The Forest of Dean District Health Forum
General Meeting Tuesday 4th September 2012
Minutes
Present:
Jan Baynham
Di Martin
Frank Baynham
Doug Battersby
Hilary Bowen
Terry Hale
Chair
Vice Chair
Secretary
Treasurer
Committee
Committee
Coalway
Cinderford TC, FoDDC
FoDDC Health Champion, Coalway
Crossroads Care FoD + Herefordshire
Boughspring
FoDDC, GCC
Gethyn Davies
Clive Elsmore
Eileen Elsmore
Sam Ferris
Margy Fowler
Tim Fretter
Mandy Hampton
Jane Lloyd
Mary Matthews
Ann Sargent
Kim Stevenson
Pam Travers
Linda Vaughan
FoDDC
FoDDC/Coleford TC
CAB/Coleford TC
NHS Glos.
Glos. Care Services
FVAF
Glos. Care Services
Village Agent
Bream Ladies’ Group
Lydney GP Practice
Awre and Blakeney PC
Newland PC
Lydney GP Practice
John Hale
Marlene Harman
Peggy Jordan
Patricia Morgan
G Smith
Public
Public
Public
Public
Bream
Lydney
Bream
Apologies: Lee Abbott, Shona Arora, Martin Gibbs, Jenny Green, Jane Horne, Jo Hume,
Barbara Jenkins, Lena Maller, Linda Prosser, Helen Roberts, Jan Royall, Viv Shorney,
Richard Skinner, Caroline Smith, Lynn Teague, Tess Tremlett.
Speakers: Les Trewin and Ted Quinn, 2gether NHS Foundation Trust
Welcome: The Chair, Jan Baynham (JB) welcomed everyone to the meeting and
introduced Les Trewin and Ted Quinn who would be speaking on the state of play and
future direction of Mental Health Services in and for the Forest of Dean.
Minutes of July 2012 meeting: JB asked if there were any amendments to the minutes.
No objections were raised and they were agreed unanimously.
Matters arising: JB referred to the Community Health Services consultation event on 9th
August at Cinderford Rugby Club. This had apparently been well attended and she
reminded members that feedback on the Consultation would be accepted until 3rd October.
Copies of the Consultation Document would be available from the GUiDE and PALS
Information Bus which would be in Coleford on Thursday 6th September. She said that
following analysis of responses to the Consultation, an extraordinary meeting of the NHS
Gloucestershire Board would be held in the Board Room at Sanger House between 10:00
am and 1:00 pm on Monday 15th October to make a decision on the future of Community
Health Services in Gloucestershire.
JB said that the first meeting of the Gloucestershire Care Services Patient Experience
Group had been held on 19th July. Jenny Green (JG) had attended on behalf of the Health
Forum. Unfortunately JG was unwell and unable to attend the Forum but JB read an email
from her saying that “I attended the first meeting of The Patient Experience – Basically they
want to try and find out the best way to get feed back from patients who may be In hospital,
have homecare at home, have a district nurse calling in etc; They want to work out how to
get feed back from these people, both good and bad and then when they have sorted out
the problem, if there is one, to get back to the patient to let them know what they have done
about it.”
JG also said that there was to be a workshop about this on 26th Sept which she would try
and get to.
JB referred to the fact that members had asked about the planned timing for the opening of
the new Kidney Dialysis Unit in Cinderford. She was happy to announce that The Forum
had been asked to attend the official opening on Tuesday 9th October.
Past meetings of The Forum had discussed the mobile breast screening units in the Forest.
At the beginning of August an email had been received from Dr Olusola Aruna, Consultant
in Public Health Medicine at NHS Gloucestershire which said:
“We are committed to making sure that local residents have the best possible access to
screening services in the Forest of Dean.
There are two mobile breast screening units in the Forest of Dean. They are currently
located at Lydney and District Hospital and Coleford Health Centre.
