We met with the Clinical Commissioning Group (CCG) and Social Services to discuss various issues. Out of this meeting it was clear that key changes are happening in the CCG with seven new members all within the managment teams.
A good report was given on Child Services which showed an improvement in care of looked after children, with a figure of 200 attending local A&E.
About a dozen people representing local voluntary sector providers met with the Clinical Commissioning Group (CCG), the Mental Health Trust and the Council's mental health social work teams to look at how various services have been running over the past year.
A lively discussion followed a report given by MIND on how safer discharge was now being given to patients leaving hospital care. Better knowledge and communication however is needed on voluntary sector services.
Services at Springfield such as the new Lotus Suite were also giving positive results with statistics showing 71% of the 250 people in crisis assessed now referred back in to the community, rather than admitted to inpatient care.
The Recovery cafes set up both in Tooting at 966 Garrat lane by Hestia and the Sunshine cafe at Wimbledon Chase are building in numbers, and have a good show of volunteers to support each service user.
For a full summary of this meeting please refer to our attached report.
Around 90% of prisoners in England live with some form of mental health problem and mental ill health is much more prevalent within prisons than anywhere else. Inmates commonly suffer with depression or anxiety, psychotic illnesses or substance abuse disorders.
However, only 1 out of 5 prison inmates with a mental health problem is currently receiving treatment. This has lead to suicide in some cases as well as a whole host of other problems.
As Wandsworth Prison is one of the top three most overcrowded prisons in England, we felt that an investigation into conditions there, and a consultation on the mental health needs of the prison inmates, was long overdue. Our consultation was carried out in conjunction with the London Assembly Health Committee's efforts to improve access to mental health support for prison inmates.
We collected information from ex-offenders, service providers and other interested stakeholders to get a better idea of the main mental health challenges faced by prisoners and to try and assess what the Mayor and the London Assembly can do to support better mental health for this group.
One of the main aims of our ‘Enter & View’ team’s current strategy is to find out more about patient experience at St. George’s Hospital. Early in 2017 we were invited to visit the renal services department. Following our visits to the hospital's renal services department, we visited Colliers Wood Dialysis Unit. The Unit has been open for six years and was designed to provide dialysis for people with chronic renal conditions but who do not require a stay in hospital.
Following major changes within St George's Trust, which had a negative impact on the delivery of its renal services, it was decided that community based satellite units would be needed to deal with the overflow of dialysis patients from St George’s. Colliers Wood is one of those additional units.
We interviewed a total of 25 patients, most of whom were between 60-79 years of age and had been attending Colliers Wood for between 4 - 6 years. Although they reported initial problems during the transition from St George's to Colliers Wood, things seemed to have largely settled down by the time of our visit.
Most patients expressed high levels of satisfaction with their care and treatment, and medical and nursing staff were praised for being respectful, helpful, and kind. Patients particularly valued the opportunities for socialising with each other at the Unit.
Our findings and recommendations, and the Unit's response to our report, are attached for information.
Enter & View Visit to Champney's Ward & Renal Services Department, St George's
Posted on 02/08/2017
One the main aims of our ‘Enter & View’ team’s current strategy is to find out more about patient experience at St. George’s Hospital. Early in 2017 we were invited to visit the renal services department. We made a total of three visits to learn as much as we could about the renal services being provided at St George's.
Before we began our visits, we became aware that major changes had recently taken place in the organisation which affected delivery of the hospital’s renal services, including a reduction in the number of inpatient beds and dialysis stations.
We spoke to nineteen patients in all and on the whole received very positive feedback about the caring and responsive behaviour of staff. Most of the negative comments we received were about changes to appointments or the unreliability of the ambulance transport service.
We were very impressed with how well St George’s staff have responded to the challenge of maintaining the quality of patient care in the face of recent changes.
Our report and recommendations are attached below.
St George's University Hospital’s Foundation Trust Board
Posted on 12/07/2017
In the main part of the meeting the changes to the quality improvement programme were discussed first, highlighting the £60 million needed for change.
