Issue - items at meetings - Written Questions from Councillors

No questions have been received

87.1    There were none.

No questions have been received

74.1    There were none.

No questions have been received

59.1    There were none.

No questions have been received

45.1    There were none.

No questions have been received

32.1    There were none.

No questions have been received

21.1    There were none.

No questions have been received

6.1       There were none.

No questions have been received

67.1    There were none.

No questions have been received

52.1    There were none.

No questions have been received

38.1    There were none.

No questions have thus far been recieved

23.1    There were none.

A written question has been received from Councillor Jason Kitcat (copy attached)

6.1       A written question was received from Cllr Kitcat. Beverly Thorp, Associate Director for Women and Children, responded to the question on behalf of Brighton & Sussex Universities Hospital Trust (BSUHT).

6.2       Ms Thorp told members that all wards at the Royal Alex Children’s Hospital were currently open, although not every ward was operating at full capacity. The Alex had opened with approximately 50 beds, with the intention being to gradually step up to full capacity (100 beds). Current capacity is 70+ beds, and this is expected to grow as the Alex develops and as the trust is able to repatriate more patients from out-of-county placements. The relocation of children’s A&E from the Royal Sussex County (RSCH) site is ongoing, with additional paediatric consultant and nurse posts being recruited.

6.3       In response to a further question from Cllr Kitcat, Ms Thorp informed members that the Alex has provision for 3 Intensive Care (IC) beds, although only one of these is currently operational. There are no immediate plans to bring more IC beds on-line, as the Alex could not readily rota the specialist staff required to run 3 beds without significantly expanding its general services (to the likely detriment of other providers in Sussex). The Alex has, however, concentrated on expanding its resource of High Dependency (HD) beds, and now has 7 in operation. These beds allow the hospital to cope with a wide range of conditions, although it may always be necessary to send some patients for very specialised care in London hospitals. Amanda Fadero, Interim Chief Executive, NHS Brighton & Hove, added that the Sussex population was not large enough to support a full paediatric IC unit, but that the PCT was committed to developing the Alex as a tertiary resource for the whole of Sussex.

6.4       Robert Brown, LINk representative, informed members that the LINk was eager to promote the Royal Alex, and wanted to encourage BSUHT to invite children into the Alex in advance of elective procedures. Beverly Thorp confirmed that BSUHT had been involved in useful discussions with the LINk on these issues.

6.5       In response to a question from Mr Brown concerning children’s cardiac surgery, Ms Thorp told members that there were no plans to perform this surgery in Brighton, but that BSUHT did have arrangements for a consultant cardiologist to visit the Alex to support families with cardiac issues.

6.6       In response to a question from Cllr Rufus regarding the cost implications of running the Alex below capacity, Ms Thorp told members that the Alex was not currently running at a loss. The trust’s long term vision was to increase use of the Alex, particularly by moving services for children currently provided at RSCH (e.g. Audiology and ENT) to the Alex, and by promoting the Alex as the Sussex tertiary centre for children’s care. Amanda Fadero added that the Alex operating at less than full capacity may be a reflection on recent developments in children’s care, particularly in terms of greater provision of community-based services. Providing services in the most appropriate settings, even if this entails under-utilisation of acute beds, should be welcomed.

6.7       Members thanked Ms Thorp for her contribution.

A written question has been received from Councillors Maria Caulfield and Jan Young:

“Dear Garry

I would be most grateful if you could consider this letter for inclusion on the agenda of the next meeting of the Health Overview & Scrutiny Committee under Section 13.3 of the Overview & Scrutiny Procedure Rules.

Funding to meet the needs of residents with learning disabilities in Brighton & Hove is based on an assessment of their need. If a person’s care needs are assessed as ‘Continuing’ or they need nursing care the health care costs are the legal responsibility of the Brighton & Hove Primary Care Trust (PCT).  If the person’s needs are deemed not to be continuing, or social care based, then the cost falls upon Brighton & Hove City Council.

Brighton & Hove City Council has submitted seventeen cases for continuing care assessment for the last two years running and so far the PCT have only assessed six in total. Two of these residents were accepted as requiring ‘continuing’ health care and the other four were refused.

The delay in assessing these seventeen cases, which the local authority, in all good faith, believe to be valid continuing care applications, means that local council tax payers now face a bill of £1.7 million in the next financial year.

I have tried through other means to get to the bottom of these delays over a period of many months but have been unable to get a satisfactory answer from the PCT. Therefore, I would like to ask that the Health Overview & Scrutiny Committee look specifically into the reason for the delays and also, more generally, at the screening and assessment process to ascertain whether this extremely vulnerable group of people are being put at a significant disadvantage compared to those from other local authority areas in the country.

