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Minutes of the Patients Forum meeting held on 15th March 2006 at Which?
2 Marylebone Road , NW1

 Present:  Jonathan Ellis – Chair (Help the Aged); Mark Hill (MND Association); Liz Ranger (Contact a Family); Carol Herrity (Royal Mencap Society); Brian McGinnis (L’Arche UK); Eileen Neilson (Royal Pharmaceutical Society); Geraldine Amos (Home From Hospital Care); Katie Rowan (Consultant); Christine Hogg (Consultant); Gerda Loosemore-Reppen (Sign); Sally Sweeney Carroll (Royal College of Paediatrics and Child Health); Frances Blunden (Which?); Ian Banks (BMA PLG); Nikki Joule (Independent Policy Consultant).  In attendance:  Diana Basterfield (Patients Forum)

Apologies: Judith Wardle (Continence Foundation); Angeline Burke (NMC); Hew Helps (Chiropractic Patients Association); Graham Box (NAPP); Peter Walsh (AvMA)

Speaker:  Janice Shersby, Department of Health ‘Our Health, Our Care, Our Say Programme Team                                                   (See Appendix for Powerpoint slides)

 Minutes of last meeting

 The minutes of the meeting held on 11th January were agreed.

 Matters arising

 There were no matters arising

 Minutes of the Management Committee  

The minutes of the last Management Committee meeting held on March 15th were noted.

 Chairs Report

 It was reported that the work by the consultants on the review of the Patients Forum was continuing.  Members who had contributed to the review were thanked.     The review would be concluded by April and a report would be sent out to all members shortly afterwards.  The May 11th Patients Forum meeting would be devoted to the review with a detailed discussion on the issues arising out of the review.      Invitations would be out soon together with the consultants’ report.

Information Exchange

Mark Hill (Motor Neurone Disease Association):   It was reported that they were currently mainly working on the Assisted Dying Bill due back from the Lords early in May.  This would be the amended report based on the Select Committee review.  Lord Joffe  introduced the Private Members’ Bill and it was now very much focused on physician-assisted death, which is where the doctor would prescribe drugs for an individual rather than on euthanasia.    It was also reported that since the last meeting there had been a Green Paper introduced on welfare reform,  The focus was to encourage people on benefits to get back to work – to ‘allow’ them an opportunity to get back to work rather than ‘telling’ people to get back to work.   One of the problems with this was that the Press seemed to pick up on particular scare stories about welfare scroungers.  One particular incident was someone who was claiming they could walk no more than 40 metres when  it was discovered that he was running marathons.  It was trying to get over stories like that.

Liz Ranger (Contact a Family):   It was reported that of relevance to the Forum was their Parents and Paediatric Project that was entering its second year.   The first phase had been very much about getting paediatricians to start referring families on to Contact a Family – a one stop shop for further and very specialist information.  The second phase was focusing on parent participation in health settings.  This tied in with Liz’s personal role which was about parent participation across all services.      They were further developing the resources they have on their website as one aspect of that work and continuing to work with parents’ groups throughout England, very much developing parents awareness of the opportunities for them to become involved in shaping services.

Mencap:   It was reported that for some years there had been a campaign called “Changing Places” which was about having accessible adult changing places to supplement the wide range of changing places available for small people.    There will be a major launch of that project in Tate Modern in July, probably because Tate Modern is one of the very few places outside the Dome where they actually have accessible changing places for adults. 

Eileen Neilsen (Royal Pharmaceutical Society):    It was reported that they had had a very successful presentation from Roz Levinson to their Council in February on the Patient Involvement Strategy.   The Council had very enthusiastically supported the work done so far as well as the next stage – developing a draft strategy. This would go out for very wide consultation in the summer.        It was also reported that Eileen sat on the Regulators PPI Group which was about sharing good practice in PPI between the Regulators.  She had been asked to lead a small piece of work about setting up a small series of informal seminars on particular topics in PPI.  The plan was that patients groups would be invited and she would be coming to the Patients Forum for volunteers or nominations for maybe a couple of representatives to go to each of those seminars.    In relation to the Joffe Bill, on of the items Eileen had been working on recently was to start a piece of policy development work about what a change in the law on assisted suicide would mean for pharmacists.     This was the most difficult topic she had been required to pick up since she had started in policy work.  She would be going to Council with an initial set of proposals in April about what that policy work would need to cover.  Clearly it would need to include engagement with all the relevant stakeholders from a very early stage; she would hope to be returning to the Patients Forum to develop informal contact with interested groups and talk about how they could engage them.

