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Monthly bulletin for volunteers and partners

February 2017

We can’t do this without you!

Welcome to the month 2017 edition of Healthwatch York’s regular monthly bulletins

for volunteers and Partner Programme organisations.

Please let us have your feedback on this bulletin – what’s useful to you and what

isn’t. If you have any ideas of what else should be included, do tell us. You can e

mail us: [email protected] or phone us on 01904 621133.

February at Healthwatch York

Three Healthwatch York reports were finalised this month: Making York work

for people with dementia; Continuing Healthcare; Support services for adults

with ADHD. These reports will be published and presented to the Health and

Wellbeing Board on 8th March.

Our 2017-18 work plan survey is open until Monday 6th March. It can be

completed online: https://www.surveymonkey.co.uk/r/OurWork2017

or pick up a copy from the office.

Please spread the word and make sure you complete the survey yourself!

Healthwatch York’s leadership group met on February 16th. A summary report

from the meeting is included in the reports section at the end of this bulletin.

Hello’s and goodbyes – In February we welcomed 2 new volunteer community

champions: Amy Creedon and Anna Perrett. We also said goodbye and a big

thank you to volunteer Gill Wadsworth.

We’d like to remind all our volunteers who go to meetings as Healthwatch York

representatives to let us have reports of the meetings. The reports are

included in our monthly bulletin so we can share information as widely as

possible and let people who can’t go to the meetings know what’s happening.

mailto:[email protected]

https://www.surveymonkey.co.uk/r/OurWork2017

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Healthwatch York volunteers - don’t forget it’s our Volunteer Development Day

on Tuesday 7th March 10.00am til 3.00pm. We will be providing lunch so

please let us know if you can come.

Local health and social care news

Be Independent invite you to the launch of their new partnerships with 3rings

and York Home Physiotherapists.

Be Independent helps people live more independently whilst providing peace

of mind for their family, friends and carers.

This event will showcase their new services and is an opportunity to hear more

about how Be Independent is extending their reach to help more people live

independently.

The event will be held on Monday 6 March 2017 from 11.00am -12.30pm at

York CVS, 15 Priory Street, York, YO1 6ET

To book your place at the event e mail: [email protected] or ring

07739827108 by Friday 3 March 2017.

It has been estimated that around 20% of patients consult their GP for what is

primarily a social concern. Social prescribing provides GPs with an alternative

referral service when working with people who require health and wellbeing

support, but whose needs are non-medical. In York the pilot scheme is known

as Ways to Wellbeing. In a recent evaluation 80% of Ways to Wellbeing

customers reported a greater sense of wellbeing and 75% reported improved

confidence. More information and statistics about the project and its benefits

are available in this leaflet: http://www.yorkcvs.org.uk/wp-

content/uploads/2016/07/York-CVS_Ways-to-Wellbeing-leaflet_2017-002.pdf

Paper copies of the leaflet are available from York CVS at the Priory Street

Centre

The York MS Society knows that there are lots of organisations in York which have mini buses that stand unused at times in the week (including the MS Society) and there are other organisations who would love to use these mini buses. York MS Society are working with York CVS and Healthwatch York to organise a meeting on Monday 6 March at 2.30pm in the Denham Room at Priory Street Centre to explore the options to make the most of York’s resources and find a better way for community transport to work for everyone – saving money and sharing resources. Gary Young from Leeds Alternative


http://www.yorkcvs.org.uk/wp-content/uploads/2016/07/York-CVS_Ways-to-Wellbeing-leaflet_2017-002.pdf

http://www.yorkcvs.org.uk/wp-content/uploads/2016/07/York-CVS_Ways-to-Wellbeing-leaflet_2017-002.pdf

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Travel will talk through some of the options from his experience of setting up community transport schemes in other areas and there will be time to talk about what might work for York and to see what you think. All are welcome. Please let Ruth Stockdale ([email protected] or 0208 827 0222) know if you are interested and if you can make the meeting on 6 March.

York MS Society want to find out whether there is a demand for toning tables in York. Toning tables and chairs are an assistive means of physical activity. You sit or lie on them and they move you to give you a full body work out. The equipment can be used by any adults, including athletes and wheelchair users and helps you to exercise all your muscles without any need for sweat or lycra! You can complete the MS Society’s toning tables survey here: https://www.surveymonkey.co.uk/r/2V7GTW2

York Parent Carer Forum (YPCF) are holding an information session for parents and carers in conjunction with York Carers Centre on Wednesday 22nd March 11.00 -2.30pm at New Earswick Folk Hall. There will be representatives from a range of organisations including York Carers Centre, YPCF, Family Fund, SENDIASS (Special Educational Needs and Disability Information Advice and Support Service), Core Assets and Healthwatch York.

Be Independent’s new private Occupational Therapy assessments are now available and there is already a great demand for the service. We can offer quick access to professional advice from a Senior Occupational Therapist. Advice can also be obtained free from your local authority occupational therapist but there is often a waiting list for their service. Equipment can assist in many areas e.g. toileting, bathing, property access, stair climbing, kitchen tasks and much more. The assessments will take place in the customer’s home and will likely result in recommendations and prices for equipment that will support the person to minimise risk and increase their independence. The cost of an assessment is £89 for people living within the City of York Council boundary area and £99 outside of that area. www.beindependent.org.uk

CHANGE are hosting a review event for the Accessible Information Standard

on behalf of NHS England to give people with learning disabilities a different

way to share their experiences. The event is on Thursday 2nd March 2017

11am-3pm at 4th Floor, Calls Landing, 36-38 The Calls, Leeds LS2 7EW.

Lunch will be provided and reasonable travel costs can be reimbursed. If you

can't attend the event you can complete a questionnaire which is open until

10th March: https://www.england.nhs.uk/ourwork/accessibleinfo/

York and Selby Children’s and Adolescent Mental Health Services (CAMHS).

Moved to a ‘Single Point of Access’ at the end of January 2017. Following the


https://www.surveymonkey.co.uk/r/2V7GTW2

http://www.beindependent.org.uk/

https://www.england.nhs.uk/ourwork/accessibleinfo/

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launch they would like to invite partner agencies/colleagues, parents and

carers to a collaboration day to discuss the operation of this new service and

welcome your feedback. The day will also include an update on information

about SPA processes and updates other initiatives- such as wellbeing worker

service.

The event will take place on Thursday 9th March at York Sports Club, Shipton

Road, 9.30am until 2.30pm. Lunch will be provided. Please confirm your

attendance to [email protected] or ring 01904 615300 by 2nd

March.

CAMHS advice and referrals can now be accepted by the following routes:

1) Clinical advice via 01904 615345. Mon- Fri 9am to 5pm 2) Electronic referral letter [email protected]

(from secure email addresses only – i.e. GSX or NHS mail)

3) Postal referrals to be received at Limetrees, 31 Shipton Road, Clifton, York Y030 5RE.

Please note that urgent referrals and advice are also available via 01904

615345 Mon-Fri- 9am – 5pm. ‘Out of hours’ advice remains unchanged via

local hospitals and GP after hours services.

Researchers at the Norah Fry Centre for Disability Studies, University of

Bristol are currently completing research to explore hospital provisions of

reasonable adjustments for disabled people. As part of the project they are

providing workshops focused on exploring the current provision of reasonable

adjustments for disabled people by hospital services. A workshop will be held

at The Village Hotel Club, Village Leeds North, Otley Road, Headingley, LS16

5PR on Wednesday 5th April, 2017, from 10am - 4pm. For more information

about the workshop and registration, see the following link:

https://www.eventbrite.com/e/the-provision-of-reasonable-adjustments-for-

disabled-people-by-hospital-services-getting-things-tickets-31494052559

The workshop is free to attend, and is open to disabled people, health

professionals, and health representatives (such as Healthwatch). If you have

any questions about the workshop, please contact Dr Stuart Read:

[email protected]; 0117 331 0471.



https://www.eventbrite.com/e/the-provision-of-reasonable-adjustments-for-disabled-people-by-hospital-services-getting-things-tickets-31494052559

https://www.eventbrite.com/e/the-provision-of-reasonable-adjustments-for-disabled-people-by-hospital-services-getting-things-tickets-31494052559


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CQC Reports

ASC

Bluebird Care – Good

http://www.cqc.org.uk/location/1-2022229649

Holgate House – Requires Improvement


Garrow House - Good


Hospital

Yorkshire Ambulance Service – Good overall

http://www.cqc.org.uk/provider/RX8

Safe Effective Caring Responsive Well-led Overall

Emergency operations centre (EOC)

Good Not

applicable Not

applicable

Not applicable

Good Good

Emergency and urgent care

Good Good Not

applicable Good Good Good

Patient transport services (PTS)

Requires improvement

Good Not

applicable Requires

improvement Requires

improvement Requires

improvement

Resilience planning

Good Outstanding Not

applicable Not

applicable Good Good

111 service Good Good Good Good Good Good

Trust Overall Good Good Not

applicable

Good Good Good

(Those areas marked as not applicable were not inspected as part of this inspection as they were rated Good in 2015.)

