern had been expressed over delays experienced on call answering.  Mr Crawley told members that the out of hours service had gained the commitment of almost all the GPs on the Island and the Isle of Wight had secured out of hours primary care.  With regard to NHS Direct and the possibility of going through a 3rd party to describe symptoms Mr Crawley indicated that the PCT wanted to use IDOC as a single point of access for Primary Care.

 

There had been a recommendation that the role of fully trained paramedics be supported.  The Select Committee asked for the number of paramedics the NHS now had and how their training and qualifications were being developed.  Mr Elderfield told members that he did not have those figures to hand but would provide them with a written response within a week.  He also indicated that treatment waiting times in the A and E Department were on track to meet Government targets.

 

Councillor Williams asked what the position was with regard to GPs performing minor surgery.  Mr Crawley advised that the PCT ensured that if GPs were carrying out minor surgery they had to comply with the Qualities and Outcomes Framework.  Anyone with minor injuries were encouraged to go to their local surgery although any injury incurred during the evening would have to be dealt with by the A and E Department.

 

The Select Committee indicated that some members of the general public appeared to be worried about contracting MRSA if they had to stay in hospital.  Mr Elderfield told members that a screening process was undertaken as part of the pre assessment process.  The Infection Control Team were constantly reviewing processes to ensure every step was taken to ensure prevention.

 

ACTION TO BE TAKEN BY THE PRIMARY CARE TRUST:

 

The Primary Care Trust provide a report on the Qualities and Outcomes Framework.

 

ACTION TO BE TAKEN BY THE NHS TRUST:

 

Additional information with regard to the number of paramedics and how their training and qualifications are being developed on the Island be provided within one week.

 

(c)               Primary Care and Dentistry

 

Councillor Gardiner asked for an update on the new dentist contracts and an analysis of unmet demand.

 

Mr Crawley indicated that there was a recognition nationally that there were fewer people going into dentistry.  A Dental Action Plan was being developed and it was believed that another 15 dentists would be needed for the Island.  Officers had visited Poland with the objective of recruiting more dentists. International recruitment would be short to medium term only.  All the dentists would be salaried and would be expected to make a full time commitment to the NHS.

 

There was a question with regard to registering for a dentist.  It was anticipated that a system would be in place whereby a contact number would be advertised and subsequently a form would be issued and processed upon its return.  The earliest probable start time would be January 2005.

 

Members asked if there was provision being made in GP surgeries for social care and how many extra community nurses had been taken on. Social care was becoming closer and more integrated and had been developing a staged strategy.  Growth in the nursing workforce had not been massive and the next stage for recruitment was start in January 2005.  The Evercare model would provide an enhanced role for nurses.

 

ACTION TO BE TAKEN BY THE PRIMARY CARE TRUST :

 

Additional information be provided on the level of unmet need and access to NHS dentists on the Island for Island residents.

 

(d)               Patient Travel and Transport

 

Councillor Howe reported that 500 patients a week were travelling to the mainland for treatment, the cost of which was causing much hardship for many patients and families.  There was some confusion as to who got their fare paid for and who had to pay for themselves.  He asked if negotiations had been undertaken with the cross Solent ferry companies to get cheaper fares.

 

Mr Crawley agreed that the system was complex.  He had spoken to the cross Solent ferry companies with regard to any concessions they may help with but unfortunately they were not willing to help.  He believed this was a cross organisation issue that had not been taken forward.  The voluntary sector was also keen to be a partner.

 

Members indicated that the Portfolio Holder for Transport should be asked to work with Health Partners to investigate what initiatives, co-operation and co-ordination could be put in place to assist Island patients in respect of travel access to Health Services both on the Island and mainland.  The work could be included in the Environment and Transport Select Committee’s current Review of Transport.  The review was considering a range of improvements to Island public transport which in themselves would help travel access to Health Services.  However, the review did not include an investigation into cross Solent transport but the scope could be extended to include Health Travel to the mainland if a request was put to the Task Group.

 

ACTION TO BE TAKEN BY THE PORTFOLIO HOLDER FOR TRANSPORT AND HEALTH PARTNERS :

 

The Portfolio Holder for Transport actively work with Health Partners to investigate what initiatives, co-operation and co-ordination can be put in place to assist Island patients in respect of travel access to Health Services both on the Island and Mainland, such work to be included in the Environment and Transport Select Committee’s current Review of Transport.

 

(e)               Maternity and Children’s Services

 

Councillor Clough asked for an update on the retention and recruitment of staff, if the consultant midwife had yet been appointed and had the skills and training programme been developed.  Mr Elderfield advised that the skills and training programme was being developed and there was now an increased number of consultant obstetricians on the Island.

 

Members were also advised that the abortion service for the Island would be opening within the next few weeks.

 

It was understood that a joint CAMHS review had been undertaken earlier in 2004, the outcome of which was reported to the PCT.  An Action Plan was available and would be made available to members.

 

ACTION TO BE TAKEN BY THE PRIMARY CARE TRUST :

 

The Primary Care Trust provide a copy of the Action Plan in respect of the CAMHS review that was undertaken earlier this year.

 

(f)                 Mental Health

 

Councillor Oulton asked if the Service User Facilitator was to be replaced and was advised that the post had been fixed term only to help set up arrangements for service users.

 

There was some discussion with reference to the PCT negotiations on assuming responsibility for prison healthcare as a pilot project.  This did not go ahead because of the PCT and Prison Services respective financial positions.  It was anticipated however that the service would be in place by April 2005.  Members asked if prisoners got preferential treatment and were told that they had to wait the same as everyone else.  Prison healthcare could be a pressure area with regard to pharmacy and drugs, Mr Crawley indicated that the cost of prescriptions for drugs to prisoners would be met by the Home Office.

 

31.              MEMBERS’ QUESTION TIME

 

Mr M J Cunningham raised a question in regard to Homestart.  The Chairman would investigate how this could best be dealt with.

 

 

 

 

 

CHAIRMAN