Shaping the Future for
Better Care Event
Friday 17th October 2014
Blackpool Enterprise Centre
Lytham Road
Blackpool
FY4 1EW
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On Friday 17th October 2014, Healthwatch Blackpool, in partnership with Blackpool Clinical
Commissioning Group, held their latest Open Event at the Imperial Hotel, North Promenade,
Blackpool FY1 2HB. The ‘Shaping Better Care’ event was attended by over sixty members
of the public. Mr Roy Fisher, Chair of Blackpool Clinical Commissioning Group welcomed
everyone to the event. It was explained that after each presentation, two questions would be
asked and attendees could vote using the voting pads that were available on their table. The
results are included below.
The first presentation was on End of Life Care. This was given by Dr Laura Edwards,
Community Consultant in Palliative Medicine at Trinity Hospice and Palliative Care Services;
and Lorraine Tymen, End of Life Facilitator at Blackpool Teaching Hospitals NHS Foundation
Trust. The presentation included an explanation of why the Liverpool Care Pathway had
been discontinued and how it was hoped good End of Life Care would be delivered in the
future and how it would aim to ensure the best possible care for dying people. The care
would be individualised and health professionals would work together, communicating
effectively, taking into account psychological and spiritual needs ensuring dignity and respect
at all times.
Q1 – Do you understand the local changes to End of Life Care? (multiple choice)
Yes
No
Not sure
Totals
2.3%
36
1
6
43
Responses
83.72%
2.33%
13.95%
100.00%
14%
83.7%
Yes
No
Not sure
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Q2 – Do you think this will improve the quality of care for people at End of Life? (multiple
choice)
Yes, definitely
Yes, Probably
Not Sure
No, not really
No, definitely not
Need more information to decide
Totals
0%
23.8%
11
18
3
0
0
10
42
Responses
26.19%
42.86%
7.14%
0%
0%
23.81%
100%
26.2%
0%
42.9%
7.1%
Yes, definitely
Yes, probably
Not sure
No, not really
No, definitely not
Need more information to decide
The second presentation was by Dr Mark Johnson, Associate Director of Acute
Commissioning and Service Redesign from Blackpool Clinical Commissioning
Group (CCG). He outlined how Blackpool CCG would work with Blackpool Council and the
Better Care Fund to achieve a 5 year strategic Health Care Plan to ensure better co-ordinated
care and the integration of services.
Q3 – Do you agree with our plans? (multiple choice)
Yes, fully
Yes, in parts
Not sure
No, not really
No, not at all
I’m still not sure what the priorities are?
Totals
10
12
8
0
0
6
36
Responses
27.88%
33.33%
22.22%
0%
0%
16.67%
100%
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0% 16.7%
27.8%
0%
33.3%
22.2%
Yes, fully
Yes, in parts
Not sure
No, not really
No, not at all
I’m still not sure what the priorities are?
Q4 – Do you have a better understanding of our plans now? (multiple choice)
Yes
No
Not sure
Totals
2.6%
32
1
6
39
Responses
82.05%
2.56%
15.38%
100%
15.4%
82%
Yes
No
Not sure
The third presentation, ‘Know Your Number’, was from Jeannie Hayhurst, Clinical Project
Manager for Blackpool CCG. The ‘Know Your Number’ Campaign is an initiative that was
undertaken in Blackpool so people could get involved in their own health and wellbeing, by
knowing what their blood pressure is. The campaign is designed to help prevent heart
attacks, strokes and hypertension. Blackpool has a high rate of people dying from heart
disease and stroke.
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The fourth presentation was from Nick Gradwell, “Nick’s Story was a presentation on the
importance of Eye Awareness and having eye checks regularly. Nick lost his sight at an early
age and talked about his experiences and some of the challenges he faces on a daily basis.
Q5 – Were you aware that we had eye awareness week from 22 September – 28 September
(multiple choice)
Yes
No
Totals
10
34
44
Responses
22.73%
77.27%
100%
22.7%
77.3%
Yes
No
Q6 – If yes, did you or any of your family/friends have (or have arranged) an eye test as a
result? (multiple choice)
Yes
No
Don’t know
Totals
3
11
3
17
17.6%
Responses
17.65%
64.71%
17.65%
100%
17.6%
64.7%
Yes
No
Don’t know
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After lunch the fifth Presentation was from Booking and Choice Manager Jackie Heardman
from Blackpool CCG. Jackie talked about patient choice within the NHS and how certain
individual people influence patient choice. The “Choose and Book” system is a national
electronic system, used by patients in all areas of the county, not just Blackpool, helping
patients choose and book their care.