It was not possible to locate a mobile unit at Cinderford Health Centre as the new larger
mobile unit (which features up to date digital equipment) was not physically able to fit into
the site.
The Breast Screening Unit is working with Forest of Dean District Council to identify other
potential locations for the mobile unit which can accommodate its size, weight and access
requirements. We are monitoring uptake as this screening round progresses to ensure that
women are continuing to access the service. Some patients registered with Mitcheldean
practice have said they prefer to travel to Gloucester, so we have ensured that they can
access screening services there.”
Di Martin (DM) said that they should also be asking Town and Parish Councils for their
views.
JB reminded members that there had been a LINks event at The Annexe in Lydney which
was looking at the Future of Ambulance Services in Gloucestershire.
Jane Lloyd (JL) said that the event had been well attended but that there was no new
information that was not already known to the Health Forum.
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Clive Elsmore (CE) said that information had been given on waiting times for Ambulance
handover at GRH. Bottlenecks had been identified which GRH was trying to sort out. In
response to concerns previously expressed by a Forest GP there was clarification of the
criteria for sending an Ambulance in response to 999 calls. The meeting had been given no
new information and the basic message had been to make sure that as much information as
possible was given when making the emergency call as the operators could only make a
decision based on what they were told. CE said that if GPs were not satisfied with this they
could always put more money into making the service better in April 2013.
JB had reported at the last meeting on the setting up of a “cartel” in the South West by 16
NHS Trusts.
JB, Frank Baynham (FB), Doug Battersby (DB) and Barbara Jenkins (BJ) had attended
the Gloucestershire Hospitals NHS Foundation Trust AGM in Cheltenham and FB had
asked Frank Harsent (FH) how this would affect future staff morale and enable the Trust to
attract and retain suitably qualified and committed staff.
FH replied that people should not worry about this and that newspaper reports had been
inaccurate. He said that there were no plans to cut staff wages but that there were some
anomalies with regard to holiday and sick pay which needed to be rationalised and brought
into line with other Trusts in the South West.
JB told members that it had recently been confirmed that there were now 20 Trusts who had
joined the cartel including 2gether and Gloucestershire Acute Hospitals. Each Trust had
contributed £10,000 and it was said that a business plan would be produced by the end of
2012. This would then be discussed by the individual Trust Boards.
DM said that she thought it was reprehensible that the Government was encouraging
regional cartels and taking away national pay bargaining.
Les Trewin (LT) noted that it was not a “cartel” and said it was a “Consortium”. He said the
problem had been that there had been a national freeze on salaries and 2gether had had to
decide whether to sit back or get involved. The decision had been made that it was better to
get involved and have a say. Any papers produced by the Consortium would be shared with
all staff who would be encouraged to be involved. He said that the process would be open
and transparent. He said that the sad fact was that the national pay bodies were not going
anywhere and it was left to regional bodies to come up with something else.
He said that some of the money contributed by the Consortium members was going towards
writing a Business Case.
JB asked if this would be made public.
LT said that it was early days yet but that a lot of papers were coming through.
Chair’s Report: JB told members that she had received a copy of the report of the Care
Quality Commission (CQC) report following an unannounced visit to The Dilke hospital. She
said that despite concerns raised in the report she would have no worries about being
treated in The Dilke.
Mandy Hampton (MH) introduced herself as Matron of The Dilke and Lydney Hospitals.
She said that the unannounced visit had taken place at the end of March during extensive
building and refurbishment works. However she accepted that there were some aspects of
the report which highlighted shortcomings and these had been tackled. She said that an
extensive action plan had been put in place and following a return visit by CQC the previous
Thursday every point had been met and passed. MH said that she had a brilliant team and
she was confident that the next CQC report would reflect that.
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Patricia Morgan (PM) said that she was aware from personal experience that there were
some issues which needed addressing.
MH said that there was a procedure for anyone with complaints or compliments to have
these dealt with. She said there was a box in each of the hospitals where these could be
posted or people could contact her direct. She said that she was always open to feedback
but when the CQC first visited there were issues which needed to be addressed. She was
confident that all these issues had been tackled effectively but was more than happy to
receive emails, phone calls or letters from patients and their families.
