Agenda and minutes

To note all the above members and officers were in attendance at the meeting.

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.

The District Council representatives elected a Vice?Chair of the Committee from amongst their members.

RESOLVED,     that Mr J Kane be elected Vice?Chair of the Committee for the ensuing year.

Apologies for absence were received from Mr D Blacklock, Mr A Cummins, Mr J Kane and Mr J Readman.

There were no changes to the membership of the Committee on this occasion.

(1)       Mr C Whiteside declared a personal interest as his wife was employed at the West Cumberland Hospital.

(2)       Mr S Wielkopolski declared a personal interest as his partner was employed at Furness General Hospital.

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 25 February 2020 (copy enclosed).

(1)       It was agreed that David Stephens, Strategic Policy & Scrutiny Adviser would circulate an update on any matters arising at the last meeting.

(2)       With reference to minute 53 – North Cumbria Vascular Services it was agreed that the word ‘that’ be added to the second sentence of the penultimate paragraph before the resolution, therefore, it would read ‘It was explained that the Newcastle-upon-Tyne Hospitals ………’

(3)       With reference to minute 54(a) – Our Strategy 2020-24 – Building Integrated Care, the third paragraph should read ‘Wider Integrated Care System’ and not ‘Wider Integrated Care Community’

(4)       With reference to minute 54(b) – Bay Health and Care Partners (BHCP) Better Care Together (BCT) Strategy and Lancashire and South Cumbria Integrated Care System Strategy the first sentence of the second paragraph should read ‘The Committee was informed that the latest BCT Strategy had been developed …..’.

RESOLVED,     that with the inclusion of the above amendments the minutes of the meeting held on 25 February 2020 be agreed as a correct record.

To consider a report from the North Cumbria Integrated Care Trust (copy enclosed).

The Committee considered a report from North Cumbria Integrated Care Trust (NCIC) which detailed the performance highlights for Urgent and Emergency Care, and Elective Care Services at NCIC to date together with delivery plans for the coming months.

Members were informed that alongside local and national partners NCIC had faced unprecedented challenges in the first half of the financial year 2020/21 due to the impact of the COVID pandemic.  It was explained that as a Trust plans were being finalised for delivery of services for the remainder of the year, which included improving models of care to address the challenges of recovering from the peak of COVID and adapting to the new operating environment, whilst planning for the forthcoming Winter period.

The Committee was informed that the Urgent and Emergency Care (UEC) pathways had been considerably challenged during recent months and post COVID.  It was explained that the challenges within the UEC pathways were multifaceted in relation to capacity within the emergency department to see patients in a timely way as well as the general patient flow across the acute and community hospital settings.

Officers explained that performance against the national four-hour standard had been challenging, particularly at the Cumberland Infirmary site.  It was explained that breaches had increased with performance declining for a third consecutive month, following an improved position at the peak of COVID in April and May.  Members noted this followed the same trend as last year at a slightly lower rate.

Members were informed that the Trust was already in a challenged position regarding elective care performance pre COVID.  It was explained this had now been further exacerbated following the pandemic period which instructed all organisations to suspend routine and elective operations.

The Committee was informed that in July 2020 the Trust began its elective theatres restart programme with the focus being on longest waiters and maximising existing resources within the confines of infection prevention restrictions.  It was explained this included the increased utilisation of West Cumberland Hospital as well as the Independent Sector capacity which the broader NHS has put in place.

Members were informed that access to diagnostics performance had been significantly impacted by COVID with performance against the 6 week standard reaching 63.5% waiting over six weeks in April which had slowly improved to 52.9% for July.  It was explained the diagnostic waiting list was now double pre-COVID levels, and performance was expected to decline again before sustained improvement could be seen.  It was noted the Trust was delivering elective care at expected post-COVID levels, however, current capacity levels did not address the challenging waiting list.

Officers explained that in response to the challenges facing elective care, the Trust had developed an Elective Care Recovery Strategy, with the aim to develop a sustainable Elective Care Programme, and was working with North Cumbria Clinical Commissioning Group as part of the national planning requirements to secure investment for sustainable elective care recovery.

The Committee referred to concerns which had been raised the previous year and  ...  view the full minutes text for item 65.

To consider a report from the Chief Operating Officer, North Cumbria Clinical Commissioning Group (copy enclosed).

