Meeting documents
Health Scrutiny Sub-Committee (DCC)
Tuesday 18 October 2005
Meeting: Health Scrutiny Sub-Committee (County Hall, Durham - Council Chamber - 18/10/2005 10:00:00 AM)
Item: A3 Annual Health Checks for Health Trusts
| Health Scrutiny Sub-Committee |  |
| Report of Head of Overview and Scrutiny |
Purpose of Report
1. To comment upon the main Health Trusts which provide services to residents in County Durham as part of a national process known as the ‘Annual Health Check’.
Background
2. The Annual Health Check is the Health Care Commission’s new system of assessment for all primary care trusts and National Health Service Trusts. It replaces a star rating system which operated until earlier this year. This new system is designed to provide a fuller picture of the performance of Trusts against 24 core standards introduced by the Department of Health.
3. National Health Service Trusts are required to carry out a self-assessment of their Trust against the core standards. A draft declaration needs to be provided to the Commission by the end of this month and a final declaration by April 2006.
4. Overview and Scrutiny Committees, together with Patient and Public Involvement Forums and Strategic Health Authorities are being invited to make comments on the performance of their local Trusts.
The Core Standards
5. There are 24 core standards divided into seven areas (domains) of activity. These are:-
- Safety - patient safety is enhanced by the use of health care processes, working practices and systematic activities that prevent or reduce the risk of harm to patients.
- Clinical and Cost Effectiveness - patients achieve health care benefits that meet their individual needs through health care, decisions and services based on what assessed research evidence has shown provides effective clinical out-comes.
- Governance - managerial and clinical leadership and accountability, as well as the organisation’s culture, systems and working practices, ensure that probity, quality assurance, quality improvement and patient safety are central components of all activities of the health care organisation.
- Patient Focus - health care is provided in partnership with patients, their carers and relatives, respecting their diverse needs, preferences and choices, and in partnership with other organisations (especially social care organisations) whose services impact on patient well-being.
- Accessible and Responsive Care - patients receive services as promptly as possible, have choice in access to services and treatments, and do not experience unnecessary delay at any stage of service delivery or the care pathway.
- Care Environment and Amenities - care is provided in environments that promote patient and staff well-being and respect for patients’ needs and preferences in that they are designed for the effective and safe delivery of treatment, care or a specific function, provide as much privacy as possible, are well-maintained and are cleaned to optimise health outcomes for patients.
- Public Health - programmes and services are designed and delivered in collaboration with all relevant organisations and communities to promote, protect and improve the health of the population served and reduce health inequalities between different population groups and areas.
6. The Health Trusts are required to indicate whether they comply with the core standards, whether the standard is not met or whether there is insufficient assurance.
Comments from the Health Scrutiny Sub-Committee
7. There is a requirement on local health trusts to seek comments from Health Scrutiny. However, there is no obligation on the Sub-Committee to provide comments. The Health Care Commission has indicated they would like Scrutiny Committees to be involved in this assessment process because they often have important and useful feedback from communities and from the experiences and views of patients. This helps to understand how Trusts are performing and ensure that patients and the public are at the heart of the work of each Trust.
8. As this is the first year of the new Annual Health Checks, the process is evolving. Health Scrutiny has been encouraged only to comment on areas where they have specific knowledge. Suggested comments on each of the Trusts appear on the following pages.
Recommendation
9. You are recommended to consider and approve the comments to be made by the Health Scrutiny Sub-Committee in relation to the nine Health Trusts with which the Sub-Committee works.
PRIMARY CARE TRUSTS
Durham Dales Primary Care Trust
Current star rating - 3 stars (3 stars is the highest award).
The Durham Dales Primary Care Trust has indicated in its draft declaration that it complies with all the core standards with the following exceptions:
- child protection where further assurances are being put in place,
- some issues about training and development for staff,
- some issues about compliance with the requirements of the National Institute of Clinical Excellence, and
- issues about equity of access to services including equity from the Ambulance Service.
Suggested Comments from the Health Scrutiny Sub-Committee
The Dales Primary Care Trust covers a wide rural area. The challenge of rurality is a particular feature of the operations of this Trust.
The Trust has a positive relationship with the Health Scrutiny Sub-Committee. A number of consultation exercises have taken place led by the Trust. The Health Scrutiny Sub-Committee have provided a strong challenge from time to time particularly in relation to the proposal of the closure of Homelands Hospital but this was seen in the context of a desire to improve and modernise services. The Trust has participated positively in all the Health Scrutiny projects particularly in relation to consideration of Exercise Referral Schemes.
