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The Committee raised their concerns regarding the use of acronyms in a number of reports and asked that these be kept to a minimum and a glossary be provided in the future. A request was also made for all future reports to include a cover report highlighting specific issues for consideration by members.
Apologies for Absence
To receive any apologies for absence.
Apologies for absence were received from Mr D Blacklock and Ms H Chaffey.
The Committee raised their concerns regarding the lack of attendance at meetings by the Carlisle City Council representative. It was agreed the Chair would write to the respective Authority expressing members concerns.
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).
(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 7 October 2019 (copy enclosed).
RESOLVED, that the minutes of the meeting held on 7 October 2019 be agreed as a correct record and signed by the Chair.
Primary Care Networks
To consider a report by North Cumbria Clinical Commissioning Group (copy enclosed).
Members received a presentation which gave an overview of the changing models for service delivery in General Practice.
The Committee was informed that General Practice worked in partnership with other health and care providers to collaboratively manage and provide integrated services for all of North Cumbria. It was explained that North Cumbria GPPC provided professional leadership and the ‘provider voice’ for general practice in the local health economy. Members noted that Primary Care Networks (PCNs) brought together groups of practices to provide services at scale across a geographical area. The PCNs would work with other community partners as part of North Cumbria’s Integrated Care Communities (ICCs) and the Clinical Director of the PCN would sit on the Integrated Care Communities (ICCs) Leadership Group. The General Practice based teams would provide care to patients with on?going illnesses, undifferentiated or medically unexplained symptoms or health anxieties.
Members noted that the development of ICCs had meant that GP practices worked in a more integrated way with community services which had improved services for patients. A discussion took place regarding the importance of the inclusion of mental health services. Members were informed that a new mental health provider had been commissioned and it was proposed primary care mental health services would form part of the ICC developments over the next year.
The Committee was informed that in the Eden area there was a proposal to recruit two health and wellbeing co?ordinators to bridge the CAMHS gap and specifically support teenagers.
The Committee was informed that PCN developments had meant there were new roles in the general practice team, working across a number of practices; pharmacists, social prescribers, physios, physicians associates and community paramedics were working collaboratively to deliver services.
Members welcomed the development of new roles and questioned whether every practice would have a dedicated resource or whether they would be shared. It was explained that individual practices could choose which services they wanted to develop, this often depended on their size but there was an expectation that all practices would equally benefit. During the course of discussion it was highlighted that the Clinical Commissioning Groups were not responsible for the allocation of resources as this was the responsibility of GPs.
A discussion took place regarding the new models in General Practice in North Cumbria which involved practices developing new ways of working and new roles with the practice team to provide an efficient and effective service. Officers drew attention to the ‘same day health services’ highlighting this had been firmly established in Workington with a new service in Copeland being recently implemented.
Members were updated on North Cumbria Primary Care Limited which was an innovative approach for those practices who wished to join a local organisation run on co?operative lines for the management of local General Practices enabling GPs to focus on clinical care.
The Committee received an update on recruitment and retention in the area and welcomed the successful GP training which had been recognised nationally for quality. It ... view the full minutes text for item 41a
To consider a report by Morecambe Bay Clinical Commissioning Group (copy enclosed).
The Committee received a report regarding the Morecambe Bay Primary Care Network (PCN). It was explained that Morecambe Bay Clinical Commissioning Group worked closely with local health and care providers, third sector organisations and patients to develop local Integrated Care Communities (ICCs) as part of a Vanguard Programme. Members noted that Morecambe Bay ICCs remained in place and were thriving with multiple examples of patient centred, holistic services which were supporting patients and improving the lives of the local populations.
The Committee noted that the majority of the PCNs and ICCs within Morecambe Bay were co-terminus and beginning to work closely together, with some of them already merged with jointly identified clinical leads. The benefits of improved access outcomes due to collaborative working was noted, highlighting that early prevention and detection would help improve outcomes for the population.
Members were informed the Morecambe Bay CCG had eight Primary Care Networks which was broadly in line with the national size range of 30,000-50,000 patients. It was noted there were two local PCNs below and three local PCNs above the average patient range due to a number of local factors including rurality and creation of ‘super practices’ which, in one case, meant that a single practice was a PCN in their own right.
A discussion took place regarding future developments and it was noted that Morecambe Bay CCG was supporting PCNs to develop and stabilise General Practice within 2019/20. Members asked about the stability of GPs in individual areas and it was explained that all GPs in the county were under some degree of stress which could affect stability.
The Committee discussed recruitment and retention and members were informed of the links with local universities. It was also explained that on occasions there would be the opportunity to move resources such as physiotherapists into the frontline to reduce waiting times.
A discussion took place regarding the inclusion of mental health services. Members were informed that following consultation with the clinical population in the south of the county work had been undertaken with MIND with a view to including mental health workers in practices. It was explained this was in the early stages but it was anticipated a primary care mental health worker would be included in all practices in the future.