Members received a report from NHS North Cumbria Clinical Commissioning Group on behalf of North Cumbria Integrated Care Partnership which outlined the collaborative approach towards winter planning for health and care organisations across north Cumbria.

The Committee noted that the Plan focussed on the collective challenge faced across the North Cumbria Health and Care Integrated Care Partnership and acknowledged that winter had been a challenging time for health and care providers and commissioners in north Cumbria in recent years.  It was highlighted that the prospect of a second wave of COVID-19 would be difficult and that the acute hospital and community trust, mental health trust, ambulance service, primary care and care homes and home care providers had a reduced capacity to enable infection prevention measures to be followed.  Officers explained there may also be late presenting health-seeking behaviour, there had been delays to some planned care because of COVID and the ongoing risks caused by significant numbers of flu cases and adverse weather incidents.

The Committee was informed that investigations were taking place with regards to working in partnership with the north east system with a view to providing additional support for patients in the event of very significant winter pressures.

A discussion took place regarding the roll out of the winter flu vaccinations and members asked how plans were developing to enable them to be undertaken without a COVID risk.  Members were informed that GP practices across North Cumbria had developed clear plans to ensure the seasonal flu vaccination was delivered in a COVID secure way.  Dr Hanley emphasised every effort was being made to ensure patients received their vaccinations.  It was noted that a collective Flu Board in North Cumbria reviewed issues and was connected to the broader North East and North Cumbria Flu Board to share standard practises. 

The Committee asked for further information regarding the review of the Discharge Team to develop a “push” rather than “pull” model.  Officers explained that “push” would involve hospital based staff identifying patients who could be discharged and receive care at home and “pull” would be community based staff identifying patients in hospitals; this described a shared endeavour with community and hospital services to enable patients to receive their care from the right sector.

A member highlighted the various treatments which had been found to be effective during the first wave of the pandemic and asked to what extend they were being used in north Cumbria.  Officers explained that all national guidelines were being adhered to and that the Trust was taking part in national recovery trials.  The Committee was informed that treatments fell into four categories, namely, the use of anti-viral drugs, immune modulators, supportive treatments and treatments for complex and diverse issues, highlighting that all treatment was associated with patients who had complex and diverse issues.

A discussion took place regarding targeted managed resource to manage risks associated with Brexit.  Officers confirmed it was anticipated there would be implications for the NHS associated with Brexit and that  ...  view the full minutes text for item 66a

To consider a report from the University Hospitals of Morecambe Bay NHS Foundation Trust (copy enclosed).

The Committee received a report from the Bay Health and Care Partners which provided an update in relation to the Winter Plan being developed by Bay Health and Care Partners for 2020/21.

Members were informed that following the announcement of the COVID19 pandemic at the end of March 2020, the NHS had been under Level 4 Major Incident command and control directions from NHSI/E.  It was explained that as part of that response, the majority of non-COVID related activities were stopped with the exception of urgent care and some cancer related activities.

The Committee noted that plans had been developed to recover non-COVID related activity over the remainder of the financial year.  Officers explained that in the interim, University Hospitals of Morecambe Bay NHS Foundation Trust and partners had been bringing back most of its non-COVID services under the appropriate restoration guidance.  It was explained that alongside this recovery and restoration work, systems were also being asked to ensure appropriate plans were in place to deliver safe services through the forthcoming winter period.  Members noted that this included the delivery of appropriate urgent care, planned elective care (under the recovery and restoration guidance), and access to primary and community care, mental health services and providing the appropriate capacity/resilience to deal with the ongoing prevalence of COVID19.

Members discussed the challenges of an already stretched system and asked for confirmation that plans were in place to deliver positive outcomes and how initiatives such as extra beds in Barrow, mental health support at home and mental health crisis line were being commissioned. 

Officers confirmed that some work had started; there were additional beds in Furness General Hospital, Barrow and they were also being developed at the Royal Lancaster Infirmary together with Nightingale wards developed in March being used as bays and side rooms.  Members were informed that the pathways were being tested for the out?of?hospital frailty co-ordination hub and frailty model in Lancaster.  It was explained that preparations for winter were taking place whilst acknowledging they needed to be agile.

