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.

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

RESOLVED,     that Mr F Cassidy be elected Vice Chair of the Committee for the ensuing year.

Apologies for absence were received from Dr M Hanley, Mr N Hughes and Mr M Wilson (Mr M Worth attended as substitute).

It was noted that Mr M Worth attended the meeting as substitute for Mr M Wilson.

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 18 May 2022 (copy enclosed).

RESOLVED,     that the minutes of the meeting held on 18 May 2022 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.

Further to the discussion held at the previous meeting regarding the vacant position of the Chairman of Healthwatch Cumbria members were informed that this post would be advertised soon.

RESOLVED,     that

                            (1)       the following be noted:-

                                        (a)       the update on the Health and Adults Task and Finish Group;

                                        (b)       the existing Work Programme;

                            (2)       the following amendments be made to the Work Programme:-

                                        (a)       Health and Care Act Update be included for a future meeting;

                                        (b)       Retention and Recruitment of NHS staff be added for consideration at a future meeting;

                                        (c)       deep dive into the Mental Health Services in Cumbria Care Quality Commission report be added to a future meeting;

                                        (d)       Update on NHS Dentistry be considered at a future meeting;

                                        (e)       Digital Strategy be considered at the December meeting.

To consider a report by the Strategic Policy and Scrutiny Adviser (copy enclosed).

Members received a report from the Strategic Policy and Scrutiny Adviser which updated the Committee on the changes to the health scrutiny function resulting from the recent Health and Care Act 2022.

The Committee would be kept informed as and when the Regulations and Guidance was available.  Members noted that the Joint Task and Finish Group established with the Adults Scrutiny Board would be looking at this in detail and the changes to the Health Scrutiny Function would also be fed into the discussions taking place about the future Scrutiny arrangements post Local Government Review implementation.

Members were informed that the new provision was designed to give local authorities greater flexibility and freedom over the way they discharged health scrutiny functions and noted that following the completion of the Local Government Review each new Council would determine which arrangements they adopted.

A discussion took place regarding the future of the Committee and suggestions were made to continue with the Cumbria?wide work in the short?term and longer?term Westmorland and Furness consider working in partnership with Lancashire to continue the good work already established.  Members also highlighted that once clarity had been agreed regarding the model to be adopted North East and North Cumbria needed to investigate how this sat in the wider system. 

The Committee was informed that the two Shadow Scrutiny Boards for the two new authorities would be looking at future scrutiny arrangements in each new Authority and would make recommendations for the future.  Members noted this was reflected in the work of the Task and Finish Group who would also make recommendations.

RESOLVED,     that

                            (1)       the implications for health scrutiny arising from the Health and Care Act be noted;

                            (2)       a further report on this matter be considered at a future meeting of the Committee.

To receive a presentation by Cumbria, Northumberland, Tyne and Wear Foundation Trust (copy to follow).

The Committee welcomed the detailed presentation on Mental Health Services at Cumbria, Northumberland, Tyne and Wear Foundation Trust which contained information regarding governance, history, demand on services, people, partnerships, achievements, buildings and environment and challenges.

Whilst members welcomed the information regarding challenges it was suggested that more information on achievements to address them together with any future plans would be helpful.

Members were informed of the increased caseloads, noting the large demands in children’s services with an increase of 50%, and a significant growth in ADHD.

Members noted the pressures on beds which were close to 100% occupied.  It was explained that demand waiting times were monitored weekly and remained static.

The Committee was informed of the concerns regarding Delayed Transfers of Care and the introduction of a flow team to support this issue.

A detailed discussion took place regarding the challenges around recruitment and retention noting that this was a national issue.  Members noted the high number of nursing vacancies across adult inpatients and community services and the temporary closure of Rowanwood Ward in August 2021.  The Committee was informed that staffing numbers increased by the use of external agencies whilst noting the cost implications of this.  Officers explained that resources were reviewed frequently and staff were relocated across services to provide cover where necessary. 

Members were informed that the locality had recruited international nurses with 20 preceptor nurses starting in September 2022 together with a successful Nurse Apprenticeship Graduate Programme underway which had seen the first cohort qualify in July 2022. 

