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The Chair welcomed District Council representatives to their first meeting of the Committee.
Election of Vice-Chair
In accordance with the Committee’s Terms of Reference to appoint a Vice?Chair who shall be a District Councillor representative for the ensuing year. The Vice?Chair shall be appointed by the District Council representatives serving on the Committee.
It was agreed that this item would be deferred until the next meeting of the Committee scheduled for 18 July 2019 when it was anticipated all District Council Committee appointments would have been agreed following their recent elections.
Apologies for Absence
To receive any apologies for absence.
An apology for absence was received from Mr J Kane, Copeland District Council representative. It was noted that Mr Kane had only been appointed to the Committee the previous night and had a prior commitment for today.
Membership of the Committee
To note any changes to the membership of the Committee.
Following the local District Council elections the following permanent changes to the membership of the Committee were noted:-
(1) Dr M Hanley replaced Ms V Taylor as the Eden District Council representative.
(2) Ms H Chaffey replaced Mrs V Rees as the South Lakeland District Council representative.
(3) Mr J Kane replaced Ms A Bradshaw as the Copeland Borough Council representative.
Disclosures of Interest
Members are invited to disclose any disclosable pecuniary interest they have in any item on the agenda which comprises
1. Details of any employment, office, trade, profession or vocation carried on for profit or gain.
2. Details of any payment or provision of any other financial benefit (other than from the authority) made or provided within the relevant period in respect of any expenses incurred by you in carrying out duties as a member, or towards your election expenses. (This includes any payment or financial benefit from a trade union within the meaning of the Trade Union and Labour Relations (Consolidation) Act 1992.
3. Details of any contract which is made between you (or a body in which you have a beneficial interest) and the authority.
(a) Under which goods or services are to be provided or works are to be executed; and
(b) Which has not been fully discharged.
4. Details of any beneficial interest in land which is within the area of the authority.
5. Details of any licence (alone or jointly with others) to occupy land in the area of the authority for a month or longer.
6. Details of any tenancy where (to your knowledge).
(a) The landlord is the authority; and
(b) The tenant is a body in which you have a beneficial interest.
7. Details of any beneficial interest in securities of a body where
(a) That body (to your knowledge) has a place of business or land in the area of the authority; and
(b) Either –
(i) The total nominal value of the securities exceeds £25,000 or one hundredth of the total issued share capital of that body; or
(ii) If that share capital of that body is of more than one class, the total nominal value of the shares of any one class in which the relevant person has a beneficial interest exceeds one hundredth of the total issued share capital of that class.
A “disclosable pecuniary interest” is an interest of a councillor or their partner (which means spouse or civil partner, a person with whom they are living as husband or wife, or a person with whom they are living as if they are civil partners).
(1) Mr C Whiteside declared a personal interest as his wife was employed at the West Cumberland Hospital.
(2) Dr M Hanley declared a personal interest as he was a member of the Alston Medical Practice and Cumbria Local Medical Committee.
Exclusion of Press and Public
To consider whether the press and public should be excluded from the meeting during consideration of any item on the agenda.
RESOLVED, that the press and public be not excluded from the meeting for any items of business.
To confirm the minutes of the meeting held on 26 February 2019 (copy enclosed).
(1) With reference to attendance at the meeting it was noted that Ms H Horne, Chair, Healthwatch Cumbria should be added to the list of attendees.
(2) With reference to minute 59(3) – Healthcare for the Future Update – Integrated Care Communities it was agreed the first two sentences of the fourth paragraph should read: ‘A discussion took place regarding the breakdown of care around an individual and how this was brought to the attention of the hubs. It was explained that good joined up working including social workers, clinicians and increasingly the third sector organisations took place which, it was anticipated, would address those difficulties’.
RESOLVED, that with the inclusion of the above amendments the minutes of the meeting held on 26 February 2019 be agreed as a correct record and signed by the Chair.
During the course of discussion it was agreed that an update on the ‘Same Day Health Centre at West Cumberland Hospital’ would be included in the Work Programme for discussion at a future meeting of the Committee.
To consider a report by the Strategic Policy and Scrutiny Adviser (copy enclosed).
The Committee received a report which updated members on developments in health scrutiny, the Committee’s Work Programme and monitoring of actions not covered elsewhere on the Committee’s agenda.
Members were given an update on the meeting of the Joint Cumbria and Lancashire Health Scrutiny Committee which had taken place on 26 March 2019. The Committee’s attention was drawn to the lack of attendance at the meeting by elected members from Lancashire. Members highlighted the importance of convening future meetings with full attendance by both authorities. During the course of discussion it was agreed that the work programme for the Joint Committee would also be considered by the Cumbria Health Scrutiny Committee.