Geraldine Amos (Home from Hospital Care):   Geraldine wished to raise something that had been going on for a long time:  when funds came from a local authority the decision about future funding always seemed to be made at the very last minute.  This left staff in a very insecure position.    Was there any way that pressure could be brought to bear to prevent such late decision-making?

Sally Sweeney Carroll (Royal College of Paediatrics and Child Health): It was reported that they had now appointed the Children’s’ Participation Project Manager, Sophie Auckland,  and the Patients and Carers Advisory Group were very much looking forward to working with her as she was full of ideas.     One of the major concerns of her group was the great concern about child protection issues and doctors and in particular the massive increase in the number of complaints against paediatricians.  The College was doing some work to get their heads around what it was all about.   It was also reported that the College was also taking a great deal of interest in the new proposed Food Bill around obesity and children.  The College was also setting up a working group looking at smoking. With the changes in the smoking law, the experience in Ireland was that although initially smoking dipped very fast, it crept back up again.    The idea was to see what they could do to prevent that happening here.  

Gerda Loosemore-Reppen (Sign):  It was reported that mention had been made at previous meetings that Sign had developed translation software for GP consultations – this produced diagnostic questions in sign language.   It has also been translated into twelve community languages with either voice input or written input with regard to the same questions.  The Department of Health had very generously decided to fund Sign to distribute the software on a trial basis to PCTs.  That had happened earlier in the year.  Sign was monitoring whether this software was actually going to be used or not.     They found that half of the PCTs that received the trial license had not even opened the email that suggested this help was available.

The others had taken it up and were trying it.   The aim was that it would then be licensed and paid for by the PCT out of special funding by the Department as part of the implementation of the document called “Equity in Access” – which was meant to improve access to services for deaf people with mental health problems.   There was a recurring budget for this which went through PCTs.  There were also some centrally funded projects among which would be a website which would show how the money had been allocated and what had happened to the proposals and recommendations.  It was also reported that Sign had set up a website called www.deaf-friendly.org.uk, which showed exactly how much money had been sent to PCTs as part of this implementation project and what had happened to it.  There are staff in place to monitor whether deaf awareness training had been commissioned and whether the software had been installed or not.  It also signposted people on to a trial website for the software so people could try it out.   Finally, it was reported that Sign was working on a model disability equality policy that would have a deaf component because it was not by any means clear that disability equality policies would be specific about the needs of deaf people.     The idea was to devise a template that might be promoted more widely.

Gerda also reported -  wearing another hat – that she was representing the Patients Forum on a working party at the Royal College of Pharmacists to do with reviewing the code of ethics for pharmacists.  This review would take quite a long time to be completed.  She would be reporting back on this at a later date as there would be a consultation for stakeholders and the Forum should have a role in that. 

Frances Blunden (Which?):  It was reported that the key new area they were developing work around at the moment was out of hours services.  They were doing a project jointly with the BMA. At the moment they were writing up the consumer research they had done and the BMA were doing similar focus groups in the same areas both relating to accident and emergency doctors and GPs. This would be a great achievement when the report eventually came out in terms of cooperation. It was also reported that dentistry continued to be a key area of work.   Recently they had done some more market research about lack of confidence among the public in the reform packages that would come into effect from 1st April 2006.   There were some real questions around charges.  Although Frances and Jonathan had both been on the working group the level of charges were now slightly different from the ones they had talked about then and this might have changed their view of the way of the world.    There was a huge amount of misinformation out there at the moment which it was important to counter.     It was also reported that Which? were continuing to work on medicines relating to issues of quality for consumers; also working on cosmetic and laser eye surgery, issues around safety and so on;   choice and system reform continued to be another key issue.   The Food Team were continuing to do a lot of work around nutrition and in their report they had highlighted the somewhat dubious practices going on around food being advertised to children.  This had captured quite a lot of people’s imagination. 

