Agenda and minutes

Members were informed that an apology for absence had been received from Ms C Driver, Chair of the Committee.  It was explained that due to personal circumstances the Vice?Chair would not take the position of Chair and had asked that a nomination be sought from members for this meeting only.

It was, therefore,

RESOLVED,     that Mr M Wilson be elected Chair for this meeting only.

It was noted that the above members and officers were in attendance at the meeting.

Apologies for absence were received from Ms C Driver, Mr F Cassidy and Ms H Horne.

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 by the University Hospital Morecambe Bay NHS Foundation Trust.

RESOLVED,     that the press and public be not excluded from the meeting for any items of business.

To confirm the minutes of the meetings held on 5 October 2020 and 15 December 2020 (copies enclosed).

RESOLVED,     that the minutes of the meetings held on 5 October and 15 December 2021 be agreed as a correct record.

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.

A member raised a concern regarding the lack of information received by the Committee which had been agreed at the meeting held on 5 October 2020.  It was agreed that specific details would be made available to the Strategic Policy and Scrutiny Advisor who would look into the matter.

A discussion took place regarding the Work Programme; the importance of scheduling Digital Strategies at a future meeting was highlighted together with the following suggestions:-

Ø    Wider Health Impact of COVID 19 Pandemic

Ø    Evidence of Improvements at the Maternity Unit, Furness General Hospital

Ø    Primary Care Provision in West Cumbria

RESOLVED,     that

                            (1)       the update on the most recent Lead Health Scrutiny Member meetings with System Leaders in the North and South of the county be noted;

                            (2)       the existing Work Programme be noted and the above suggestions be considered.

To receive verbal updates from the University Hospitals of Morecambe Bay NHS Trust and North Cumbria Integrated Care NHS Foundation Trust.

The Committee received a verbal update on the COVID pandemic from the University Hospitals of Morecambe Bay NHS Trust (MBUHT) and North Cumbria Integrated Care NHS Foundation Trust (NCIC).

(1)       South Cumbria

Members received an update on MBUHT’s strategy and planning during the current wave of the pandemic and noted that predictive models had been carried out.  It was explained that collaborative work had been undertaken with partners to ensure support was available to either prevent hospital admissions or discharge patients as soon as possible.

The Committee was informed the availability of additional beds in care homes in Barrow and Kendal had proved positive, together with the work undertaken with colleagues in primary care to establish a frailty co?ordination centre to provide care at home and avoid admissions to hospitals wherever possible.

Members noted an additional 80 beds had been made available between the Furness General Hospital and Lancaster Infirmary sites, with an increase from 14 to 35 critical care beds during the latest phase of the pandemic.  It was explained this had resulted in the deployment of staff from other clinical areas to resource the intense situation.

Members were informed that approximately 30 mutual aid critical beds had been provided over a 4?6 week period to colleagues in the south.

The Committee was informed that extensive estate works had been undertaken to ensure the sites were COVID secure with a number of colleagues being supported whilst working from home.  The sites had been operating at 85% occupancy; at the peak there had been approximately 230 patients which had recently reduced to about 130 across both sites

A discussion took place regarding contact with staff whilst they worked from home and any improvements which could be taken forward for the future.  It was explained that virtual meetings had been well received whilst acknowledging the benefits of face to face contact and that a future working from home policy was being considered.  During the course of discussion members noted that virtual outpatient appointments had been successful during the pandemic.

The Committee was informed that the science regarding the treatment of COVID had changed considerably due to an increase in pharmacological treatment and non-invasive ventilation.

During the course of discussion a member asked if there had been a need for Nightingale hospitals in the Bay area.  The Chief Operating Officer confirmed there had not been any need to transfer patients to the Nightingale Hospital in Manchester explaining that the commissioned cohort of beds in care homes had helped manage the situation.

The Committee was informed that plans were in place to begin to step up elective activity, but officers emphasised there was a need to bear in mind that that the staff were fatigued, therefore, this would be introduced gradually. 