The Senior Staff of the Trust, Governors and members of the public spilt in to small groups to walk around the hospital assessing conditions and speaking to staff - a new initiative. They were asked to give their impressions and then discussed the following topics:
How to remedy the failings noted by the CQC (Care Quality Commission)
The redesign of the quality and performance report with more emphasis on reporting actions and progress rather than just presenting data
Emergency department weak performance
The reported final, financial deficit for last year at £73.9 million
The attached report contains more from this meeting
This was the Bi-monthly Suicide Prevention Meeting. The key focus was on the implementation of referral pathways and protocols for dual diagnosis and treatment involving DAAT (Drug and Alcohol Team) and other services.
Attended by both charity and public service sector representatives, including the Met Police and Samaritans.
The Launch of Wandsworth and Westminster MIND's new Wellbeing Hub in Tooting
Posted on 12/07/2017
Nearly 100 MIND service users and supporters as well as representatives of Wandsworth Social services and other mental health agencies gathered for the formal launch of Wandsworth and Westminster's new Wellbeing Hub. Based on the ground floor of a new residential block at 201-3 Tooting High St service users will have access to:
the provision of recovery-focussed training and other activities for mental health service users who qualify for social care funding
access to a large meeting/training room, an IT suite, a spacious kitchen for training in food preparation, office space and a couple of smaller rooms for 1:1 work
MIND's supported housing service which provides housing and support, including a key worker, for about 40 people with mental health problems in Wandsworth
This link is the inspiring real-life story told by two young men, one of whom had saved the other from suicide on Waterloo Bridge nine years ago and are now campaigning for change.
The attached report contains more from this meeting.
Clinical Quality Review Group (CQRG) Community Health Services Meeting
Posted on 28/06/2017
The meeting looked at the quality of services being provided to patients by the Community Adult Health Services provider - CAHS - and focused on St George's Hospital losing the contract for CAHS whilst introducing the new provider - Central London Community Healthcare Services - a community health provider.
The main points from the meeting were:
Greater consistency in care
Patient Surveys show poor results for many community nursing teams
Following varied results from an audit of services provided by therapists, we suggested that all patient goals should be agreed and co-signed by patients
The attached report contains more from this meeting.
Our representatives met with the St George's Hospital Quality Committee to discuss a number of key issues regarding hospital management.
New procedures are being prepared for consent following serious incidents and complaints received about the hospital. Patient involvement in shaping these new procedures is key and welcomed; we may also be approached for input.
Other improvements were mentioned including new beds, a review of safe staffing levels and improving the quality of end of life care for both patients and the bereaved.
Both the Care Quality Commission (CQC) and Wandsworth Clinical Commissioning Group (CCG) continue to monitor progress.
For more details of this meeting please see the attached report.
A wide variety of important issues relating to CAMHS (Child and Adolescent Mental Health Services) were discussed at this meeting.
Out of the six key areas of focus, particularly well received was Dr Essau's presentation on Super Skills for Life; a programme targeted at pupils in Year 6 who are susceptible to anxiety regarding the transition from primary to secondary school.
Other topics discussed included the new Transition Service which went live on the 1st April. The aim of the service is to help children and young people move more smoothly from CAMHS to adult mental health services.
For fuller details on mental health services for children and young people, please see the attached document.
Wandsworth Clinical Commissioning Group (CCG) Board Meeting East Putney
Posted on 31/05/2017
The meeting included members of the Clinical Commissioning Group (CCG) Board; Healthwatch; Social Services; and the general public.
There was a technical focus on some key issues concerning clinical procedure, finance and effective commissioning and the importance of the public's voice in some of these matters. Coupled with discussions on the merger of the Clinical Commissioning Group (CCG) with South West London’s Sustainability Transformation Plan (STP) this provided both an informative and in-depth meeting.
From a financial perspective QUIPP (Quality, Innovation, Productivity and Prevention programme ) provided figures stating expected savings to have doubled for 2017 and 2018 to £21.5 million. This presents its own risks to the CCG (Clinical Commissioning Group), where some savings are now planned whilst others remain speculative.
Please see the report attached for further details on these agenda items.
Healthwatch also provided a strong voice on the importance of public engagement in these discussions, and are committed in highlighting this to the CCG (Clinical Commissioning Group) where the difficulty lies.
Our visit to Ward 2 at Springfield Hospital was part of a series of Enter and View visits to inpatient wards at South West London and St George's Mental Health NHS Trust. We visited the ward twice as our findings on the first visit were inconclusive, and spoke to 11 patients as well as to their friends and relatives.