Q7 – Did you know much about “patient choice” before you saw the presentation today?
(multiple choice)
Yes
No
Totals
Responses
56.41%
43.59%
100%
22
17
39
43.6%
56.4%
Yes
No
Q8 – Do you feel you got enough information about patient choice from today’s session?
(multiple choice)
Yes, lots
Yes, some
Yes, A little
No, not really
Still unclear about patient choice
Totals
10
9
11
5
5
40
Responses
25%
22.50%
27.50%
12.50%
12.50%
100%
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12.5%
12.5%
25%
27.5%
22.5%
Yes, lots
Yes, some
Yes, a little
No, not really
Still unclear about patient choice
A question and answer session followed with a panel of representatives; consisting of:Roy Fisher, Blackpool Clinical Commissioning Group; Gary Doherty, Chief Executive Officer,
Blackpool Teaching Hospitals NHS Foundation Trust; Dr Amanda Doyle OBE, Chief Clinical
Officer, Blackpool Clinical Commissioning Group; Professor Heather Tierney-Moore, Chief
Executive, Lancashire Care Foundation Trust; Gordon Marsden, MP Blackpool South; David
Rigby, Sector Manager for Fylde Coast, North West Ambulance Service.
Please find below the questions asked and the responses given.
What further steps can the Health
Service and other services in
Blackpool take to reduce the
alcohol issues in the town? I would
like to see pressure from Blackpool
CCG and the Health & Well-being
Board in Blackpool towards the
alcohol industry, aimed at the
Government, to reduce licensing
times and look at the price per unit
cost of alcohol. What are your
views?
Roy Fisher said the Health &Wellbeing Board and
Public Health are working hard to address the issue.
Dr Amanda Doyle said she recognises that this is a
massive problem that leads to long term health
issues, such as high blood pressure and sclerosis of
the liver, which then becomes a drain on resources.
In the short term, Blackpool gets a lot of visitors as
well as locals who have issues with alcohol. This is
an acute problem; the pubs and clubs are open late
and alcohol is readily available. As a short term
solution, the introduction of the Night Safe Scheme
into the town that is manned by trained Nurses who
monitor any person admitted to them under the
influence of alcohol until they are well enough to go
home. On the longer term, some GP’s are asking
about patient’s alcohol intake and advising them
accordingly. The CCG has also funded Alcohol
Liaison Nurses. These Nurses help to signpost
individuals into these services, thus people with
alcohol issues should not spend as much time in
hospital. This is becoming a huge financial burden.
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Gordon Marsden said alcohol is such a huge
problem both long and short term. He would like to
see a more pro-active approach by having alcohol
education in schools, colleges, and youth clubs with
a positive Role Model distributing the knowledge and
positive peer pressure. There should be a pro-active
link with Public Health and the Licensing Board
within the town. It has been observed that people
often come into Blackpool whether it is by bus or
train having already had a considerable amount to
drink. Maybe we could work with the British
Transport Police to address this? We need to reduce
the minority of the visitors coming to the town who
drink and work towards social things being done.
Heather Tierney Moore reported that two Public
Health Consultants had been appointed who were
leading a programme to train all clinical staff to
advise on alcohol, smoking, sexual and mental
health issues when in contact with such patients
and thus signpost them to the support services.
Gary Doherty also stated that the Blackpool
Alcohol Liaison Nurses; are engaging service users
in Lifestyle Changes; they were offering a friendly,
informal and pragmatic approach. They are doing a
lot of work with families and forming partnerships.
The work they are doing is based on an American
model, being involved with families who have
children under two years old primarily working
through issues and challenges. There is a lot of
work going on in Blackpool surrounding alcohol
issues that the people of Blackpool should be proud
of.
If it comes to it, what steps will the
Blackpool CCG take to contain
Ebola?
Dr Amanda Doyle said to keep things in
perspective. The disease is spreading in countries
such as Sierra Leone where their sanitation,
hygiene, and education is not the same as it is in
Western countries, but they are taking measures to
contain it. Gordon Marsden stated it is a very
serious issue in the African Sub Continent. There is
a Glaxo system in Texas being looked at for the
treatment of Ebola, but that will not be ready for at
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least two years. We can only do what we are doing
as an immediate measure which is to send out our
British Troops to help educate and re-construct their
healthcare system and help their healthcare
workers. Gordon Marsden said that Blackpool
Victoria Hospital does have isolation units if the
Ebola virus should become airborne, which it is not
at the moment. Patients and Staff at the hospital had
been asked if they were worried. Whilst they were
not worried, they would not become complacent
either and the feeling was they were far more
worried about seasonal flu and encouraging people
to take up the offer of flu jabs.