John Hale (JH) said that we had to appreciate the difficulties our hospitals faced in these
trying times but he was sure that they were moving forward in the right way.
JB reported that it had been announced that the NHS Chief Executive Sir David Nicholson
had announced a major shift in power to the new NHS which would see control pass from
many Primary Care Trusts (PCTs) to leaders in the NHS Commissioning Board and NHS
Trust Development Authority. This would mean that they would take on “management
responsibility” for the delivery of NHS performance in 2012/13 from 1st October 2012, six
months before the abolition of PCTs and Strategic Health Authorities (SHAs). However it
had been said that PCTs and SHAs would still remain the legally accountable organisations
for delivery until their abolition.
JB said that she had been totally confused by this and that she and FB had contacted
Becky Parish (BP), Deputy Director, Public and Patient Engagement at NHS
Gloucestershire for clarification, particularly in light of the consultation on the future of
Community Health Services.
BP had replied that the changes did not affect the timetable for consideration of this in any
way and everything would go ahead as planned. She also said that all commissioning
responsibilities associated with Community Services would remain with NHS
Gloucestershire and other PCTs until they were transferred to the Clinical Commissioning
Groups.
JB said she was still a bit confused but pleased that the NHS Glos Board meeting as
reported earlier would still go ahead and hopefully be able to make a decision on the future
of Community Health Services.
FB said that he believed that the majority of Gloucestershire Care Services (GCS) Staff
were in favour of GCS being established as an NHS Trust and he felt that was what the
public wanted most. If that was the outcome of the consultation it was hoped that the Board
would support it and establish an NHS Trust without having to put the services out to tender.
DM said that we must hope that this goes ahead.
JB said that people shouldn’t be overly optimistic at this stage as the new Health Minister;
Jeremy Hunt may have other ideas.
JB then tabled a number of documents including the Annual Report and Financial
Statements from the Age Concern AGM which she and FB had attended, the
Gloucestershire LINkS Annual Report and the schedule for the GUIDE and PALS Bus which
would be on the Railway Drive car park in Coleford on Thursday 6th September.
JB told members that the 2gether Trust AGM would be held from 5:00 pm to 7:00 pm on
Thursday 20th September at Gloucester Docks. She said that anyone wishing to attend
should ring Anna Hilditch on 01452 894165.
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Also tabled were the Touched by MS newsletter and a brochure on GAVCA Training
Courses.
JB said that she had received the good news that the Helipad had re-opened at GRH. This
had been closed for two years while the multi storey car park was being built. It was then
discovered that the approach to the Helipad was difficult and a different set-up had to be
designed. Although it was welcomed that transfer times for critically ill and injured patients
would be reduced JB was concerned that short term parking space had been lost next to
A+E. She wondered where people bringing urgent cases to A+E would now be able to park
so as to be able to access A+E without delay.
Treasurer’s report: Doug Battersby (DB) said that the accounts had been audited by Tim
Fretter (TF) and found to be in order. He expressed his thanks to TF for his time and effort
in doing this. The balance at year ending 31st July 2012 was £711.79. This included a grant
of £200 from Cinderford Town Council for which a letter of appreciation had been sent. He
informed us that an application for funding from Coleford Town Council was in hand.
Members’ Reports: Tim Fretter (TF) said that the highly successful “Trim and Strim”
Project was being extended to Coleford. He explained that this was a project which
employed clients with learning difficulties to help to tidy the gardens of elderly and infirm
clients. It was supervised by an excellent gardener who was trained in adapting gardens to
meet the needs of the client group. TF said that there were opportunities for people in the
Coleford area to join the scheme both as clients and volunteers. Anyone interested should
contact FVAF direct on (01594) 822073 or email: contact@fvaf.org.uk
Clive Elsmore (CE) said that he was involved with a group looking at Community Transport
in the Forest. He said that it had been decided that Lydney Dial a Ride was to be called
Community Transport and would be offering services linking Chepstow, Symonds Yat and
Clearwell to the main Bus Network. He said that Newent Dial a Ride would be offering a
similar service to villages in the north of the Forest. This new service would be open to
anyone who wished to use it. The name change was an attempt to relaunch the service to a
new client group.
