Venue: Conference Room A/B, Cumbria House, Botchergate, Carlisle, CA1 1RD
Contact: Lynn Harker Email: firstname.lastname@example.org
Apologies for Absence
To receive any apologies for absence.
An apology for absence was received from Mr M Cassells.
Membership of the Committee
To note any changes to the membership of the Committee.
There were no changes to the membership of the Committee on this occasion.
Disclosures of Interest
Members are invited to disclose any disclosable pecuniary interest they have in any item on the agenda which comprises
1. Details of any employment, office, trade, profession or vocation carried on for profit or gain.
2. Details of any payment or provision of any other financial benefit (other than from the authority) made or provided within the relevant period in respect of any expenses incurred by you in carrying out duties as a member, or towards your election expenses. (This includes any payment or financial benefit from a trade union within the meaning of the Trade Union and Labour Relations (Consolidation) Act 1992.
3. Details of any contract which is made between you (or a body in which you have a beneficial interest) and the authority.
(a) Under which goods or services are to be provided or works are to be executed; and
(b) Which has not been fully discharged.
4. Details of any beneficial interest in land which is within the area of the authority.
5. Details of any licence (alone or jointly with others) to occupy land in the area of the authority for a month or longer.
6. Details of any tenancy where (to your knowledge).
(a) The landlord is the authority; and
(b) The tenant is a body in which you have a beneficial interest.
7. Details of any beneficial interest in securities of a body where
(a) That body (to your knowledge) has a place of business or land in the area of the authority; and
(b) Either –
(i) The total nominal value of the securities exceeds £25,000 or one hundredth of the total issued share capital of that body; or
(ii) If that share capital of that body is of more than one class, the total nominal value of the shares of any one class in which the relevant person has a beneficial interest exceeds one hundredth of the total issued share capital of that class.
A “disclosable pecuniary interest” is an interest of a councillor or their partner (which means spouse or civil partner, a person with whom they are living as husband or wife, or a person with whom they are living as if they are civil partners).
Mr R Gill and Mr C Whiteside declared personal interests as their respective wives were employed at the West Cumberland Hospital.
Exclusion of Press and Public
To consider whether the press and public should be excluded from the meeting during consideration of any item on the agenda.
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 24 July 2017 (copy enclosed).
With reference to minute 4 – Disclosures of Interest it was agreed that the words ‘wife was’ should read ‘wives were’.
RESOLVED, that with the inclusion of the amendment referred to above the minutes of the meeting held on 24 July 2017 be agreed as a correct and signed by the Chair.
To receive a presentation from Healthwatch Cumbria.
The Committee were shown a short video which gave an insight into the work of Healthwatch Cumbria.
The Chief Executive welcomed the opportunity to work collectively with the Cumbria Health Scrutiny Committee. He emphasised the role of the Committee was not to scrutinise Healthwatch but to ensure all concerns raised were heard, highlighting in particular needs of the mental health and deaf communities.
The Committee were informed that Healthwatch Cumbria was undertaking a learning difficulties review and it was agreed the information would be made available to members in due course.
To consider a report by the Chief Executive, Healthwatch Cumbria (enclosed).
The Committee received a report from the Chief Executive, Healthwatch Cumbria which updated members on the background and rationale with regards to the Cumbria Participation, Inclusion and Engagement (PIE) network at the centre of a world class health service co?produced with the people of Cumbria.
Members were informed that a substantive role of Healthwatch Cumbria was to ensure, and provide mechanisms for, the voice of people to be heard in the development, review and delivery of health and care services which was carried out in a variety of ways:-
· engagement in local communities of interest of place, listening to, recording and analysing people’s experience of services;
· strategic interventions to prompt system leaders to engage, involve and welcome early and active participation of people in the thinking, design and delivery processes.
Members acknowledged the critical stage of change across the whole health and care system in both west, north and east Cumbria and in south Cumbria through the development of two Sustainability and Transformation Partnerships (STPs). The importance of good communication to support the change process was highlighted and it was felt as many people as possible should be directly involved in all aspects of the development work.
The Committee noted that to support this Healthwatch Cumbria had developed and was trialling an engagement model – the Participation, Inclusion Engagement Network (PIE) which it was believed was one mechanism which could help to achieve a significant shift in the way that people were involved. This approach had been recognised as having real value in ensuring that people were fully involved and engaged in future service design and improvement through their respective STP processes.
Members held a detailed discussion and questioned whether Healthwatch was sure that services in Cumbria would eventually be co?produced. The Committee were given examples of co?production activity which was taking place at Wigton, Alston and Maryport Community Hospitals as well as the maternity services at West Cumberland Hospital. Whilst the work undertaken was welcomed it was highlighted that there was a need to find ways to be able to support people to be better able to participate in co?production. It was felt that this would enable effective relationships to be formed with system leaders based on trust and for open and transparent communication to underpin everything.
