Agenda and minutes

Apologies for absence were received from Mr D Blacklock, Dr M Hanley, Mr A Semple and Mr D Shepherd.

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

Mr F Cassidy declared a non?pecuniary interest in agenda item 8(b) – Retention and Recruitment of NHS Staff (South) (minute no 52(b) refers) as his daughter was employed at the Royal Lancaster Infirmary.

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 13 December 2022 (copy enclosed).

With reference to minute 40(b) – Update on Digital Strategies – North Cumbria the seventh paragraph should read ‘Members drew attention to cyber security and it was confirmed that the Trust had a dedicated Team for this.’

RESOLVED,     that with the inclusion of the above amendment the minutes of the meeting held on 13 December 2022 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.

Mr N Hughes suggested that he should attend the Health Scrutiny Committees in the new authorities to share his experiences. 

Mr Hughes thanked all officers for their support and highlighted the outstanding achievements in a number of areas such as mental health and maternity provision during the life of the Committee.

RESOLVED,   that

                          (1)          the update on the recent Lead Health Scrutiny Member meetings be noted;

                          (2)          the following topics be recommended for consideration by the new Health Scrutiny arrangements across Cumberland and Westmorland & Furness:-

                                        (i)        Pharmacy

                                        (ii)       Optometry

                                        (iii)      ICB, ICP and ICC Updates

                                        (iv)      Stroke

                                        (v)       Cancer

                                        (vi)      Maternity

                                        (viii)    Mental Health

                                        (ix)      Learning Disabilities and Autism

                                        (x)       GPs

                                        (xi)      Digital Agenda (including digitisation of patient records);

                          (3)          any further topics recommended for consideration by the new unitary authorities be forwarded to David Stephens.

To receive a presentation by NHS North East and North Cumbria Integrated Care Board (copy enclosed).

The Committee received a presentation which provided a detailed update regarding the changes on 1 July 2022 when integrated care became legislation via the Health and Care Act.

Members were informed that the NHS North East and North Cumbria Integrated Care Board (ICB) was established following closure of the 13 Clinical Commissioning Groups in the North East and North Cumbria and took on the NHS commissioning functions and was accountable for NHS spending and performance within the system.  Officers explained that the Integrated Care Partnership (ICP) was also established as a statutory committee and saw health and care partners work together by agreeing joint priorities and a joint health and care strategy. 

The Committee was informed that Cumbria County Council was a statutory member of the Partnership and noted that this would change in line with the new unitary authorities from 1 April 2023; North Cumbria would be covered predominantly by Cumberland Council with a small number of the North Cumbria population being within the Westmorland and Furness Council.

Members were informed that the ICP had engaged with local people and partners on the draft priorities and a Final Strategy had now been agreed.

The Committee was advised of the four key goals of the Integrated Care Strategy for the North East and North Cumbria and the support received from neighbourhoods, local authorities and ICPs to deliver it.

Members noted one of the aims was to be England’s greenest region by 2030 and asked how this impacted on the key goals.  The Committee was informed that as the NHS was a significant employer they had been asked to be an anchor institution and take account of the green agenda whilst delivering services. 

The Committee was informed of the national Core20PLUS5 approach which was designed to support Integrated Care Systems (ICS) to drive targeted action in healthcare inequalities improvement.

A discussion took place regarding the current workforce and members were informed of the significant amount of vacancies which needed to be filled; explaining that funding was available for existing posts.  Members were informed of the recruitment and retention problems, advising of the need to work collaboratively with other agencies such as Healthwatch and the 3^rd sector to utilise their resources and pathways of communication.

Members were advised of the national requirement for an NHS Joint Forward Plan.  Officers explained it was anticipated a draft Forward Plan would be completed by the end of March with a final Plan in place by the end of June.

In conclusion the Committee noted the upcoming milestones which included further work being undertaken to develop the North Cumbria Area ICP, partnership governance arrangements being worked through with Partners to come into effect from 1 April 2023 with the ICB taking on delegated responsibility for dentistry, pharmacy and optometry from NHS England.

Members were informed that the ICB would meet in April following Local Government Reorganisation with the intention of meeting with all partners to discuss responsibilities.  The Committee was advised that integration was key  ...  view the full minutes text for item 51a

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

The Committee received a detailed report and presentation which outlined the establishment of a Lancashire and South Cumbria Integrated Care Board (ICB) and Partnership, developing an Integrated Care Strategy for the Integrated Care Partnership (ICP) and Place Based Partnerships in South Cumbria following closure of the eight Clinical Commissioning Groups in Lancashire and South Cumbria.

Members were informed that the strategic aims of the ICB were to improve outcomes in population health and healthcare, tackle inequalities in outcomes, experience and access, enhance productivity and value for money and help the NHS support broader social and economic development.

The Committee received an update on developing the ICP, noting that the ICB and upper-tier local authorities had worked collaboratively with other partners on a set of priorities to form the basis of an Integrated Care Strategy for the ICP.  It was explained that the ICP covered the whole of the Lancashire and South Cumbria footprint and following a review of the needs of local communities a set of draft system-wide priorities were proposed.

