Issue - meetings

To consider appropriatre conclusions and recommendations for the review.  A report that brings together all the key evidence considered by the review and suggests possible areas for discussion is attached.

The Panel, with the assistance of Professor Sue Procter and Gerry Taylor and Delia Thomas from Haringey TPCT, considered all the evidence that it had received during the course of the review.

It noted that there was a strong need for information to be collated across health and social services.  At the moment, records tended to be episodic instead of patient centred.  For instance, GPs were required to hold disease registers that contained information on patients with particular conditions rather then focussing primarily on the patients with them.  It was not clear how many people were at high risk of admission to hospital and could therefore potentially benefit from appropriate interventions.  Collaborative clusters were currently looking at ways that they could better identify people. GPs could potentially play a big part in addressing the issue.

It was recognised that there was limited scope for effective local action to address the shortcomings of information systems.  However, there would still be some need for information systems to be developed locally in order to better join up services.  It was felt that it was essential that that these were patient centred, rather then being episodic or disease based.  In addition, it was felt that it was essential that Camidoc and other relevant providers were included in information sharing.

It was noted that a significant percentage of high impact users suffered from mental health conditions.  It was therefore important that the Mental Health Trust was included within information sharing.  In addition, there was currently a lack of psychiatric cover for older people at the North Middlesex Hospital due to a lack of agreement between the TPCT and the Mental Health Trust on how this should be provided.  It was felt important that this be resolved. 

Ms Taylor reported that Haringey TPCT had not met the target of 21 for the number of Community Matrons posts that they were required to establish by March 2008.  They were currently evaluating the effectiveness of community matrons as part of a stage process to expanding their numbers.  Consideration was being given to increasing their numbers gradually.  However, effective evaluation was complex.  For example, people who had three emergency admissions in one year were generally less likely to have the same number of admissions in the following year irrespective of any intervention.  Many evaluations that had been undertaken of community matrons were based on the US experience, which was not comparable to the UK due to different ways of working. 

Information from up to 2006 on the effectiveness of Community Matrons had now been collected and was now being analysed.  There had been a general decrease in the rate of hospital admission for older people and there was a need to look at data covering a longer period before reaching decisions.

It was noted that the TPCT was currently using alternative ways of providing case management to make good the shortfall in the numbers of community matrons.  Targets for the number of people to be receiving case management had  ...  view the full minutes text for item 40