A discussion took place regarding the engagement with Healthy Lancashire and South Cumbria Sustainability and Transformation Partnerships (STPs). It was acknowledged that there was a challenge regarding the two separate Cumbria Clinical Commissioning Groups but informed members that both STPs had welcomed the approach, recognising the real value in ensuring that people were fully involved and engaged in future service design and improvement through their respective processes. Members were informed that a lay person, support by Healthwatch Cumbria, had been formally welcomed onto the Integrated Care Communities (ICC) Steering Group and an invitation had been extended for a second person to be co?opted onto the Mental Health ICC Steering Groups. There were also plans for further discussions ... view the full minutes text for item 16b
To consider a report by the Chief Executive, NHS North Cumbria Clinical Commissioning Group (copy enclosed).
The Committee received a report from North Cumbria Clinical Commissioning Group on the service areas where decisions were made following the Healthcare For The Future Consultation.
Members noted that the maternity referral to the Secretary of State had been sent to the Independent Reconfiguration Panel (IRP) for investigation and they had requested further information from the NHS which had been provided in a full and timely manner. It was explained that the Panel comprised of medical experts from various fields to oversee the process and evaluate whether the plans agreed were safe and sustainable and met regularly.
The Committee highlighted the necessity for the Panel to visit the county to appreciate the geographical challenges and it was confirmed that a visit would take place. Members emphasised that it was not only the 40 mile distance between the two hospitals which needed to be factored in but account also needed to be taken of the extra distance patients south of Whitehaven had to travel before getting to hospital.
A discussion took place regarding the report from the Royal College of Anaesthetists (RCoA) which highlighted again the challenges of sustaining a safe obstetrics service and the challenges of maintaining a fully recruited anaesthetics rota. Members asked the views of the CCG regarding the suggestion by RCoA of ‘batching’ elective caesarean operations in both Whitehaven and Carlisle as one possible way of preserving consultant maternity skills at West Cumberland Hospital. It was explained that the review had highlighted a number of issues, therefore, it was felt an external clinical view was important. The Committee were informed that the review had highlighted evidence that teams should work across both sites and this would be considered. Members noted the ongoing discussions regarding the appropriate number of elective caesareans.
Members discussed the future maternity services and a question was raised regarding how the Independent Review Group (or any other body) would prevent options 2 or 3 being implemented if it identified that the risks associated with the distance women would have to travel under those options did not have clear mitigations and, if it found that those risks were more substantial than the risks associated with sub-optimal staffing which would cause option 1 to be excluded.
In response the Committee were reminded of the decision made on 8 March that the CCG were committed to option 1 (retaining consultant-led maternity services in Whitehaven) provided that longstanding recruitment issues could be addressed. It was explained that option 1 would be excluded if it was found to be unsustainable and option 2 would be excluded if it was found to be unsafe, therefore, option 3 would be arrived at in accordance with the process.
It was explained that the IRG would consider the risk in line with the terms of reference provided to the Committee.
The Committee highlighted the importance of co?production and members were informed that the CCG were working closely with Healthwatch Cumbria on this issue, noting the different stages this was at ... view the full minutes text for item 17.
To consider a joint report by NHS North Cumbria Clinical Commissioning Group and NHS Morecambe Bay Clinical Commissioning Group (copy enclosed).
Members received a joint report from NHS North Cumbria Clinical Commissioning Group and NHS Morecambe Bay Clinical Commissioning Group which provided an update on the progress made in Cumbria against the 2015–2020 Cumbria?wide Mental Health Strategy ‘Better Mental Health for All’ and its subsequent alignment with the priority actions outlined in the NHS England Five Year Forward View for Mental Health, including intentions regarding in-patient configuration consultation.
The report also encompassed the update from Morecambe Bay CCG which, following boundary change in April 2017, continued to align its mental health programme within both the Morecambe Bay’s Accountable Care System Strategy of ‘Better Care Together’ and the continued delivery of the 2015-20 Cumbria countywide strategy.
The Committee noted that it was felt advantageous to continue with the Cumbria footprint and build on the existing relationships with partners.
The progress update also reflected the position of Cumbria within the two new Sustainability and Transformation Partnerships (STPs) of West, North and East Cumbria and Lancashire & South Cumbria. It was noted that both STPs focussed on a wider system response to making improvements across mental health services and achieving positive outcomes for the population.
The Committee were informed that in 2014 key stakeholders agreed the need to review and improve how mental health services were designed and delivered across Cumbria. It was noted that this had acknowledged the ongoing quality, safety and performance challenges relating to mental health service provision at that time.
Members noted that as part of the improvements a Cumbria wide multi stakeholder Mental Health Partnership Group was established to drive and monitor improvements. The Committee were informed that the membership of the Group included representatives from Cumbria County Council, Partnership Trusts, North and South CCGs and direct user representation noting the Group met around the county on a bi?monthly basis. Members noted that improvements would continue to be monitored at Cumbria level. It was agreed that the Terms of Reference of the Group would be circulated to the Committee.
Members were given a Programme Update which included information on Early Intervention and Prevention (including Primary Care Integration), Improving Access to Psychological Therapies (IPAT) including developments of long-term conditions model, integrated urgent care and crisis services and perinatal care.