Members were informed that community rehabilitation beds at Risedale and Kendal were ready and it was hoped confirmation of funding would be given that week. 

It was highlighted that the central IMT hub which considered issues on a daily basis had been invaluable over the past six months.

A discussion then took place regarding the ‘In Hospital Actions’ and in particular the Critical Care Capacity and Capacity Adjustments to Become COVID Secure. 

Officers explained that with regards to the critical care capacity and the relocation of the Intensive Care Unit to increase capacity to 14 beds from 7 there were plans in place to go back into theatres and use them to have separate areas for Intensive Care.  It was noted that earlier in the year an area had been created which had capacity for 14 beds provided in one space.  It was anticipated a self-contained intensive care unit would be available at both the Furness General Hospital and  ...  view the full minutes text for item 66b

To consider a report from the University Hospitals of Morecambe Bay NHS Foundation Trust (copy enclosed).

Members considered a report from University Hospitals of Morecambe Bay NHS Foundation Trust regarding the impact of Integrated Care Communities on Acute Settings in South Cumbria. 

The Committee was informed that the original definition of Integrated Care Communities (ICCs) had served the developing system within Morecambe Bay well and they continued to provide local focal points for place-based partnership collaboration and were a delivery vehicle for holistic integrated care delivered by a range of providers including voluntary sector and primary care.

Members noted that the further development of Primary Care Networks (PCNs) was shaping the landscape in which integrated working was developing.

Officers explained there were now eight Integrated Care Communities in Morecambe Bay reflecting the geography and natural communities in existence of which six were within South Cumbria.  Members noted that in the first instance these were co-terminus with the county boundaries in which those General Practices operated.  It was highlighted that these were not unchanging and may alter to reflect local changes in communities and also have sub-communities within them.  It was explained each practice delivered their health in different ways dependant on size and availability of practice facilities. 

Members discussed the successful roll out of the Mindfulness Training in primary and secondary schools; a project to help maintain and develop resilience to change to enable young people to have the skills to support themselves and others through change.  It was agreed that the Committee would be provided with further information on the outcomes of Mindfulness Training in primary and secondary schools and reflections on the benefits this had generated for young people.

The Committee was informed that knowledge of their local population health profiles was now well embedded into ICC thinking and behaviours.  It was explained there were now also the relevant skills in the workforce changing interactions from being illness focussed to promoting wellness, self-directed care and self-management.

A discussion took place regarding the responsibility of admission teams who provided support to prevent hospital admissions and it was highlighted such teams should be supported by a workforce who had the skills to assess individuals in order to make the correct decisions.  Members were informed that in South Cumbria such positions would be held by advanced nurse practitioners.

The Committee welcomed the community engagement which involved building a culture of partnership with patients, people and communities and was vital to the success of ICCs and PCNs.  It was explained that ICCs had made community engagement a key element from the very beginning as they embarked on a shared vision to building their understanding of their populations health needs and co-designing personalised care.

The Committee were given examples of successful community engagement which included successful health fests focussing on wellbeing and healthy town initiatives with a large amount of work being undertaken with third parties such as GPs, Healthwatch, sports industry and ambulance service. 

During the course of discussion concerns were raised regarding the challenges for third sector organisations post COVID due to lack of funding during the  ...  view the full minutes text for item 67.

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 discussed length of future meetings and suggested that if hospital discharges could not be considered at a future scheduled meeting either an additional public meeting or an informal meeting be considered.

RESOLVED,   that

                          (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)          Mr D Shepherd be nominated as the Committee’s Carlisle representative on the Cumbria Health Scrutiny Variation Sub-Committee;

                          (3)          the existing Work Programme be noted and the following items be added:-

·               Podiatry Services in Morecambe Bay – December 2020

·               Patient Records;

                          (4)          the following items be discussed at future Lead Member meetings:-

·               One Stop Shop Breast Clinic at West Cumberland Hospital

·               Number of Radiographers

·               Ensure points are taken up with Coroners’ regarding reported deaths in 2018

·               Privatisation of NHS;

                          (5)          an agenda planning meeting would be scheduled to discuss future items.

To note that the next meeting of the Committee will be held on Tuesday 15 December 2020 (venue to be confirmed).

It was noted that the next meeting of the Committee would be held virtually on Tuesday 15 December 220 at 10.30 am.