Venue: Conference Room A/B, Cumbria House, Botchergate, Carlisle, CA1 1RD
Contact: Lynn Harker Email: email@example.com
Apologies for Absence
To receive any apologies for absence.
An apology for absence was received from Dr M Hanley.
Membership of the Committee
To note any changes to the membership of the Committee.
There were no changes to the membership of the Committee on this occasion.
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).
Mr C Whiteside declared a personal interest as his wife was employed at the West Cumberland Hospital.
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 18 July 2019 (copy enclosed).
RESOLVED, that the minutes of the meeting held on 18 July 2019 be agreed as a correct record and signed by the Chair.
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 received an update on the Joint Cumbria and Lancashire Health Scrutiny Committee and noted it was anticipated the next meeting would take place in December 2019. The Committee asked for further information regarding the procurement process for Renal Dialysis Services in Lancashire and South Cumbria and was informed commissioning of the services was imminent but no timeframe had been made available.
The Committee discussed the appointment of a Joint Health Scrutiny Committee for the Lancashire and South Cumbria Integrated Care System. It was noted that Lancashire County Council was taking the lead on establishing the Joint Committee which would ultimately be considered by Cumbria County Council’s Constitution Review Group with approval by full County Council. Members raised the following matters regarding the draft Terms of Reference:-
· concerns regarding the low quorum levels. It was suggested that the membership include a minimum of five members from at least three authorities;
· each authority should decide whether district councils, with voting rights, should be included in their representation on the Joint Committee;
· clarification on substitute arrangements requested;
· there should be a published calendar of meetings as far in advance as possible.
The Committee drew attention to a recent visit by members to the Maryport ICC and it was agreed to forward any feedback to David Stephens.
(1) the Joint Cumbria and Lancashire Health Scrutiny Committee update be noted;
(2) the following matters be raised regarding the appointment of a Joint Health Scrutiny Committee for the whole of Lancashire and South Cumbria Integrated Care System:-
(a) concerns regarding the low quorum levels. It was suggested that the membership include a minimum of five members from at least three authorities;
(b) each authority should decide whether district councils, with voting rights, should be included in their representation on the Joint Committee;
(c) the Committee receive clarification on substitute arrangements;
(d) there should be a published calendar of meetings as far in advance as possible;
(e) any further comments be forwarded to David Stephens;
(3) the Joint Health and Adults Scrutiny Advisory Group update be noted;
(4) the following members be appointed to the Cumbria Health Scrutiny Variation Sub?Committee:-
Allerdale – Mr P Scott
Carlisle – Mrs A McKerrell
South Lakeland – Mr M Wilson;
(5) the existing Work Programme be noted and the following suggestions be considered:-
(a) a discussion on a programme of items for the Work Programme coming out of the HealthCare for the Future update;
(b) North and South System Plans be considered by the Committee at its next meeting in December 2019;
(c) Winter Pressure Arrangements be considered by Lead Members at their next meeting with System Leaders;
(d) Health Inequalities for those with mental health issues be considered at a future meeting;
(e) Vascular Services be discussed at its next meeting in December 2019.
To consider a joint report by NHS North Cumbria Clinical Commissioning Group, Chief Officer, Morecambe Bay Clinical Commissioning Group and Chief Operating Officer, Northumberland, Tyne and Wear NHS Foundation Trust (copy to follow).
The Committee received a joint report which provided information on the planned changes to the provision of mental health rehabilitation inpatient services, currently delivered by Cumbria Partnership NHS Foundation Trust (CPFT) through the Acorn Unit at the Carleton Clinic in Carlisle.
Members were informed that due to the membership of the Cumbria Health Scrutiny Variation Sub?Committee not being agreed at the time of the proposal the full Cumbria Health Scrutiny Committee was asked to consider the first phase of the Variation Protocol; whether the proposal constituted a substantial service change.
The Committee held a detailed discussion regarding the review of the pilot 16 bed Acorn Unit at Carleton Clinic, Carlisle which was initially established to facilitate rehabilitation for men with complex mental health needs. Members were informed that future provision would be to meet the needs of both males and females.
It was explained this was established under agreement that CPFT held responsibility for costs other than those agreed at the time the pilot was commissioned. It was noted the Clinical Commissioning Group (CCG) had agreed to support the pilot service on a ‘cost per case’ basis, up to a maximum of 10 beds.