This is a politically motivated question.
As we are a country that is creeping
towards privatisation, what are the
risks of more privatisation if a Labour
Government is elected and the
Transatlantic Trade and Investment
Partnership goes through between the
European Union and the United
States.
Gordon Marsden said the Transatlantic Trade and
Investment Partnership is a very complicated issue
especially between the International Growth Trade
and the America Health Care system. This has
resulted in the Government being sued and trade
being restrained, and the NHS should not be
included in Transatlantic Trade and Investment
Partnership. It is a live issue going through the
Private Sector. The NHS blocked its Quasi
competitive issues, in the best interests of the
patients and services as a whole.
Why is nothing being done about the
amount of drinking that is going on in
Blackpool The majority of drinking is
not going on in pubs and clubs it is
taking place at home or on the streets
and the majority of street drinkers are
young girls.
Roy Fisher said that the council had introduced
initiatives to combat the drinking. They had tried to
put a stop to two for one deals and happy hours and
had introduced a scheme to encourage drinking one
alcoholic drink then having a soft drink in between.
Dave Rigby said people pre-loading at home on
cheap alcohol before they came into the town centre
were a big issue of concern. Booze is still very
cheap and drinking establishments are still open
very late. North West Ambulance Service (NWAS)
are taking a pro-active approach in Blackpool,
encouraging the Night Safe scheme, using it as a
point for education and encouraging individuals to
take responsibility for their own actions. NWAS is
working in conjunction with Public Health on this
matter.
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What is a typical working week for a
GP in Blackpool? How many days?
Dr Amanda Doyle said there is no typical working
week as such, morning surgery consists of about 3.5
hours, then there would be chasing up of blood
results and doing some paperwork, followed by
Home Visits. After that there would be afternoon
surgery, more paperwork and then late evening
appointments, working 5 days a week.
If a patient in Blackpool needs
National Institute for Clinical
Excellence (NICE) approved
treatment in another area of the
country, say Sheffield or
Manchester and the consultant in
charge deemed it necessary for the
treatment to go ahead, can
transport costs and financial help
be received through Blackpool
CCG?
Dr Amanda Doyle said if you attend Blackpool
Victoria Hospital and the consultant thought the
patient needed specialist treatment elsewhere, as
long as it was a recognised treatment, the cost
would be met by Blackpool CCG.
I have been taking the same
medication or some time, since
2004. I feel that the standard and
strength of the medication has
declined. If a cheaper alternative is
being manufactured and distributed
is this not false economy?
Dr Amanda Doyle said this is a complicated issue.
Over time, the same drug may not work as
effectively on the same patient, that is why they are
reviewed and changed. Gordon Marsden had a
personal observation which was that generic
prescribing is becoming more common.
Governments have realised that they need the best
value for money under the NHS when it comes to
finding more complex drugs. Therefore the NHS
drug bill shot up. Gary Doherty asked had if the
asker of the question had informed his/her GP that
the drug was no longer working effectively. Different
pharmacies in Blackpool supply different brand
names of the same drug. When a drug is first
invented, the drug is patented by that company and
no one else is allowed to supply it. During this time
the drug company is charging more for the drug to
plough back the profits, as it would have cost a lot of
money to first produce it. When the patent for that
drug comes to an end, other companies are allowed
to manufacture the drug but the drug will still have
the same active ingredients as the original patented
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one.
At BVH why is there not a specialist
Multiple Sclerosis (MS) Nurse?
There are so many people
diagnosed by the Neurologist’s at
the BVH but there is no specialist
MS nurse.
Gary Doherty stated that he would check the
national standards and statistics for this and that it
had not sob eeen far flagged up on any inspection at
the Blackpool Victoria Hospital. Dr Amanda Doyle
stated that Blackpool Teaching Hospitals does not
provide a Neurologist Service.
If someone with a mental health
condition suffers deterioration and
the situation with that individual
escalates and reaches crisis point,
why is it taking up to 4 hours for
them to be seen and sectioned
where necessary? This service
used to be sorted out within an
hour of a call taking place.
