Venue: Conference Room A/B, Cumbria House, Botchergate, Carlisle, CA1 1RD
Contact: Lynn Harker Email: firstname.lastname@example.org
Apologies for Absence
To receive any apologies for absence.
Apologies for absence were received from Mr D Blacklock and Mr S Wielkopolski.
Membership of the Committee
To note any changes to the membership of the Committee.
(1) It was noted that David Shepherd had replaced Anne McKerrell as the Carlisle City Council representative on the Committee on a permanent basis.
(2) Mr G Roberts attended as substitute for Mr S Wielkopolski for this meeting only.
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) Mr G Roberts declared a personal interest as he was a member of the Cumbria, Northumberland, Tyne and Wear Partnership.
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 10 December 2019 (copy enclosed).
With reference to the second paragraph of minute 41(b) – Primary Care Networks (South Cumbria) it was agreed that ‘co-terminus’ should read ‘co?terminous’.
RESOLVED, that with the inclusion of the above amendment the minutes of the meeting held on 10 December 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 appointment of a Joint Health Scrutiny Committee for the Lancashire and South Cumbria Integrated Care System and the Joint Health and Adults Scrutiny Advisory Group.
A discussion took place regarding the number of cancelled operations and it was agreed this would be considered further with Lead Health Members.
(1) the update on the appointment of a Joint Health Scrutiny Committee for the whole Lancashire and South Cumbria Integrated Care System be noted;
(2) the update from the Joint Health and Adults Scrutiny Advisory Group be noted;
(3) the existing Work Programme be noted and the following items be included for future meetings:-
(i) Sustainability of Rural Health Services be considered at the May 2020 meeting;
(ii) Impact on any Future Unitary/Devolution Proposals for Cumbria on Health and Care Services.
To consider a report by NHS England (copy enclosed).
The Committee considered a report on North Cumbria Vascular Services which provided background information as to why those services needed to change.
Members noted that in April 2019 a discussion paper had been shared with NHS England which offered three potential options to enable the continuation of safe and sustainable vascular services to North Cumbria patients at the end of the Service Level Agreement with Dumfries and Galloway in September 2019. It was explained that in May 2019 a request had been made to North England Clinical Senate to provide an independent clinical view on an interim service model whilst a sustainable solution was pursued.
Members noted that in July 2019 a further option was also presented to allow Newcastle and North Cumbria to work together as a networked model and would include the recruitment of a fifth vascular consultant as an interim model to maintain vascular services in North Cumbria. It was explained that following agreement for the interim model work would focus on the evaluation of future options for a sustainable long-term service model. Officers emphasised there were no plans to remove services from North Cumbria.
The Committee asked whether a previous option was still being considered to collaborate with the northern vascular centre at the Freeman Hospital in Newcastle to continue providing emergency service at the Cumberland Infirmary as an ‘upgraded spoke’ with support from Freeman consultant surgeons to maintain an emergency service. It was explained that consultants remained in North Cumbria and were undertaking more specialist interventions.
Members were informed that in October 2019 consultant vascular surgeons had focussed on an appraisal of the following options:-
(1) Newcastle and North Cumbria as two separate vascular hubs working as a networked model.
(2) A hub and spoke model with Newcastle as the hub.
It was explained that the feasibility of an emerging preferred option of two separate vascular hubs working as a networked model had also been considered. Members noted this focussed on potential arrangements for aligning governance pathways, running multi-disciplinary teams, joint appointments and outpatient pathways.
Members welcomed the report and raised their concerns regarding the additional pressures on the service due to staff absence and the difficulties encountered regarding recruitment and retention. Officers explained there were challenges regarding the recruitment of specialist nursing and this was on the NCIC Trust risk register with current actions being progressed.
A discussion took place regarding the number of vascular consultant clinics in West Cumbria and members questioned the accuracy of the reference to 11 which had been referred to in the report. Members understood there were only eight in the west of the county consisting of three at West Cumberland Hospital and five in Workington. Officers agreed to investigate this and report back direct.
The Committee emphasised the importance of services being retained in West Cumbria and raised their concerns regarding resourcing issues. Officers explained that a broader range of staff with the necessary clinical knowledge was being investigated to try and alleviate any problems. During the course ... view the full minutes text for item 53.
To consider a report by North Cumbria Integrated Care NHS Foundation Trust (copy enclosed).
The Committee considered a report which gave an update on the North Cumbria Health and Care Strategy 2020-24. It was explained this represented an updated strategy for North Cumbria which set out how the NHS Long Term Plan ambitions would be delivered locally.
Members discussed what this would mean for individuals, communities and staff, noting that health and care teams would work together to ensure that hospital admittances would only be made if absolutely necessary. A question was asked about the level of co?operation with local housing authorities and it was explained work was being undertaken on this matter acknowledging that improvements were still required at local level.