Members were informed that over the five years of the Acorn Unit being available it had never gone beyond its pilot status, therefore, it had not been formally commissioned by either CCG. It was explained it had not reached optimum level of inpatients, usually with no more than 60% of its beds filled at any one time, with use across the two CCGs varying each year.
The Committee was informed that the male patient group had been very mixed and there was some confusion around the aims and purpose of admission, expected length of stay and clinical outcomes. It was highlighted they had varied from the pilot stage to present service delivery and little change had occurred to the model whilst demand and need for rehabilitation services had changed around the Acorn Unit.
Members were given an update on the background to the Unit which admitted men from acute mental health treatment and rehabilitation wards that had a longer length of stay as well as providing active rehabilitation for a number of them. It was noted that it also acted as a ‘step-down’ for male patients returning to Cumbria from Low or Medium Secure Forensic Hospitals elsewhere in the country. The Committee was informed that the typical discharge destination from the Acorn Unit was supported living, including individual tenancies, which was a pathway supported by the system and provided a positive outcome to service users. A concern was raised that the mental health pathway for patients currently in the Acorn Unit had not been completed. Members were informed that due diligence reviews had been undertaken with all patients.
The Committee was informed it had been agreed to review the current mental health services, including the Acorn Unit as part of a wider review of Rehabilitation Pathways in Mental Health services. It was explained that as ... view the full minutes text for item 30.
To consider a report by NHS North Cumbria Clinical Commissioning Group (copy enclosed).
The Committee considered a report from NHS North Cumbria Clinical Commissioning Group regarding the Copeland Same Day Health(SDH) Centre which went live in February 2019.
Members were informed that as part of the growing pressures on GP Practices in Copeland innovative ways of offering improved access to patients had been considered collectively by the seven practices. It was highlighted that this was a collaboration between practices to support patients in a new way with resources available proportionate to their patient list size.
The Committee noted that it was felt the SDH Centre was an important step in building an urgent care hub and a fully integrated health and care system for West Cumbria. It was explained the Centre was led by Copeland GPs and was based in the Outpatient Department at West Cumberland Hospital. It was felt that this allowed the development of a connected network across primary and secondary care, and provided a multi?speciality model for primary care in Copeland.
Members were informed that the seven Copeland GP practices had access to an electronic cross-organisation appointment system for urgent on?the?day appointment requests. It was explained that patients were triaged by their registered GP practice and directed to the SDH centre as appropriate.
The Committee noted the service was offered Monday to Friday between 2.00?8.00 pm and provided urgent GP, nurse practitioner and extended scope physiotherapy appointments. It was explained that from 5.00 pm routine cytology, practice nurse and healthcare assistant appointments were also offered. There was full access to primary care medical records to the GP and health practitioners based in the SDH centre.
A concern was raised regarding staff in GP practices having the necessary medical knowledge and understanding to be able to advise and triage patients. It was explained that each GP practice triaged in different ways but assured the Committee that where this was the responsibility of non?medical staff they would receive a considerable amount of training and advice before being expected to carry this role out.
During the course of discussion a concern was raised as to expectation for GPs to provide cover at the SDH Centre after they had carried out their normal daily duties at a surgery. The Committee was informed that a GP was paid by the Copeland Primary Care Network to provide extended access and worked permanently in the Centre with other cover provided proportionately by individual practices.
The Committee welcomed the project and felt there should be consideration of how this could be further promoted to increase public awareness. Members were informed that information on the new service was available in GP practices and on their websites but it was agreed that further communication would be discussed with the Copeland Primary Care Network.
(1) the report be noted;
(2) a progress report be made available to the Committee in the future.
To consider a report by NHS North Cumbria Clinical Commissioning Group (copy enclosed).
Members considered a report which gave an update on the current North Cumbria Podiatry Service which provided assessment, diagnosis and treatments to any person registered with a GP in North Cumbria.
The Committee was informed that the Service delivery included generic and specialist podiatry across the county with specialist/advanced care delivered in specific locations. It was explained that the current practice and criteria for ongoing long-term care had not changed for a number of years and was no longer evidence based.
It was highlighted to the Committee that taking into account an increase in chronic long-term conditions and the ageing population the current model was no longer sustainable, especially if the service was to efficiently manage more complex foot problems.
The Committee was informed this proposal was to roll out the use of a new evidence?based eligibility criteria, to reassess the current caseload and, where appropriate, to signpost patients to other providers who were no longer eligible for ongoing care.
