Agenda item

Briefing note and presentation of the Director of Public Health

The following representatives have been invited to the meeting for the consideration of this item:

Dr Surinder Chaggar, GP and Clinical Lead for Integration, Coventry and Rugby Clinical Commissioning Group (CCG)

Dr Colin Gelder, Consultant Respiratory Physician, University Hospitals Coventry and Warwickshire (UHCW)

Michelle Horn, Primary Care Lead Nurse, Coventry and Rugby CCG

Dr Paul O’Hare, Consultant Diabetic Physician, UHCW

Dr Madeleine Wells, GP, Coventry and Rugby CCG and Coventry Local Medical Committee

The Scrutiny Board considered a briefing note and received a presentation of the Director of Public Health concerning the clinical management of large scale chronic diseases. Councillor Maggie O’Rourke, Chair of the Adult Social Care and Health Overview and Scrutiny Committee, Warwickshire County Council, Dr Colin Gelder and Dr Paul O’Hare, University Hospital Coventry and Warwickshire (UHCW), Michelle Horn, Clare Hollingworth and Nikkie Taylor, Coventry and Rugby CCG and Josie Spencer Coventry and Warwickshire Partnership Trust (CWPT)attended the meeting for the consideration of this item. Councillor Gingell, Cabinet Member for Health and Adult Services also attended. 

The presentation informed of how pathways were being managed in primary care for a range of challenges. An explanation was provided about long term conditions which generally couldn’t be cured so the focus was on slowing or stopping progression; preventing complications; minimising the impact on quality of life and supporting patients to lead fulfilling lives. Information was provided on national policy along with local initiatives. Local prevention included health training and weight management services; stop smoking service; NHS health checks; lifestyle services directory; and a single point of access. There were individual disease pathways for diabetes, chronic obstructive pulmonary disease, heart failure, dementia and strokes. The presentation concluded with information on proposals for future work.

The briefing note described the services being delivered in primary care to prevent the onset or progression of long term conditions currently commissioned by Public Health; explained the existing pathways designed to prevent progression and manage specific long-term conditions; detailed plans to transform existing long-term conditions pathways, focusing on areas were a move towards delivery of care in primary care setting was planned; and highlighted plans to provide more integrated, holistic care for patients with multiple long term conditions or frailty rather than focussing on individual conditions.

The Board questioned the officers and the representatives on a number of issues and responses were provided. Matters raised included:

·  The difficulties of treating patients with complex needs in their own homes

·  Feedback from pilot project developed at the hot house workshop involving a three tiered model of care to support the frail elderly funded by the Better Care Fund.

·  The importance of the role of the voluntary sector

·  The support available for patients and their families when they have been diagnosed with dementia

·  An understanding of the financial implications in the local health economy, particularly in light of the cuts to local authority budgets

·  The importance of being able to provide holistic support to patients with long term conditions enabling them to lead fulfilling lives

·  What was being done to educate the public to prevent large scale chronic diseases developing

·  Concerns that behavioural changes could lead to other problems developing, for example smoking cessation could lead to an increase in weight and subsequently the onset of diabetes

·  The proposals for the support to be provided in the community

·  The support available for GPs and nurses to enable them to support their patients with large scale chronic diseases including sharing good practice

·  What was being done to improve the city’s environment so reducing health problems

·  Concerns about patients struggling to get GP appointments so their conditions get worse before they receive treatment 

·  The potential to triage patients in GP surgeries to determine who actually needs to see the GP and who can be seen by the practice nurse.

RESOLVED that:

(1) The presentation be noted.

(2) The services commissioned by both Public Health and the Coventry and Rugby CCG and delivered in primary care settings designed to prevent onset or progression of a number of different long term health conditions be noted, especially the planned changes to treatment pathways.

(3) The plans to provide more holistic, integrated care to those with multiple conditions and frailty be noted.

(4) Councillor Gingell, Cabinet Member for Health and Adult Services be requested to recommend future progress reports on the pilot projects for consideration by the Scrutiny Board as and when appropriate.