As you will be aware, the Local Government and Public Involvement in Health Act 2007 provides new powers for council overview and scrutiny committees to look in detail at the work of partner organisations. This is part of a legal framework for Local Area Agreements, which places a ‘duty to co-operate’ on a range of public bodies (of which PCTs are one), including a duty to respond to council scrutiny. I believe that the learning disabilities issue I have outlined above would be an ideal opportunity to make use of these new powers.

Jan and I would also be more than happy to come and speak at your next meeting to expand on these issues.

With all good wishes.

Maria Caulfield, Cabinet member for Housing

Jan Young, Cabinet member for Finance

68.1    The Chairman told members that this item had been deferred to a later meeting at the request of the authors of the written question.

No written questions have been received

49.1    There were none.

None have been received

33.1    There were none.

Two Councillor Questions have been received.

a) from Councillor Brian Pidgeon:

Over the past few days a leaflet from NHS Brighton & Hove has been delivered to every household in the city.

The leaflet, introduced by Darren Grayson, the Chief Executive of NHS Brighton & Hove, contains lots of very useful information, informing people how to make best use of local services, giving tips on healthy living, and outlining how the PCT uses its resources to improve the health of city residents.

The last page of the leaflet contains instructions on how to get a translation of this material: the information can be provided in seven different languages.

However, nowhere in the leaflet is it mentioned that NHS Brighton & Hove has made provision for blind or visually impaired people, by having the information available in large print, in Braille or in audio format.

Is it the case that NHS Brighton & Hove does not think that blind people are entitled to basic information about the healthcare they have paid for through their taxes? Or is it once again the case that blind people have been overlooked by the very organisation which should be most concerned with their needs?

If provision has been made for blind people to access this leaflet, can the Chief Executive of NHS Brighton & Hove explain how people are meant to find out about it? If no provision has been made, I call on the Chief Executive to apologise to the city’s blind community for this omission, and to promise that all future NHS Brighton & Hove publications will be as accessible for blind people as they rightly are for people whose main language is not English.

b)  from Councillor Jason Kitcat:

1. What are the clinical reasons GPs are being recommended to prescribe

Tamiflu to all patients with suspected swine flu?

2. As 'flu friends' are not being asked to pay for Tamiflu it is free for

patients. This is in contrast with the usual prescription charge policy.

What has this free dispensing cost the PCT so far? How is it being funded?

What is the per unit charge the NHS are paying for Tamiflu?

3. As someone who experienced severe headaches when taking Tamiflu I was worried to learn the level of side effects experienced elsewhere. For

example in Japan the Ministry of Health & Welfare has instructed doctors not

to give Tamiflu to patients aged 10 to 19 due to extreme behavioural

side-effects. At least 18 children in Japan have died as a result of

irrational behaviour. The US Food & Drug Administration have also issued a

warning about Tamiflu's potentially fatal neuropsychiatric side-effects.

Japan uses 60% of the world's Tamiflu so are experienced in its use, however

the UK did not issue similar warnings in its use. Two studies by the UK's

Health Protection Agency (published in Eurosurveillance) found that 51% of

the 248 children aged 11 to 12 studied had side-effects including nausea,

headaches and stomach aches. A study of 85 London pupils also found more

than half had side-effects when given Tamiflu as a preventative measure

including 18% reporting a neurophsychiatric side-effect.

Given that the efficacy of Tamiflu type drugs (neuraminidase inhibitors) are

still debated by clinicians and that their advertised benefits of a slightly

reduced period of illness are hard to detect in most patients; one must

question the cost-benefit of using Tamiflu.

Does the PCT believe that the financial costs, the potential side-effects,

the impact on individual health outcomes and wider public health outcomes

been correctly balanced?

20.1    There were two Written Questions from Councillors.

20.2    In response to a question from Councillor Brian Pidgeon, Darren Grayson, Chief Executive of NHS Brighton & Hove, apologised for publishing information on local healthcare services which could not be readily accessed by blind or visually impaired people. Mr Grayson told members that NHS Brighton & Hove had subsequently been in contact with the Federation of Disabled People to ensure that the information contained in the leaflet was available to local people with sight problems.

20.3    The Chairman noted that, aside from unfortunately being inaccessible to blind people, this was a truly excellent publication, presenting important healthcare information in a very readable format. The Chairman congratulated all those involved in preparing and publishing the leaflet.

20.4    Councillor Pidgeon noted that this was not the first time he had been obliged to raise similar matters with NHS Brighton & Hove and he trusted that he would not need to do so again.

20.5    In response to a question from Councillor Jason Kitcat, Dr Tom Scanlon, Director of Public Health for Brighton & Hove, told members that the decision to prescribe anti-viral drugs widely was taken at a national level after assessing all the available research evidence. The drugs were effective against the virus if taken early although the side effects, most of which were minor, had been greater than had been suggested by previous clinical trials. Regarding whether or not the use of paracetamol and ibuprofen prolonged the symptoms of flu, Dr. Scanlon cautioned against over-interpretation of one study, but also stated that even if their use slightly prolonged the presence of the virus in the body, their effectiveness in dealing with the symptoms of the flu was likely to outweigh this concern. The vast bulk of evidence was that they were both safe and effective.