Our findings on Ward 2 were very mixed and not always positive. However the ward management team has changed since our visits and the new team has plans for improvement. We were also able to make a number of recommendations for improvement which Springfield Hospital has responded to very positively. The report and action plan from our visit to Ward 2 are attached below.
We also visited Laurel Ward at Queen Mary's Hospital in Roehampton, and spoke to 8 of the patients. Our impressions of this ward were very positive overall; most patients were happy with their surroundings and with the treatment they receive from the nurses and other staff on the ward. Our recommendations for Laurel Ward were therefore very general in nature, but were well received and have either already been achieved or are in progress.
The report and action plan from our visit to Laurel Ward are attached below.
Those in attendance were: Mark Robertson (Mark Robertson, Head of Mental Health and Learning Disability Commissioning - Wandsworth Clinical Commissioning Group), Tarlochan Ghale (Strategic Health Facilitator- Wandsworth Clinical Commissioning Group, Yvonne Tester (Head of Community Learning Disability nursing – St George’s Hospital), Phillipa Brooks (Carer’s Participation and Volunteer Development Manager- Wandsworth Carers).
We heard some great new initiatives and reports led by: the London Disability Learning Mortality Review, Health and Social Care Action Plan, Generate, and the Multi-Community Speciality Provider.
Of particular interest is the Dying Matters week in May which gives great timing to the NHS programme being run by the London Disability Learning Mortality Review on this sensitive subject.
The next meeting is on 20 April and we will be looking out for reports from the Multi-Community Speciality Provider as they have been working with the Battersea GP Federation on issues like healthchecks, care planning and community services.
For more information on the above issues please read the report below by our Healthwatch Manager - Sarah Cook.
St George’s Hospital Quality Committee (QC) Meeting
Posted on 17/05/2017
The Quality Committee provides an excellent two-way opportunity for Healthwatch: we can be kept up to date with progress on key issues at the hospital as well as being able to make our views directly to the Executive Directors and NEDS (Non-Executive Directors). A huge step forward.
This was the second meeting of this newly established forum to discuss some serious weaknesses in quality assurance idenified by the CQC - Care Quality Commission. Those attending were: the Chair (Non Executive Director), Chief Executive (interim), Director of Medical Division (standing in for Medical Director), Director of Quality, Head of Governance, Quality Improvement Lead, Director of Estates and Facilities Corporate Secretary. Despite those present the meeting unfortunately was not quorate as it required two Non- Executive Director's to be present.
Key issues discussed:
The Report from the Patient Quality and Safety Board. Safe staff nursing, the current dual presrcribing system and IT ifrastructure were areas highlighted,
The Regulatory and Performance Matters in Paediatrics, the Quality Improvement Plan, Infection Control and Patient Feedback on hospital experience to name a few,
And Goverance in relation to the quality of water, responses to patient complaints, and Quality reports.
South West London Healthwatch (HW) liaison meeting with South West London St George’s (SWLStG) Mental Health Trust
Posted on 15/05/2017
A large and busy meeting with much to talk about since the last review meeting in September last year. Those attending were the Trust's top management, and representatives from all the South West London Healthwatch organisations.
Healthwatch took particularly interest in eight of the key items discussed, some of the highlights, as follows:
The new Lotus Assessment suite
Two Crisis Cafes being opened in April by voluntary sector providers.
Our Healthwatch representatives have been invited to comment on the Trust's Quality Priorities for the coming year February - the key priority being more emphasis on 'improving community services'.
The Trust reported that waiting times for CAMHS services (Child and Adolescent Services) were now virtually all within the 18 week target except for the Neurological Assessment team.
One area of concern was that Merton mentioned complaints about cuts in the SUN project for people with personality disorders.
We will continue liaising with the Trust and raising areas in need of improvement. Wandsworth Healthwatch will be hosting the next of these meetings on 10 April. Please see our full response below.
A number of key issues were discussed and presented on at this meeting where our Healthwatch representative attended as an observer. It has been decided that in light of the presentations given that Healthwatch will take action in monitoring how the Trust's finances may impact these services, and move ahead with planned Enter and View visits where necessary.
