Agenda and minutes

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.

There were a number of apologies received from District Council representatives, therefore, it was agreed that this item would be deferred until the next meeting of the Committee.  Mr F Cassidy was appointed as Vice-Chair for this meeting only.

Apologies for absence were received from Mr D Blacklock, Mr J Kane, Mr A Semple and Mr D Shepherd.

It was noted that Mr J Bland had replaced Dr S Haraldsen as a member of the Committee on a permanent basis.

Mr C Whiteside declared a personal interest as his wife was employed at the West Cumberland 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 4 October 2021 (copy enclosed).

RESOLVED,     that the minutes of the meeting held on 4 October 2021 be agreed as a correct record and signed by the Chair.

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 from the Cumbria and Lancashire Joint Health Scrutiny Committee noting that the meeting was to look specifically at the recent University of Morecambe Bay Hospitals Trust Care Quality Commission report and the measures the Trust was putting in place to address the issues which the report had raised. 

The Committee was informed that a further meeting would be convened in the New Year to examine the progress which had been made as well as considering the outcome and subsequent decision on the Community Beds Consultation which had been circulated to all members of the Cumbria Health Scrutiny Committee for information and comment.

A discussion took place regarding the existing Work Programme and the Strategic Policy and Scrutiny Advisor confirmed that a report regarding Liberty Protection Safeguards would be considered by the Committee in May.

RESOLVED,   that

                          (1)          the update from the Cumbria and Lancashire Joint Health Scrutiny Committee be noted;

                          (2)          the existing Work Programme be noted and the following items be added for consideration at future meetings:-

                                        (i)        Urology at University Hospital Morecambe Bay NHS Foundation Trust;

                                        (ii)       Mental Health Provision in North Cumbria (an invitation be extended to the Chair of the Youth Council);

                                        (iii)      Recruitment Pressures.

To note the draft minutes of the Cumbria and Lancashire Joint Health Scrutiny Committee meeting held on 9 November 2021 (copy enclosed).

The Committee received the draft minutes of the meeting of the Cumbria and Lancashire Joint Health Scrutiny Committee meeting held on 9 November 2021 which had considered the Care Quality Commission (CQC) Inspection Report and Recovery Support Programme.

The Chair of the Joint Committee gave a positive update and explained that a further meeting would be convened in March 2022 to monitor the implementation of the CQC Action Plan and the outcome of the Community Beds Consultation

RESOLVED,   that the draft minutes be noted.

To receive verbal updates from the University Hospitals of Morecambe Bay NHS Trust and North Cumbria Clinical Commissioning Group.

Members received similar updates on the Impact of the COVID 19 Pandemic from representatives of both the University Hospitals of Morecambe Bay NHS Trust and North Cumbria Clinical Commissioning Group (CCG).

The Committee was informed of the significant pressures which were being experienced by the whole health and care system including the North West Ambulance Service and mental health services.  Officers explained that currently there were approximately 40-60 in?patients in hospital with COVID in South Cumbria with fewer in North Cumbria as well as patients experiencing the longer term effects of the virus.  Officers also highlighted the increase in sick patients presenting to A&E departments as well as a rise in cancer referrals.

Members raised their concerns regarding the rise in demand for mental health services during the pandemic and asked whether any assistance could be provided from non?clinical resources.  Officers acknowledged the increase in demand for mental health services and the pressures this was adding to the system as a whole.  It was explained that six out of the eight Primary Care Networks now had mental health practitioners in place with additional recruitment being sought from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) for dementia support workers as well as investigating ways to triage patients upfront and offer support and advice.

A concern was raised regarding the North West Ambulance Service and whilst these were acknowledged it was explained that this was outside the remit of the Trusts.

A discussion took place regarding the pressures on A&E departments and members were informed there was anecdotal evidence that due to the significant pressures which were being experienced by GPs patients were presenting themselves to A&E and bypassing their GPs.  During the course of discussion officers emphasised the invaluable support which the Trust had received from GPs during the pandemic highlighting the successful roll out of the vaccination programme as an example.

A discussion took place regarding the impact of COVID on unvaccinated patients.  Officers confirmed that this increased morbidity and mortality and evidence suggested that those patients tended to be more poorly and required a longer stay in hospital.  Members were informed that pregnant women were significantly at risk if not vaccinated, therefore, work was being undertaken to target those individuals.

Members were informed that a significant factor with regards to hospitals being at full capacity were connected to the problems with regards to discharging patients, noting that this was also affecting their ability to deliver elective care.  It was agreed that information with regards to the delayed transfers of care figures for the Morecambe Bay area over the last quarter would be provided to the Committee.

A discussion took place regarding elective care and members were informed that to?date no elected operations had been cancellation.  It was explained that all patients were prioritised for surgery in accordance with their acute clinical needs.

Members were informed that although previously the majority of patients who were admitted to hospital with other conditions had  ...  view the full minutes text for item 36.

To receive a joint presentation from NHS North Cumbria Clinical Commissioning Group and NHS Morecambe Bay Clinical Commissioning Group (copy enclosed).