Dave Rigby reported that there are strict time
frames for a patient in crisis. Patients are dealt with
between the guidelines of 20 minutes, 1 hour and
between 1 and 4 hours to hit the targets. He went on
to say that they were looking at the possibility of a
dedicated service vehicle, but that would depend on
funding. Also, he would be happy to answer further
questions and give details of the protocols involved
at a later date. Heather Tierney Moore added that
The Harbour will have a 136 suite in addition to the
beds for Adult, Older Adult, Specialist Dementia and
Intensive Care. The 136 suite allows people to be
brought straight to the hospital for assessment
rather than A&E and the flow of patients through the
system will be dramatically improved. Overall,
patient flow has already been improved resulting in
fewer patients waiting for beds or being placed out
of the area. Only 2 people were currently in ‘out of
area’ beds across the whole of Lancashire.
How does Blackpool CCG assure
quality of service to patients when
they use the ‘Choose and Book’
service. Also, if a patient access a
service in another area at another
hospital is their local CCG’s
responsible for the quality of
service? Also, if somebody wanted
to complain about the service they
received, would by complain to the
CCG of the area they received the
treatment in or the Blackpool CCG?
Dr Amanda Doyle The local CCG takes
responsibility for their quality. There is an Associate
Commissioner to Contractors at other hospitals. If
the person wishing to complain was a resident within
Blackpool, but received the service elsewhere, they
should also complain to the Blackpool Clinical
Commissioning Group.
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In Blackpool we tend to help lonely,
bereaved and depressed individuals
from all over the country and take
them under our wing. What help is
available to help these people and
families? Where do the budgets
come from to provide these
resources? Where is the
integration of services to educate
families if we are going to go own
the preventative measure route,
when will this happen?
Gordon Marsden said that the Holden Commission
had published a report and it outlined the issues
surrounding Integrated Health and Social Care
services. He said that Blackpool was
demographically different from other areas of the
country in that it had a large proportion of young
people and a large proportion of older people and
that there was increased pressure on services.
When people move to within the area and then one
partner dies, it puts pressure on the services. It
would be nice not to issue pills to help but
encourage people to get involved in the Voluntary
Sector and signpost people to groups that could
help. There are local organisations such as the
Blackpool, Wyre & Fylde Council for Voluntary
Service that could help, but that they are struggling
under financial constraints. A move towards
Integrated Health and Social Care was needed
involving voluntary groups within the structure. Dr
Amanda Doyle said that they are working under the
Neighbourhood Model where, when anything
happens the GP is still the person people go to. The
move should be towards the GP surgeries giving out
Voluntary Group details and getting the knowledge
of these groups out into the community.
When someone has an underlying
medical condition and also suffers
from a complex condition too, if
they are taken to hospital with an
unrelated matter, how will the
complex medical condition and the
underlying health condition be
picked up and known about? So in
effect, how would you deal with the
acute immediate issue without
knowing about the underlying
ones?
Gary Doherty said that it is all to do with expertise
and knowledge. They would talk to families and
communicate better with them. Heather Tierney
Moore said that it was about sharing records
between the patient and the carer. Within the
National Technology Fund and the LPRES, certain
information is allowed to be shared. Dr Amanda
Doyle said that all GP surgeries work from the same
computer system. A&E staff can look up GP records
if necessary Consent may not be needed if the
patient themself is not well enough to give it as an
overriding decision can be made. Also, NWAS has
access to the computer system. Dave Rigby said
that there is an Acute Visitor Service (AVS) running
in Blackpool. This involves a Community Care Plan
and a direct link with a doctor 24/7. The patient stays
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at home and is treated safely. At present, within
Blackpool, Wyre and Fylde, there is a 70% to 80%
success rate of patients not being re-admitted to
hospital within 30 days?
Why do MS carers have so little
time between calls/visits? They
work long hours for very poor pay, I
am very concerned for these
hardworking girls.
Gordon Marsden said that there have been cuts in
social care making the time allowed for calls tighter.
On the whole as a country we need to raise the skills
levels with the Care Service who in return should get
proper re-numeration.
Preston and Chorley Hospitals
Gary Doherty said BTHFT are running things such
display a Gold Award for integrating as the Butterfly Scheme, issuing Memory Packs and
Dementia Care into their wards,
using liaison services.
becoming more dementia friendly.
How is BVH embracing this?
Why are the bus drivers, who
operate services at BTHFT, not
informing passengers where to get
off to access certain services? Can
this be addressed?
