Representatives from the following will be in attendance to provide an overview on their areas of expertise.
· Clinical Commissioning Group (CCG)
· Bath Royal United Hospital (RUH)
· Chippenham Hospital
· Public Health
· Healthwatch Wiltshire
Following the presentations there will be an opportunity for questions.
Minutes:
The Chairman welcomed the Health and Wellbeing panel members to the meeting.
Each representative was invited to give a brief presentation on their respective area of expertise before questions would be welcomed from the floor.
The presentations made were as follows:
Dr Ted Wilson (Group Director for North and East Wiltshire CCG)
· The Wiltshire CCG Governing Body comprised a number of local GPs, clinicians, health professionals and lay members.
· The Clinical Commissioning Group (CCG) was responsible for commissioning services for the people of Wiltshire, including commissioning services from the 3 main hospital providers in the area, namely Bath RUH, Great Western Hospital and Salisbury Hospital.
· The aspirations of the CCG were to build a healthcare system based upon the needs of patients and local communities including providing care closer to home.
· The key priorities were:
Ø Keeping Wiltshire healthy and preventing ill health – encouraging self management
Ø Planned care – to ensure appropriate provision surrounded planned care
Ø Unplanned care and caring for the frail elderly - to ensure appropriate support for those in crisis
Ø Mental health – to better services
Ø Long term conditions - ensuring appropriate delivery of care
Ø End of life care – providing the most appropriate care for the patient, noting that 80% of those admitted to hospital indicated a preference to remain at home at end of life
Ø Community services and integrated care – work would continue with partners to provide services
· The CCG had been in operation as per legislative requirements since April 2013 and had made several improvements since that time, including the following:
Mental Health – improvement on dementia assessment and diagnosis. Within six months average waiting times had reduced from 11 months to 4 weeks. Working with the voluntary sector, such as Alzheimer Support and Alzheimer Society had proven invaluable in improving the service.
Urgent Care – To deliver appropriate care, extra A&E Consultants would be in place in Bath RUH and Great Western Hospital and improvements made to the Surgical Assessment Unit. A better model was also being developed for the discharge of patients from hospital in accordance with the wishes of the local community.
Community Transformation – The CCG were working closely with Wiltshire Council to appoint care co-ordinators across GP practices. These coordinators would support patients who may otherwise be admitted to hospital. Enhanced community nursing support was also being provided to provide evening rapid response times within one hour.
Additional community hospital beds would be provided over the winter period supplemented with the support of Wiltshire Council on the ‘step up, step down’ service which provided additional support to prevent hospital admissions as well as supporting those leaving hospital.
· Dr Nick Brown (local GP) was also in attendance and confirmed that although the CCG took over responsibility from the PCT in a more financially favourable position the biggest challenge remained an increasing aging population. Acute services were often used for elderly patients without an acute medical need and the CCG were looking to adopt a range of options to address this.
Sarah Truelove – Bath RUH
· Bath RUH was one of 3 acute hospitals within the local area that provided a range of services both at the hospital itself and within the community.
· Bath RUH was working with partners, including the CCG and Wiltshire Council, to provide better integrated care for the benefit of the patient.
· Services provided in the community area included a stroke unit at Chippenham Community Hospital, where support was provided for non acute conditions.
· Within the last few months work on urgent care including an improved patient discharge service had been undertaken. More work was needed but the hospital was now better prepared and would continue to strive to improve services.
· Bath RUH were also working with the CCG to identify future priorities ensuring that the strategic direction of the hospital was in line with the wants of the local GPs and, as a result, the local population.
· Ambitions for the future included the development of a specialist cancer centre to provide a centre of excellence. This was developing particularly since receiving a recent significant donation from businessman James Dyson.
Voxpops DVD – Chippenham Hospital
Prior to the next presentation a short Voxpops DVD was shown of interviews with local residents in relation to their thoughts on Chippenham Hospital.
Maggie Rae, Corporate Director Wiltshire Council
· Wiltshire Council continued to work with partners to help deliver better health services to the local population.
· Attendees were reminded that Public Health was a 24 hours a day, 7 days a week service whose role included:
Ø Protecting the local population from ill health
Ø Preventing disease
Ø Promoting healthy lifestyles
Ø Reducing health inequalities
· The needs of the population having been identified where included within the Joint Strategic Assessment for Wiltshire which had five key health and wellbeing priorities as detailed below:
Ø To identify and support complex and vulnerable families
Ø To reduce harms associated with substance misuse
Ø To support the rising number of people with long term conditions
Ø To manage their health and needs
Ø To reduce long term care home placements
· Recent work undertaken by the Public Health team has included awareness around alcohol consumption and the implications of over indulgence.
· There were a high level of long term conditions which the public were being encouraged to help manage themselves.