The Committee was informed that pressures remained around medical staffing with a large number of consultant psychiatrist vacancies and continued concerns from system partners regarding the lack of section 12 doctors.  Officers highlighted that safe staffing levels continued to be achieved by the use of Locum and North East psychiatrists together with the use of other clinical staff in different ways. 

Members were informed that the Trust employed international trainee doctors who undertook a prescribed programme in the UK which allowed them to carry out consultancy work.  Officers explained the Trust had an international team who advised and developed programmes accordingly to meet the needs of the international medical staff. 

A detailed discussion took place regarding workforce and the use of agency and bank staff.  Whilst officers acknowledged the increased costs to the Trust of agency staff informed members there were a number of reasons, including work life balance, as to why individuals chose to work for agencies rather than the NHS.  Members were informed that the Trust had invested heavily in making permanent posts attractive with some positive outcomes.

During the course of discussion a Member suggested that rented accommodation at a reduced rate could be made available to prospective employees to encourage them to live and work in the area.  Officers explained that limited accommodation was available at the Carleton Clinic site as well as a relocation package.  A suggestion was made that the Garden Village Project could be an opportunity in the future.

Members  ...  view the full minutes text for item 22.

To receive a presentation by NHS England and NHS Improvement (copy enclosed).

The Committee received a presentation from NHS England and NHS Improvement which provided an update on NHS Dentistry in North Cumbria following concerns raised regarding the lack of NHS dentistry throughout the county.

Members were informed that no formal registration in NHS dentistry was required and that patients could contact any NHS dental practice to access care.  It was explained that dental contracts and provision was activity and demand?led with the expectation that practices delivered and managed their available commissioned activity to best meet the needs of patients presenting to the practice.

The Committee was informed that the Contract Regulations set out the Contract Currency which was measured in Units of Dental Activity (UDAs) that were attributable to a ‘banded’ course of treatment prescribed under the Regulations.  Officers highlighted that NHS England did not commission private dental services but the NHS Dentistry Regulations did not prohibit the provision of private dentistry by NHS Dental Practices.

Members noted that the COVID-19 pandemic and requirement to follow strict infection prevention control guidance significantly impacted on access to dental care over the last 2 years with demand for dental care remaining high across all NHS dental practices.

The Committee noted the pressures and challenges which included the impact of the pandemic, workforce recruitment and retention, Dental System Reform and the number of Contracts which had been handed back.

Officers highlighted that COVID-19 continued to have demands on NHS dental services which was predominantly around backlog due to the strict infection control policy during the pandemic.  It was explained there were a total of 40 commissioned dental practices across North Cumbria but there still remained a high demand for dental care.

Officers explained that the legacy of COVID was that NHS dentists had to spent approximately 20% more time on each patient to make up for the treatment that could not be carried out during the pandemic, therefore, this reduced the number of patients who could receive treatment.

Members were informed of the local actions taken to date noting that incentives continued for all NHS dental practices to prioritise patients who had not been seen in the practice within the previous 24 months (adults) and 12 months (children) who required urgent dental care.  Officers explained there was Investment in additional clinical triage capacity within the out of hours integrated NHS111 North East and North Cumbria Dental Clinical Assessment Service and an increased investment into the new Dental Out of Hours Service contract to ensure there was a sustainable capacity available to treat ‘clinically confirmed’ urgent and emergency patients that presented via NHS 111.

The Committee noted that additional funding was made available to practices in 2021-22 who were able to offer additional clinical capacity above their contracted levels with a focus on prioritising patients with urgent dental care needs and access for nationally identified high risk groups.  It was explained that work was being undertaken with practices to maximise their clinical treatment capacity by encouraging them to maintain short notice  ...  view the full minutes text for item 23.

To note that the next meeting of the Committee will be held on Monday 3 October 2022 at 10.30 am at County Offices, Kendal.

It was noted that the next meeting of the Committee would be held on Monday 3 October 2022 at 10.30 am at County Offices, Kendal.