RESOLVED, that the report be noted.
In conclusion, the Committee welcomed the PCNs as a positive way forward. The need for good engagement with members was highlighted as a mechanism to allow them to have good visibility of future developments around the county.
During the course of discussion a progress update was requested on the six county Health and Wellbeing Fora and it was agreed this would be considered at a future meeting of the Committee.
Winter Preparedness Plans
To consider a report by North Cumbria Integrated Care NHS Foundation Trust (copy enclosed).
The Committee received the draft 2019-20 Winter Plan from North Cumbria Integrated Care NHS Foundation Trust. It was explained this was based on the 2018?19 Plan and included systems and structures already in place as well as additional actions being taken to manage this winter’s pressures.
Members were informed that performance over recent months against the A&E four hours standard had been challenged, as in the rest of England. It was explained that performance had deteriorated month on month from 87.4% in July 2019 to 79.9% in October 2019. It was noted that activity had been broadly similar to the same period in 2018 in both attendances and admissions but there were fewer beds available and the acuity of the patients had increased. Officers highlighted that North Cumbria, therefore, entered winter in a pressured environment and was implementing a range of improvements to manage those pressures.
The Committee was informed that discussions had taken place earlier in the day to plan for extra capacity to be released into the system as soon as possible. It was explained that consideration of what further medium term actions could be built on and what additional contingencies the Trust would be forced to take if the situation continued as it was or became worse.
Members were informed that bed activity in North Cumbria had not significantly increased and was broadly consistent with last year, highlighting the problems incurred due to longer hospital stays. The Committee raised their concerns regarding the impact one additional day in hospital could have on operational capacity.
A discussion took place regarding the number of beds available in the North. The Committee was informed that due to changes in medicine and the increasing number of operations undertaken in day surgery had seen a reduction in the number of beds required. It was acknowledged there was a need to be more realistic and credible about bed reductions.
It was highlighted that in addition to this the impact of the first wave of flu and norovirus was causing significant challenges in an already stretched hospital. Whilst the Committee welcomed the innovative use of beds members were concerned about the availability of staff to support them.
Members were informed that the Trust’s A&E Delivery Board were seeking to carry out further actions to improve patient flow to discharge patients to other care environments. It was explained that in the immediate future planned operations were being significantly reduced and that support measures were being put in place to support staff to enable them to deliver the best care possible.
During the course of discussion concerns were raised regarding the Delayed Transfer of Care (DToC) figures and members highlighted the need for measures to be undertaken for this to be resolved. Whilst officers acknowledged the concerns raised they informed members that part of the problem was the responsibility of the local Authority and that work was being undertaken to ensure the same or more care packages and nursing/residential home ... view the full minutes text for item 42a
To consider a report by University Hospitals of Morecambe Bay NHS Foundation Trust (copy enclosed).
Members considered a report from University Hospitals of Morecambe Bay NHS Foundation Trust regarding their Winter Plan for 2019/20.
The Committee noted the Winter Plan was focussed on three key elements, in line with the A&E Delivery Board’s Urgent and Emergency Care Recovery Plan:
· admission prevention at the front door and in particular a focus on frailty seeking to avoid admissions and support people at home instead;
· improving systems and processes and improving in-hospital resilience under increased pressure within Emergency Departments (ED) and on the in-patient wards, and;
· reducing the levels of delayed transfers of care through delivering a full Discharge to Assess and post hospital support model ie Home First operating at full capacity and pathway 3 utilising a mix of cohort and spot purchase beds.
Members were informed those initiatives would be underpinned by continuous effort to ensure sufficient nursing and medical staff in the EDs, Assessment Areas and base wards as well as ongoing improvements in pathways for ambulatory care, elderly frail and internal discharge processes.
The Committee was given an update on admission prevention and was informed plans were being developed to enhance the Trust’s nursing and therapy rapid response services at weekends to provide a “hospital at home” model of care to prevent escalation of need and avoid admission to acute care for each site. It was explained that recruitment was also underway to support a new Respiratory Network; a team of community respiratory staff to support patients to stay well and independent at home.
During the course of discussion officers confirmed that the Langdale Unit at Westmorland General Hospital continued to be a step?down facility.
Members were informed that NHS England/Improvement had provided the Trust with an additional £1.7m capital which had to be spent by 23 December 2019 to support key projects, mostly at the Royal Lancaster Infirmary, that would support the delivery of improved ED performance.
The Committee noted it was anticipated through occupancy modelling that the range of interventions would moderate the high bed occupancy experienced in the last few years to more manageable levels of approximately 90% through the high pressure winter months. It was explained that together with improved resilience in terms of staffing and capacity it was expected that 4-hour ED performance would improve again on previous years and deliver positively against the 90% trajectory set for Trusts by the end of March 2020.