The difficulty of rurality has arisen recently in relation to proposed changes in the Ambulance Service in the Dales. The Primary Care Trust has been working jointly with the Health Scrutiny Sub-Committee and the Ambulance Trust to consider this issue.
Derwentside Primary Care Trust
Current star rating - 2 stars.
In relation to the core standards, the Trust has indicated in its draft declaration that it complies with all the standards with the exception of an insufficient assurance at the moment about ensuring clinicians up-date their skills, a need to improve processes in relation to medical records and a need to make improvements in relation to provision of information to patients, the public. There is also non-compliance in relation to some of the environments in which health care is provided.
Suggested Comments from the Health Scrutiny Sub-Committee
The Derwentside Primary Care Trust has worked closely with the Health Scrutiny Committee and has built up a very positive relationship. A number of consultation issues have been under consideration and the Trust has approached this in a helpful way providing information and explanations to the Health Scrutiny Members. The outcome of recent proposals to introduce changes to the Stanley Health Centre have demonstrated a willingness to listen carefully to the public and take their views into account .
It is noted in the interim declaration that further work needs to be carried out to achieve full compliance with the standards in relation to making information available to patients and the public. The action plan to address this issue is likely to be a welcome introduction as far as patients are concerned.
The Trust has been particularly helpful in providing assistance to the Scrutiny Committee in terms of the training required for the new Scrutiny function. The Trust has also been very willing to engage with the Sub-Committee to provide information and advice when requested.
Durham and Chester-le-Street Primary Care Trust
Current star rating - 3 stars
In the draft declaration, the Primary Care Trust has indicated compliance with all the core standards with the exception of a need to address National Institute of Clinical Excellence technology appraisals and also arrangements about mandatory training programmes for staff.
Suggested Comments from the Health Scrutiny Sub-Committee
The Durham and Chester-le-Street, through its Director of Public Health, has taken a lead in relation to a number of health issues considered by the Health Scrutiny Sub-Committee. In particular, a study of child health for under 5s in County Durham was greatly assisted by information provided by the Trust. The input of the Director of Public Health, who also provided a keynote speech at a conference held by the Health Scrutiny Committee following the publication of its report, was invaluable.
The relationship between the Primary Trust and the Health Scrutiny Sub-Committee is positive and helpful. There have been a small number of consultation issues involving the Health Scrutiny Sub-Committee. The Primary Care Trust has assisted with these exercises and sought to consider the needs of patients.
Easington Primary Care Trust
Current star rating - 2 stars.
There is only one area in which the Trust has indicated that it is not yet compliant. This is in relation to safety for the acquisition and use of medical devices which is part of a larger domain.
Suggested Comments from the Health Scrutiny Sub-Committee
Easington PCT has perhaps the most significant challenges of all the PCTs with which the Health Scrutiny Sub-Committee works. For hospital care, in particular, people in Easington need to travel either to the north to Tyneside, to the south to Tees Valley or, to a lesser extent, to the west to County Durham. As services are separated this way, this provides a particular challenge for Health Scrutiny in seeking to monitor services on behalf of Easington residents.
The Easington PCT has worked well with the Health Scrutiny Sub-Committee in all of its projects. In terms of consultations, the recent Advance Project demonstrated this positive working relationship and the desire to focus on the needs of local residents. Transport is a particular issue for Easington residents in facilitating access to services. The Easington PCT has sought to be proactive in this area. The additional funding allocated to the PCT to meet the needs of the area is most welcome. The PCT’s role in securing additional funding is much to its credit.
Sedgefield Primary Care Trust
Current star rating - 3 stars.
The Trust has indicated in its draft declaration that they comply with all the core standards without qualification.
Suggested Comments from the Health Scrutiny Sub-Committee
Sedgefield PCT has worked closely with the Health Scrutiny Sub-Committee on a number of projects. Recently, the Chief Executive of the PCT has taken the lead in relation to transport access to health facilities in the County. Transport is a constant theme which arises in relation to considering health services in the County.
The Primary Care Trust has assisted the Sub-Committee with all of its Health Scrutiny projects. It has been supportive and encouraging. The PPI Forum for Sedgefield has commented in detail about each of the core standards. The detailed involvement of the Forum in a wide range of issues demonstrates the strong commitment of the PCT to involving patients and the public in health service provision.