The Committee discussed the size of North Cumbria’s footprint which was part of a wider Integrated Care Community and included four Integrated Care Partnerships and asked what it was doing differently. Officers agreed the county was different due to its rural geography and was set apart through a number of measures including engagement and partnership work with third sector organisations. The development of its clinical networks, such as the availability of cancer services at the Cumberland Infirmary in Carlisle to keep services local, was also highlighted. Members were informed that regional engagement had also taken place with Primary Care Networks to consider the place based approach.
During the course of discussion a concern was raised regarding a disconnect with Age UK in West Cumbria and it was felt a dialogue with them was required. Members were informed that the first draft Outline Business Case in West Cumbria was being finalised and welcomed a further conversation regarding this matter. An invitation to the Healthwatch West Cumbria Community Forum was also extended to Age UK.
A discussion took place regarding hospital services and members asked which areas currently experienced the worst staffing shortages making them vulnerable. Members were informed there were recruitment and retention problems in elderly care and accident and emergency as well as general internal medical wards.
The Committee discussed the core areas of focus which included living well, noting the need to identify the risk factors affecting the health of communities and the provision of the correct information and support to help prevent ill health. It was explained there was a need to improve wellbeing in communities and work together to address the wider determinants of health, such as housing and the local environment which included reducing smoking, alcohol consumption and obesity.
Members welcomed this and asked what strategies were in place and their effectiveness. Officers informed the Committee that the Population Health Programme set out the Population Health Plan which sat alongside North Cumbria Integrated Health and Care – Our Strategy 2020?2024 and considered prevention. The challenges regarding obesity were highlighted and it was explained that investment had been made in the Healthy Weight Programme to try to overcome them which included access to services locally such as Slimming World.
The Committee asked if the Plan would direct funds from acute services upstream and translate into savings. It ... view the full minutes text for item 54a
To consider a report by Healthy Lancashire and South Cumbria (copy enclosed).
Members received a joint report from Morecambe Bay Clinical Commissioning Group and Healthier Lancashire and South Cumbria regarding the NHS Long Term Plan (LTP) which set out a range of ambitions for the NHS for the next 5-10 years. It was explained that alongside this, the Bay Health and Care Partners (BHCP) Integrated Care Partnership (ICP) had agreed to undertake a refresh of the Better Care Together (BCT) Strategy.
The Committee was informed that the BCT Strategy had been developed over a number of months and the BHCP Leadership Team and Partnership Board had been engaged in the process through updates and discussion on key elements of the document as they had evolved, such as the key priorities and financial principles.
Members received the final draft version and the Committee was asked to give consideration and feedback on the document prior to a final Strategy being produced for approval by BHCP and partners in March.
The Committee also discussed the draft ICS Plan which had now been produced and was asked to note development and consider the document.
Members were informed that the Plan built on plans in local areas. Officers highlighted the need to accelerate changing the way in which services were provided across Lancashire and South Cumbria over the next four years; improve the health and wellbeing of local communities, deliver better joined up care closer to home and deliver safe and sustainable high quality services. It was also recognised there was a need to address health inequalities, achieve national standards, improve quality and tackle the financial deficit.
The Committee considered the financial challenges ahead and asked how confident the Trust was that they could be overcome. It was explained there was a need to reconsider plans to close the gap, indicating that if the governance was correct there was a better chance of getting nearer to balance.
The Committee discussed the provision of care within the community to prevent hospital admissions, highlighting the positive move forward following the recruitment of 16 home care practitioners and felt this reflected the strength of the developing ICCs.
Members were informed that as part of the Strategy development, Morecambe Bay CCG, on behalf of Bay Health and Care Partners, had sought public feedback on its challenges and proposed priorities. Concerns were raised that one of the key findings from the survey was that respondents had selected that they ‘were not meeting national standards of care’ as the most important challenges to tackle. Officers explained that work was being undertaken to prioritise standards, particularly with regards to clinical patients.
The Committee noted the new NHS infrastructure in which care would be delivered and reaffirmed commitment to work at three levels: ICC and neighbourhood level; the continued development of the Morecambe Bay ICP; and the continued development of the Lancashire and South Cumbria ICS. Members noted there was also a recognition of the direction of travel towards more integrated commissioning across the ICS and with local authorities; and the development of a group ... view the full minutes text for item 54b
To receive a presentation by Lancashire Commissioning Support (copy enclosed).
The Committee received a presentation which gave an overview of the redesigning of Child and Adolescent Mental Health Services (CAMHS) in Lancashire and South Cumbria in line with THRIVE.
