PRESENT: IN ATTENDANCE:

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1 Minutes of the 58th Meeting of the Belfast Local Commissioning Group held at 2.00 pm on Thursday 19 February 2015 in The Enler Complex, Unit 9, Craigleith Drive, Dundonald BT16 2QP PRESENT: Dr T Maguire - Chairman Cllr T Attwood - Local Government (left at 3.10pm) Mr K Bailey - Community/Voluntary Mr S Breen - Allied Health Professions Dr M Cunningham - General Practice Dr R Gray - Dentist Ms V McConnell - Social Care (Adults) Mrs C Rooney - Social Care (Children) Ms E Ross - Nursing IN ATTENDANCE: Mr I Deboys - Commissioning Lead, Belfast Ms D McIntyre - Public Health Agency Mr D Petticrew - Health & Social Care Board Mrs C Lynn - Corporate Business, HSCB APOLOGIES: Apologies for absence were received from Dr P Darragh, Mr D Power, Mr S Mullen and Ald M Henderson MBE. ACTION 1

2 09/15 Welcome and Opening Remarks The Chair recorded his thanks to Mr Power for chairing the last meeting as he was in attendance at the HSC Board meeting. The Chair welcomed members of the public to the meeting of the Belfast Local Commissioning Group. In order to help identify health needs of the population, he encouraged the public to participate in the meeting and voice their opinions. 10/15 Presentation Proposed Foot Protection Scheme The Chair welcomed Denise Killough, Podiatry Professional Head of Service, Belfast Trust to the meeting. Ms Killough noted that the costs of Diabetic complications including foot ulcers and amputations were higher than Stroke, kidney failure, Ischaemic heart disease and Myocardial Infarction. She reported that foot complications in England account for 20% of the total NHS spend on Diabetes care, 650m per year or 1 in every 150 that the NHS spends. She drew attention to ongoing work taking place on a foot care model by members of a multidisciplinary Diabetes foot team. Ms Killough reported that 11,000 patients are registered with podiatry in Belfast which represents 60% of those on the Diabetes register. She noted that a 2 week audit was undertaken which identified 296 active ulcerations across the community. She highlighted the raising amputation rate per 1000 people on the Diabetes register as being 2.99 per 2

3 1000 for 2013/14 in NI in comparison to 0.9 per 1000 for England for 2013/14. Ms Killough highlighted the number of bed days for people with complex wounds and noted that the number of days decreased from 2097 (in 2011/12) to 1970 (in 2013/14) due to the work of the Multidisciplinary Diabetes Foot Team. Ms Killough drew attention to a quote by Marion Kerr (2012), It is estimated that almost half of foot care expenditure in diabetes is for primary, community and outpatient care. Much of this care is not recognised by commissioners as attributable to the diabetic foot. She highlighted the Trust s proposed Podiatry model involving education, GP screening, community Foot Protection Team and hospital provision including a multidisciplinary Diabetes Foot team, amputation clinics and Orthotist clinics. Ms Killough reported on work undertaken by GPs on low risk foot care with no Podiatric need, the Foot Protection Team on Podiatric Intervention, monitor risk and bespoke education and the Multidisciplinary Foot Team on ulceration, intervention and rehabilitation. Ms Killough highlighted the importance of risk stratification with bespoke education for each patient and the appropriate management of podiatric need and monitoring of condition. She noted the need for emergency access supported by the independent Prescribing Podiatrist with direct access to the hospital Multidisciplinary Foot Team in reach staff. She stressed the importance of utilising available IT systems and to undertake a retrospective root cause analysis of all amputations. In terms of measurable outcomes, Ms Killough suggested an update of every person s risk stratification; (i) monitor the trends of each risk stratification; (ii) monitor the percentage of people 3

4 who have a minor amputation who then have a major amputation and (iii) the amputation rate. Following the presentations a number of comments were made: The Chair stressed that a root cause analysis should be undertaken following every amputation and Dr Michael McKenna advised that this matter had been discussed at a recent Regional Diabetes meeting. Mr James Watson referred to a newspaper article circulated at the last LCG meeting which highlighted that there were 5,000 unnecessary amputations in England and asked whether an amputation was the preferred method of treatment for Diabetes. He drew attention to some people paying for appointments with Podiatrists rather than be placed on NHS waiting lists. Ms Killough advised that in relation to appointments, all emergencies are seen within 5 days and all appointments within 9 weeks. She noted that most ulcerations do not result in amputations within the Belfast Trust, rather amputations are the result of lifestyle choices or complications. She stressed the need to educate especially as people are living longer and noted the disappointment and upset if someone has an amputation. Mrs Mary Morrison reported that the G6 try to educate their members and go to the GP if they have any concerns in relation to their foot care. She noted that in some cases older people prefer to pay for a private appointment. In response to a query by Mrs Ross, Ms Killough reported that a risk stratification is undertaken for all Podiatry patients. Mr Bailey asked whether there is a difference in foot care treatment for type 1 or 2 Diabetes and Ms Killough reported the treatment is similar. 4

