Agenda item

To consider a joint report (copy attached) on the actions taken to progress the development of integrated services and governance structure in relation to delivering integrated services for older people.

 

9:35 – 10:05

Councillor Bobby Feeley, Lead Member for Social Care Adults and Children’s Services introduced the report (previously circulated) whilst Phil Gilroy, Head of Adult and Business Services and Sally Baxter, BCUHB Acting Director of Planning, apprised the committee how the project was progressing in relation to their respective fields.

The Committee were reminded of the size of this project and advised that the Older People's Commissioner was very keen to promote the service and see it expand to a 7 day service model.  For this to be achieved a great deal of work needed to be done and resources found to support it. It was noted that:

·        to date there was a high satisfaction rate with the service from service-users

·        key to good service delivery would be good governance, therefore during the forthcoming months the Denbighshire Health and Social Care Board would be reviewed to ensure that it was fit for purpose and fitted-in with the Health Board's changing structures.

 

 

Members of the committee conveyed concern regarding feedback from consituents that patient care in hospitals is sometimes impersonal and that lack of empathy and apparent concern left some people with a residual perception of poor quality nursing.

 

It was acknowledged that this matter had been highlighted as an area for concern in the recent Andrews Report, ‘Trusted to Care’, on the Abertawe Bro Morgannwg University Health Board, which had subsequently been reviewed by all Health Boards. This has resulted in the implementation of spot checks and the Community Health Council (CHC) operating “care watch” in hospitals.

 

The CHC continue to undertake announced and unannounced spot check visits on all aspects of care, including compassion and dignity.  These visits had proved an extremely valuable tool for identifying good and bad working practices and for sharing good practice.  Health representatives undertook to check whether these visits were permitted to take place during 'protected meal times'.

 

Health Board representatives acknowledged that more work needed to be done to educate Health staff of the benefits of CHC visits for patients and health workers alike.  The CHC needed to be regarded as a supporting friend rather than a critical adversary;

 

The Committee heard that Wrexham Maelor Hospital had been taking part in a pilot called 'i Want Great Care', which canvassed the views of patients on their care experiences at the hospital.  As a matter of course this pilot would be evaluated when it ended in January 2015 before a decision would be taken on its suitability for roll-out across other Health Board establishments. Consideration would need to be given to the potential reluctance to report negative experience if ongoing treatment was required.

 

 Both Health and Social Services officers assured members that:

 

·        compassion and dignity formed part of the basic nursing training programme;

·        treating people with dignity and compassion was an integral part of both health and social care occupations;

·        everyone should be treated courteously and with respect at all times and staff should be encouraged to report any incidents which fell short of this mark.

 

The Head of Adult and Business Services explained that front line staff had recently undergone customer service training on “The Denbighshire Way” which had resulted in a workbook that would be circulated to all employees. He reported that there had been a hundred percent positive feedback response from clients to services delivered under the Framework, who felt that they had been treated with dignity and respect.  Nevertheless, members asked officers to be mindful of a possible false high satisfaction level with the services based on the fact that vulnerable people may be reticent to criticise the services received for fear of losing them.

 

Health Board Officers also confirmed that new starters are shown the “What do you see when you’re looking at me?” teaching film at induction and that top up training is mandatory for nurses, backed up by ward rounds and inspections.

 

Members of BCUHB were asked if Supporting Independence in Denbighshire (SID) would inform the development of their 3 year plan and how they saw the Health Service at the end of that period? They were assured that the Health Board had recently agreed in principle to support the approach outlined in the Local Service Board's (LSB) Single Integrated Plan - Denbighshire's Well-being Plan - and its single theme of supporting independence and resilience.  This Strategy would form part of the Health Board's new three year strategic plan as a number of the Well-being Plan's aspirations reflected the Board's future service delivery intentions e.g. investment in community and primary care services with a view to reducing prolonged hospital stays which compromised long-term independence - early intervention or prevention was far more cost effective in the long-term for all concerned.

 

It was acknowledged that many individuals do not need professional care to live independently but do need company and social interaction in order to thrive. To mitigate the risk of social isolation Health and Social Care staff were working to engage expert services from among the voluntary sector to deliver community based events. It was suggested that GPs (who for some may be the only form of social contact) share those at risk of isolation about services which may be available to them.  Any services commissioned from the voluntary (3rd sector) organisations would be subject to strict contract monitoring arrangements which would include safeguarding matters.

 

Reference was made to the potentially large projected overspend announced recently by the press. Health officials advised that the Board was actively working with the Welsh Government (WG) to reduce the overspend, which was partly the result of the slow progress made with the programme of health service modernisation in North Wales, and the efficiency target of 8% set for the Board to achieve.

 

The Lead Member for Social Care and Children’s Services, who had been privy to the Health Board’s draft 3 year plan,  stated that the proposed three year plan looked hopeful with three sub regions based on prospective merged Local Authorities and therefore three hospitals focussing on different specialisms.

The Committee discussed the review of governance arrangements and the implementation of the new Partnership and Leadership Forums and Citizen Panel. Members asked that consideration be given to the following:

·        for any new Health Board committees or groups which covered both Conwy and Denbighshire local authority areas to have an equitable number of representatives on them from both areas;

·        for the proposed composition, recruitment and appointment processes for the new Citizens Panel to be examined by the Committee when the details were available

·        for enquiries to be made on whether BCUHB would be applying for the additional funding made available by the UK Government for dementia services, and if so which services would benefit considering that North Wales had the lowest rate in Wales for diagnosing dementia.

 

The Head of Adults and Business Services advised that, whilst the Intermediate Care Fund (ICF) monies would cease at the end of March 2015, he was hopeful that negotiations could start with the Health Board soon to explore whether any of the additional funding allocated to the Health Service could be utilised to fund and support the excellent work started with ICF money.  He also enquired on the availability of the Heath Board's induction video on basic compassion and dignity for the purpose of training a wider audience of social care staff.

 

The Lead Member for Social Care (Adults and Children's Services) advised that she had already been privy to a draft of the Health Board's new three year plan.  She felt it was deliverable and hoped that the recent negative media publicity around the Health Board would not detract its implementation and undermine its deliverability.  The Lead Member was hopeful that now both the Health and Social Care services lay within the same WG Minister's portfolio of responsibilities that there should be a more cohesive approach in national policy development and decisions on funding.

 

Following detailed discussion the Committee:

 

Resolved:  subject to the above observations. to note all actions taken to date by all stakeholders to deliver the Statement of Intent for providing integrated services for older people with complex needs.