Agenda item

Matthew Cole, presented the report, which in response to comments at earlier Board meetings was in a new layout style, and provided the quarter 1 performance and update on health and wellbeing in the Borough.  The report highlighted areas that had improved and also indicated areas that required improvement. 

The Board discussed a number of issues including, the poor performance in regards to Health Checks, care home placements and vaccination rates.

In response to a question from Cllr Turner, Matthew Cole provided information on the national initiative to ensure that all pregnant women receive a Whooping Cough (Pertussis) vaccination.  Matthew said this initiative had been well received by pregnant women and had a good take-up rate locally.  There had been one death locally from Whooping Cough.  Dr Heeps, BHRUT, explained that maternity services vaccinations are given by GPs not at the hospital.  Matthew Cole advised that he believed that a business case had been approved to allow the vaccinations at any maternity service health point, including the hospital, and he would check on this and report back to the Board in due course.  Anne Bristow suggested that Partners needed to investigate ways to improve the provision of vaccination services to pregnant women, so they were provided in a patient centred way.  Cllr Turner supported the suggestions and said that it was important that vaccination services are provided by all GPs, as well as being offered at other health points.

The Chair raised the issue of additional support for the CCG in view of the additional work pressure the CCG would have following recent CQC inspections.  Ceri Jacobs explained the governance role of NHS England, the support provided to Primary Care and that there were also NHS England medical directors available to support the CCG.  Sharron Morrow, Chief Operating Officer, Barking and Dagenham CCG, explained that a committee had been set up to look at performance issues and to develop improvement / actions plans and how the CCG input into those plans as well as looking at poor health presentation through promotion.  Dr Mohi provided information on the logistical and business planning work that was being undertaken with local GPs.

BHRUT gave an update on the 18 week Referral to Treatment (RTT) position and it was noted that the number of patients who have waited a long time had reduced by 67% since 3 April 2016.  The target for operating theatre productivity had been exceeded, but there is a very significant challenge to return to meeting the RTT standards in a sustainable manner.  This would involve carrying out around 5,000 operations and 93,000 outpatient appointments over an 18 month period.  A management and assurance process was now in place to achieve a return to RTT standard, this included meeting with NHS England and the BHR System Resilience Group. 

BHRUT assured the Board that the clinical reviews of those patients waiting over a year indicated that there were no cases where there had been clinical harm due to the length of time they had waited.  The clinical review tool/programme had been so successful that it would continue to be used.  Work was also being undertaken to identify capacity gaps in order that service provision would match demand.

BHRUT would continue outsourcing to independent providers, whilst BHRUT had revamped their letters, BHRUT felt they had always made it clear in their letters to patients that even if they are attending private facilities they are NHS patients and the treatment would be totally free. 

Cllr Carpenter welcomed the detail provided in Dr N Moghal’s letter of 16 September 2016, which included the number of LBBD residents on the waiting list by speciality, but was concerned that with 11,333 people on the list it could take two to three years to get through the backlog.  BHRUT responded that they were now coping with the current demand and were also making in-roads into the backlog.  Dr Heeps advised that not all discipline would need surgery and there were some conditions where they could initially be dealt with by GPs.

The Chair was concerned that pressures at A&E would be increased as people chose to go to A&E because of long waits for referred treatment, especially if they were in pain.  BHRUT advised that the demand pathways are in line with national practice.  Whilst some patients would turn up at the door of A&E, this pressure would be reduced by providing accessible and well signposted alternative pathway choices.

Ceri Jacobs advised that BHRUT actions and strategies were now being held up by NHS England as a good example to other health trusts who have got into difficulties on how make the necessary improvements. 

In response to a number of questions from Cllr Turner, Anne Bristow advised that the trend lines would be included in future reports for information only, as the detail should be dealt with by the LBBD Health and Adult Services Select Committee (HASSC).

The Board:

(i)  Received and commented on the report and noted:

(a)  The current position of BHRUT’s Action Plan in regards to the 18 week Referral to Treatments standards and  the situation in regards to the individual medical disciplines as set out in Dr Moghal’s letter of 16 September 2016;

(b)  The use of clinical harm reviews as a tool to prioritise patients and the assurance from BHRUT that the recent reviews of those patients waiting to be seen / treated had indicated that there were no cases of harm found;

(c)  The roles of the NHS England and CCG in commissioning, governance and the monitoring of GP and other primary care services;

(d)  The LBBD Health and Adult Services Select Committee is already scrutinising issues of concern around Referral to Treatment and the Committee’s work programme was on the Council’s website; and

(ii)  Partners agreed to investigate ways to improve the provision of vaccination services to pregnant women, in particular Whooping Cough (Pertussis).