5 Mr Brendan Heaney, Diabetes UK reported that Marion Kerr, Insight Health Economics has been asked to speak at an event organised in June 2015 and asked why action has not been undertaken on foot care before now. Dr Michael McKenna advised that he is preparing a proposal for Diabetes care to include education and a community foot team. The Chair noted that a robust, transformational business case should be prepared as soon as possible to be presented to the LCG. Mr Arthur Templeton, Diabetes UK reported that he had a foot ulceration and had received first class treatment with structured education. Mr Breen thanked Ms Killough for her excellent presentation which he felt was indeed transformational change. He noted that he had recently visited the Amputees Disability Unit at Musgrave Park Hospital which highlighted the need to save limbs, which in turn saves monies elsewhere. The Chair thanked Ms Killough for her useful presentation. 11/15 Chairman s Business Donaldson Report The Chair advised that discussion had taken place at the workshop earlier today on the Donaldson report, especially in relation to media and political interference and the overall ineffectiveness of commissioning in health and social care. He stressed the need for rigorous transformation and change. Mr Eugene Reid, Healthcare Manager, Lilly drew attention to Donaldson s criticisms of the commissioning system. The Chair indicated that he will bring forward his own proposals for improvements in commissioning to the next meeting. Chair 5

6 Issues raised by service users/advocates Senior s Forum Mrs Mary Morrison, Chair, Greater Belfast Seniors Forum (G6) provided an update on the following issues: Dr Cathy Jack, Medical Director Belfast Trust will attend a meeting of the G6 to discuss the discharge arrangements of frail elderly patients in terms of appropriate times of the day and keeping carers informed; G6 have had discussion on Transforming Your Care; A meeting has taken place involving Belfast City Hospital and Castlereagh Lifestyle Forum to discuss proposals on using a patch in place of needles. Care Packages Mr James Watson stressed the need for appropriate care packages to be put in place before the patient is discharged from hospital. Mr Deboys noted that the LCG has indeed invested in the community through such services as Acute Care at Home Team and Respiratory Team provision to avoid hospital admissions and will not retract any funding from hospital as a result until /15 Minutes of Previous Meetings held on 15 January 2015 The minutes of previous meeting held on 15 January 2015 were approved and signed by the Chair. 13/15 Matters Arising from the Minutes None 6

7 14/15 Report from Commissioning Lead, Belfast (i)hsc Commissioning Plan 2015/16 Mr Deboys reported that the LCG is currently working on the Draft Local Commissioning Plan 2015/16 which will be incorporated into the HSC/PHA Commissioning Plan 2015/16. He noted that the Financial Plan for 2015/16 has not yet been agreed with the DHSSPSNI but it is hoped that funding will be available for Diabetes, care in the community, reducing attendances at EDs, additional investment for carers and access for young people in transition to adulthood to day opportunities. He also reported that the LCG had discussed how it could better ensure the delivery of what it had commissioned. The LCG was considering the potential to fund providers at a lower level than the current SBA where the volumes of care were not being delivered. This would require withholding funds which could then be earned back with a higher productivity or redeployed to alternative providers. Consideration was also being given to funding groups of GPs to manage patients locally and appropriately to avoid referrals to hospital leading to many months of waiting to be seen by a Consultant or receive a scan or other diagnostic test. Mr Deboys reported that a workshop will take place with service users and carers on 11 March 2015 to discuss the Draft Local Commissioning Plan at the Mount Conference Centre. Carers Mrs Morrison asked that respite care provision be made available especially for older carers looking after younger people. Mr Petticrew agreed that respite care was very important and reported that the LCG is planning additional funding for respite, short and 7

8 recreational breaks. He noted that respite should fit around the carers needs and a carers assessment helps identify the respite break that the carer requires. 15/15 Addressing Life Inequalities Ms McIntyre provided an update on the following: (i)procurement update The first of the Mental Health and Suicide Prevention specifications has been issued, with the PHA currently developing phase 2 with the intent to notify providers by December 2015 with the view to have services in place by 1 April (ii)the Belfast Strategic Partnership has launched its new website (iii)launch of the Belfast a Learning City Strategy The Lifelong Learning thematic group has developed a strategy called Belfast, a learning city to set out a vision of Belfast where learning is used as a positive force to expand and enhance life chances for all citizens of all ages in Belfast. (iv)active Belfast is launching the fourth year of its Grant Scheme, which aims this year to support more people to be active in cycling and neighbourhoods. City wide projects grants of 25,000 are available or a smaller grant of 10,000. Up to an additional 1,200 will also be available for groups wishing to include a nutrition element in their programme. 16/15 Any Other Business None 17/15 Date of Next Meeting The next meeting of the Belfast Local Commissioning Group will take place at 2.00pm on Thursday 19 March 2015 in the Millennium Centre, Springfield Road, Belfast BT12 7DU. 8