Ian Banks (BMA Patients Liaison Group):    It was reported that this was a very interesting time  for the PLG because they were reaching that point where the PLG was really being recognised by the BMA as a force within the BMA itself.  With that recognition came an element of fear that the BMA had a bit of a tiger by the tail, was it going to go the right way?   The beauty of it was that the PLG had been given a free rein and it was felt that input from the Patients Forum into the PLG on issues such as the use of  A & E could be very valuable.   There were many issues, particularly patient confidentiality, because of its close relationship with the doctors working there, so it  tended to be very high on the agenda.  The implementation of the White Paper was also very important. They were very concerned about the representation of ethnic groups on the PLG and keen to see that this was properly addressed. 

Jonathan Ellis (|Help the Aged):    It was reported that a lot of work had been done, particularly  in recent months about NHS funded continuing care.   There had been a Panorama documentary at the beginning of March which had looked at this issue.  They had been working on this with a small group of organisations including Age Concern, the Alzheimer’s Society and the Royal College of Nursing for quite some time, working with the Department of Health and helping them to develop the new National Framework for Continuing Care.   The central issue seemed to continue to be the boundary and the lack of certainty about the lack of boundary between where NHS funded universal health care stopped and means tested social care started.  There were a number of people falling through the gaps and paying for what should be universally free NHS funded continuing care.  The organisations had just produced a guide for the public on NHS funded   continuing care and this updated people on the current case law.  There had been a very recent case which had further clarified the situation.   The guide gave people suggestions on what they could do if they felt they should not be paying for their long-term care – whether they were receiving it in a care home or in their own home.     This would continue to be a big issue ahead of the consultation on the National Framework for Continuing Care – this was supposed to start in April.    This was getting to the crux of the boundary between health and means tested social care.      

 

Appendix

Janice Shersby, Department of Health ‘Our Health, Our Care, Our Say Programme Team  

 

 Most contact with services occurs in the community

86% of patient contact occurs in the community – outside of hospitals

Everyday there are thousands of contacts with community health and social care:

890,000: Consultations with a GP or practice nurse

315,000: Non GP Community contacts

18,000: NHS Direct calls

4,000: Walk in centre events

26,000 NHS sight tests

482,000: social care contact hours

1.7m adults receiving social care

Inputs to White Paper development

The demographic challenge

lifestyles are adding to risks

rise in obesity & associated problems

binge drinking

rise in LTCs

baby boomers are getting older

elderly have more LTCs & use more services

more older people living alone, away from family and friends

 The service challenge

insufficient focus on prevention & education

access is unfair & inconvenient

quality is uneven

care often in expensive remote settings

services don’t work together for user

 

The public’s priorities

more choice and control over their health and care

promote prevention & independence

greater convenience & easy access

focus on all their needs

Focus on those in greatest need/ greatest risk

 The people’s choices

 The four goals of the White Paper

better prevention & earlier intervention for improved health and well-being

more choice, control & a stronger voice

improve access to community services
& tackle inequalities

better support for people with longer term needs

   

Better prevention & earlier intervention

NHS life check targeted @ key life stages

health and social care working together

strengthen roles of DASS and DPH

better information, more self care

confront mental illness & isolation

a fitter Britain for 2012

   

More choice & a stronger voice

extend those entitled to direct payments

pilot individual budgets

choice of GP made a reality

accessible information

clear links from voice to action

   

Tackle inequalities

strengthen local commissioning, health and social care alignment

ensure that funding is fair, targeting need

new providers in areas of poor provision

role of community & voluntary sector

   

Improve access to community services

extended use of pharmacies

easier to access GP

shifting care - community hospitals

co-location of services

urgent care strategy reducing admissions

establish end of life care networks

access to community health services

   

Support for people with long term needs

health and social care jointly responsible

invest in more self care – expand EPP

develop common assessment framework

care plans

helpline, respite care & training for carers

assistive technology

multi-disciplinary teams

   

How are we going to make this change?

Inclusive approach

strengthened voice arrangements

Pilot and develop models

system reforms

shifting resources into community and prevention

workforce development

better joining up of services at a local level, new outcomes framework

encouraging innovation & social enterprise

allowing different providers to compete and successful practices to expand

 

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  Last updated 18/4/2006   © The Patients Forum 2006