The Committee discussed the Care Quality Commission (CQC) report regarding the University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT). A concern was raised regarding a perceived number of factual inaccuracies in the report regarding feedback from both staff and patients and it was felt this should be investigated further. Members were informed that Cumbria Health Scrutiny Committee Lead Members were scheduled to meet with System Leaders from South Cumbria to discuss the report further with a view to a response being formulated.
During the course of discussion it was agreed that there were a number of lessons to be learnt from the report. A number of issues were raised including the problems incurred due to the geography of the county. Members were informed that work had been recognised to address the inadequate services provided by the Morecambe Bay Trust. The Committee was informed that the CQC UHMBT Report and Trust response would be considered at the July meeting of the Cumbria Health Scrutiny Committee.
The Committee was informed that Lancashire County Council was taking the lead on establishing the Joint Health Scrutiny Committee for the Lancashire and South Cumbria Integrated Care System. It was explained that the Chair of the Cumbria Health Scrutiny Committee would attend an imminent meeting of the Steering Group which would develop the Terms of Reference. It was agreed that an update would be made at the July meeting of the Cumbria Health Scrutiny Committee.
Members received an update on the Joint Health and Adults Scrutiny Advisory Group noting that the most recent meeting had focussed on Population Health Management Models being developed in the North and South systems. The Committee noted the Group had recommended that information and data from Social Care would be incorporated in the Population Health Management System (Radar) in North Cumbria and requested that this information be circulated to members of the Cumbria Health Scrutiny Committee.
A discussion took place regarding waiting times and members were informed that performance metrics were publically available and would be provided to the Committee to inform the Work Programme.
The Committee had a brief general discussion regarding recruitment and retention. During the discussion a question was raised regarding the new system for recruitment of GPs and whether this was proving positive. It was agreed that reports regarding recruitment and retention from both ... view the full minutes text for item 7.
To consider a report by the Chief Operating Officer, NHS North Cumbria Clinical Commissioning Group (copy enclosed).
The Committee considered a report from NHS North Cumbria Clinical Commissioning Group which provided an update on the progress made following the Healthcare For the Future Consultation.
(1) Maternity and Paediatrics
Members were informed that currently there were no changes to consultant?led maternity services.
The Committee received an update on accessibility to electronic maternity notes via an APP. It was noted that since going live on 1 April, 100% of women registering a new pregnancy had signed up to the service. Members were informed that NHS Wi-Fi could also be used to access the APP if necessary.
Members were informed that the Short Stay Paediatric Assessment Units (SSPAU) were working well on both sites. It was explained there were currently no changes to overnight beds at the West Cumberland Hospital. The Committee noted that SSPAUs would continue to develop when the required staffing was in place but, to date, no additional staff had been recruited.
The Committee received a update on the 12 months review and feedback from the Independent Review Group regarding the long?term sustainability of consultant?led services at West Cumberland Hospital, Whitehaven which had ended on 31 March 2019. It was explained that the review of data was underway and it was anticipated that a report would be made available to the Clinical Commissioning Group in the summer.
(2) Stroke Services
The Committee were informed that work continued to develop a Hyper Acute Stroke Unit (HASU) at the Cumberland Infirmary, Carlisle. It was emphasised that acute services for north Cumbria would not change until conditions to support the development were in place.
Members noted that considerable work was under way to ensure estates and equipment issues were resolved. It was explained that a Stroke Consultant had been appointed which would alleviate some of the ongoing challenges around staffing.
The Committee was given a positive update on the Copeland Community Stroke Prevention Group which was planning a series of community events offering health testing and advice to reduce the number of avoidable strokes. Members were informed there were several projects being rolled out, highlighting that the Rotary Club had been the driving force behind a number of events being organised to reach members of the community who did not attend GPs regularly. It was explained that pro-production was being undertaken with a wide range of voices in the Copeland area which, it was anticipated, would be rolled out in other areas of the county in the future.
During the course of discussion members were informed that both the North and South CCGs were part of a pilot Atrial Fibrillation Programme. It was explained the programme would not confirm a diagnosis but would give an indication if medical treatment was required.
It was explained there was also a community pharmacy project underway in communities where there were significantly higher than the average numbers of strokes.
(3) Integrated Care Communities (ICCs)
Members received an update on ICC developments which included details of health and wellbeing action groups being ... view the full minutes text for item 8.
To receive a presentation from North Cumbria Health and Care (copy enclosed).
(The Committee requested that acronyms be avoided in future reports).
Members received a presentation regarding ‘Familiar Faces’; a new service for North Cumbria which had been developed to address the needs of patients often termed ‘Frequent Attenders’.
The Committee was informed that the traditional medical model of care was inadequate when dealing with frequent attenders. Members noted there was evidence that consistent management by a skilled team, through a clinical care plan shared across the health system was beneficial.