During the course of discussion it was suggested that strategic plans to deal with winter preparedness should consider deploying resources to build more resilience into the network with beds being strategically reconfigured to have a realistic and achievable level of utilised beds in future.
Members were informed that when surveillance was undertaken at acute hospitals most of the beds were being utilised by patients who needed a clinical bed highlighting the challenges in making risk challenges.
The Committee was informed that at the present time there were 97 patients waiting to be assessed and that all beds in Lancashire were full. It ... view the full minutes text for item 42b
Recruitment and Retention
To consider a report by the North Cumbria Integrated Care NHS Foundation Trust (copy enclosed).
The Committee considered a report by North Cumbria Integrated Care NHS Foundation Trust (NCIC) which provided an update on workforce plans and issues facing the Trust on both a short and long?term basis.
Members noted that the short?term focus was on vacancies across key professions, agency/bank use and the ‘hot-spots’/pressure points within the Organisation and the interventions/actions that had been identified to assist in mitigating the risks generated by staffing issues. It was explained this was in addition to the longer?term focus which was the commitment of the NCIC to the Cumbria Integrated Health and Care Workforce Strategy.
The Committee was informed that across the three Care Groups of NCIC there were a range of vacancies highlighting the most significant was in Nursing, which was consistent with the national picture. It was explained there was reliance on contingent labour (agency and bank) to support essential services and shortfalls in staffing numbers. Members noted that the in-house team had some success in delivering innovation in agency management and the focus for the Trust was now on increasing bank use in the most cost effective and efficient manner to further reduce spend on agency. The Committee welcomed the plans for co production work which the Trust hoped to undertake with the West Cumbria Community Forum.
The Committee received an update on selected workforce pressure points/hot spots which included A&E Medical Staffing at West Cumberland Hospital and had historically been difficult and expensive to staff with a high reliance on agency. It was explained the Consultant rota would be reviewed and an independent expert brought in to advise on alternative staffing models.
Members were informed theatre nurse shortages had contributed to long waiting times. It was highlighted there was a focus on recruitment and deployment of agency staff to bridge the gap, with planned recruitment of specialist Health Care Assistants.
The Committee noted that due to the significant pressures on the system, delayed transfers of care and super stranded patients, the Trust had an unprecedented number of escalation beds now in place. It was explained this had resulted in significant staffing issues with increases in the number of areas currently being staffed via agencies.
It was noted that Hyper Acute Stroke Unit staffing difficulties were now under control and being supported with agency staff which would be replaced as substantive staff moved into post.
The Committee drew attention to the number of agency staff and was informed that work was undertaken to encourage them to work directly for the Trust. It was felt that substantive staff working in the same environment delivered better care due to their familiarity with the surroundings.
Members were informed that robust recruitment continued within a number of specialities through the development of bespoke advertising campaigns and rotational programmes. Whilst officers acknowledged the challenges for a system as large and complex as the Health and Care system in Cumbria it was emphasised that the NCIC was committed to the Cumbria Integrated Health and Care Workforce ... view the full minutes text for item 43a
To consider a report by the University Hospital Morecambe Bay NHS Foundation Trust (copy enclosed).
Members received an update from the University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) regarding Recruitment and Retention.
The report provided an overview of regional and organisational structures, approaches and strategies; a description of the measures which had been designed and/or used to provide an impact analysis of actions and initiatives; an up-to-date position on the delivery of targets and measures and an overview of ongoing challenges and next steps.
The Committee raised concerns regarding the retention of staff, highlighting the pressures on healthcare assistants. Members were informed that UHMBT had the lowest staff turnover figures nationally. It was explained there was regular engagement with staff to ensure support was available as and when necessary. Members were informed the Trust had a ‘Colleague Experience Strategy’ which could be shared with the Committee.
Members received a positive update on a successful international radiology pilot programme highlighting that six radiologists had been recruited on the back of this. It was explained this had been deemed a success by Health Education England who recommended this be replicated around the country.
The Committee welcomed the report and gave a positive update on the support provided to nurses from outside the area. It was felt that there was a need to ensure all agencies worked collaboratively to ensure there was a more sustainable service in rural areas.
(a) the report be noted;
(b) further information be provided on the work being undertaken on retention of staff.
The Chair, on behalf of the Committee, thanked officers for their reports and suggested that front?line staff/patients be afforded the opportunity to meet members in the future. An opportunity to meet new starters was also welcomed.
Officers welcomed the opportunity and also suggested that the Committee could attend future Trust induction events to meet new starters.
To receive a presentation by the North Cumbria Integrated Care NHS Foundation Trust (copy enclosed).
Members received a presentation from North Cumbria Integrated Care NHS Foundation Trust (NCIC) which gave a North Cumbria Digital Update.