· There was also a desire to reduce the number of long term care placements noting that many frail elderly residents wished to remain at home.
· Other work from the Public Health team included:
Ø Healthy Child Programme – Wiltshire Council was responsible for school nursing in the community.
Ø Safe Drive Stay Alive Programme – a lot of work was being undertaken in Chippenham on road safety. Chippenham having a slightly higher number of road traffic collisions than average in Wiltshire.
Ø Wiltshire Stop Smoking Service – With the help of GPs the campaign was proving successful with 3,000 people this year alone giving up.
Ø Active Health scheme – Encouragement for the local population to become more active.
Ø Health Trainers – Aspirations for at least one whole time equivalent in each area board area to be a trainer offering help to others.
· Maggie Rae was pleased to highlight the following achievements as follows:
Ø The life expectancy for men had risen to 80.1 years and for women to 83.8 years with the gap between the two showing signs of reducing. This was the first time that men in Wiltshire had an average life expectancy over 80 years.
Ø Wiltshire’s cardiovascular disease mortality rates had significantly reduced with a 50% improvement in the last 5 years and were below those of the South West and England nationally.
Ø Noting that Abdominal Aortic Aneurysm (AAA) was an identified risk for men, accounting for approx 9% of emergency admissions, a screening programme for males aged 65 and over was in place.
Ø The latest set of data indicated no rise in childhood obesity for the first time. Although a significant achievement there would be a continued drive to reduce the levels.
Ø Those over 40 years of age would now receive an invitation from GPs every 5 years for a screening health check. Of the 30k offered, 14,700 had been completed.
· In noting that an aging population was identified as a factor to be taken into consideration in future health planning, attendees were also reminded of the positive contribution made by the older population, which included a significant amount of voluntary work.
· Noting the national increase in Dementia, Wiltshire aspired to be identified as Dementia friendly with an encouragement for all town and parishes helping to promote a supportive community.
Patrick Wintour, Healthwatch Wiltshire
· Healthwatch was an organisation established via the Health and Social Care Act 2012 at the same time as CCGs.
· The purpose of Healthwatch Wiltshire was:
Ø To promote the voice of the consumer in the development of health and social care strategies (children and adults);
Ø To provide and promote effective signposting and information systems;
Ø To promote, monitor and inspect the quality of services commissioned to meet health and social care needs (enter and view)
Ø To tell the Wiltshire story
· Healthwatch Wiltshire had statutory powers to allow it to enter hospitals, surgeries, care homes, etc, if it had concerns over the service being provided and it felt appropriate to do so. However, clarity was provided that Healthwatch was at an early stage of its work and it was hoped there would not be a need.
The Chairman thanked the panel members for the interesting presentations and opened up discussion to the floor where the following points were made:
· There were many surveys and questionnaires in circulation at present seeking the views of the public on healthcare services. This included the ‘friends and family’ test within hospitals asking the public whether they would recommend the hospital. This had identified some problematic areas within some wards which were being addressed
· To help spread awareness of the work of Healthwatch, representatives were presenting at the authorities area boards and would continue to use these forums as a valuable point of contact with the public. Healthwatch had minimal resources but would continue to seek other forms of awareness, including through GP surgeries.
· Healthwatch understood the invaluable work of voluntary advocacy services within Wiltshire and would continue to listen to their views to ensure adequate awareness for elderly patients was provided on available services. Care Coordinators, as mentioned previously, would also have a key role in this area.
· Patient Choice remained at the heart of service provision. Conversations would need to take place between the patient and their GP to decide on the most appropriate care provided.
· The services and opening times of Chippenham Community Hospital were also raised. Although the representative from Great Western Hospital was unable to attend the CCG representative, Ted Wilson, confirmed that service provision needed to take into consideration the number of those using the service. Further consultative work would take place to establish what was required within the local community and future services built around that.
· In addressing questions over consistency of care clarity was made that Wiltshire Council as part of its tendering exercise included the need for quality of service in addition to ensuring financial viability, noting that all providers were paid on outcomes as a result.
· Bath RUH clarified that work also continued within the hospital to address consistency of care with an emphasis on full time staff and clarity of roles during shift handovers included.
· The public were encouraged to be at the heart of decision making in relation to their own health, with a need to ensure they looked after their own health in the first instance.
· Mental Health services for the young was raised as a concern. It was understood that Wiltshire Council along with Swindon Council had applied to become an early intervention provider as they were aware of the importance of tackling mental health problems at as early a stage as possible. It was suggested that perhaps the Youth Advisory Group could be encouraged to help provide research in this area.
· To ensure future engagement, the CCG were hoping to have representatives at future area board meetings across the county.
· The meeting today was an opportunity to understand how the various health professionals in attendance worked together.
The Chairman thanked all panel members again for their attendance at the meeting and for taking the time to answer questions.