Members were informed that providers had been requested to collaborate with each other, Voluntary Community and Faith Sector (VCFS) providers and Clinical Commissioning Groups (CCGs) to clinically lead the co?production of a core service model for NHS funded CAMHS services across Lancashire and South Cumbria.
The Committee noted that all NHS funded services (partially or fully) that could or should deliver activity towards the new national CAMHS access target were in scope. It was explained that the Care Partnership team had received a mandate which explained what the model needed to offer and they were asked to produce a proposal.
Members received information regarding the co?production methodology and welcomed the recruitment of children and young people, families and carers to join participation groups in each ICP. It was explained those groups met regularly to discuss and reflect on emerging design themes and co?production of solutions with support and oversight provided from Healthwatch.
It was noted that as part of the co?production methodology wider members had joined closed Facebook groups and circulated ‘live’ questions and feedback into the workshops. Officers had welcomed the responses and explained it was not all positive. During the course of discussion members suggested that pupils could also provide feedback via school nurses.
The Committee was informed of stakeholder engagement which involved more than 70 individuals from 27 NHS, local authorities, education, police, voluntary and community organisations across Lancashire and South Cumbria working together with parents, carers and young people on the redesign. Officers explained that feedback from groups regarding co?production of the Thrive Model had been positive and they were keen to stay involved as the design was developed and implemented.
Members noted the core recommendations from the design process which included 1-4 hours, 24 hours or 72 hours emergency care/crisis service, intensive support service to deliver short term intensive interventions, day service/unit to provide daily intensive therapy and crisis/safety beds.
A discussion took place regarding a child or young person seeking help and advice independently. Members were informed that a 24 hour helpline service would be available; a single point of contact which would be triaged initially.
The Committee highlighted that joint working in North Cumbria between CAMHS and Barnardo’s had seen them attaining 100% target which comprised of a 90 minutes 360? holistic assessment within eight weeks before accessing other services which may be required. Officers explained that currently South Cumbria was exceeding the national access target of 35% by achieving 36% with the anticipation of reaching 100% by 2024. It was suggested that officers examine the work undertaken in North Cumbria on meeting access standards to see what learning could be adopted in the Lancashire & South Cumbria ICS.
A discussion took place regarding the inclusion of GPs with the importance of their intervention being emphasised. During the course of ... view the full minutes text for item 55.
To consider a report by the Morecambe Bay Clinical Commissioning Group (copy enclosed).
The Committee considered a report from Morecambe Bay Clinical Commissioning Group (MBCCG) which advised members of their intention to engage widely regarding the proposal to implement consistent referral and treatment criteria for the podiatry service provided by University Hospitals of Morecambe Bay Trust (UHMBT). It was explained the express intention was the provision of an improved service for people with diabetes or other medical needs who were at a higher risk of developing serious foot problems.
It was explained that in recent years the podiatry teams had seen an increase in patients with higher needs, particularly those associated with diabetes, and teams were now carrying out much more complex work than they had previously. Officers highlighted that those patients with high-level podiatry needs could experience delays because of the limited capacity of the podiatry teams.
The Committee noted that in order to ensure there was sufficient service capacity the NHS service could only deal with high medical or podiatric needs, therefore, those with lower needs would be supported by organisations outside the NHS or given information about self-care. A discussion took place regarding encouraging self-check and it was explained there was a need to work with colleagues to educate people, and advice was being sought from North Cumbria. Officers explained that podiatry teams would also go into communities to train and support individuals.
Members were informed there was strong clinical evidence that good foot care services could reduce the duration of ulcers and the rates of hospitalisations and amputations, thereby improving lives and saving money.
The Committee noted that the CCG intended to engage widely regarding the proposal to consistently implement agreed referral and treatment criteria for the podiatry service. It was explained the express intention was to provide an improved service for people with diabetes or other medical needs who were at a higher risk of developing serious foot problems.
The Committee was informed that MBCCG would carry out a public engagement process to gain views on the proposed service change and to provide an opportunity for any alternative options for change to emerge during the engagement period.
(1) the report be noted;
(2) learning from the engagement process undertaken in North Cumbria be incorporated in the engagement plan for South Cumbria;
(3) the report from the British Chiropody and Podiatry Association be circulated to the Committee;
(4) engagement take place with the County Council and appropriate district councils and elected members;
(5) briefings be provided to the Committee at key stages of the engagement process and a report be provided to a future meeting once the engagement had been completed.
Date of Future Meeting
To note that the next meeting of the Committee will be held on Monday 11 May 2020 at 10.30 am in County Offices, Kendal.
It was noted that the next meeting of the Committee would be held on Monday 11 May 2020 at 10.30 am in County Offices, Kendal.