National health and social care news

The CQC have now completed their programme of inspecting all adult social

care services and GP practices in England that were registered before 1

October 2014. In total, including inspections which have been carried out in

response to risk, the CQC have carried out over 30,000 inspections across

adult social care services and over 8,000 inspections within GP practices.




http://www.cqc.org.uk/provider/RX8

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Information about their findings is available in the 2015/16 State of Care

report: http://www.cqc.org.uk/content/state-of-care

Summary and easy read versions are also available. Contact the Healthwatch

York office if you would like a paper version.

Public Health England (PHE) wants all hospitals to offer people help to quit

smoking as part of patients' treatment. A recent report by the British Thoracic

Society was based on 14,750 patient records submitted from 146 institutions

across the UK. Results included:

o 25% of hospital patients were recorded as being "current smokers"

o Only one in 10 hospitals enforces a smoking ban outside health service

buildings,

o More than a million smokers are admitted to NHS hospitals every year.

o One in 13 patients who smoke were referred to a hospital or smoking cessation service in the community

o One in 16 institutions completely enforce smoke-free grounds o More than one in four patients were not asked if they smoke o Nearly three out of four smokers were not asked if they would like to quit

smoking o 50% of frontline healthcare staff in hospitals were not offered training in

smoking cessation

The report said there was "much to do to improve smoking cessation

treatment for patients in hospitals across the UK". It called for support for

smokers in hospital by referring them to specialised help to quit, improving the

prescription of nicotine replacement therapy, and investing in staff across all

hospitals dedicated to helping people stop smoking.

With increased pressure on NHS services across the country, pharmacists have a vital role to play in helping people manage their health.

Research commissioned by Healthwatch England found that the general

public are very open to visiting pharmacists instead of GPs. More than half of the people polled said they would see their pharmacist instead of their doctor

for advice regarding a specific minor illness or injury. However, not everyone knows about the services and support pharmacies can provide. This includes:

o support with minor ailments – including coughs, colds, aches and pains

o help with your medication – pharmacists are experts in how to use medicines safely

http://www.cqc.org.uk/content/state-of-care

https://www.brit-thoracic.org.uk/document-library/audit-and-quality-improvement/audit-reports/bts-smoking-cessation-audit-report-2016/

https://www.brit-thoracic.org.uk/document-library/audit-and-quality-improvement/audit-reports/bts-smoking-cessation-audit-report-2016/

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o repeat prescriptions – your pharmacist can manage your repeat

prescriptions for you o help to live a healthy life –your pharmacy can help you eat more

healthily, lose weight, and stop smoking

What do you think of your local pharmacy services? If you've got an

experience of a local pharmacy you would like to share, contact Healthwatch York!

The Jo Cox Commission on Loneliness is working to address the impact loneliness has on so many different sections of society. Focusing on the positive action we can all take to recognise it, build connections and help ourselves and/or others. Loneliness can affect anyone at any stage of their life. It can affect people of all ages and from all backgrounds - from the bullied school child, to the new mother, to the pensioner who has outlived her friends and immediate family. Feeling lonely becomes a major problem when people are overwhelmed by it

– when it is chronic - and can’t, for many reasons, act to tackle it. Details of the

scheme can be found here https://www.jocoxloneliness.org/

Key dates for March 2017

CCG Governing Body Meeting, March 2nd, 10am, Memorial Hall, Potter

Hall, Pickering

York MS Society community transport meeting, March 6th, 2.30pm, Priory

Street Centre

Healthwatch York Volunteer Development Day, March 7th, 10am – 3pm,

Priory Street Centre

Health and Wellbeing Board, March 8th, 4.30pm – 6.30pm, West Offices

Looking ahead to April:

Healthwatch York Leadership Group meeting, April 10th, 4pm-6pm, Priory

Street Centre

Healthwatch York Assembly, April 25th, 2pm-4pm, Priory Street Centre

Here are the details of the community venues and events where Healthwatch York will have information stands during next month. Please can volunteers who are doing these stands check the dates and contact the office if there are any problems or questions. If for any reason you are unable to do an information stand, please let

https://www.jocoxloneliness.org/

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the office team know as soon as possible so we can try and get someone to take your place. If we can’t hold a planned information stand it’s really important we let the venue know so we can maintain our positive working relationships with them.

01-Mar Lidgett Grove Community Cafe Fiona

06-Mar Sainsbury's Monks Cross Jackie, John

08-Mar NELLI café Chris H, Jackie

13-Mar West Offices foyer David, Maddy, Priscilla

15-Mar Fulford Church Judith

17-Mar St Sampson's Fiona

21-Mar Oaken Grove Community café To be arranged

22-Mar Parents & carers info session, York Parent

Carer Forum

Jackie, Fiona, Jane

28-Mar Spurriergate Centre Chris H (10-12), John

Meeting reports

Healthwatch York staff and volunteer representatives attend a variety of meetings every month. These are the reports from some of the meetings held since our last bulletin. There is a ‘jargon buster’ at the end of this bulletin to help explain some of the abbreviations and acronyms in the reports.

Name of Representative: Chris Hodgson

Title of the meeting: Autism strategy group meeting

Date of meeting: 26 January

Date of next meeting:

Purpose of the meeting (please give short summary):

Looking at the government green paper Improving Lives

Attended by Lance Racey (leading the group); Blueberry academy Learning and

Work Advisor Ruth Hobson; City of York Council social care manager; student social

worker; Healthwatch York Christine Hodgson

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Main areas of discussion: The meeting was about action plans implemented for employment, there are not

enough people in employment with Autism spectrum disorder and mental health.

Central information

Healthwatch York to be involved to link autism and mental health. Autism awareness

training for human resources and companies, holistic approach, crediting people in

roles of expertise who support people with autism.

New ways of working

Buddy system, buddy pals in employment (someone to talk to), supported

employment providers, think outside of the box.

World Autism day is 2nd April. Lance suggested Healthwatch York could organise

an event to support Autism.

There is a hub at Energise Cornlands Road decorated in Autism friendly colours,

access through the learning disability team.

People who are in the Support group should have stimulation and be kept occupied

for self worth and confidence. Should have meaningful activities.

Job Coaches

One on one. Most people shy away from people with Autism, shops need more

autism awareness training, if they have an issue they just call the police.

Challenge the fund approach

It was suggested we have Autism Villages for people with Autism, Drop in centre for

Autistic Spectrum disorders so that they can get information and support an Autism

friendly environment

The next meeting is at United Response.

Follow up/actions for Healthwatch York (Anything HWY needs to respond to?): Do you feel that this meeting was useful?

Yes No

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Name of Representative: Siân Balsom

Title of the meeting: Patient Experience Steering Group

Date of meeting: 31.01.17


Main areas of discussion:

Patient story - a video of a woman's experience, whose husband passed away in hospital. Talking about importance of recognising and supporting carers. Ward 28 - lots of improvement. Previously quite short staffed. Done a ward improvement action plan. Fewer complaints coming through - and recent very positive feedback on Patient Opinion. Discussed changes to visiting hours - some staff still saying they are not aware of the changes. Mainly positive feedback about the changes. Has been discussed in a variety of forums. Clear visitor's code around things like children's visits, also clear visiting is at Sister's discretion (e.g. around noise, intimate care, need for rest, ward rounds). Will be further support for junior staff around having difficult conversations with relatives. Scarborough elderly wards have been more flexible, so not experiencing the same challenges as in York. Patient Experience Quarterly Report PALS has moved into a new office on the main corridor of York Hospital. This space now includes a private meeting space, which has been well received. Now they are working to raise awareness of what the PALS service is and isn't. New process for recording compliments - important to capture what is working well and learn from good practice. Talking about tiny noticeable things. Complaints - now agreed how these should be handled. Should not affect people outside the hospital, no changes to timescales etc. Maternity Patient Experience - HWY report on antenatal and postnatal services in York. Also got feedback through Discover Maternity work led by PCU. Were also getting comments through Friends and Family. Held a focus group at hospital, got 1 person. So instead went out to Children's Centres. Had already planned to reinstate and revamp antenatal classes. Now following the model used in Scarborough. 3 sessions over 3 weeks, with health visitors and children's centres and midwifery. Focus on parenting, public health type activity. Caring, feeding and bonding. All about helping parents to be equipped for a new baby. Already started this month across York & Selby. Promoted through article in Press and via Facebook page - Bumps to Babies. By basing it around Children's Centres hoping to embed it into the community approaches.

