Agenda item

12.15 pm

 

This item is an update on progress in improving services for people who are suffering from neurological conditions. It follows on from a discussion at the 16 July 2009 meeting (Minute 42/09 refers). Speakers attending the meeting will include Philippa Muir, Head of Specialist Commissioning and Clinical Networks; Sue Barnden, Service Development Manager and concerned members of the public. A ‘Health Needs Assessment for Long Term Neurological Conditions’ report which has been prepared for the Oxfordshire PCT Board is attached for the Committee’s attention at JHO10, together with a briefing for the Committee prepared by Philippa Muir and Sue Barnden.

Prior to the question and answer session with the invitees, namely Philippa Muir, Head of Specialist Commissioning and Clinical  Networks, Alan Webb, Director of Service Redesign, and Sue Barnden, Service Development Manager, Oxfordshire PCT; and Dennis Morgan, Chair, Oxford Neurological Alliance, members of the Committee were addressed by Mrs Dickinson, mother of John Dickinson, who had made representations to the Committee on 16 July 2009 (Minute 42/09 refers) about alleged deficiencies in the service given in Oxfordshire Health services.

 

Mrs Dickinson informed the Committee that since July 2009, her son’s treatment had not improved. She informed the Committee of a number of problems her son had encountered with the service and that they had lodged a formal complaint against the PCT and the ORH alleging a lack of leadership from within the Department, a lack of support staff and that the wrong drug had been used during a Drug Challenge test. She summed up by stating the following:

 

-                      Despite reviews of the service extending over two years, there was still no specialised Parkinson’s Disease nurse working exclusively for patients in the South and West Oxfordshire area;

-                      The part-time nursing post had not been extended to a full-time post;

-                      It was good news that the PCT had given £145k of funding for the neurological services, but it has come 3 years too late for her son;

-                      Her son had been refused a refund for travel fares to London for his treatment;

-                      Her son had disassociated himself from the services offered by Oxfordshire NHS , believing them to be of no relevance to the most vulnerable people of Oxfordshire.

 

Alan Webb, Philippa Muir and Dennis Morgan were invited up to the table. They put forward the following views:

 

-                      The PCT were aware of the anxiety and distress caused to Mr Dickinson had suffered and his views on the services in Oxfordshire;

-                      Discussions had followed questions raised by Mrs Dickinson at PCT Board meetings and there had followed an independent review and conciliation process;

-                      New information had now been brought forward with regard to the Drug Challenge Test and the PCT was working with Mr and Mrs Dickinson on it. There had been some progress made to improve these services but there was a need to ensure that services were available to all patients;

-                      Part of the Health Needs Assessment was about learning how many people were in treatment. This had been complemented by a service review which had been delegated to representatives from Health & Social Care and the voluntary organisations to do. A draft copy of this review had been presented to the Neurological Group last week;

-                      Funding had now been directed to the treatment of existing services and also to the commissioning of new services;

-                      On 12 May, the Local Implementation Group (LIG) comprising users, carers, voluntary and charitable groups looked at the draft service review. This Group, would be considering each commissioning model in July;

-                      There would be a formal consultation process carried out on the business plan.

 

The Committee asked a number of questions of Alan Webb, Philippa Muir and Dennis Morgan, some of which are included  below:

 

Q         Is Mr Dickinson to receive some community support?

R         (AW) stated that he would if it is appropriate. There would be community staff support in the future.. The PCT was looking at how many services could be re-designed to become community based. They were looking to provide services where they were required and where there was no out-patient source.

 

Q         Are there long delays for out-patients in hospital settings?

R         (PM) was not aware of the numbers, but they are within the standard NHS requirements. She undertook to look at the Service Level Agreement and to report back to the Committee via Roger Edwards.

 

Q         A Parkinson’s Disease nurse appears to be the key player with regard to assisting patients and assessment, but the post is only part-time. Will more hours be given to the post?

R         (AW and PM) stated that the nurse was engaged on a full-time basis, but 0.5 fte was devoted to research. The PCT were looking to address community support and assessment. This would be included in the Service Level Agreement which would be circulated to members of the Committee. The PCT were involved in genuine debate with service users about how best to spend the money to ensure that patients were within commuting distance.

 

Q         The LIG meets in July, which is exactly 12 months since the issues relating to the service were scrutinised at this Committee. Do you have any concrete proposals for support Mr Dickinson? How quickly can you start the recruitment process?

R         (PM)  stated that a business case would be worked up, adding that the sooner the Neurological Group could produce a model, the sooner it would be that the service could be commissioned. The recruitment process could be started by the end of July if approval was given by the LIG.

 

Q         If your data is not available, how will you reach the correct recommendations?

R         (PM) stated that it had been decided on 12 May that the service review was not complete. The problem was that data on the numbers of patients was not recorded easily. The PCT were using the data from the North East Public Health Observatory, which is 200 pages long. There was very little information on hospital admissions, episodes etc. There was a need to get better in the future at collecting information.

 

The Chairman summed up by stating that the PCT had gathered a large amount of information to date over a significant period of time, but still nobody was in post. He added his hope that the PCT would look at the commissioning of Neurology services at the ORH in light of the lack of provision of appropriate services. Alan Webb responded that there was no clear cut answer to that as yet, though acknowledging that there was a need to ‘push on’ with efforts to get a service to work across the whole spectrum. To do this, knowledge from the neurological alliance was required. The Committee had been assured by Philippa Muir that this could be supplied.

 

Dennis Morgan assured the Committee that his organisation had been discussing service requirements with Philippa Muir and service users. The PCT had attended these discussions and had fed information back. The priorities identified were those which had been identified by the Oxfordshire LINk. His organisation were looking at models which would benefit patients at all stages, rather than at only one.

 

Philippa Muir was asked what would happen if no agreement was reached at the LIG meeting on 14 July. She responded that, to date, there had not been sufficient time to think about different models. The PCT did not wish to take a directional approach, but it was hoped that a decision would be made on that day.

 

The Committee AGREED to:

 

(a)                 thank Mrs Dickinson for her address;

(b)                 thank Philippa Muir, Sue Barnden; Alan Webb and Dennis Morgan for attending the attending the meeting and for responding to members’ questions; and

(c)                 request Philippa Muir to communicate to Roger Edwards the outcomes of the Local Improvement Group’s deliberations as soon as possible following the meeting and that he, in turn, be requested to relay these to members of this Committee.

 

Alan Webb undertook to develop some proposals on how to take this forward and to share them with the Committee.