Members were informed that in the Autumn, the ICP had engaged with local people and partners on the draft priorities and that partners had further refined the priorities and produced a draft Strategy which would be considered further by partners for further feedback prior to resident engagement.

The Committee noted the draft ICP priorities and the development and responsibilities of the place based partnerships.

A discussion took place regarding learning disabilities and inequalities.  Officers confirmed inequalities was a key issue going forward and formed part of the national Core20PLUS5 approach.

Officers acknowledged the complexity of the changes whilst highlighting the opportunity for health and social care to work collaboratively in the future to achieve better models of care.  The Committee emphasised the importance of good communication with the public.

A concern was raised regarding a potential lack of collaborative work.  Officers acknowledged the role of councillors in the neighbourhood and the importance of building relationships whilst emphasising that every effort would be made to ensure effective collaborative work took place.

A Member raised a concern regarding the effects that the current economic situation could have on future resources and asked what the proposals were to support people into employment.  The Committee was advised that it was felt this was a real opportunity to develop new models to encourage the public to take up the local opportunities which were offered.

During the course of discussion concerns were raised regarding reduced socialisation, particularly following the pandemic.  Issues were highlighted with regards to on?line consultation and the need to have a balanced approach with regards to face to face contact.  Officers acknowledged the concerns raised and also highlighted the effects the cost of living crisis could have on digital exclusion.

In conclusion members were informed further engagement on the updated version of the Integrated Care Strategy would take place in February 2023 prior to the ICB taking on delegated responsibility for dentistry, pharmacy and optometry from NHS England on 1 April  ...  view the full minutes text for item 51b

To receive a presentation by North Cumbria Integrated Care NHS Foundation Trust (copy enclosed).

The Committee received a presentation from North Cumbria Integrated Care NHS Foundation Trust regarding recruitment and retention of NHS staff.

Members were informed of the current Trust staffing position and the recruitment hotspots and highlights, noting they were a national challenge and not unique to Cumbria.

A discussion took place regarding casual workers and members were informed that resources to fill gaps for both medical and administrative posts were managed through a robust policy by a successful in?house team with the hope that the workforce could be shared with local authorities in the future.

The Committee noted the international recruitment and was informed of the temporary funded external pastoral support which was key to the success of the international nurse recruitment programme at NCIC.

During the course of discussion the Committee’s attention was drawn to the continued problems regarding the lack of available suitable accommodation to rent for new recruits into Cumbria (especially in the west of the county).  Members acknowledged the challenges and suggested that local authorities be approached to investigate ways to try and help to alleviate the problems.

Members drew attention to the turnover of staff and asked if there were any particular reasons for this to peak in the summer of 2022 and what the future aspirations were.  Officers explained that this was a national trend and was partly due to the pressures which staff had experienced and advised that the aspiration of the Trust was to keep the turnover as low as possible.

The Chair thanked officers for their presentation.

RESOLVED,     that the update be noted.

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

The Committee considered a detailed report which provided an overview of the strategic drivers for the NHS people function, an insight into the 4 P recruitment strategy at University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT), details on the strategic approach being taken to engaging and deliver the future workforce, a briefing on the refreshed policy changes and the next steps planned for 2023/24.

Members drew attention to the People Promise principles and the new UHMBT values that the Trust had embarked on; a revised programme of recruitment training which focused on recruiting mangers on ‘Values Based Recruitment’ and asked whether fair and inclusive recruitment had taken place previously.  It was explained the Trust had always been inclusive but had faced criticism following the Care Quality Commission inspection, therefore, a policy change had taken place to enable future audits to be undertaken.

The Committee was informed of the ‘T Levels’ which were new 2-year courses launched in September 2020 which were taken after GCSEs and broadly equivalent in size to 3 A?Levels.  Members were advised the courses had been developed in collaboration with employers and education providers so that the content met the needs of industry and prepared students for entry into skilled employment, apprenticeship or related technical study through further or higher education.  It was explained that the courses were in the early stages with the aspiration for the qualification to be converted into entry level into the NHS and social care roles.

The Committee discussed Geo-fencing (a virtual geographical boundary that triggered a marketing action to a mobile device) APP which had been used to advertise and promote vacancies noting that the success of this was still awaited.

Members were informed of the support which had been provided by the Trust for all refugees through the Ukrainian Refugee Hub, RefuAid and East Meets West.  The Committee was advised the support had included the provision of employability information, assistance with application forms, work experience, workshops and tailored 1:1 coaching.

A discussion took place regarding accommodation and members were informed that this was constantly reviewed whilst highlighting that although the Trust had secured private long?term tenancies and had approached the local authorities this remained challenging.  During the course of discussion officers emphasised the importance of a good standard of accommodation.

The Committee received an update on patient representation in recruitment decisions.  Members were informed patient representation had been agreed following engagement with the community  and noted that the next stage would see the incorporation of patient views in relevant recruitment decisions.

