Agenda and minutes

Apologies for absence were received from Councillors Hoban and Lister.

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 8 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 approve the minutes of the meeting of 20 November (attached).

AGREED:

That the minutes of the meeting of 20 November be approved.  

To receive a presentation from the Council’s Adult Services on the use of telecare to help prevent avoidable admissions to hospital from vulnerable people with long term medical conditions.

The Panel received evidence from Lesley Prince and Paulette Blake from the Council’s Community Alarm Service and David Souter from Tunstall

The Panel noted that the Service had been supporting elderly and vulnerable people in the Borough since the 1980’s. This was done by monitoring emergency calls via a warden’s call out system for people living in Supported Housing and dispersed units for people living in their own homes. It has expanded over the years and currently supported up to 4500 people within Haringey.

Following improvements in information technology, the government set up the Preventative Technology Grant scheme to expand services that were provided.  This was done in order to encourage the greater use of such technology and create greater links between local authority social service departments and other organisations and individuals that support individuals, such as occupational therapists, integrated care teams, home care agencies, Housing Association supported housing officers, district nurses, community matrons and GP’s.

In Haringey, people were now considered for telecare as part of assessments that had been undertaken in response to referrals.  The scheme aimed to;

·        Reduce hospital admissions and readmissions

·        Reduce dependence on care services and families

·        Provide security in the home and enable greater independence.

·        Reduce anxiety

·        Improve the quality of life for patients and informal carers

·        Delay the move into long-term residential care.

The basic systems just involved a button that was carried around the neck and could be pushed by clients in the event of an emergency.  This was connected to a telephone line and would alert relevant staff.  There were also a range of other sensors such as ones that detected movement, flood, carbon monoxide, falls, property exit and epilepsy.  The equipment was battery operated and did not require hard wiring.  It provided a warning to the control room when batteries were low.

Door exit sensors were particularly effective for individuals with increasing dementia, which could be exacerbated when they were removed from home into residential care. The sensor monitored when the client left the home.  If and when they did, a call was generated and received in the Control Room, where appropriate action was taken. 

The funding that was allocated to local authorities from the Preventative Technology Grant was generally intended for the purchase of equipment.  However, it was important for the applications to be supported by appropriate staff.  Haringey’s system was backed up by a call centre that was covered around the clock and based at Woodside House on Wood Green High Road.  There was also a response service which ensured that calls were acted upon.  Some local authorities had installed systems but did not have the support systems to respond effectively to calls.

The basic cost to the client was £5.95 per week for the alarm on its own.  Additional items were charged at 50p. per two items.  Each local authority had its own way of charging.  The service tried to keep the cost low and had taken advice on fair charging.  In addition to direct benefits to  ...  view the full minutes text for item 30.

To receive evidence fromthe following groups and organisations on their perception of services that are provided to support vulnerable people with long term conditions:

·        Age Concern

·        The Alzheimer’s Association

The Panel received evidence from Jennifer Strathearn from Age Concern and Julie-Ann Philips from the Alzheimer’s Society Haringey. 

Age Concern

Ms. Strathearn reported that she was providing a new service on behalf of Age Concern, which involved acting as an advocate in cases where elderly patients from Haringey were subject to delayed or failed discharge.  This covered situations where patients did not want to go to where they had been allocated or where they had been unable to find accommodation.  Sometimes people could not afford care or found it hard to accept it.  Local authorities were fined £120 per day unless for delayed discharges, unless they were the fault of the NHS.  In addition, she could provide benefits advice.  Advocacy was currently only available in hospital and was provided at both the North Middlesex and the Whittington. 

Mr. Brown commented that it was known that there were gaps in this particular area.  This was especially true of the Whittington Hospital, which had experienced problems with patients refusing to move out of the hospital.  The service had been established using pooled budget money with the North Middlesex and the Whittington and services were commissioned jointly with them. The objective of the service was to try and assist in resolving difficult issues, where an impasse had been reached.

Ms. Strathearn reported that clients sometimes told advocates things that they had not mentioned before and which could make a difference.  Older people were sometimes suspicious of professionals and were therefore likely to be more open with independent people.  In addition to addressing delayed and failed discharges, advocates could also help to prevent readmission to hospital.  For instance, preventative action could be taken to reduce the risk of falls.  Older people sometimes found it hard to accept that life had changed following hospitalisation and could have the mistaken expectation that they would be able to continue their life as it had been before. 