The PCT has assisted the Health Scrutiny Sub-Committee with consultation exercises, most recently a proposal affecting some Sedgefield patients in relation to mental health and learning disability services.
County Durham and Darlington Acute Trust
Current star rating - 3 stars.
The Trust has indicated full compliance with all the core standards in its draft declaration.
Suggested Comments from the Health Scrutiny Sub-Committee
The Health Scrutiny Sub-Committee has built up a good relationship with the Acute Trust. A senior officer from the Trust regularly attends the Health Scrutiny Sub-Committee meetings and is able to deal with queries from Health Scrutiny members.
A number of projects undertaken by the Sub-Committee have specifically involved this Trust. In particular, there has been an on-going consideration of MRSA as it affects County residents. The Trust has provided information and arranged the attendance of staff to explain at first hand the context and practical issues of hospital acquired infection.
A study of coronary heart disease and stroke services is underway. The Trust has been helpful in arranging visits and discussions with staff and patients including providing information to assist the Committee in understanding these services.
In terms of consultation, the Trust has been involved, together with PCTs, in a number of recent exercises and have willingly provided information in response to issues raised by Health Scrutiny members.
County Durham and Darlington Priority Services Trust
Current star rating - 3 stars.
The Trust has indicated in its draft declaration that they do not currently meet the standard in relation to clinical and cost-effectiveness and co-ordination of services for mental health for older people. There is also a need to develop a rolling programme of child protection checks on staff, some issues about safety systems and a need for co-ordination in relation to patient information.
Suggested Comments from the Health Scrutiny Sub-Committee
The Health Scrutiny Committee has been working closely with the Priority Services Trust. There have been a number of consultation issues which have arisen about reconfiguring services on which the Committee has commented. Some of these consultation exercises have been quite challenging. The Priority Services Trust have approached this in a transparent way and have been very willing to debate issues with Committee members. The Sub-Committee has built up a good relationship with the Trust.
A Scrutiny project relating to mental health services for young people entitled "Minding the Gap" has been instrumental in introducing improvements in services. The Trust has approached this in a positive way.
It is noted in the Interim Declaration that further work needs to be carried out to achieve full compliance with the standards in relation to making information available to patients and public. The Sub-Committee notes that there is an action plan and a target date to address this.
Tees and North East Yorkshire Trust
Current star rating - 2 stars.
In the draft declaration, the Trust has indicated that all of the core standards are met with the exception of some issues relating to staff development, making information available to patients and the public and the environments in which services are provided.
Suggested Comments from the Health Scrutiny Sub-Committee
The Health Scrutiny Sub-Committee has had detailed involvement with this Health Trust on a number of issues. We have built up a good relationship with the Trust and they have attended a number of Health Scrutiny Sub-Committee meetings to provide information and answer questions. The consultation about the Advance Project provided an opportunity to appreciate the Trust's approach to the involvement of patients and public in developing services. It was clear that the Trust had well-developed processes in place to listen to patients and the public and take into account their views. The approach to the proposed merger with the Priority Trust has also illustrated the Trust's desire to tackle this in a very transparent way.
North East Ambulance Trust
Current star rating - 3 stars.
In the draft declaration, the Ambulance Trust have indicated that they comply with all of the core standards.
Suggested Comments from the Health Scrutiny Sub-Committee
One of the first visits made by the Health Scrutiny Sub-Committee was to the Ambulance Headquarters on Tyneside. This provided a useful overview of the Services provided by this Trust. The Committee has recently been considering transport to health facilities and a specific session was devoted to the Ambulance Service in County Durham. The Service provided detailed information and will be providing further information following a request from Health Scrutiny members.
A consultation exercise is likely to start shortly concerning ambulance services in the Dales in County Durham. This is an issue which has caused some controversy. To meet the concerns, the Trust Chair and Chief Executive attended a local meeting arranged by the Health Scrutiny Sub-Committee to seek to explain to key local stakeholders the rationale behind the changes. This demonstrates the positive relationship between the Sub-Committee and the Trust. The local meeting assisted greatly in increasing understanding about the reason for considering change and the implications.
The particular concern of Health Scrutiny members has been equity of service. This is a challenge for a rural area which, in terms of the Ambulance Service, in practice, will not be able to match the response times in urban areas. The Health Scrutiny Committee and the Trust will need to work together closely to consider the important issues which have been raised by members of the Sub-Committee and local people about the issue of response times.
| Contact: Ian Mackenzie Tel: 0191 383 3506 |
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