The Committee welcomed the positive update regarding digital maternity records which was first in the country and top in utilisation.
Members were informed that in 2019/20 there had been £1.5m internal investment and £1.6m external investment and support from the Department of Health and Social Care (DHSC) with a potential additional £2.m investment. It was explained that in 2020/21 £1.5m of external investment for infrastructure had been secured with £2m supported for Electronic Prescribing and Medicines administration. The Committee noted that work was ongoing with the North East and North Cumbria Integrated Care System and DHSC for future funding in 2020 to 2023 for Electronic Patient Records and with DHSC for infrastructure and transformation.
Members welcomed the report and whilst the update demonstrated there was still a significant amount of work to be undertaken to improve the situation it was acknowledged that this had started. Officers confirmed that a cost analysis had been undertaken explaining that initial investment would be used to eliminate risk.
A discussion took place regarding the ability for all systems to be able to communicate. Officers confirmed this would be possible and had been included in the Specification whilst highlighting their concerns regarding digital failure in the interim.
The Committee thanked officers for their update and acknowledged this was an ongoing investment.
RESOLVED, the update be noted.
To consider a report by the Bay Health and Care Partners Integrated Care Partnership (copy enclosed).
The Committee considered a report from the Bay Health and Care Partners Integrated Care Partnership which provided a digital overview and update.
Members were informed that cross?system working was increasingly supported by the Strata Health system which was facilitating care navigation, the effective management of non-eRS referrals (electronic referral service for first Consultant outpatient appointments) across the system and better awareness of the care assets available in Morecambe Bay. It was explained that work was ongoing to implement Strata into General Practice and Community services providing decision support tools that formed part of the process to digitally refer patients to appropriate care services.
The Committee discussed the Electronic Patient Records system which was anorganisation centric system supporting workflow, scheduling and record keeping. It was explained primary, community and hospice services utilised the EMIS Web system which was considered to be a modern, reliable, and fit for purpose digital system that facilitated the effective capture of clinical records, supported organisational workflow and facilitated record sharing between partner organisations using the system. Members were informed that work was being undertaken to ensure paramedics also had access to records.
During the course of discussion a concern was raised regarding the number of licences which would be required. Officers confirmed all staff would have access to the system and there were no issues regarding licences.
RESOLVED, that the update be noted.
A discussion took place regarding both the North and South and the ability for all systems to have the ability to communicate. Officers confirmed this would be possible and had been included in the specification. There was an expectation that the transformational journey would take between 3-5 years depending on the availability of funding.
Members welcomed a further update 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 received an update on the appointment of a Joint Health Scrutiny Committee for the Lancashire and South Cumbria Integrated Care System which was being led for Lancashire County Council. It was explained that the Terms of Reference and the request to establish a Joint Committee would be considered by Cumbria County Council’s full Council on 9 January 2020.
A discussion took place regarding membership for the Joint Health Scrutiny Committee for the Lancashire and South Cumbria Integrated Care System. It was clarified that a formal request for nominations would be made once the Committee was approved by Council but it was suggested that Helen Chaffey, Sol Wielkopolski and Mark Wilson be nominated. During the course of discussion it was highlighted that any member of the Cumbria Health Scrutiny Committee could attend the joint meetings as observers.
Members were informed that the Scrutiny Management Board had agreed to the request from this Committee that the Joint Advisory Group continued for a further twelve months. It was explained the Group had met and focused on the work being undertaken to prevent and mitigate the impact of Adverse Childhood Experiences (ACEs) throughout life. The Committee noted the next meeting would focus on Cumbria’s Dementia Profile with input from the Alzheimer’s Society.
The Committee’s attention was drawn to an idea put forward during the review of maternity services in the county regarding consideration of a school of rural medicine which could provide training for doctors to have career opportunities in rural areas. It was suggested that the Committee consider this proposal further with a view to this being considered by Central Government in the future.
A request was made for early sight of the Quality Accounts and although this could not be guaranteed officers agreed to try and obtain them as early as possible.
(1) the update on the appointment of a Joint Health Scrutiny Committee for the whole Lancashire and South Cumbria Integrated Care System be received;
(2) the update from the Joint Health and Adults Scrutiny Advisory Group be received;
(3) the existing Work Programme be noted and the following additions be made:-
(i) Winter Pressures Review to be considered at the May 2020 meeting;
(ii) Impact of Integrated Care Communities on Acute Settings in South Cumbria to be considered at the May 2020 meeting;
(iii) Digital Records to be considered at the December 2020 meeting.
Date of Future Meeting
To note that the next meeting of the Committee will be held on Tuesday 25 February 2020 at 10.30 am in Conference Room A/B, Cumbria House, Botchergate, Carlisle, CA1 1RD.
It was noted that the next meeting of the Committee would be held on Tuesday 25 February 2020 at 10.30 am at Cumbria House, Carlisle.