Agenda and minutes

None received.

The Chair will consider the admission of any late items of urgent busines. (Late items will be considered under the agenda item where they appear. New items will be dealt with at item 7 below).

None.

A Member with a personal interest in a matter who attends a meeting of the authority at which the matter is considered must disclose to the meeting the existence and nature of that interest at the commencement of that consideration, or when the interest becomes apparent.

A Member with a personal interest in a matter also has a prejudicial interest in that matter if the interest is one which a Member of the public, with knowledge of the relevant facts, would reasonably regard as so significant that it is likely to prejudice the Member’s judgement of the public interest.

None.

To note the scope and terms of reference for the review, as agreed by the Overview and Scrutiny Committee (report attached).  

The Panel noted the scope and terms of reference for the review that had been agreed by Overview and Scrutiny Committee.  It was agreed that information would also be sought on how the statistics about which people were deemed to be most at risk from emergency admission (on which decisions were taken) were collected.  In addition, Members felt that quality of life issues would also be considered and not just value for money.

In respect of independent expert advice, Members agreed that the possibility of commissioning some external input would be explored in order to provide an element of challenge and advice on possible lines of inquiry. 

The Panel noted the definition of high intensity user that was used locally by Haringey Teaching Primary Care Trust (TPCT): “people who are likely to be users of multiple services and have frequent attendances or admissions to hospital because they have long term conditions”.  No distinction was made between people who just presented at Accident and Emergency and those who were actually admitted to hospital. “Ambulatory care sensitive” (high impact users with primary care sensitive conditions) was not a piece of terminology that was used.

In respect of mental health, it was noted that, although this was a long term condition, it was treated differently as a different range of services were required. There were now fewer patients going to Accident and Emergency now due to the emergency reception centre at St. Ann’s Hospital and there were now systems in place to address the issue.  It was agreed that the TPCT would be asked to provide relevant statistics in relation to mental health as well as information on the ethnicity of high impact users.

Members noted that thalassaemia and sickle cell were prevalent in Haringey due to the ethnic background of  people in the Borough and felt that there should be consideration of these within the review.  Gerry Taylor for the TPCT reported that there was a particular unit that dealt with this condition at the North Middlesex Hospital.

AGREED:

1.      That the provision of external expert advice for the Panel be investigated further, in consultation with the Chair.

2.      That the issues of mental health, thalassaemia and sickle cell disease be considered as part of the review.

3.      That the TPCT be requested to provide relevant and up to date statistical information on high intensity users,  including people with mental health problems, within the Borough.

To consider progress with the review and future timetable.

Noted.

To receive the following from Gerry Taylor, Acting Director of Strategic Commissioning at Haringey Teaching Primary Care Trust:

·        An overview of strategic issues in addressing the issue of high intensity users

·        An outline of current support arrangements and their effectiveness

·        Details of any relevant development plans as well as an assessment of the likely implications of current changes to services, such as reconfigurations of acute care, the Haringey Primary Care Strategy and Professor Sir Are Darzi’s “Framework for Action”.

Gerry Taylor, Acting Director of Strategic Commissioning at Haringey TPCT, Delia Thomas, from the Integrated Care Team at the TPCT and Dr. Jyotindra Pandya MBE, a Tottenham GP and clinical director for the south east collaborative cluster of primary care practitioners provided an overview for the Panel on what was currently done to prevent the unnecessary hospitalisation of people with long terms and complex conditions.

Ms Taylor reported that Haringey practice was based on national guidance and strategy. This was generally based on the principle of helping people to support themselves.  Haringey was currently on track to meet the national target to reduce emergency bed days by 5% by 2008 through improved care planning in primary care and community settings. The Community Matrons (CMs) scheme had been recommended as a particularly effective approach.  Haringey’s target was to have 21 matrons by 2008 and there were currently 14 posts established, of which 11 were filled. 

One of their key roles was to identify very high intensity users and those most at risk from being admitted, as an emergency, to hospital. Some of the matrons were generic (4.25 posts) in their role whilst others specialised in a particular condition.  They were based within each collaborative cluster.  In identifying appropriate patients to work with, they liaised closely with local primary care practitioners.  Before relevant patients were taken on, CM’s had a discussion with the patient’s GP in order to be appraised on their history.  The patient was then visited.  The CMs had more time to work with the patient then GPs.  They undertook a range of functions, including reviewing medication and undertaking social and psychological assessments.  They worked separately from the District Nurses.  They worked intensively with patients at first and monitored them closely.  Following this, they could taper down their involvement, if appropriate. 

The CMs were employed directly by the TPCT.  The scheme was intended to follow an evidence based approach.  A pilot scheme had been set up initially using a telephone only contact with patients but this approach alone had been found not to be successful.    CMs currently worked with a caseload of approximately 50 patients as this was felt an appropriate amount for them to handle.  It was recognised that the level of service provided was not based on a complete picture of overall need/demand. 

The scheme was relatively new and had only been established locally in November 2006.  It was possible that caseloads could grow once the scheme had developed further.  The CMs had developed links with a wide range of organisations, including the Council’s Adult Services, the community alarm scheme and the ambulance service.  There was a specific CM network which allowed them to share expertise and knowledge.  As it was a new service, it was currently being evaluated to ensure that it was effective.  Current evidence was still unclear as to its overall effectiveness. 

Patients who might benefit from the service were identified either from them having been admitted and discharged a number of time or by  ...  view the full minutes text for item 6.

None.

30 October at 6:30 p.m.

Tuesday 30 October at 6.30pm.