Speaker: JB introduced Les Trewin (LT) and Ted Quinn (TQ) from 2gether NHS
Foundation Trust. She said that she wasn’t quite sure what their responsibilities were other
than that LT was Director of Adult Mental Health at the Trust.
LT confirmed that this was true when the talk had been arranged but that, like the
Government, there had been a recent “cabinet reshuffle” at 2gether Trust. He said that most
of the operational responsibility was now shared between him and TQ. LT was Director of
County Wide Services, such as inpatient, crisis and intensive outreach services, and TQ
was Localities Director (Community Services and Entry Level Services, such as primary
mental health and managing memory services) which included all three sectors in the
Forest.
In response to a question from DM, LT said that Substance Misuse was currently subject to
tender and this would not be decided until early November.
LT then introduced the talk with the title “Fair Horizons - Services for Today and Tomorrow ”
and explained that this was based on a slide show which had been designed for GPs so
where references in it said “you” they should be seen as meaning GPs and not The Forum.
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LT went on to explain that much of the mental health service had previously been delivered
in silos and Fair Horizons was an attempt to get away from that and towards a more holistic
service which fitted around the individual. In coming to this point the Trust had looked to
build on already great examples of how they already delivered patient centred care added to
a desire to deliver even more equitable services and a desire to deliver even more
personalised services.
The principles behind Fair Horizons had been influenced by an independent inquiry into
access to healthcare for people with learning disabilities which was established under Sir
Jonathan Michael's leadership in May 2007, following the publication of the Mencap report
“Death by indifference”, which described the experiences of six people who died whilst
under the care of the NHS. The Disability Rights Commission Formal Investigation into
equal treatment had also raised questions about the quality of healthcare for people with
learning disabilities who were physically ill. This had been followed by the Government
guidance document “New Horizons: a shared vision for mental health” which had been
replaced by “No health without mental health: a cross-government mental health outcomes
strategy for people of all ages” which was published in February 2011.
TQ said that it was important to recognise that people didn’t always come to 2gether with
just one condition. He said that bringing together different disciplines conflicted with the
existing structures, as highlighted in Death by Indifference which pointed out the difficulties
in linking learning disability and mental health treatment. To get over this, there was a need
to adjust services to better enable multi-specialty working when required to meet the various
needs of the individual patient
Fair Horizons (FH) was a programme which was clinically conceived, driven and maintained
to provide inclusive, person centred and non-discriminatory healthcare and focus on an
individual’s needs rather than their age or IQ. By embracing national best practice it would
put the emphasis on quality, patient safety, prevention & patient experience. It was also
designed to be accessible to the community providing ‘one stop’ teams to meet the majority
of local needs. This would mean providing care and treatment closer to or at home with
direct access to specialist teams and inpatient services if needed. It would also provide
management systems for long term conditions with integrated, multi-disciplinary/specilaity
teams that work across the traditional boundaries of age and IQ.
LT said that in order to effectively deliver FH it was important to have an effective transition
policy. A patient could not be released into the new system without being formally accepted
by someone who would take responsibility for coordinating their treatment. In this regard,
2gether was ahead of the game in setting national best practice.
LT said that there were currently over 66 referral entry points into the Trust. The proposal
was to have one main telephone number providing one main place for GPs to direct new
referrals to adult secondary care, with direct referral to entry level and some tertiary services
There would also be supporting web based information and resources.