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York Press asked to do a day with maternity services. Did this last summer, and there was a really lovely article as a result. Asked within the article for recent mums who wanted to help. Have 9 mums involved, looking at 'better birth' - birth planning and postnatal care. Night Owl Project Came out of FFT feedback. Consistent theme of noise and bright lights until late at night. Have also had great support from the charities connected to the hospital for sleep packs. Encouraging wards to make night owl pledges. Some wards are handing out higher numbers of packs than others. Longer term need to think about it becoming embedded. Could make it part of routine admission process. Volunteering Update Got some good practices in place now. Really trying to consolidate what we have. Now have opportunity to join in an initiative, Helpforce. Personally endorsed by Jim Mackie, NHSI. Sir Thomas Hughes-Hallett sees the creation of a volunteer workforce that sits alongside the health workforce. Could have a coherent approach to roles beyond the traditional, more of a community response. Looking at a little bit of help, not formal volunteering. Aim to grow capability and capacity, through shared training. Central team are looking for 4 pioneers and 8 early adopters. York wants to be an early adopter. National Cancer Patient Experience Survey 2015 - Results and Learning Analysis of national survey results Main theme about narrative comments (488 received) Appreciation - 536 mentions - 91%. Important to acknowledge this. Average rating out of 10 is 8.8. York Safe Space Scheme Agreed would be good to update for next meeting. One Stop Urology Shop Some members of the Board went to the opening. Really beautiful facility, would be good to get feedback on this. The CCG led this work with YTH input responding to patient feedback so would be good to know what everyone involved now thinks. Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):

Add John's campaign to the Assembly meeting on 20th. (Also add Be Independent) Consider a Night Owl feature in the HWY magazine

Do you feel that this meeting was useful? Yes

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Name of Representative: David Robson

Title of the meeting: Regional meeting - England Vision Strategy

Date the meeting took place: 1st February, 2017


Meeting attended together with HWY volunteer Chris Love

The CEO of the Pocklington Trust outlined the Strategy Priorities.

In England over 1.5 million people are living with sight loss but public health

messages rarely discuss eye health. Health and social care systems are under

immense pressure and often do not join up properly to provide best care and

support for people with sight loss. Blind or partially sighted people frequently find

themselves with barriers to work, education, travel and leisure. More needs to be

done to combat these issues.

To address problems faced on a daily basis by individuals with sight loss, and

promote importance of maintaining good eye health, leading organisations in

England working together to deliver a plan for change called the England Vision

Strategy. The Strategy has identified six priorities until 2018 as key building blocks

for change, chosen following extensive feedback from stakeholders. The priorities

are:

1. Detecting eye conditions early, especially in seldom heard groups;

2. Promoting a consistent strategy for eye care commissioning;

3. Improving the Certification process – making sure people who are eligible

actually get certified and registered and that relevant data flows through the

whole eye health and sight loss pathway;

4. Early intervention to ensure practical and emotional support post diagnosis. For

example, an Eye Clinic Liaison Officer (ECLO) available in every eye

department;

5. Habilitation and rehabilitation available on a free and timely basis for as long as

needed to learn or relearn key life skills including mobility;

6. Development of peer support and self-help groups in every community for

adults, children and families to provide voluntary sector support for independent

living and to lobby for inclusive local public services.

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The six key priorities will be addressed across England by task and finish groups

actively promoting partnership working across the Adult UK Sight Loss Pathway and

the Pathway for Children and Young People (0 to 25 years) with Visual Impairment

and their families. Regional groups will be established across all nine England

regions with line of sight to every local authority and clinical commissioning group

area in England. An inclusive national consultative group is being developed to

enable input from a wide range of stakeholders into the delivery of the England

Vision Strategy.

Following City of York Council’s recent retendering of services, the Wilberforce Trust

(charity for blind people) have established sensory support hub for blind and partially

sighted people.

A presentation by Phillippa Crowther of the Wilberforce Trust outlined the 6 priorities

and how the charity was to deliver them in York.

Engagement e.g. multiple referral routes;

Outreach, through e.g. a mobile demonstration vehicle [making weekly visits to

clients], and kiosks in community centres:

Services, e.g. registration and multi-sensory assessments;

Signposting to e.g. social services, the 2 deaf societies, and so on;

Prevention e.g. community assessments, online hearing tests, sight screening;

Inclusion, though e.g. support groups and a befriending service;

Was the meeting useful: Yes

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Title of the meeting: Vale of York CCG Governing Body meeting




Questions from members of the public Gwen Vartigans on behalf of Mick Phythian: Selby OOH GP service is not operational between midnight and 8am. What are people expected to do if they are taken ill in the night. Taxis are very expensive. What is the OOH coverage in Vale of York? Dr Philips – OOH service is provided between 6.30pm-8am Monday to Friday. The service in Selby comes from other areas. The service is an outcomes based service through Yorkshire Doctors. This contract allows them to decide how to best meet needs. Activity through Selby after midnight is quite low so not necessary to have a GP based there all the time. But priority cases will be triaged, e.g. from Malton or York. If call goes to NHS111 after midnight and requires GP assessment it will go to a GP based elsewere. If GP decides they need face to face they will either encourage patient to come to York or go to visit. OOH can also send taxis to collect patients. YD say this has happened – spend on taxis is +£3k in 2016. Gwen Vartigans – can the Vale of York explain when where and how the people of York will get the opportunity to feed into the STP work? Phil Mettam – the way the STP will work is mainly on a local basis. Any engagement activities will be done locally. This CCG did not actively participate in the Mental Health meeting in Willerby in January. On 20th January there was a symposium at Priory Street, a full room, with TEWV, CYC, and the CCCG. Spent all day talking about mental health and how we will shift our focus. The afternoon session was facilitated by Rachael Maskell. Together we are going to commit to improving mental health locally. We want to find a way of investing more. But our forecast deficit for this year is £28M. We are working with the council on how to develop a strategy for mental health. Many of the priorities came out in the symposium. Gwen – and will this be for all aspects? Phil – Yes Dr David Killan – are the CCG aware that deferring surgery for those with BMI over 30 affects a significant proportion of our society, and have they considered the impact? Andrew Philips – yes, we are aware, we are concerned about impact of obesity and smoking on people. Question mentions desirability – we would want obesity to be considerably lower. York CCG has a statutory responsibility towards improving health and wellbeing. Maximising health is a critical element of improving health care sustainability. Therefore the CCG does not routinely commission surgery for those who are obese or smokers. This gives the GP opportunities to look at health

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interventions. The CCG is not banning surgery for these patients but giving an opportunity for interventions to improve longer term outcomes. The CCG is backing a NYCC initiative tackling childhood obesity – 21% of children in NY are obese. Minutes of previous meeting, 5th Jan, Selby – matters arising CCGs allocation grant – Michael Ash-McMahon – medium term financial strategy in draft but close to being finalised. Weight management and smoking cessation services – deferred until Sharon Stoltz (director of public health, CYC) available (off sick at the moment). Accountable Officer report Turnaround – forecast outturn has deteriorated further to £28.1M. Now committed to no further deterioration, that will be our closing position. Positions imposed through legal directions have not been met so CCG is in breach of legal directions. Phil Mettam will need to meet with NHS England to understand what the consequences of this are. Part of the reasons for this, part of ongoing conversations about contract with YTH. Negotiations now concluded. The operational plan sets out the focus for next 2 years. This was submitted a number of weeks ago. On Tuesday received formal feedback from NHS England. Commended focus and comprehensive nature of the plan. Meeting with NHS England as part of quarterly assurance meeting so should be in a position to bring this to March governing body meeting. Issues around costs of acute care – increase of £10M over 2016/17. Council of Reps – focus on strengthening primary care. Looking to use GP Forward View monies innovatively and effectively. Also reviewing pathways with ambulance service. Medical director – Dr Philips & Dr O’Connell have both accepted offers to take on these roles with separate portfolios. Better Care Fund – coming towards end of year. Off the pace on some schemes / areas. Will incur cost for both CCG & CYC. Focusing now on a good BCF for 2017/18 to meet needs of our population and reduce costs. Has to be negotiated across 3 councils so quite complex. Main problems are around delayed transfers of care, falls, and non-elective admissions. Also issues around Continuing Healthcare, mental health acute care and liaison. Now developing a 2 year plan, but still awaiting national guidance. Awards – CCG has been nominated for a number of awards. Despite the difficulty the CCG faces, the CCG has a number of high calibre individuals within it. Funding award for Priory Med – good news, small amount but good to note. The Governing Body thanked Siân for her work on the Governing Body – and committed to doing more work around engagement with Healthwatch York and other partners in the future. 5 risks have materialised – 1 significant - restructuring of PCU.

