Mr John Finn, Managing Director of the Eastern Locality Northern, Eastern and Western Devon Clinical Commissioning Group will be in attendance following a request by Members, to answer questions.
Minutes:
The Chairman welcomed Mr John Finn, Managing Director of the Eastern Locality Northern Eastern and Western Devon Clinical Commissioning Group (CCG) to the meeting.
Councillor Mrs J Roach asked Mr Finn who made decisions regarding what could be prescribed in terms of gluten free bread and cakes? She asked was it possible to review this in the light of the fact that gluten free food was now readily available in supermarkets and health food shops?
Mr Finn replied that decisions regarding prescriptions were down to the individual GP. He stated that the CCG supported GP’s to make the most effective use when prescribing but there were currently no formal guidelines for what they could describe, although items were mainly staple items and not luxuries such as cakes and biscuits. Consideration was being given to guidance and he offered to provide an update at a future meeting.
Cllr Mrs Roach said that many people she knew had drugs on prescription which were available over the counter; they had them on prescription because the over the counter drugs were sold in relatively small packets. Most would be willing to pay for the drug. Was there any non-bureaucratic way of addressing this issue, thus freeing up money for cancer drugs etc?
Mr Finn replied that when possible, in small doses, people should be encouraged to buy their own items, such as paracetamol. However, he explained that limits on the number that could be purchased had been introduced to limit suicides and this had proved successful. He explained that a leaflet regarding medicines for self-care was being produced for instances were a pharmacist could help a patient to self-medicate.
Cllr Snow asked why medication was cheaper abroad than in this country to which Mr Finn explained that he was not aware of a price deferential but that there had been a period of time when European companies were buying up stock and therefore pushing up prices, he considered that this practice had now ceased.
Cllr Mrs Roach then asked a question regarding bed blocking. She said that despite denials from many that bed blocking was a problem in Devon, she had seen at first hand the number of beds that were blocked on one ward by older people who were waiting for transfers from the RD&E. She asked who kept records of bed blocking and which organisation considered the impact of bed blocking on other agencies such as the ambulance service?
Mr Finn explained that records regarding bed blocking were kept by the provider and reported nationally on a monthly basis through the Better Care Fund. He considered that one provider for acute and primary care could help the situation (as in North Devon) and that he had aspirations that this would be the case when the Royal Devon and Exeter (RDE) took over in this area.
Cllr Mrs Roach then said that despite reassurances that Social Services and the NHS were able to provide care for people in their own homes, she had evidence that there were insufficient carers to meet the needs of people who required care at home. In one case it took thirteen months to find the care needed to enable someone to return home from a nursing home. Who was responsible for the overall planning and who was the named person who had that responsibility?
Mr Finn stated that transfer to a community hospital was not always the best course of action and that getting a patient back home was a main aim, with an appropriate care scheme in place. Commissioning of Social Care was the responsibility of the local authority (DCC). He had been advised that DCC had revised its procurement arrangements for social care by providing a number of accountable providers and he considered this to be a good step forward. Mr Finn offered to attend a future meeting of the Committee with DCC Officers in attendance so that they could each answer questions regarding their own areas of responsibility.
Cllr Mrs J B Binks asked Mr Finn how he viewed the value of IT and specifically tele-health and tele-care, given the huge problems of delivering health care in a large, sparse and rural county.
Mr Finn responded by saying that it was important to embrace IT but evidence was weak at the moment and its benefits needed to be proven by evidence based trials. He explained that some trials had been successful, including remote monitoring of prostate cancer patients. It was hoped that this could be rolled out into further areas, in particular for patient follow up and that with budgets being stretched this needed to be embraced. Mr Finn stressed however that these methods would only be used when they had been tested and it was proven safe to do so.
Cllr Mrs J Binks also asked for more specific details about the use of Crediton Community Hospital as a health hub following the recent decision to close inpatient beds. The people of Crediton and its rural catchment deserved facts not flummery on the exact services which were to be put in place to replace the inpatient beds facility, together with the rationale behind the thinking. Given the difficulties of rural transport and the lack of decent digital infrastructure in the rural surrounds, how were these services going to be accessed by all patients? Further, the question of ownership of property at Crediton Hospital, much of which was provided by the Crediton Hospital League of Friends for the benefit of inpatients and their friends and families, needed to be addressed transparently and speedily if recent actions like the withdrawal of support from LoF in Moretonhampstead were to be averted. How are you going to resolve the issue of property ownership here?
Mr Finn explained that the question of ownership was a national issue and that the CCG had been proactive in challenging this. National policy would not allow community ownership and the property still remained part of the NHS. Mr Finn explained that a single officer had been appointed to work with the local population regarding this; Charlotte Ives would be responsible for Development Hubs.
Cllr F J Rosamond asked with financial resources under strain, what mechanism would be adopted if rationing or a reduction in service provision was required?
Mr Finn stated that it was not a matter of rationing, but a matter of efficient use of health resources to provide care. He said that there were opportunities to free up resources and that for example the spend on elective surgery in this region was higher than elsewhere in the country. This needed to be investigated to find out why in order that resources could be used appropriately. He agreed that an aging population could be more prone to problems such as loneliness and depression and that funds diverted from elective surgery could be reinvested in these areas. The Hubs would also be proactive in this area.
Cllr Rosamond also said that he had heard that when consultants practiced at Tiverton Hospital, they could be limited in scope by the absence of key piece of equipment causing elderly people to travel to Exeter. What could be done to improve facilities within Tiverton Hospital?
Mr Finn explained that he hoped the forthcoming change of provider would help with this situation and then there would be a full review of services. It may be that they would look to specialise in different areas. He also suggested that the League of Friends had a role to play in this.
Cllr Mrs R Berry informed Mr Finn that she had noticed a display stand regarding prostate cancer at the RDE which provided dietary advice which she considered to be inappropriate.
Mr Finn responded that this was an area where the CCG and local authorities providing public health and social services needed to work together. He reiterated his offer to attend a future meeting of the Committee along with colleagues from public health and social care at Devon County Council, in order to more fully answer such points.
The Chairman thanked Mr Finn for his time and for his offer to attend a future meeting.
Note: - Cllr Mrs J B Binks declared a personal interest as she was a member of the Crediton League of Friends.