Referrals generally came from the Integrated Care and Discharge teams of each hospital. She normally just talked just to the patient but could also involve family members, if they were available.  She frequently came across people who had no support at all and, in such circumstances, could provide practical help including benefits advice.  She could also refer people onto other services, as appropriate. 

Alzheimer’s Society

Ms. Philips reported that the Alzheimer’s Society was a small, national charity.  They provided a number of services within Haringey including advocacy, a drop in facility and a café.   There were approximately 1400 people in Haringey with dementia.  Significant numbers were treated at St. Ann’s.  There was a high prevalence of vascular dementia within the Borough.

Dementia could present problems if people were admitted to hospital.  They could, for instance, refuse to get into an ambulance.  Dementia also affected those who cared for people with the condition.  Carers could, however, play a key role in helping to keep people out of hospital. 

The Panel noted that the volume of people attending Accident and Emergency  ...  view the full minutes text for item 31.

To receive a presentation a presentation from Professor Sue Procter from City University, the Panel’s independent expert adviser, on:

·        General principles and policy issues

·        Evidence of what works best.

The Panel received a presentation from Professor Sue Procter, from the City University, on key issues relating to high intensity users and interventions that have undertaken.   

High intensity users tended to have one or more long term conditions (LTCs) plus complex social circumstances and/or additional mental health problems including anxiety and depression.  Not all patients with one or more LTCs became high intensity service users.  Those that did tended to make additional demands on A&E and out of hours services, including hospital admissions, and/or suffered from LTCs that had traditionally been managed by the NHS in isolation from social services (e.g. COPD, diabetes, heart failure). 

High intensity users could be managed as part of a strategic response to LTCs, but tended to require additional demand management strategies such as;

·        Anxiety management

·        Out of hours and fluctuating support from social services in response to exacerbations of their condition

·        Help to address complex social circumstances

·        Containment strategies in order to prevent the patient bypassing planned care system

The Chronic Care Model identified the essential elements of a health care system that encouraged high quality chronic disease care.  Strategic responses to high intensity were typically based on these.  These elements were:

·        Community resources and policies

·        Health care organisation prioritising chronic care

·        Self-management support

·        Delivery system design

·        Decision support for to ensure integration of protocols and guidelines

·        Clinical information such as

Ø      Reminder systems to support compliance

Ø      Feedback to health professionals providing information on chronic illness measures such as hypertension or lipid levels

Ø      Registries for planning individual patient care and conducting population based care.

The role of the Community Matron was an important part of many strategies.  Community Matrons typically took responsibility for about 50 older people with high levels needs and worked collaboratively with all professionals and care givers.  They worked in partnership with GPs and members of the primary health care team.  They worked with the patient to develop a personal care plan, kept in touch and regularly monitored the patient’s condition.  They performed a range of useful functions such as:

·        Initiating action as required

·        Updating medical records

·        Mobilising multi-agency resources as required

·        Educating care givers into when to alert services

·        Generating additional support as required

·        Maintaining responsibility for patient even if they are admitted to hospital

·        Preparing relatives and patients for health outcomes

·        Evaluating care packages with GP.

In respect of telemedicine, there was very little UK evidence so far.  Its implementation was still beset by technical problems.  It required a well maintained system of response and worked best when linked to telecare and call alarm systems.  An evaluation undertaken in NE London indicated that telemedicine aided communication between patients and health care professionals and could lead to the resolution of seemingly intractable problems.  However, it was not universally acceptable to all very high intensity users. In addition, patients and families already experiencing high levels of stress may not welcome additional stress when technical problems are experienced with telemedicine.

On the whole, UK information systems were not  ...  view the full minutes text for item 32.

To consider progress with the review and future timetable.

It was noted that a meeting was in the process of being arranged with the Chief Executive of Camidoc.  This would enable issues relating to our-of-hours care to be raised.

None.

To agree a date for the final meeting of the Panel.  

It was agreed that a meeting to agree appropriate conclusions and recommendations for the review would be arranged and that efforts would be made to ensure that Professor Procter was able to attend on order to feed in her expertise.