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4 serious – including failure to meet dementia coding target, risk around lack of assurance. Growing concern about public health policy decisions and impact on day to day activity in health, especially in GPs but also in acute and mental health. Phil wants to consider how we do joint Health Impact Assessments, as local authority ones do not adequately pick up longer term impact on health. Dr Emma Broughton confirmed there are areas that she is working on collaboratively with Sharon – e.g. around sexual health and understanding impacts of cuts. Some of the work around cardiovascular issues and the impact of lack of health checks. Results of public consultation on new mental health hospital – Elaine Wyllie, Exec Director of Joint Commissioning What will be in the new hospital? – adult and older people’s inpatient services, crisis and intensive care teams and care home liaison, 136 suite. Asked about beds and configuration, sites and preferred location. Equality Impact Assessment – identified issues around students, carers, LGBTQI. About bed numbers – 48.1% agreed, 51.9% didn’t. Concern around capacity in community, and out of area placements. Site – Bootham Park Hospital site had most support – 49.32%, Haxby – 31.88%, Clifton - 18.8% Next steps – today – the CCG Governing Body considers the recommendations March 2017 – TEWV take forward detailed options appraisals for the 3 sites April 2017 – progression of business case for 1 or more sites (a 2 stage process) Jan 2018 – confirmation of final site and detailed design Dec 2019 – completion of build CCG needs to limit the financial risk for the CCG. Tim Maycock – bed numbers – is this the midpoint across England and Wales? What’s the standard deviation? Relies on strengthening and investing in community services. David Booker – is this future proof against demographic change? TEWV agreed will explore this further in developing the business case. Phil Mettam – consulting on this scale, over something where rightly views and feelings run high is challenging, it’s great that the work has been recognised by NHSE. Also thanks to our provider, TEWV, for supporting this work. Financial Update £28.1M deficit, of which over £13M is within acute contracts. Need reassurance that the CCG is tackling this acute demand situation. Some of the acute overtrade is down to non-delivery of QIPP plans, not wholly about demographic change. Many of these QIPP schemes are joint ones, so need new contract to build in levers to manage risk across the system. David Booker – was the arbitration helpful?

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Jim – arbitration is never helpful there will always be consequences, and it means giving the decision over into someone else’s hands. We will always try to avoid it. But sometimes there are no further options. Performance Report – Jim Set up a whole system care recovery group – looking at capacity, how can we utilise initial resources from NHS England best to deliver along RTT, and delivering improvement plan. Now received improvement plan from the Hospital Trust around RTT and are working with them to look at delivery. Biggest issue is A&E performance – has an impact not just on A&E but also cancelled operations, with resultant impact on RTT times. In Feb will review what happened over Christmas. Elaine – 2 elements – IAPT and CAMHS In terms of IAPT, it was improving, however issues are coming up again. Have had some counselling appointments cancelled. Intensive Support team will be coming in to do a deep dive into how to improve the system. CAMHS – this was flagged as a key concern, with over 500 patients waiting. There are now 166. 116 of 166 were seen within 4 weeks. 27 people have been waiting longer than 12 weeks. So this is a significant improvement. Some due to data problems within TEWV. Dementia – Louise Barker – conversation a few meetings back about the importance of diagnosis. National target is that 2/3 of people with dementia should have this recorded on their GP records. One of the issues has been around coding – a lot of people may have dementia but not have a code on their record. It has been a real challenge. GPs are really stretched, and it is not seen as a priority. But this is a target we need to meet. Tim Maycock – could we do something to release our local GPs from some of the existing form filling to allow time to do this coding work? Phil Mettam – Exec team needs to look at the creative options for tackling this. Safeguarding children Lots of good work – No Wrong Door, tackling child sexual exploitation. Real worries around public health services – cessation of sexual health services, especially emergency contraception, with no options but to travel outside of York to acquire it. Also worried about new specification for school nursing – e.g. removal of basic sight tests. Emma Broughton raised issues around GP training / Allied Health Professionals – now a lack of standard paediatric training in primary care. Now limited through qualification. Wants to look at exploring locality based support around safeguarding. Unaccompanied asylum seeking children – small numbers here, but not receiving any funding for these, unlike refugee children, so writing to NHS England about this. Reduction in services by local authorities – concerned regarding domestic violence, mental health. Our own mental health plans need to take this into account.

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Phil Mettam – do we have enough focus on children and young people? Would like Michelle to look at this, including clinical capacity. AOB Phil Mettam – engagement strategy – how do we start to move forward with consultation. Been following the live tweets – want to thank Sharron and the team for their work. Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):

Quality and Experience meeting next Wednesday (check with Michelle Carrington re dates going forward)

Do you feel that this meeting was useful?

Yes No

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Name of Representative: Lesley Pratt

Title of the meeting: Healthwatch England Committee Meeting

Date the meeting took place: 2 February 2017

Date of next meeting: May 2017


Update and seek approval of reports.


Chairs report

Jane Mordue has been appointed chair of Healthwatch England. In her report she highlighted the key role Healthwatch can play in the Sustainability & Transformation Plans (STP).

There is increasing recognition nationally of the value of Healthwatch and she was pleased to see that the Care Quality Commission (CQC) had been given a positive mention in their State of Care report.

She mentioned that she had met with the chair of NHS Digital and their Chief Executive. They were interested in meeting as their work on opening up the NHS to patients, eg via apps, is at a stage where it would benefit from public input.

She advised that Healthwatch had been the subject of debate in the House of Lords in December when peers reviewed support and funding for both national and local Healthwatch. The peers expressed concern that the new relationship with CQC should not weaken the Committees independence.

National Directors Report

Imelda Redmond has now been appointed to this role and at the time of the meeting she had been in post for two weeks. She stated she was very keen to meet everybody and was open to invitations.

Delivery Report

Neil Tester presented the paper and confirmed that Healthwatch England will continue to focus on the three priorities.

1) Leadership, support & advice for local Healthwatch.

2) Bringing peoples views to the heart of decisions.

3) Developing our effectiveness.

Operational Report

At the end of quarter 3 there was a recorded spend of £2,077,302 against a year to date budget of £2,389,088.

Based on expenditure to date, the projected spend to year end is estimated at £2.781m.

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Business Plan

Following delivery of the plan members of the Committee commented that the phrase Patient Experience should be replaced as not everybody involved was a patient. It was suggested the term be replaced by ‘ people experience ‘ .

Members stated that only about 20% of the public knew about Healthwatch and that media training should be made available to local Healthwatch.

The inclusion of the voluntary sector was highlighted as a valuable source and Healthwatch England should recognise this.

Risk & Tolerance & Healthwatch Intelligence

Both papers were discussed and questions put. Most of the information was the same as those listed in Siân’s report in Healthwatch York’s January bulletin.

Public Participation

Warrington asked if data could be provided using the STP footprints but were advised that this would be too complex as some local Healthwatch cover more than one STP area.

Kirklees asked how Healthwatch England business plan would trace the change Healthwatch had achieved.

Concern was raised over the fact that CCGs are making different choices over what they will pay for.

Leeds stated that we need to be honest and share as the same problems keep being highlighted by different local Healthwatch.

Darlington pleaded to the Committee to look at the distance, time and cost some of the local Healthwatch have to cover to attend Healthwatch England meetings.

Conference 2017

Will be held in Nottingham on 7 July 2017

Details of the award categories will be sent out to local Healthwatch in February.

Clarification of the purpose of the conference was asked for to avoid people attending workshops expecting help whereas it is to share what works.

Papers are available in anybody wishes to read them.

Follow up/actions for Healthwatch York (Anything HWY needs to respond to?):


Yes No x

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Name of Representative: Barry Dane

Title of the meeting: A&E Steering Group (AESG)

Date of meeting: 9th Feb 2017

Date of next meeting: 9th March 2017


Ongoing pressure within the system and discussion around plans for the Easter period.