Members noted that NHS England had described improvements to perinatal care as critical to ensure a safe and high quality experience for new mothers and their babies. The Committee discussed the national programme to be delivered for the Lancashire and South Cumbria STP which would also include the provision of a regional specialist in-patient unit for mothers and babies at Chorley. It was explained that this was a specialist in?patient unit which could provide support to a small number of patients in the south and was a similar distance to a specialist unit in the north east used by patients in the north of the county.
The Committee were informed that NHS sought to improve uptake of Psychological Therapies to improve the access rates and benefits to users, but ... view the full minutes text for item 18.
To consider a joint report from Cumbria Partnership NHS Foundation Trust and University Hospitals of Morecambe Bay NHS Foundation Trust (copy enclosed).
The Committee received a joint report from Cumbria Partnership NHS Foundation Trust and University Hospitals of Morecambe Bay NHS Foundation Trust on the Organisational Leadership of Community Services in the Bay Area.
Members were informed that the Better Care Trust (BCT) Strategy envisaged a closer integration of health and care services currently provided by a range of providers and partners (Bay Health & Care Partners (BHCP)) to Bay Area residents. It was noted the integration of services supported the new care model which was delivered through 12 Integrated Care Communities (ICCs) and which were expected to deliver a number of benefits, leading to improved health outcomes and more sustainable local services:
· clearer patient pathways,
· population health segmentation,
· increased multidisciplinary team working,
· better care coordination and navigation,
· improved sharing of clinical information.
· reduced per capita cost.
It was noted that a key part of the development of an integrated model of care for the Bay were proposals to change the way in which community services in the Bay area were led. It was explained that University Hospitals of Morecambe Bay NHS FT (UHMB) and Cumbria Partnership NHS FT (CPFT) were working with Blackpool Teaching Hospitals NHS FT (BTHFT) and Morecambe Bay Clinical Commissioning Group (MB CCG) to create a defined portfolio of community services across the Bay, as a means of supporting integration of adult, physical health community services. Members acknowledged this would be a significant part of the approach to transforming care.
The Committee discussed the inclusion of Blackpool Teaching Hospitals and members asked if there was a likelihood that services would be subsumed into Blackpool. Members were informed that by April 2018 it was anticipated services for Blackpool would be provided by UHMBT noting that this had been agreed in principal.
The Committee were informed that as part of the development of those proposals the UHMB and CPFT Boards had agreed to transfer community services from CPFT into the new Accountable Care System (ACS) from 1 April 2018, with UHMB as the host for those services. Members noted the discussions supported an agreed direction of travel for the Bay area towards an accountable care model; a parallel strategic direction for accountable care in WNE Cumbria, as part of a bilateral partnership with North Cumbria University Hospitals NHS Trust (NCUHT) was also being developed.
The Boards of UHMB and CPFT approved an Outline Business Case in July 2017 to set out the principles under which this transfer would progress and established a framework for involvement of commissioners and other partners of BHCP. Members noted that a final agreement, via a Full Business Case, was expected to go to the Trust Boards in November 2017. The next stage proposed would include development of a corresponding transfer of community services in North Lancashire to the ACS, hosted by UHMB.
The Committee were informed that engagement with staff who may be affected had begun with a series of joint engagement sessions taking place in July to which both UHMB and CPFT staff were invited. ... view the full minutes text for item 19.
To consider a report by the Strategic Policy and Scrutiny Adviser (copy enclosed).
Members received a report which updated the Committee on developments in health scrutiny, the Committee’s Work Programme and monitoring of actions not covered elsewhere on the Committee’s agenda.
The Committee’s attention was drawn to a community dentistry case for change in Copeland and it was agreed the information would be circulated to all members for consideration as to whether this should be referred to the Cumbria Health Scrutiny Variation Sub?Committee.
(1) an update on the status of the Committee’s referral to the Secretary of State be received;
(2) the arrangements for a development session for Health Scrutiny to take place on 27 October 2017 be noted and a schedule be circulated in advance of the event;
(3) the engagement on clinical policies for Lancashire and South Cumbria CCGs on complementary and alternative therapies and the new draft policy for rehabilitation after damage to the facial nerve be circulated to the Committee for consideration and comment;
(4) the existing Work Programme be noted and the following issues be added for future meetings:-
(i) figures and reasons for cancelled operations;
(ii) eating disorders
(iii) Healthwatch Cumbria review of learning difficulties (early 2018);
(iv) implementation of ICCs;
(v) GP Federations;
(vi) NWAS use of other agencies (February Committee meeting).
Date of Future Meeting
To note that the next meeting of the Committee will be held on Thursday 14 December 2017 at 10.30 am in Conference Room A/B, Cumbria House, Botchergate, Carlisle.
It was noted that the next meeting of the Committee would be held on Thursday 14 December 2017 at 10.30 am in Conference Room A/B, Cumbria House, Botchergate, Carlisle.