20.6    Dr Scanlon also pointed out that although Tamiflu’s side-effects had been rather more than had been anticipated, this did not mean that its use had been a mistake. There had been relatively few deaths in the UK in the first wave and it may have been that the widespread use of anti-virals had saved a number of lives.

20.7    Dr Scanlon told members that he had thus far been unable to ascertain the cost per unit of Tamiflu, but would pass that information on once he had it.

A letter from Councillor Rufus has been received.

Breast Cancer Screening           

In light of recent figures showing that just 8 per cent of women in Brighton and Hove and East Sussex were seen within 36 months of their last routine breast cancer screening between January and March this year (some 79 per cent below that of neighbouring West Sussex screening service), can the PCT:

-          detail what steps are being taken to ensure this situation improves

-          detail what, if any, adverse health consequences there may be for women waiting this long for routine screening?”

6.1       The question from Councillor Rufus was considered alongside Item 3 (Chairman’s Communications).

A letter has been received from Councillor Jason Kitcat:

Dear Chair of HOSC,

I have recently learnt of a number of small problems in the new Royal

Alexandra Children’s Hospital. While undoubtedly this new building is a fine

and important addition to the city's health provision, these two issues do

raise questions about the design of new NHS buildings.

In particular I have learnt that in patients' rooms the main light cannot be

switched on or off, it is always on and there is in fact no switch at all.

Nurses have resorted to putting pillow cases over the lights in an attempt

to give the children some respite.

I also understand that the windows fitted cannot be opened due to health and

safety concerns. Because the windows would open out fully - even on the

highest floors - children could fall out through the windows. It would have

been preferable to have a different design of window which would have

allowed fresh air to circulate without putting children at risk.

Of course these are small matters in the context of the major facility the

new children's hospital represents. However fresh air and a dark room for

rest do play an important part in recuperation and healing.

I wonder if you would be so kind as to ask the Chief Executive of Brighton &

Sussex University Hospitals NHS Trust to respond to the issues raised?

Furthermore would the Chair agree that a tour of the existing Royal Sussex

County facilities to examine such issues as these, and signage as previously

discussed at the Committee, would be helpful before the major '3T'

redevelopment of the Royal Sussex County Hospital site progresses any

further?

Yours sincerely,

Cllr Jason Kitcat

87.1    Councillor Kitcat followed up his written question (see agenda) with supplementary questions concerning research on the impact of light and ventilation on patient recovery and the arrangements in place for monitoring carbon dioxide levels at the Royal Alexandria Children’s Hospital. Duane Passman, 3T Programme Director at Brighton & Sussex University Hospitals Trust (BSUHT), promised to provide a detailed written response to these queries.

87.2    The Chairman suggested that Councillor Kitcat might wish to arrange to visit the Children’s Hospital to check conditions personally, and requested that, if he did so, he might also take the time to check signage in the Royal Sussex County Hospital (as members had previously commented on the hospital being difficult to navigate).

A Written Question has been submitted by Councillor Jason Kitcat:

"Can the Chief Executive of the Primary Care Trust (NHS Brighton & Hove) detail who will pay for the planning process, building and refurbishment required for opening the city centre GP-led clinic? Will it be Care UK, the PCT or another body?"

(A written response from the Chief Executive of NHS Brighton & Hove is included in the papers for this item.)

75.1    Councillor Jason Kitcat asked the following question:

"Can the Chief Executive of the Primary Care Trust (NHS Brighton & Hove) detail who will pay for the planning process, building and refurbishment required for opening the city centre GP-led clinic? Will it be Care UK, the PCT or another body?"

75.2    Members were referred to a written answer from NHS Brighton & Hove (re-printed in the papers for this meeting).

75.3    Councillor Kitcat then asked a supplementary question relating to patients’ ability to register at the GP-Led Health Centre. Mr Grayson responded by saying that any city resident could register or receive unregistered treatment at the centre. It should also be possible for patients to register at the GP-Led Health Centre and retain registration with their local GP.

75.4    Mr Grayson added that the GP-Led Health Centre was expected to have a list of around 5000 patients when fully operational – in line with the list size for an average GP surgery. At this kind of size, it was not anticipated that the GP-Led Health Centre would have an impact on adjoining GP practices such that it might compromise their viability.

75.5    Mr Grayson was also asked to confirm whether the figures he had recently given the committee for activity at the Sussex Orthopaedic Treatment Centre referred to total activity or activity commissioned for Brighton & Hove residents. Mr Grayson confirmed that these figures represented total activity at the centre.