Gary Doherty said that if the hospital was to be built
now it would have a totally different layout and it
would be more compact, and that there were always
navigators available.
How much did the new entrance to
the BTHFT cost and why all the
glass?
Gary Doherty said the cost was £5 million for the
new entrance. The money for it was borrowed from
the National Foundation Trust which is a financial
facility. The shops within the area at the Blackpool
Teaching Hospital Foundation Trust namely, Costa,
WH Smith, and M&S pay rent. That money goes to
re-pay the loan. The glass allows natural light into
the area.
It does not appear that any thought
was given to the location of the Eye
Clinic in relation to the Pharmacy or
the Car Park.
Gary Doherty asked for ideas regarding this subject
to be submitted to him with regard to site
development and car parking.
When wanting to cancel an
appointment with a GP surgery,
why can there not be an answer
phone service that stops people
waiting in the queue for the actual
Dr Amanda Doyle said that this was not a problem
at Bloomfield and that there was a system in place
there. This could be looked into.
Page 13 of 15
GP appointment be utilised? A
patient is more likely to just hang
up and not cancel the appointment
if they have to wait in a telephone
queue.
Is it not possible to build alcoves on Gary Doherty said that this is a busy corridor and
the corridor to rest when going to
that the task would be costly. Maybe look into the
and from Outpatients?
prospect of having folding chairs at the bottom of the
stairways.
It is possible to catch a bus from
the main entrance to outpatients
but not a return one - why?
This question will be asked at the Healthy Transport
Group which Healthwatch Blackpool attends.
The 5 year commissioning plans
seemed to deal mainly with the
needs of the elderly population.
There was little mention of mental
health issues and their lack of
parity with physical health.
Blackpool CCG are working with all providers to
implement parity of esteem on mental and physical
health. This is intrinsically linked to mainstream
services where they need to ensure that they are
skilled in working with patients with mental health
and other problems. We are keen to ensure that we
begin to monitor this through our contractual
processes. We will look to develop specific outcome
measures to enhance monitoring.
As a member of the CCG, who is
planning the 5 year plan, what work
is being done towards the approach
of mainstreaming Eye Health, given
that it ties so many of the CCG
priorities?
Blackpool CCG has invested in a variety of public
awareness raising materials, which have been
disseminated to Blackpool GP practices, voluntary
services and public places, in order to raise
awareness of the importance of looking after your
eye health and how it may link in with many other
priority long-term conditions.
When will Eye Health be placed on
the Joint Strategic Needs
Assessment (JSNA) document for
Blackpool, Wyre and Fylde?
The Public Health team are incorporating
information into the JSNA currently related to eye
health. Representatives of Public Health at
Blackpool Council met with Action for Blind People
in July 2014. It was discussed what intelligence
could be provided in order that more comprehensive
local information could be available on eye health in
the JSNA. Unfortunately, Action for Blind People
have not yet responded to Blackpool Council, in
Page 14 of 15
order to progress this further.
Blackpool Council are happy to work with national
and local voluntary sector organisations in order to
include greater intelligence on specific conditions in
the JSNA. The expectation however, is that the
owners of the information would work closely with
Blackpool Council, to ensure that what is included is
robust and relevant to Blackpool.
Lancashire County Council has sections on visual
impairment in their JSNA. The excel system
downloads include stats for Blackpool as well as
Fylde and Wyre and so can be used by Blackpool
CCG until Blackpool Council incorporate sections on
this in their own JSNA.
http://www.lancashire.gov.uk/corporate/web/?siteid=
pageid=35900&e=e
Why are GP’s still not referring
people to Ophthalmology?
It is envisaged that this local campaign around eye
health will encourage this, but the topic will also be
raised at the local health professional forums, Nurse
Lead Forum, GP link meeting and Practice
Managers Forum as necessary.
What can be done to encourage
GP’s to be more aware of Eye
Health and the referral pathway
when people present with eye
problems,
Blackpool CCG have raised awareness with GPs
recently, by sending information to each GP practice
on eye health awareness and including more
information on the GP newsletter and CCG website.
Awareness has also been raised with the CCG GP
leads who have links to all the practices.
Referral pathways are in place locally, but Blackpool
CCG will continue to monitor these.
In addition, GP practices have details of high street
Optometrists, who also provide the management of
eye conditions in a primary care setting
The event ended with a quiz, a raffle and a big thank you to everyone for attending.
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