Main areas of discussion: Performance overview through the Weekly Emergency Improvement Dashboard indicate the A&E challenge continues with no big movement in figures and there remains a struggle with emergency care performance. The picture for York and Scarborough is reflecting regional and national figures. The chair commented, a ‘positive’ within the system has been proactive offers of help, rather than reactive offers. Ambulance handover is a priority and continues as a separate piece of work: communications from NHS Improvement emphasise the need to work together to reduce handover delays that take ambulance crews off the road and reduces ambulance service capacity with a risk to keeping patients safe across the system. Bridlington MIU provision – It has been established and clarified that access to the unit is an option for YAS crews. Focus on Easter Plans: pressure on emergency services appear no longer to be just a consequence of traditional ‘winter pressures’ and the next extended break will mean, no doubt, a need to manage any increased demand. The question of the Easter impact on Mental Health breaches was raised. The Chair has written to each organisation requesting detail around what additional capacity/plans will be put in place over the bank holiday period. These plans, what we have and what we don’t have, will be discussed at the 9th March meeting to allow the AESG to report to the A&E Delivery Board on the provision of Urgent and Emergency Care over this period. Follow up/actions for Healthwatch York (Anything HWY needs to respond to?): Do you feel that this meeting was useful? Yes

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Title of the meeting: York Adult Care Workforce Strategy Group


Date of next meeting: 02.05.17


Feedback from Safeguarding peer review – key issue, we do not celebrate our successes enough. Need to tell our stories better. Our staff are a bit bashful and very busy, so we need to think about how we involve people providing and in receipt of services to tell powerful stories. Local Area Co-ordination – Joe Michaeli Local Area Co-ordination is an internationally recognised evidence based approach to support vulnerable adults to contribute to society. Started in Western Australia, but has spread. York is the 11th English area to adopt it. All about asset based community development, resilience, and helping people stay out of services. Not just about working alongside individuals and their families, but about developing our communities. Very topical – open evening for candidates last night. Going forward in 3 neighbourhoods – Tang Hall, Westfield, and Huntington and New Earswick. Recruiting 1 worker for each community. Last week had an awareness raising session in each of the 3 communities, involving local VCS groups, elected members and partners. Involving panels of local people in the recruitment process. Aim to prove the concept and then spread to all wards in York. Performance and Impact subgroup Put together template for subgroups to feed back – all groups now using it. Looking at issues arising from other subgroups – e.g. data collection and analysis. Supporting Positive Risk subgroup 3 areas to focus on – reimagining – support to live well, working, what we ask for Initial focus ‘Reimagining support to live well’ – event planned for May 2017 – New Philanthropy, Citizenship and Community, initial meeting of influential industry leaders scheduled for 7th March. Agenda – brainstorm on new philanthropy, furthering common interest in health and wellbeing of citizens. Recruitment Retention and Career Development Subgroup Agreed 4 projects that the group will focus on:

1. Shape your future booklet and event 2. NHS Market place event 3. I-Care Ambassador Service – strong network to support work of partners and

employers recruitment and retention ambitions 4. Sharing and promotion of careers pathway tools to encourage recruitment and

in-work progression – shared case studies of apprentice of the year award recipients

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Broader profiles subgroup About what the VCS workforce brings to ASC. Covering paid and unpaid employment. Thinking about carers. Workforce turnover in VCS – 22%, turnover in ASC sector – 27%. Recommending commissioning a qualitative and quantitative study across workers in ASC from all sectors, paid and unpaid. Lots of links with volunteering, volunteering opportunities, and community connections. Update from Humber Coast and Vale Local Workforce Action Board Key area – how do we support advanced care practitioners across health and social care – providing greater flexibility and opportunity. Applied for funding for co-ordination to deliver advanced care. 3 co-ordinators which will work across the patch. Local Sustainability and Transformation Plan Agreed across Vale of York footprint – York is covered by Central, then North (Ryedale) and South (Selby). Second workshop this afternoon. Then a co-ordinating group. Invited to HCVSTP but more interested in local delivery. People and Communities Board – report about priorities for the STP. Beginning to gain traction. Social Care Assessment work – shadow board set up, securing external support and hope to do that this side of Easter. Mike Richardson will be leading from CYC side. Nurse associates – nationally 17,000 applications. Looked at existing workforce, supporting them to be in a position to do this. Lessons to learn for preparation work for our workforces around basic skills. Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):

Action: telling the stories – how do we get people to tell their stories?

Note for research volunteer meeting – can we start videoing people to capture their stories? Will CYC support us to do this? Look at @Work programme as opportunity to capture positive experiences of integrated working, and why we need to keep pulling this together.


Yes No

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Title of the meeting: Central Locality Workshop (Formerly ITB)




Behaviours and principles for the work – agreed language is important. Still talk about inappropriate presentation. What we mean is that there are better ways to meet needs. These can deliver better outcomes for the people presenting with needs. Need clarity about what the offer is, how the system worked. Learning Event – Ruth Hill, Michael Melvin and Elaine Wyllie Discussion around Delayed Transfers Of Care. Providers and LA had done a review, looking at what has happened and how it works, perceptions and understanding of how it works within different organisations. Useful exercise – feel we should use this approach to test out areas of our work programme. Agreed that action learning is a helpful way of learning through delivery. Workplan Discussion about understanding what we need to do within this meeting, and what is being done elsewhere. E.g. A&E Delivery Board has set up a sub group looking at ‘stranded patients’ – those who no longer have an acute medical need but cannot get out of acute care due to issues of what is available out there. They could keep us updated on this work, and bring barriers to addressing it to us to help resolve. Also discussed public health issues – smoking, obesity – and links with prevention agenda. Thinking about workplace health. Public health happy to lead on this, but Sharon keen to have volunteers for this. Discussed structure of the plan – is it helpful to base these around the Care Act headings of Prevent, Reduce, Delay, Manage Differently? This could be a useful structure. Also discussed concept of Accountable Care System – more helpful to focus on aspiration to work in partnership to improve how the system works for people, rather than getting hung up on the delivery model. Discussion – what is the question we need to ask, what is the problem we want to solve? Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):


Yes No

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Name of Representative: John Clark (HWY Chair)

Title of the meeting: HWY Leadership Group

Date of meeting: 16 Feb 2017

Date of next meeting: 10 April 2017


The Healthwatch York Leadership Group is a strategic advisory body, supporting the staff team to deliver Healthwatch in York. The Leadership Group is not a formal sub-committee of the York CVS Board of Trustees. However, it plays an important role in overseeing Healthwatch York’s strategic direction monitoring the progress of Healthwatch York’s strategic direction, monitoring the progress of Healthwatch York against its work plans and overseeing the delivery of Healthwatch York in line with the contract. The group at present comprises of five volunteers, the Director of Healthwatch York and the Chief Executive of York CVS. The principal role of the leadership group is to provide advice, guidance and support to the organisation and the staff team. It meets six times a year at the Priory Street Centre.


Our first meeting of 2017 took place on 16th February and we looked at the

following areas:

feedback from the recent Healthwatch York staff development day

an update on Healthwatch England (from whence our central governance and direction come)

an examination of evaluation plans in relation to the Key Performance Indicators (KPI’s) contained in our City of York Council Contract

general work update including the work plan, trends from the issues log, the magazine and newsletters and took note of general work activity and initiatives

budget update and related staff grading review by CVS

Notes from the leadership group meetings are published on the Healthwatch York website Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):

Do you feel that this meeting was useful? Yes

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Title of the meeting: Primary Care Home (PCH) Stakeholder Meeting




Mark Davies - regional lead from National Association for Primary Care - link into PCH team 3 PCH within the city. Today - looking at how we can move this forward. Realignment of services around 3 PCHs. Looking for demographic data around the 3 localities. One to the North including Huntington, Haxby, Strensall. South - Unity including Uni, Heworth, Tang Hall, Hull Road. West - Acomb practices. Wanting Public Health and CCG Business Intelligence data. Each 30-50 (most around 40,000). Would be looking to work with community, particularly district nurses. Ideally wrapping district nurses around the PCH. Some challenges around recently signed contract with YTH for community services. Some work to do about what this means - Management has to come through YTH, but could be about liaison and working together, greater collaboration. YTH keen to look at blending of Community Reablement Teams, District Nursing and others - improving outcomes for patients. Agreed will require flexibility on both sides. Suggested a piece of work around practice nursing, district nursing, the skills mix, and making best use of all resources. Council also looking at how they move services towards community level. Urgent care, nursing home care and home visits are priorities across the 3 areas. About shifting resources out of secondary care into primary care. But also want to choose an area (using the BI and PH data) and co-produce a different type of service to support that group. Want HWY support with the co-production approach. All driven by wanting to improve experience for people accessing services. But has to start with unplanned care, and where the spend currently happens. Learning from National PCH work - most successful schemes have started with the question "What are the needs of our population?" And then start working on addressing them. Not getting into organisational structure and management. Use the data to drive conversations. Then - phase 2 - data linking, segmentation and stratification - a linked data set that allows you to look at 'cohort' management - e.g. Frail elderly, tracking expenditure, outcomes, when doing something differently. Don't get too hung up on services, but on the challenge - e.g. Thinking home visits instead of "what would be a better solution for supporting frail elderly people within our communities?" Discussed Esther and Kenneth - 'example' patients that you consider when making changes, what would this mean for Esther?

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Also discussed workforce, culture change, and supporting through change. Highlighted benefits of doing this through co-production model. Actions need to be recorded, people need to take on responsibility. Big issue for HWY - resources to support work around co-production model. Supporting expanding role of PPGs, encouraging people to get involved. National offer - 3 common issues. Population segmentation, and how you do this in a simple way that allows you to make progress quickly. NAPC has developed something, which we could pilot here. Also lots of conversations nationally around workforce. Suggested get in contact and can share emerging resources for this. Health and Care Conference in June - aim to pair up a test site and one setting out now, to be on the stage and talk about the journey. Will liaise with Lesley Godfrey about this. Next meeting: 16th March - given apologies. Thursday 13th April probably next meeting. Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):

Send details of the book! Do you feel that this meeting was useful?