The meeting was attended by Executive Directors and other senior managers from the Trust; representatives from the CCG (Clinical Commissioning Group) and NHS England who commission general and specialist services from the Trust. Some of the following were discussed after senior presentations were given:
A Presentation on the service for people with cancers of unknown primary (CUP service) - Staffing and funding were shown to present an issue, as 30% of the 2000 cancer patients treated annually are in need of more specialist care.
A Presentation by the Consultant Orthopaedic and Trauma surgeon on the hospital’s hip fracture programme. - This service is now meeting 46.7% of it's Best Practise Targets (BPTs), however concerns over theatre waiting times still remain an issue.
There was a second part to the meeting that remained brief, however, it called in to question the PALS service and the number of non-elective re-admissions. It was helpful to know that CQRG (Clinical Quality Review Group) are alert to the need for improvements in the various services.
For a fuller look at the report please read the attached PDF.
The workshop, which was jointly run by South West London St George's (SWLStG's) Mental Health Trust and Wandsworth Community Empowerment Network (WCEN), demonstrated how community organisations were involved in the set up of the new Talk Wandsworth psychological therapy service.
Representatives from the Trust, Gareth Jones and Darren Fernandes, outlined key features of the new service and presented specific ideas for strengthening the service's links with local communities.
Malik Gull of WCEN, along with local faith representatives and community organisations exchanged ideas and agreed that a clear framework needs to be outlined concerning:
Overcoming inequality in the uptake of therapy
The need for goverance by community partners
Additional funding streams
Our Healthwatch representative has outlined the importance of this workshop in the attachment below and will actively monitor the development of this service.
Wandsworth CCG (Clinical Commissioning Group) Patient & Public Involvement Reference Group
Posted on 08/05/2017
This was an informative and information based meeting chaired by the Clinical Commissioning Group (CCG) and attended by the PPI (Patient & Public Involvement) Team, Healthwatch and various local charities.
Two comprehensive presentations were given; the first by Lauren Ashley-Boyall on the Voluntary Sector Co-ordination Project and the second by representatives from the GP Federation (a group of general practices or surgeries working together as an organisation in the local community) on the history of the Federation & MCP (Multi-specialty and Community Provider), Claire Ratnayake and Chief Executive Jim Fenwick.
Healthwatch noted the staff changes taking place within Wandsworth CCG's Public Involvement Team and is committed to monitoring the commissioning and quality of services within the borough.
St George's University Hospital’s Foundation Trust Outpatient Service Re-design 2nd Workshop
Posted on 08/05/2017
Around 50 people attended this workshop, including patients and Governors who were well represented, together with some external stakeholders.
The purpose of the workshop was to present, and get feedback on, ways of improving appointment booking processes and dealing with clinical information. A number of core issues were highlighted and discussed:
Which software will be most effective? A simple and effective system will be set up and staff will be given training to use the system properly
Aim to have all GP appointments booked via the NHS e-Referral System (which used to be called 'Choose and Book')
The patient will have the freedom to view and change appointments and choose their preferred contact method
Patient needs, clinical pathways, and the implementation of hubs to consolidate clinics are all in process
Good communication between GPs and Consultants will be key to pulling this new system together. Healthwatch, and others present, highlighted the necessity of patient involvement throughout this process.
The next meeting will involve the Outpatient Transformation Team. These are exiciting changes for the benefit of patients and staff. Please refer to the comprehensive report below for more details.
St. George's Emergency Department Frequent Attenders Workshop.
Posted on 26/04/2017
Stakeholders and staff from many agencies concerned with Emergency Department patients attended this workshop. With 50 in attendance it was an opportunity to look at the problem of frequent attenders at the St. George's Emergency Department (ED), and to discuss ways to generate safe and appropriate out of hospital solutions.
The meeting was structured in to stages beginning with the numbers of active attenders over the last two years. It then progressed to why and what the conditions were and underlying problems. The question still asks - how best can the hospital address this?
From data gathered, 90% of approximately 280,000 people used the service once or twice with other users increasing to three or times.
A group of twenty-seven attenders were documented as using the service over forty times.
With this a complex range of conditions were evidenced with the majority being drug and alcohol dependent, being admitted via ambulance.
Although the burden is not great it does raise the question of why this is happening, and is representative of a failure in the system.
Communication and access to relevant data seems key to making the necessary improvements.
Healthwatch will attend further meetings to monitor and see how improvements are being made to develop the healthcare and social needs of these attenders.
Please refer to the summary report below for further details.