The Chair, on behalf of the Committee, thanked the Officer for a detailed report.

RESOLVED,   that the report be noted.

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

Members received a presentation which provided an overview of strategic direction, current challenges in North Cumbria and future Service Development Plans.

The Committee noted the national strategic drivers of the NHS Long Term Plan which included improved access to mental health services across the whole system; fully integrated teams and pathways, easier and quicker access to crisis and urgent care, expanded specialist mental health care for mothers and the continued development of services in the community and inpatient settings and provision of the right level of care for more people with common or severe mental illnesses.

Members were informed of the local challenges which included accessing care and discharge, recruitment and retention, maintaining safe and quality sustainable services in West Cumbria and managing public expectations.

The Committee considered data with regards to referrals, caseloads, demand for crisis services, neurodevelopment access challenges for children and young people and delayed transfers of care.

Members raised concerns regarding the rise in referrals since 2021.  Officers explained this was due to social detriments of physical and mental health which was largely due to the pandemic whilst highlighting the prevention agenda.

A discussion took place regarding the challenges around capacity to provide resources for a Section 117 of the Mental Health Act; aftercare services to meet a need that arises from or relates to mental health problems whose aim is to try and reduce the risk of mental conditions deteriorating and admission to back to hospital.

Members were informed that the Acorn Ward at Carleton Clinic, Carlisle was currently being used to house inpatient learning disability services and discussions were taking place at ICS level with regards to a permanent ward being available.  Officers explained the success of community support and highlighted the Trust’s ambition to provide this rather than in?house facilities.

A discussion took place regarding resources and the high number of vacancies with a local reliance on the high use of agency staff to maintain safe staffing levels.  Members were informed that the £1.1m target spend on agency staff had been achieved and that a bank of staff was being built up in Cumbria for the future.  Officers acknowledged the increase in waiting lists whilst emphasising that patient safety was paramount.

In conclusion it was felt there was a need to work together with partners at place, improve capacity for discharge and alternatives to specialist secondary care services, increasing capacity to reduce long waits for assessment and specialist treatment, urgent care pathway, therapeutic offer for inpatient care and sustainable services in West Cumbria.

The Chair thanked officers for their presentation.

RESOLVED,   that the update be noted.

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

The Committee considered a detailed report which gave an overview of Lancashire and South Cumbria NHS Foundation Trust (LSCFT) Mental Health, Learning Disability and Autism services provided for the people of South Cumbria, current challenges and recent and future developments.

Members noted the Trust provided Adult and Older Adult Inpatient and Community Mental Health Services; Children and Young People’s Inpatient and Community Mental Health Services as well as Adult and Children’s Autism Spectrum Disorder and Learning Disability services.

The Committee discussed the Adult Learning Disability Community services which covered the South Cumbria area, with a multi-disciplinary approach to assess and support the development of care planning to enable adults with learning disabilities to live in the community. 

Members were informed that investment of transformation monies from the Integrated Care Board over the past three years had allowed for improved access to those teams, with service users being seen within all national and local waiting time targets.

The Committee noted that a new Team now offered intensive support to any person at risk of admission.  It was explained the aim was to ensure patients attended and then enacted any required action from the community treatment review meetings which took place at least either annually or 6 monthly but more frequently if deemed necessary.

Members were advised that whilst the Trust was trying to enhance the community offer to avoid institutionalisation they were informed that currently beds were not specifically provided for learning disabled and mental health adults but following a successful national bid it was anticipated 20 beds would be available in the future.

The Committee received an update on the Kentmere Ward which had reopened in August 2022 on the Westmoreland General Hospital site.  Members were advised the fully refurbished adult ward had 12 individual rooms with en?suite facilities, direct access to outdoor space and ample therapy space.  Officers extended an invite to the Ward to all members.

A discussion took place regarding the recruitment and retention of staff across all services in South Cumbria noting that, as is the national picture, this was particularly challenging for clinical/registered staff.  Officers confirmed the budget constraints and highlighted a number of initiatives which had been introduced to improve recruitment and retention which included promoting the benefits of working for LSCFT in South Cumbria, introduction of a Welcome bonus scheme alongside a relocation package, international recruitment, apprenticeship schemes, establishment of wellbeing champions and “Stay interviews” to identify any opportunities to retain staff and support their careers within the locality.

The Committee was informed the Trust had committed to working with the Primary Care Networks (PCNs) to develop the primary care mental health worker roles based within the PCNs.  Members were advised it was anticipated there would be three or four primary care hubs which would provide wrap?around care.

Members discussed the 100 day discharge challenge which was being led by NHS England and noted this project would aim to support the flow of discharges and, therefore, timely admissions supporting partner agencies.  ...  view the full minutes text for item 53b

To note this is the last meeting of the Committee in the life of Cumbria County Council.

It was noted that this was the last meeting of the Committee in the life of Cumbria County Council.

The Chair thanked member and officers for their help and support and wished them well for the future.