Yes No

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Name of Representative: David Robson

Title of the meeting: Travel & Transport




To discuss staff and patient issues relating to travel and transport at hospital group.

Meeting held at Scarborough, with 6 York staff attending, plus 2 by video link, 1

Governor, and myself from York. No Scarborough staff were in attendance.

Main area of discussion: Overview of car scheme provided by ‘Enterprise’, by

company representative.

Enterprise scheme 3 years old, and where company [a] provides a pool of cars for

staff use at 5 locations, with 24/7 support, and [b] hire cars for day use, intended to

make cash saving and reduce CO2 emissions.

500 members [out of 8,500 staff] in scheme, and have in 3 years travelled 500,000

miles in over 1,000 journeys, and made a saving of over £70,000.

In addition 2,400 other miles travelled per annum by staff in their own cars, and the

aim is to reduce this mileage by the use of the pool and hire cars [delivered to the

drivers door at commencement of the journey, and collected at end of the journey],

intended to be more economical and more sustainable reducing emissions.

Also, intended to extend use of pool cars to ‘community’ staff, who would use them

in out of office hours, reducing standing time, and also being encouraged is lift

sharing, particularly on York / Scarborough journeys.

Android system now in use, allowing members with a smart phone to book cars

online.

Also reported was the following.

Travel plan. Being prepared, aim to reduce staff use of cars, and by 1 per cent of

Patient. Also, it appears York council is in the early stages of looking at [a]

improving the bus lane on Wigginton Road, York, and [b] running the ‘Park and

‘Ride Service’ to / via the hospital.

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Scarborough / Bridlington shuttle bus. 2 X 3 month trials carried out. Ultimately

found only 1/3 of costs of running service recouped from fares, and local CCG and

Councils not prepared to subsidise the service.

Renewal of taxi contracts. Fleetways continue to be company answering

telephone in the reception area of York Hospital. 3 companies selected for use by

the Hospital Trust because of their ability to provide wheelchair accessible vehicles.

Car parking:

[i] At Malton Hospital for urology patients. Governor pointed out although 21 blue

badge parking places allocated at hospital for patients attending for dialysis, the

signage is poor. Meeting assured this would be looked at, and improvement

initiated where required.

[ii] PALS reported problems with parking at Scarborough Hospital, and complaints

about poor / lack of route marking, which meeting told would be looked at.

[iii] Reminder that cancer patients not able to have their parking tickets validated in

the Magnolia Centre, York, can do this at the main reception desk.

Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?): None


Yes No

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Name of Representative: Lesley Pratt

Title of the meeting: Fairness Forum

Date the meeting took place: 23 February 2017

Date of next meeting: 25 May 2017


Up date & inform forum


Patient Story

This story was raised at the Hospital Board meeting on the 22 February. It concerned a service user who was deaf and their experiences in attending clinics.

Two years ago the patient had been referred to the hospital and despite the GP flagging up the need for a BSL interpreter to be in attendance when they arrived no signer arrived. The patient had in fact arrived at the wrong hospital and they were unsure of where to go. An interpreter had been booked but had not arrived .They were left in the waiting room and staff tried to communicate but they were unable to hear what was being said. The staff tried to find out what the problem was by writing it down but as the patients first language was not English they were unable to understand what was written. They left and the staff tried to get them back but by this time they felt humiliated and scared and left. It was agreed that this situation was not acceptable and all staff should be made aware of how to deal with this type of issue. One of the members of the forum stated that the patient involved had been involved in feeding back their experiences and this had been included in the Healthwatch York report on Access to health & social care services for Deaf people published in December 2013.

The Hospital system now shows a flag on patient records so everybody knows what requirements are needed when attending clinics.

The service is now provided by Big Word. It was thought the name of the service should be re named to interpreting services and should cover all disadvantages.

It was suggested that there were BSL interpreters in the community and perhaps the hospital should look at the possibility of using them.

Concern was raised over how a person could complain about their signer as they would have to rely on them to translate their concerns.

It was suggested a policy and protocol should be looked at so everything could be joined up. A meeting is to be set up to discuss this suggestion.

Uniform

Due to the number of different lanyards used it was suggested that ‘Dress Code’ should be reviewed and refreshed.

Concern was raised over ‘scrubs’ being worn whilst going through hospital corridors/ restaurant.

Accessible info standards

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The possibility of using i Pads to assists people with hearing problems is being looked at.

The lack of wheelchairs was highlighted. There are 21 wheelchairs available. It was suggested that volunteers could help in retrieving those left in the car park .

Concern was raised over the car park lift being out of action. We were advised that a notice had been put at the entrance of the car park advising people who needed wheelchairs to alight at the bottom level and get assistance.

It was suggested that if a charge of £1.00 was made people might be encouraged to return them to the correct location.

The forum were advised that at the Scarborough site there were no benches for people to sit on if they needed a rest. This matter is to be looked into.

Examples of where the Trust has made reasonable adjustments for disabled patients were requested as I have been invited to attend a workshop on this subject. I will take this info along with our reports.

Access to services

Work is going on with York St. John. It was suggested that Easy Read should be used throughout the Trust.

Capital Projects

A revised project design for the ritual washing facility have been agreed and arrangements with the local Imam is to come to discuss the design to ensure it meets all requirements. Once this has been agreed an application will be made for charitable funds

Patient Experience Team.

The lead for patient experience has met with the Scarborough Outpatients Improvement Manager to look at signage and info in letters about how to locate parking places on site. Signage was a problem and it was identified that there is no map of Scarborough Hospital. Particular concern is over blue badge holders who if not familiar with the site would not know where to go and this could result in missed appointments.

Safeguarding Adults & Learning Difficulties

Since November 2016 there have been 59 referrals.

The profile of the learning disability nurse has been raised for GPs in the surrounding areas and is the role and referral form is now part of the CCG on line GP referral system for York, Scarborough, Ryedale and Whitby areas.

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Meetings have been arranged with care providers in York & Scarborough to discuss the provision of reasonable adjustments within the York Teaching Hospitals and importance of hospital passport

The Safeguarding Adults Team LD Assistant has been involved in creating a film about reasonable adjustments that can be provided within the hospital. This could be used for educating hospital staff.

Visual Impairment

Work within the hub space by Ellerbys restaurant was used to demonstrate to staff how people with visual problems cope and what it was like to experience poor sight.

LGBT Network

York Pride will take place on 10th June and the network would like to request the hospital ‘raise the rainbow’ by lighting the roof again.

A meeting with the LGBT staff network for N.Yorks Police has been arranged with the aim of sharing ideas and working together.

Feedback from local issues

York City of Human Rights should the Trust sign up to this.

On the 18 January the community midwife attended a meeting concerning travellers awareness which proved very useful.

Any Other Business

We were advised of special screens being made available to mothers who are to poorly to see their baby.

Copies of Healthwatch York newsletters were made available as well as a copy of the new mental health guide.

A film has been made by Whizz Kidz York in which 12 wheelchair users demonstrated how they got around the hospital site.

Follow up/actions for Healthwatch York (Anything HWY needs to respond to?):

Issues to record on the log:


Yes No

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Title of the meeting: Health & Adult Social Care Policy & Scrutiny Committee




Public participation: Sue Snellgrove, Mental Health Action York (MHAY) and former mental health nurse: York needs to have a comprehensive range of mental health services. Used to have 8 older people units. Lost Peppermill Court, an example of the types of services that have disappeared. NHS investment into 6 VCS organisations – “positive engagement will help reduce the need for services later” Ruth Hill – but do not believe this is a substitute for specialist services. Anne, Mental Health Action York and former mental health nurse Wishes to raise issues around implementation of recommendations from scrutiny review. BPH was closed with 5 days notice in October 2015. Distress caused to individuals, family and friends. BPH had one of the lowest death rates in the country. No building is free of risk, but good nursing care can reduce risks. CQC reasons for closing the building did not put good care at the heart of care. CQCs actions cannot be justified and their written response is lacking in compassion and consolation. Protocol now in place to look at how organisations work together in the face of such an event in future. But still no organisation in York has taken responsibility for what has happened. MHAY respectfully suggest the people of York require answers. Joanne Lazenby, MHAY Amongst the group that visited the hospital in Hertfordshire. Reminded me of a garage. BPH offered many easily accessible treatments and support for individuals and families. Who is looking into links with the private sector, Alan Milburn, Price Waterhouse Cooper, and vested interests? BPH closed not in the interest of patients but in the interest of private enterprises. Agenda Item 4 – Third Quarter Performance Monitoring Report, Adult Social Care Overall net projected spend is an overspend on the budget of 0.5%. – £244,000 Cllr Craghill – issues about Better Care Fund underperformance. Answer – worst case scenario on Better Care Fund is £600,000 demand on council. Number of schemes within this that are meant to benefit the system. We do not believe that the impact of these schemes is as much as was anticipated. Already working on BCF for 17/18. Need to learn some lessons to understand future impact. Cllr Craghill – what would a 600k impact actually be? What are the impacts on service users?