The Committee received a joint update from NHS North Cumbria Clinical Commissioning Group (CCG) and the NHS Morecambe Bay CCG regarding access to primary care and pharmacy.

Members received information outlining the challenges which included the long-standing issues regarding recruitment and retention of staff, stability of a number of practices, increase in demand (delayed health seeking behaviour, acuity, more complex patients, people waiting for diagnostics and treatments), new ways of consulting which opened up ‘other lanes’, fragilities and pressures across all the health and care sectors and patient expectation.

The Committee received details of patient experiences which included the difficulties in getting an appointment, long waits on the telephone, an increase in the availability of face to face opportunities, concerns regarding sharing information with receptionists and inability to book an appointment on the day with the need to call again the next day.

During the course of discussion officers explained that COVID infection prevention measures were still in place in health settings, therefore, this had reduced face to face capacity, whilst highlighting there was a facility which enabled those most in need and vulnerable to be seen in person safely.  Members were informed that face to face appointments had also reduced post pandemic with an increase in virtual appointments.

A discussion took place regarding the responsibility on GP receptionists to triage patients and the need for appropriate training.  Officers acknowledged that the role of receptionists was changing and the requirement for appropriate training.

A discussion took place regarding workload and the Committee noted there were fewer GPs per patient as well as long?standing challenges of recruitment to some areas of Cumbria.  It was explained that fewer GPs had the desire to become partners and preferred to be salaried, therefore, this could result in more planning to work part?time.  Officers highlighted the increasing number of retirements and the availability of fewer locums which contributed to the workforce problems.

A discussion took place regarding the use of locums and whilst it was acknowledged this provided a short?term solution the significant cost of this service was highlighted. 

Members raised their concerns regarding the number of GP vacancies and the effects this had on primary care.  Officers explained that in the north of the county vacancy rates differed between practices.  The Committee’s concerns were acknowledged and it was explained that a recent recruitment campaign had resulted in no applications being received for vacant GP positions.

The Committee was informed that GP practices were undertaking different approached to the changes in workforce which included salaried and part?time GPs as well as investigating a video service across the whole of north Cumbria to increase capacity. 

Members were informed that south Cumbria was experiencing the same problems.  It was explained that the rotation of staff and remote consultations were being investigated to try and resolve some of the issues due to the recruitment challenges.

A discussion took place regarding the NHS 111 Service and members were informed this was also under immense pressure.  ...  view the full minutes text for item 37.

To receive a presentation by Lancashire and South Cumbria Pathology Collaboration (copy enclosed).

The Committee considered a report from the Lancashire and South Cumbria Pathology Service which provided an update regarding the planned formation of a single pathology service for Lancashire and South Cumbria by 2023.

Members were informed that the services were not patient facing; therefore, there would be no change to the provision received as a result of the transformation.  However, it was explained there were a number of benefits to be achieved from this programme of work which had the potential to improve outcomes for patients across the health economy.

The Committee was informed that the nature of modern pathology services had become much more reliant on efficient and effective technology and this area was an absolute key enabler for the success of the collaboration.  It was emphasised that the ability to share results in real time would enable effective diagnosis for patients across the whole of the ICS footprint.

A discussion took place regarding the life?span of the modular build and officers confirmed the building had at least a 60 years planned lifetime.

Members were informed that the IT infrastructure was crucial to the clinical quality, patient safety and operational effectiveness of pathology collaboration and had been identified by NHSI as one of the critical success factors.  Officers explained that the collaboration had applied for national capital funding to support the deployment of a standardised Laboratory Information Management System (LIMS) and to progress aspirations relating to digital pathology.

The Committee was informed that standardising equipment would facilitate greater alignment of operating procedures, quality systems and training across all sites which would lead to greater workforce flexibility, with staff more easily able to work across multiple sites and/or relocate permanently between sites.  A discussion took place regarding potential future employment and it was confirmed there were no planned redundancies and all staff would remain on NHS terms and conditions. 

A concern was raised regarding the potential effect this could have on the future of the Royal Lancaster Infirmary (RLI).  Whilst comments could not be made specifically about the Hospital it was confirmed that the Pathology Department only used 5-10% of space in the RLI; part of which was not fit for purpose. 

Members asked for clarification regarding the possible savings and it was confirmed that majority of this was in capital and avoidance of expenditure; highlighting a significant saving with regards to automation.

A discussion took place regarding the opportunities to innovate and work differently with a willingness of GPs to support this project.  Members were informed that although this was outside the remit of a number of GPs further discussions were anticipated with them on this matter.

Members discussed future transport and were informed there was an intention to reorganise and reorder this with the potential use of drones in the future.

The Committee was informed that a process of due diligence had been completed to identify any risks and issues associated with the formation of a single pathology service; a requirement of NHSE/I and of  ...  view the full minutes text for item 38.

To note that the next meeting of the Committee will be held on Tuesday 22 February 2022 in Conference Room A/B, Cumbria House, Botchergate, Carlisle.

It was noted that the next meeting of the Committee would be held on Tuesday 22 February 2022 in Conference Room A/B, Cumbria House, Botchergate, Carlisle.