A discussion took place regarding the extreme hard work which had been undertaken by health colleagues during the pandemic and asked how they would be supported in future.  Members were informed that COVID assessments were undertaken on staff and they  ...  view the full minutes text for item 89.

To receive a presentation from Healthwatch Cumbria on the experiences of people accessing mental health services during the COVID 19 pandemic.

Members received a video from Healthwatch Cumbria which provided feedback from three mental health service users.

The Chief Executive, Healthwatch Cumbria and Lancashire explained to the Committee that they had strong relationships with both of the county’s mental health trusts and future work would be undertaken with them based on the feedback from the mental health service users. 

Members were informed that the motivation behind the service users was to help improve the services and avoid other clients having the same negative experiences.  The key learning themes included:-

Ø   support staff to demonstrate kindness;

Ø   address lack of compassion;

Ø   ensure urgent support is available in a timely fashion;

Ø   responsiveness of those services; appreciate the issues are no less urgent than response times from an ambulance service or A&E department;

Ø   feel welcomed and not a burden.

Members were informed that whilst it was acknowledged there were additional pressures on the service due to the current pandemic it was felt important that improvements were undertaken and the service users were happy to be involved to turn their experiences into a learning tool.

A discussion took place regarding the opportunity for highly trained volunteers within the NHS to help during a crisis.  Officers felt that this was a crucial role for volunteers and explained that CNTW had a Team located in the county who were recruiting and training volunteers and that LSCFT was undertaking an exercise with partners to maximise the benefit of volunteers. 

Members highlighted the importance of leadership and sought reassurance that plans were in place to improve the current service.  The Chief Executive, LSCFT informed the Committee they now had a new Leadership Team in place and one of their priorities was to be visible to staff.  It was explained that a recent staff survey had been undertaken which had given positive feedback regarding visibility; although the initial feedback had been positive it was appreciated there was still a need to radically change the service.

The Group Director (North Cumbria Locality), CNTW acknowledged the accounts given by the three service users did not give a good reflection of the services.  In response to a question regarding a vision for the future he explained that they had adopted the current services and appreciated the amount of improvement which was required whilst highlighting the Trust was prepared for the challenges ahead.

A discussion took place regarding the high percentage of COVID related deaths from young people with learning disabilities.  Officers acknowledged the disproportionate effect of COVID on people with learning disabilities.

Members were informed that work had been undertaken with partners in Lancashire and South Cumbria to improve the services for people with learning disabilities in the community.  Officers explained an Intensive Support Team as well as an Autism Outreach service had been introduced to support people to stay at home and avoid hospital admission. Officers acknowledged the challenges regarding the effects of COVID on people with learning disabilities and explained partnership work was being undertaken to focus  ...  view the full minutes text for item 90.

To consider a report by Lancashire and South Cumbria NHS Foundation Trust (copy enclosed).

The Committee considered a report and detailed presentation from Lancashire and South Cumbria NHS Foundation Trust (LSCFT) regarding Mental Health, Learning Disability and Autism Services and the Impact of COVID-19 Pandemic and Future Plan together with an overview of LSCFT’s strategic direction, current challenges and future service development plans.

A discussion took place regarding the NHS Long Term Plan and members noted that the Transforming Care Programme and Building the Right Support (2015) for people with Learning Disability had led to better co-ordination of efforts for people with learning disabilities across Lancashire and South Cumbria (LSC).  It was explained that the Transforming Care Programme had identified some considerable issues that needed to be addressed systematically to ensure high quality services for people with Learning Disabilities.  The target of 35-50% reduction in in?patients with Learning Disability and/or Autism was supported by the LTP commitment for a 35% reduction by 2020.

The Committee discussed the challenges of mental health noting that the issues in the urgent care pathway were related to availability of in?patient Mental Health beds for people who required an admission.  It was explained that the LSC footprint had seen significant reduction in in?patient bed capacity with a reduction from 2006/7, where the capacity in Lancashire was close to 800 compared to today’s figure of circa 300, together with a parallel reduction in whole time equivalent Mental Health Community Team capacity.