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Answers – within York we are a low spend Adult Social Care authority with a good outcome. Our budget for the whole service will be used to support people in the best and most efficient way. So we will look at any budget impact and try to reduce spend by putting in reablement services to maximise people’s ability to stay well at home. Strategy is to provide care at the lowest level people need, give intensive support to get them back on their feet. Cllr Barnes – 5.2% overspend against managed budget. Some mitigation – e.g. taken from Care Act reserve. Can you tell us about this? How does it get topped up, what is it used for? When will it run out? Answer – Care Act reserve was created by underspend on the Care Act grant in previous years. What remains is the last of this. There are some commitments already made against this, but there is no further use for this. Care Act reserve built up over 4 years. From 2016/17, Government has ceased to allocate Care Act funding as a separate grant, but has rolled this into baseline funding. This has been allocated to the adult social care budget. The recently announced £1M extra is over and above the Care Act grant funding. Council is investing some of this funding in areas like Local Area Coordination, a more outcomes focussed approach. Cllr Barnes – BCF, para 16 – risk share of 600k. Does this mean the remaining 90% of the budget is safe, banked etc? Answer – for this year yes, for next year this is still being worked through. It is only on shared schemes that the profit or loss is shared. For CCG led schemes they take the benefit or risk, and vice versa for CYC led schemes. Cllr Doughty – invested £25,000 in a social work pilot scheme at the hospital. Did CYC cover the full cost? Has it been successful? Answer – CYC has funded this, but it was based within York integrated care team, and the hospital has redeployed some of their resources to this. Efforts have mainly focused on the acute hospital. Have seen a 32% reduction in delays attributable to social care. This scheme isn’t wholly responsible for this, but it has definitely helped. Cllr Doughty – why is there a cost line around moving people with Learning Disabilities into supported living? Answers – part of a reasonably big piece of work around Transforming Care Partnerships with the CCG and TEWV. Complex issue around bringing people back into area. Important to get this right. Has been a whole programme of work to look at the care around these individuals. Public health Sharon Stoltz – because we didn’t have a substantive Director of Public Health in place there were a number of roles as interim measures. When I was appointed in

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May I started to look at the structure. This wasn’t implemented until September, but the budget was set in line with the new structure. All posts only fully established by October. There is now a risk we could see overspends against this next year. For example, problems controlling out of area sexual health activity spend. But we are looking at ways of managing these risks – e.g. recommissioning sexual health services and working with the new provider to limit these costs. Suicide prevention East Riding and Hull are taking a zero tolerance approach to suicide. North Yorkshire and York are taking a slightly different approach – we want to be a suicide safer community, we don’t believe zero suicides is a realistic target, but we are taking a zero tolerance approach, if this is the right way to describe it, about understanding local suicides. We are investigating these deaths and learning lessons. We are also developing a suicide prevention strategy, and we will bring that back to this committee when it is developed. Yorkshire Ambulance Service NHS Trust – Karen Morner, Mark Inman. Highlights from the CQC Inspection Report YAS is the only NHS provider serving the whole of Y&H. Covering 23 CCG areas. Provide ambulance services, non-emergency patient transport services and NHS 111. During 2015/16 received 855,015 emergency calls, responded to 730,329 incidents of which 314,987 were immediately life threatening. Undertook 1,036,052 non-emergency patient transport journeys, answered 1,511,038 calls to NHS 111. CQC now monitor against 5 domains – safe, effective, caring, responsive, well-led. Inspections took place across September and October 2016. They visited 14 ambulance stations, visited every area, spoke to hospital staff, spoke to patients, inspected vehicles, patient records, and observed the care of 40 A&E patients. Overall rating – Good – and good across all domains. Significant improvement – previously were requires improvement and had one area that was inadequate. Very pleased with all staff and volunteers who helped deliver this improvement. Positive feedback on outstanding practice:

Red Arrest team providing support for patients who suffer a cardiac arrest. Currently if you have a cardiac arrest in Yorkshire you are more likely to survive than anywhere else in England.

Introduction of palliative care nurses in the NHS 111 centres to support end of life care.

Partnership working to improve integrated urgent and emergency care across the region.

Clinical developments within hazardous area response team (HART)

Outstanding rating for resilience planning.

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CQC also praised the Trust’s volunteer community first responder schemes, the commitment to supporting the placement of public access defibrillators in local communities, and the ‘Restart a Heart’ campaign training schoolchildren in CPR. NHS 111 – first inspection of this service. Found to be one of the best performing NHS 111 services in the area. Recent innovations include specialist support around mental health and pharmacy related calls. 3 must do areas for improvement:

Sufficient numbers of suitably skilled qualified and experienced staff (staff recruitment plans to address this previously brought to scrutiny)

All PTS ambulances and equipment are appropriately cleaned and Infection Prevention Control (IPC) procedures are followed (already replaced a number of vehicles)

Seating for children available in ambulance vehicles (have secured harnesses suitable for babies through to 5 years old)

Stakeholder Quality Summit likely to be 24 April. Cllr Barnes – congratulations on this result, huge achievement. Massive patch you cover, with huge variations. E.g. rurality. As you know I work in Leeds. Aware of the work being done through the Vanguard. Obviously this isn’t in York, we haven’t got this funding here. Mark – there are ways of expanding the use of volunteers – training up community responders. This can save lives. Karen – real opportunity to think now about what is needed and how we improve the system. The accelerator zone (the Vanguard) has been brilliant as it allows us to try things out. I also think there is a lot that could be done through our 24/7 centre. We could become a contact point for frail elderly residents, people with mental ill health, etc. Cllr Doughty – we’ve heard stories of patients and paramedics being stuck at York hospital. What can we do to improve this? Mark – we work hard with hospitals to improve this. It’s about sometimes not taking people to hospital – hearing and treating on the phone, sending Urgent Care Practitioners to people’s homes and treating them there, but still work to do on finding a solution as quickly as we can. Sharon Stoltz – JSNA. One of the problems we have with YAS is the sharing of information and data that will help us identify where there are problems and how we might work on this together. E.g alcohol, falls, palliative care. Is there scope to have further conversations about how we might share data and intelligence? Karen – yes, we have lots of data and would be happy to share. Will give some contact details to Steve, and willing to come to Health and Wellbeing Board.

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Cllr Craghill – what has enabled you to deliver this improvement? Karen – huge amount in CQC report previously about culture – staff not feeling valued – and about IPC, and equipment challenges. The ambulance service hasn’t been in the same place as acute trusts when it comes to improvement programmes. Over past 2 years we have worked hard on helping people notice what you need to notice – e.g. integrity of vehicles, empty hand gel dispensers. We have really improved basic practices. Workforce – been through huge change. Have done a huge amount improving engagement with the whole staff team. Brought management staff and frontline teams together. Cllr Cullwick – what about should items? Any challenges? Karen – biggest challenge was around supporting bariatric patients but now have a very clear protocol, and have increased equipment available. Mark – new fleet all able to support bariatric patients. Karen – other issue is nurses to support NHS 111 clinical triage, especially evenings and weekends. This is a national issue, but we have developed a plan. Cllr Cullwick – what strategy do you have to encourage volunteers? Karen – would welcome any opportunity to work with Local Authorities and others on training up volunteers. Mark – and also happy to provide defibrillators for community buildings. Developing a new mental health hospital for York – Elaine Wyllie and Ruth Hill See notes from Governing Body meeting 2nd February. Work will be done to develop plans for the new hospital, with final site decision by Jan 2018 to allow for building to be complete Dec 2019. 8 recommendations for TEWV to work on in progressing this. Cllr Doughty – in summarising the report, would suggest Bootham is preferred site and there is concern on bed numbers, and capacity within community services. Also question earlier about loss of older peoples services like Peppermill Court. Ruth Hill – heard very clearly a concern around community, and investment in services to reduce the need for beds. We are doing some work to look at what the shift in need and resource would look like. Have done a lot of work around e.g. psychiatric liaison, and this already shows we can prevent and reduce admissions and provide good care to help people stay e.g. in care homes. Has also been inappropriate use of beds where there haven’t been better options. In older people’s services at one point there were 30 older people in beds because there weren’t places for them. Now, through better partnership working with the support of colleagues, we are at less than 10 (currently 7).