Whilst the Committee recognised the parameters for re?scoping the Service they raised their concerns regarding access to on?going care for patients on low income. Members were informed that part of the communication package included information which signposted patients to various agencies to provide financial package support.
Members were informed this had been piloted in the Copeland locality where 1,000 patients had been discharged from the current caseload as a result. It was explained that the pilot was to test out the communication package and strategy and ensure it was robust and minimised any potential complaints.
The Committee noted that extensive engagement had been undertaken with patients and third sector groups such as Age UK and Alzheimer’sSociety as part of the pilot; resulting in more integrated working.
Whilst members recognised the reasons for the pilot in Copeland and the desire to work with high risk patients they still had concerns regarding the prevention agenda. They asked how confident the Service was that there would not be pockets of areas in the county where provision was patchy. The need to have appropriately qualified podiatrists in the county to ensure patients were not being inadvertently exposed to sub?standard service was highlighted. Officers emphasised that on discharge patients were only signposted to qualified podiatrists explaining that a number of existing private podiatrists already undertook work on behalf of the Trust.
Members were informed that Cumbria’s NHS Podiatry service was not unique in having to manage their caseload more efficiently and concentrate on more high risk patients. It was emphasised that the Podiatry service in north Cumbria would continue to maintain an open access service for all patients for a one?off assessment and advice.
A discussion took place regarding the effects of diabetes and members were informed that in Cumbria diabetes foot?related bed days and number of amputations were above the national average. It was explained that approximately 30% of the existing podiatry caseload was increased due to high risk diabetic care.
The Committee was informed of ... view the full minutes text for item 32.
To consider a report by the NHS North Cumbria Clinical Commissioning Group (copy to follow).
The Committee considered a report which provided information regarding progress made on outstanding developments following the Healthcare For the Future Consultation.
Members were informed that the building work for the purpose built Hyper Acute Stroke Unit (HASU) at the Cumberland Infirmary Carlisle (CIC) had been completed and was now operating for patients who would have received their treatment in Carlisle. It was explained the Unit would eventually be fully operational and include patients from West Cumbria.
The Committee noted that the full opening would mean that all potential stroke patients would initially be brought to the Unit at CIC for a maximum of 72 hours where they would have access to a specialist stroke team 24 hours a day, seven days a week. It was explained the patient would then be either discharged home with support from the Early Supported Stroke Discharge (ESSD) and the Integrated Care Community (ICC) teams or remain in hospital for ongoing care and rehabilitation.
Members were informed there had been considerable work over the last two years to develop the HASU including the design of the Unit, recruitment of additional specialist staff and the development of the new ESSD team in Copeland and Workington to support patients at home, or closer to home. It was explained that after previous recruitment difficulties introduction of the new model had improved this situation.
The Committee was informed the Trust was expecting imminent confirmation from the North West Ambulance Service (NWAS) as to when they would be in a position to provide the appropriate transport. Members asked that they be given early notice if there were any indications that there would be delays in NWAS being ready to enable access to the HSCU.
During the course of discussion a concern was raised regarding the term ‘Zone of Disadvantage’ being used with reference to the Copeland area and potentially giving the impression that the population would not benefit from the HASU. Officers acknowledged the concerns this could raise and agreed to raise this matter with the West Cumberland Hospital Group but emphasised the HASU would improve services for the whole of the county.
Members drew attention to the constant fragile services in West Cumbria and were assured that collaborative work was being undertaken to investigate any matters of concern.
The Committee welcomed the new improved service and it was agreed the Co?Production Review would focus on the HASU to ensure all evidence was captured and shared when convenient.
A discussion took place regarding future reporting of HealthCare for the Future to the Committee and it was agreed that Lead Health members, the Strategic Policy and Scrutiny Adviser and Head of Communications and Engagement, NHS North Cumbria Clinical Commissioning Group would consider how best to continue to monitor developments around the topics usually covered under this agenda item.
(1) the report be noted;
(2) early notice be given to the Cumbria Health Scrutiny Committee if there are any indications that there will be delays in NWAS being ... view the full minutes text for item 33.
To consider a report by North Cumbria University Hospitals NHS Trust (copy to follow).
The Committee received a presentation from North Cumbria Integrated Care NHS Foundation Trust regarding cancelled operations in North Cumbria. Members were informed there were six purpose?built theatres at the West Cumberland Hospital (WCH) and a further ten theatres at the Cumberland Infirmary, Carlisle (CIC) with all of them used for both planned and urgent operations.