The Committee was informed that the Trust had a limited number of rehabilitation beds and had recently taken on the responsibility for the contract with the independent sector to ensure close system oversight was established.  During the course of discussion a question was asked about the use of the private sector and drop of 35-50% in?patients with Learning Difficulties.  Officers confirmed there was a gap of approximately 90 beds which was being investigated.  It was explained that out of area provision was being used as an interim measure with this peaking at 67 during the pandemic but the aim was to eradicate this with the ongoing work at the Kendal Unit.

The Committee was informed that there was no in?patient facility at present for people with learning difficulties in South Cumbria, therefore, they had to go out of area but a business case was being discussed to establish a learning disability unit locally.

Members noted that the Trust had completed a comprehensive review of their in?patient bed capacity and demand and acknowledged that Lancashire and South Cumbria had a bed gap for adults and older adults of 101 beds. It was explained that the Trust and Clinical strategies outlined their principles to address the gap by providing high quality, single sex in?patient accommodation across the ICP footprints.  Officers also confirmed that a Sexual Safety Strategy had been developed to ensure environments were safe.

A discussion took place regarding the challenges of Child and Adolescent Mental Health Services (CAMHS).  Members were informed that the current  CAMHS services were under increasing pressure, with a  ...  view the full minutes text for item 91a

To consider a report by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (copy to follow).

The Committee received a detailed presentation from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust on the Mental Health Impact of the COVID 19 Pandemic and Future Plans.

Members were informed that a significant number of documents had been received from Central Government which had been shared with colleagues and considered by task and finish groups as appropriate.  It was explained that a staff absence line had been established to support staff.  The Committee noted that staff and patient testing had been undertaken; patients were tested three times on admission, after periods of leave and pre?discharge.

The Committee was informed that three staff vaccination clinics had been designed and implemented to support staff and 7,700 patients, staff and partners had received their vaccine to date.

Members received information on referral rates, acute urgent care crisis daily activity, adult and old peoples bed occupancy, out of area placements.

A discussion took place regarding the system wide approach suicide prevention network which had been given urgent priority with a wide?ranging inter?disciplinary public health response in place.  Members were informed that on?line training regarding suicide awareness was available and it was agreed Julie Lawlor would share this with the Committee

The Committee was informed of the Long COVID actions which included significant training and awareness?sharing of developing knowledge appropriate for all staff together with strategies to support staff.  

A discussion took place regarding the Care Quality Commission (CQC) inspection and members noted that despite the current pandemic good progress had been made on the 38 recommended improvements.  Members noted that plans were in place to address the estate concerns which included the replacement of dormitory style accommodation in Oakwood and the installation of nurse call system in the next few weeks.

Members were informed that despite the demands of the current pandemic step changes in performance had continued in line with national quality priorities; the growth in the number of children and young people accessing mental health care had been maintained; all patients on community mental health team caseloads had been reviewed with therapeutic activity increased and support had been provided to GP practices to ensure learning disability was identified on their register.

The Committee noted that crisis lines were now open 24/7 but there was further work to be undertaken to deliver nationally prescribed waiting standards, especially around adult autism diagnosis and expanding services for children in crisis, including home treatment. 

A discussion took place regarding the demands on the CAMHS service and officers confirmed there were 86 children in Eden and Carlisle with 6 waiting more than 18 weeks and 37 in Allerdale with no one waiting more than 18 weeks.  Members were also informed there were 17 children with learning difficulties waiting for the Early Intervention and Behaviour Service with no one waiting for more than 10 weeks.

A Member asked about the number of rejections of GP referrals to CAMHS and emphasised the frustration of GPs in the Eden area regarding the frequency of  ...  view the full minutes text for item 91b

To note that the dates of future meetings are to be agreed.

It was noted that the next meeting of the Committee would take place on Thursday 3 June 2021 at a venue to be agreed.