A discussion took place regarding selection of the 300 patients from the total population. Members were informed that the top 1% of frequent attenders had been investigated and discussed further with GPs for selection.
Members were informed that Adverse Childhood Experiences (ACE) often had a significant impact on later life outcomes and contributed to patient complexity and clinical outcomes. It was explained that one to one patient contact would not address the problems of those patients, therefore, it was felt this had to be addressed as a system with consistent management, early identification and relevant staff who were trained to identify vulnerable patients.
The Committee noted that work was required to be undertaken across the whole system including public health, local authorities and third sector organisations to look at a system wide strategy. Members welcomed this approach and highlighted the benefits of shared learning across the wider system. During the course of discussion the inclusion of Crime Safety Partnership Groups was welcomed and the need to work more closely with them to provide help and advice to the districts was highlighted.
The Committee noted that the Familiar Faces service was embedded in three Integrated Care Communities (ICCs) across North Cumbria and the priority for 2019/20 was to extend the service to the remaining five ICCs offering equity of service and significant release of resources for the system.
Members were informed that each of the three ICCs who currently had access to the Service included one clinical psychologist who could provide direct therapy and one living well coach to provide direct support or links with other parts of the system. It was explained that the current ICCs involved were in Copeland, Maryport/Cockermouth and Carlisle but the future ambition was to involve all ICCs.
A discussion took place regarding the variability in service in the Eden area. It was explained that whilst living well coaches had recently been appointed there were still no coaches in Alston due to problems regarding recruitment.
The importance of effective system change was emphasised with the need for all the healthcare system to be involved to provide help and preventative measures.
Members welcomed the unique methods which had been developed to reliably identify the patient cohort from data across the health economy (including primary care, out of hours, emergency care, secondary care and emergency services).
The Committee discussed the need for a sustained period of specialist one to one services which would be needed and questioned how this would be achieved within the resources available. It was explained ... view the full minutes text for item 9.
To consider a joint report by North Cumbria and Morecambe Bay Clinical Commissioning Groups (copy enclosed).
The Committee considered a report by the Chief Operating Officer, North Cumbria CCG and Director of Planning and Performance, Morecambe Bay CCG which updated members on changes to mental health services in North and South Cumbria in respect of the CCGs’ joint Commissioning Intentions. Members noted that the changes affected Adult Mental Health Services, Children and Young People’s Mental Health Services (CAMHS) and Learning Disability Services.
Members were informed that with regards to mental health services, the Commissioning Intentions also recognised that although Cumbria Partnership Foundation Trust (CPFT) provided some good services they had had a CQC rating of ‘Requires Improvement’ for a number of years. It was explained that many of the underlying issues were difficult for a small Trust in a challenging geographical position to address on its own. It was highlighted that linked to this, there were a number of services, particular CAMHS, which had been in need of significant improvement for some time, despite the best endeavours of the Trust. It was felt wider organisational change or support was needed to make a difference.
The Committee noted this was supported in a ‘Patient Safety Initiative’ meeting between the Trust, CCGs and NHS England, NHS Improvement and CQC, where national mental health leads supported delivery of the commissioning intentions as a way of accelerating improvement in services.
Members were informed that the commissioning intentions for mental health services set out three clear objectives, the need to:
· ensure an improvement in the quality of services, particularly for areas such as CAMHS
· ensure the clinical and financial sustainability of services;
· deliver care models and pathways consistently across the wider Integrated Care System footprints for North and South Cumbria: ie in the South, across Morecambe Bay and as developed across Lancashire and South Cumbria Integrated Care System; in North Cumbria, as developed across North Cumbria and the North East of England.
The Committee were informed that the Commissioning Intentions of Morecambe Bay were clear and that the CCG believed the best way of addressing the three drivers was a transfer of services from CPFT to Lancashire Care NHS FT (LCFT). It was explained that the intentions for North Cumbria were for services to be delivered by, or in a very robust partnership with, Northumbria Tyne and Wear NHS FT (NTW).
It was explained to the Committee that NTW provided improvement support to other trusts through its consultancy arm, Trust Innovations (NTW TI). Members noted that NTW TI had been supporting improvement work in Cumbria since 2018, with an early focus on CAMHS. It was felt that this was essential as all organisations recognised that whilst a transfer of services could bring about significant improvement and clinical sustainability over the medium term, there was also a need to continue improving services whilst the process of transfer was taking place.
The Committee received an update on future arrangements and members were informed that all health organisations had undertaken appropriate assurance work and agreed that a transfer of services to LCFT was appropriate ... view the full minutes text for item 10.
Date of Future Meeting
To note that the next meeting of the Committee will be held on Thursday 18 July 2019 at 10.30 am at County Offices, Kendal.
It was noted that the next meeting of the Committee would be held on Thursday 18 July 2019 at 10.30 am at County Offices, Kendal.