Contact: Penny Velander, Health Review Officer, ext 7479

[email protected]

1 Background

1.1 The work programme for reviews for 2004/05 was agreed by the Health Review Committee on 30 March 2004. This report gives account of progress made to date

1.2 This work will support aims 1 and 5 of the Corporate Strategy: `maximising life opportunities' and `improving services'

2 Review of access to therapy services in schools

2.1 This review was one of the initial four identified by the Health Review Committee under the general theme ` the health of our children and young people'. In addition Hampshire County Council recently received a complaint from the Ombudsman over the provision of speech and language therapy for a pupil in one of the Council's schools. Both Education and Health have expressed concerns over this service and welcome the interest of the Health Review Committee in reviewing provision.

2.2 An initial meeting with Mid Hants PCT, showed that preliminary work on this topic has already been carried out. A multi-agency discussion group met on 2 May 2003 to focus on `provision of therapies in schools'. The group identified challenges, opportunities and ways forward for the service and produced a three page report of it's conclusions.

2.3 Due to the relatively recent findings of the above report it is proposed it is used as the basis for the review with the following format for the working group.

i. Background research is carried out by Health Review Officer to ascertain what actions from that paper have been carried out. Meetings are held with officers and users of services to identify what issues have emerged in the past year that need to be taken into consideration. Time - June


ii. Cllr McNair Scott and Health Review Officer meet to agree review details, scope and information for briefing papers. Time - early July

iii. Briefing papers are prepared and circulated to working group. Time - One week before workshop


iv. Half day workshop held for key personnel from Health, Education and service users to make presentations to the working group on the service they provide/use. This will be followed by a group forum to agree improvements that need to be made to the service and how best to achieve such changes. Time - mid July


v. Report from workshop prepared and distributed to working group and partners for comment. Time - end of July


vi. Final report presented to Health Review Committee on
21 September by Cllr McNair Scott

2.4 The role of the working group will be to:

· Read briefing papers in preparation of workshop


· Attend half day workshop to:-


a. Challenge the rationale for existing services


b. Facilitate joint agreement between agencies for improvements


· Read and comment on review report

2.5 Cllr McNair Scott is taking the lead on this review. Cllrs Randall has expressed an interest in being on the work group. Further nominations are needed

3 Review of administration of medication to children in schools

3.1 This topic arose during the health of school age children review and was felt worthy of some investigation to see if a full review was needed.

3.2 Cllr Ellis and the Health Review Officer met with Education to assess current practice and identify any issues or concerns for both children and staff.

3.3 It was explained that guidance for the administration of medicine in schools has been developed by the DfES and the County Council. It was noted that, amongst local authorities, Hampshire County Council has taken the lead in developing guidance. Each school is encouraged to write a policy document which is approved by the governors. The majority of schools in the county have adopted a policy with only a handful still to do so. There are tensions between the unions and Education on this issue.

3.4 Staff who agree to administer medicine do so on a voluntary basis. Training is provided and there is supporting paperwork to detail date, time, medicine given and dose. The County Council accepts liability on behalf of the employee should a claim for alleged negligence arise.

3.5 Where possible the child will be supported to administer their own medication however if this is not possible a written health care plan should be drawn up by the school in conjunction with the parents and other health professionals.

3.6 Overall this service seems to be well managed with few causes for concern. If a complaint arises there is an established grievance procedure and officers at Education headquarters are competent in arbitration. It is therefore recommended that no further action is taken on this review.

4 Review of access to foot care for people with diabetes

4.1 This is an issue identified through referral to the Committee. Requests for information regarding the monitoring of these services have been made to the Strategic Health Authority.

4.2 An initial meeting was held on 9 December and included a representative from the Strategic Health Authority and local Podiatry services. This suggested

· The need for access to foot care for people with diabetes is a recognised priority for podiatry services. National Guidelines have been published by the Royal College of general Practitioners and these will shortly be up-dated in new Guidance produced by NICE


· The costs to the NHS of not providing this access is high in terms of the treatment of lower limb problems including ulceration and amputation. Anecdotal information relating to SUHT suggests that as much as £1.8 million pounds per year can be used treating these conditions and that the incidence of lower limb amputation is increasing.


· In the context of the fact that much of this is preventable, and is strongly supported by clinical evidence, it has been of concern that there is no way of demonstrating that people with diabetes receive the right levels of support and advice, including information about foot care, when they have their annual reviews. Individual experience in this area suggested that this advice was not provided.


· All PCTs report that foot care is provided in practices but the commissioning process may vary from area to area.


· Approximately 45% of podiatry services are provided to people with diabetes but it is not clear whether the professional care available is being appropriately targeted to the those with greatest need.


· A foot assessment tool that is simple and easy to use is available but it is not clear how widely this is used.


· All diabetic patients are assessed annually but it is not clear if foot care is routinely covered in this process. The need for this to be available for people with type 1 and type 2 diabetes has been supported in recent NICE guidance.


· Emergency access to a podiatrist should be available, ideally within 48 hours.

4.3 This is an area where there is clear clinical evidence that preventative treatment can prevent severe complications for individuals and significant cost to the NHS. Therefore

· A follow-up meeting is to be held to identify the scope for raising the profile of podiatry services with PCTs

· Options for securing feedback from people with diabetes across Hampshire are considered. One option will be to explore the feasibility of inviting comment through `Hampshire Now'

· That further work is done to ascertain the actual costs to the NHS of lower limb complications for people with diabetes

· That the SHA is asked to respond to the Guidance produced by NICE

4.4 Cllr Dowden is taking the lead on this review. Cllrs Mason, McIntosh and Williams have expressed an interest to be involved.

5 Recommendations

i. That the progress made with the review programme is noted


ii. Additional Members are nominated for the Therapy Services review


iii. That no further action is taken on the administration of drugs in schools

N.B. The list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act.