FH was designed on the basis of six entry level, direct referral services e.g. IAPT (the
Improving Access to Psychological Therapies programme) and Prison In-reach and would
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be characterised by information sharing, signposting and clinical consultation and advice
leading to accepting the referral. TQ said that the Trust in partnership with GPs needed to
move into cultural change where the Trust directed the referral to the correct team for
effective treatment without the need to involve the GP in a referral if their initial referral was
wrongly directed.
TQ said that the Criminal Justice Liaison Service was now operating Countywide.
FB said that he knew that people were coming to the attention of the Police who may have
mental health issues and asked how this was being dealt with.
LT said that there was a newly established136 Suite which provided a ‘place of safety’ for
vulnerable adults detained by the police under Section 136 of the Mental Health Act. This
was situated at Wotton Lawn, enabled assessment in a more appropriate environment than
the cells and was working well..
JL asked if the single number direct referral was available to the public.
TQ said that the contact centre number was only available to GPs and primary mental
Health Nurses at present and that the Trust was someway down the road in implementing
that.
JB said she had been trying to get a single number referral system for everything but found
that funding it had been an issue.
LT said that they wanted patients to be able to self refer but that was some way off.
FB asked what would happen if there was a Friday night crisis.
TQ said that once firmly established on a Monday to Friday basis the Trust would consider
opening at weekends but weren’t there yet. He said that calls are directed to the “crisis
team” and went on to say that a new Contact Centre would fully operational across the
county by November 2012 It is staffed by trained call handlers supported by senior
clinicians and would have direct access to consultant psychiatrists who may provide
telephone advise to GPs. It has supportive technology with secure access to electronic
records and provide real time clinical supervision and support.
Access to electronic booking for appointments would lead to increased choice and there
would be secure individual web-based care plans.
JL asked if there were problems with electronic records and TQ responded that there were
issues about the time taken to input data and navigate through the system. He said that the
system “RIO” was otherwise an improvement over paper based records, but that there were
fields which had to be filled in to meet national and local commissioner requirements and
that the Trust’s performance is measured on that information.
TQ said that services have been organised by locality leading to the development of close
working relationships with GPs who have access to a psychiatrist. He said that Clinical
Commissioning would lead to a better interface with GPs and that meeting each of the GP
practices was important to getting feed back and the development of better services. He
was hopeful that more involvement of GPs would lead to shared protocols and care
pathways. He said that the Forest of Dean GPs were good at working with the Trust at
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making sure that they were well informed on the status of patients being released into their
care.
DM asked about the future of Colliers Court and Coleford House.
TQ said that Colliers Court was being retained as the administrative hub for adult mental
health services in the Forest and that this will require development which will also include
consulting and clinic facilties. The future of Coleford House was largely dependent on
winning the tender for the provision of substance misuse services but it was clear that
2gether would require consulting rooms in Forest towns in order to deliver an efficient
service.
DM asked about the “Let’s Talk” programme.
LT said that this was currently delivered at Coleford House..
TM asked if they were sometimes driven by a financial need to discharge patients.
LT said that the timing of patient discharge wasn’t always just about health care alone and
they would try their best to ensure that appropriate support systems, perhaps provided by
other agencies, were in place before discharging a patient.
TQ said that patients were discharged because it was appropriate. Some needed more
support and other had phases of need.
LT admitted that sometimes they got it wrong and he recognised the need to improve in
some areas. Resources were difficult, as with everybody, and there was a constant
challenge to do more with less. He said that the message was that GPs, Care Services, the
Acute Trust, 2gether and the Voluntary Sector all needed to work together to deliver an
integrated service.
JB said that that was a good message on which to end and thanked LT and TQ for their
contributions.
AOB: There were no items of AOB
Next meeting: JB said that the next meeting would be the AGM on Tuesday 6th October
and encouraged members to consider joining the Committee.
The next Ordinary Meeting would be held on Tuesday 6th November.
Speaker: JB said that she was hoping that it would be possible to have speakers who could
tell us more about Clinical Commissioning and the results of the PCT Board decision on
Gloucestershire Care Services
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