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Cllr Craghill – on sites. In the report you included a comment that people needed more information to make fully informed decisions. Could you detail the financial considerations on this? 2 belong to the NHS. Who needs to pay whom for what? Answer – in simple terms, two are owned by NHS Property Services. The third is in private hands. With all sites, TEWV have been looking at suitability of sites, and working with the owners to understand the values involved with these sites. TEWV would have to pay NHS Property to acquire either of the 2 sites. We would also have to pay to acquire the private site. NHS Property is run as an entirely separate organisation within the NHS. The costs depend on the actual value, exactly the same as any commercial property organisation. NHS Property service works exactly as any commercial company would. Cllr Craghill – the preferred choice by quite a way is the Bootham site. The recommendations make specific reference to being guided by the preferences expressed. How are you moving forward on investigations about planning on this site? Elaine – NHS property is a national set up, not something we have chosen. In terms of the options, the recommendation is about reflecting back what the public told us. The CCG has a duty to listen and respond. We were very clear in saying this to the provider. So TEWV will be looking at the preferred option as the one to explore first. The complication is about the heritage issues – the other sites have other challenges. Ruth – there are a number of constraints. Against all of the sites we will look against all the criteria – accessibility, price, deliverability – all of these will be taken into account. So all sites are being worked up to help inform us of the next steps. We are doing everything we can in the time we have to progress things – working closely with CYC and Historic England. We’ve heard lots of wild rumours about what can be done, but we need to work with the facts. Cllr Craghill – heard from a number of people about disabled access on the Bootham site. Surely this is possible? Ruth – this relates to concerns regarding disabled access on the current site. But any new building must have good disabled access. Cllr Barnes – one way of reassuring people is to have a published set of criteria and a balanced scorecard approach. Is this something you would consider? Can you share the additional comments with the members of this committee? Elaine - the comments are in the public domain, through the website. We have shared already the comments made about e.g. specialist services with the relevant commissioner (NHS England). Ruth – we would always have a set of criteria building in to the appraisal. It should be possible to publish this, just making sure any commercially sensitive data is removed.

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Cllr Craghill – there was concern on bed numbers? Can this number still be increased? Ruth – yes, this is being looked at. Depending on how we remodel this and the solutions we develop this could mean an increase, or even a decrease if the service model supports this. We hope to demonstrate different models and what this would mean. We want to make sure this is exactly right for our population. Cllr Craghill – is the objective to make sure no one is placed out of area? Ruth – yes Cllr Craghill – there is something within the report about the cost of commissioning empty beds. How does this work? Is it not possible to have space without staffing? Ruth – the bed modelling looks at occupancy. There is an optimum occupancy rate – without too much spare capacity, but enough to make sure if you need a bed you have one. There is also an optimum size and staffing level for a ward too. So there are a range of factors building into staffing and space requirements. Cllr Craghill – it is easier to increase staffing, subject to funding, than to increase beds if you don’t have the space. Ruth – We would set our staffing in line with safe staffing levels for the number of beds. Cllr Cullwick – timescale set out, with a number of caveats. Are you satisfied this is realistic and achievable? Ruth – we believe we can deliver a new hospital by December 2019 and that York deserves this. There is a lot to do, but we are quietly confident. But we can’t let up, and we need to keep hitting the timescales laid out. There is not a lot of wiggle room so we need to keep the momentum going. Update on the implementation of recommendations from the Bootham Scrutiny Review Cllr Doughty – although all parties have responded positively to the recommendations, but still not clear who would take responsibility if something like this ever again. Steve Entwistle – NHS England shared an action plan following negotiations with various parties. This addresses many of the questions raised in the recommendations. All parties are signed up to the action plan. Ruth Hill – NHS England asked some service users and carers to review this and add into this. NHS England submitted parts of the plan to the service user group and there was a level of robust discussion. Cllr Doughty – can we sign this off now? Cllr Craghill – none of this is finished, so how can we sign this? Cllr Barnes – in support of Cllr Craghill, NHS England’s response doesn’t give me assurance. Why should we believe Phil Mettam can succeed where his predecessor couldn’t? This is not a criticism of Phil who appears to be working well, but is about confidence the protocol will hold up. Workplan NHS England are willing to speak on the action plan, if it is signed off by all parties.

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Cllr Craghill – the Bootham Report – point 2, about details of all mental health services delivered or planned in City of York. Could we have this overview report at a further meeting? Siân suggested the list provided at the CCG Governing Body meeting might help with compiling this list. Cllr Craghill said it wasn’t a list but a greater understanding of how it all comes together. Sharon – this is one of the priorities of the new Health and Wellbeing Strategy, so we could look at this. Cllr Barnes – similarly, would like to look at CAMHS. Anecdotally, hearing stories of cases where school wellbeing co-ordinators, heads and GPs are looking for services but struggling to access higher tier services. Are children being denied services they should have access to? Cllr Doughty – could this be something a task group could look into? Steve – will check whether this falls within the remit of this group and come back to members. Follow up/actions for Healthwatch York (Anything Healthwatch York needs to respond to?):


Yes No

Jargon Buster

BCF Better Care Fund – a topslice of the NHS budget given to CCGs to support projects that integrate health and social care. BCF schemes should reduce emergency admissions in hospitals

CAB Citizen’s Advice Bureau

C&YP Children and Young People

CCG Clinical Commissioning Group

CHC Continuing Healthcare

COPD Chronic Obstructive Pulmonary Disorder

CQC

The Care Quality Commission – the independent regulator of all health and social care services in England. For more information, see their website at http://www.cqc.org.uk

CSU Commissioning Support Unit – formed following the Health and Social Care Act. These organisations provide business support services to Clinical Commissioning Groups. The

http://www.cqc.org.uk/

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areas they help with include finance, communication and engagement, and buying health services.

CYC City of York Council

ED Emergency Department

FFT Family and friends test

HASCPSC Health and Adult Social Care Policy and Scrutiny Committee (formerly Health Overview & Scrutiny Committee)

Herbert Protocol

This form is designed to make sure that, if someone with dementia goes missing, the police can get access to important information about that person as soon as possible. If a relative cannot be found this is a deeply distressing and upsetting time for their family and friends. Being asked by a police officer to remember all sorts of information can add to this stress, and these forms are designed to remove some of that worry.

HWBB Health & Wellbeing Board. This is a group of people from different organisations including City of York Council, York Hospital, Vale of York Clinical Commissioning Group, Leeds & York Partnership Trust, the police, the voluntary sector, and Healthwatch York. They work together to make improvements to the health and wellbeing of York residents. For more information see - http://www.york.gov.uk/info/200170/health_and_wellbeing/341/york_health_and_wellbeing/3 They are responsible for delivering the Health & Wellbeing Strategy for York, available from the above web link.

HWERY Healthwatch East Riding of Yorkshire

HWE Healthwatch England. This is the independent consumer champion for health and social care in England. Healthwatch England is the national voice for Local Healthwatch groups.

HWNY Healthwatch North Yorkshire

HWY Healthwatch York

IAPT Improving Access to Psychological Therapies is a programme to increase the availability of talking therapies, and also the name used for psychological therapy services.

JSNA Joint Strategic Needs Assessment – a report bringing together information on current and future health and wellbeing needs in York. This is used to help make decisions regarding future strategies and plans. It is updated regularly.

LYPT Leeds & York Partnership NHS Foundation Trust – the provider of mental health and learning difficulty services across Leeds, York and some of North Yorkshire until October 2015

http://www.york.gov.uk/info/200170/health_and_wellbeing/341/york_health_and_wellbeing/3

http://www.york.gov.uk/info/200170/health_and_wellbeing/341/york_health_and_wellbeing/3

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MAPPA Multi-Agency Public Protection Agency

NHS National Health Service

OOH Out of Hours service

PALS Patient Advice and Liaison Service

PATCH Person alleged to have caused harm

PCU Partnership Commissioning Unit - They work across the 4 main CCGs in North Yorkshire and York to commission more specialist services

PH Public Health

PLACE Patient Led Assessment of the Care Environment

PPE Patient and public engagement

PPI Patient and public involvement

QiPP Quality, Innovation, Productivity and Prevention

RATS Rapid Assessment and Treatment Service

RTT Referral to Treatment

SAB Safeguarding Adults Board

Step down beds

They are a way of enabling people to leave hospital by moving to and being specially cared for in a residential care home bed.

STPs Sustainability and Transformation Plans

TEWV Tees, Esk and Wear Valleys NHS Foundation Trust - the provider of mental health and learning difficulty services in York from October 2015

TLA Three letter acronym – there are far too many of these in health and social care!

UCWG Urgent Care Working Group

VCS Voluntary & community sector

VoY CCG NHS Vale of York Clinical Commissioning Group (see CCG)

YD Yorkshire Doctors

YTH York Teaching Hospital – the main hospital in York

YTHFT York Teaching Hospital Foundation Trust – the Trust that runs York Hospital, Scarborough Hospital, and several other smaller hospitals such as Selby

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