The Committee was informed that overall cancelled operations were showing a slightly increasing trend since April 2019. It was noted that hospital initiated non clinical and clinical cancellations were showing a slightly increasing trend since April 2019 with patient initiated cancellations remaining constant over the same period.
A discussion took place regarding patient initiated cancellations and officers felt there was a need to improve joint decision?making with patients to ensure they were aware of the outcome and benefits of the surgery and hopefully avoid cancellations.
Members were informed that the 28 day breach performance had deteriorated compared with the same period the previous year, although the position in August was similar year on year. It was noted that the number of non?clinical cancellation on the day was similar year on year, however, there had been more 28 day breaches in 2019/20.
It was explained to members that for quarter 1 in 2019/20 the Trust compared favourably with the national average number of non-clinical cancellations, but had more than double the national average breaches.
A detailed discussion took place regarding the information presented and members were informed of the trend towards a growth in cancellations for a number of reasons. It was explained to members that although every effort was made not to cancel operations on the day this did happen.
The Committee raised their concerns regarding the lack of communication with patients regarding cancelled operations. Members felt that pro?active work was needed to ensure patients were informed of cancellations. The Trust acknowledged the communication problems and informed members that work was being undertake to improve this. During the course of discussion the Committee drew attention to possible technological solutions and it was confirmed this was being investigated.
It was agreed that data regarding operations cancelled two or three days in advance of the planned date would be provided to the Lead Health Scrutiny members.
During the course of discussion members asked whether account was taken of pre?existing conditions of patients, particularly with regards to cancellations. It was agreed that further information would be provided to the Committee.
The Chair of the North Cumbria Integrated Care NHS Foundation Trust highlighted that the Trust’s Board was concerned with the situation; and taking into account the onset of winter, had agreed to make extra beds available in the system to try and alleviate the problems, particularly at the CIC.
During the course of discussion concerns were raised regarding the disproportion between the north and south of the county with better performance in the south. Officers explained that the number of operations required were significantly more than available resources could deliver, acknowledging that north ... view the full minutes text for item 34a
To consider a report by the University Hospitals of Morecambe Bay NHS Foundation Trust (copy enclosed).
The Committee considered a report from University Hospitals of Morecambe Bay NHS Foundation Trust which provided an update on cancelled operations in south Cumbria. It outlined the performance against the national headline 28 Day Cancellation Standard and local total Last Minute Cancelled Operations standard, benchmarked performance and the causes, implications and actions to resolve any issues.
Members were informed that the theatres were largely separated between emergency and planned operations highlighting that trauma spikes did occasionally affect their use.
The Committee noted the number of elective operations cancelled and not re?booked within 28 days against the standard of 0. It was explained the standard had been met in eight of the previous 12 months, with a spike of four in February, one breach in October and December 2018 respectively and one in June 2019.
Members were given details of a number of completed actions which had been undertaken to maximise theatre throughput and reduce the potential for last minute cancellations which included the implementation of the Theatre Efficiency Programme, maximisation of the theatre capacity across the three main sites, daily operational call to review theatre activity, review of pre?operative assessment, escalation process in place to ensure that authorisation was given for last minute cancellations and a focus on staff health and well?being through the Flourish programme and attendance management, therefore, reducing cancellations due to sickness and other absence.
During the course of discussion members sought assurances that actions were being undertaken by the Trust to address cancelled operations and suggested that they be made available in a public forum.
The Committee was informed that the cancellation of elective procedures at the last minute was and would continue to be strenuously avoided as a last resort in order to maintain patient safety. It was emphasised to members that operations were not cancelled due to lack of beds.
Members discuss the number of operations cancelled multiple times and asked that the Committee be provided with further data.
In conclusion, the Committee felt that performance in the south of the county appeared to be much better than in the north and the need to find an equity of service throughout the county was highlighted.
The Chair welcomed the report and agreed discussions would continue regularly at the Lead Health Member meetings.
(1) the report be noted;
(2) assurances be available in the public forum to outline actions being undertaken by the Trust to address cancelled operations;
(3) data on the number of operations being cancelled multiple times be provided to the Committee.
Date of Future Meeting
To note that the next meeting of the Committee will be held on Tuesday 10 December 2019 at 10.30 am in County Offices, Kendal.
It was noted that the next meeting of the Committee would be held on Tuesday 10 December 2019 at 10.30 am at County Offices, Kendal.
There was a suggestion that hospitals should be considered as possible venues for future meetings of the Committee.