Agenda and minutes

Cumbria Health Scrutiny Committee
Monday, 14th May, 2018 10.30 am

Venue: Council Chamber - County Offices, Kendal, LA9 4RQ. View directions

Contact: Lynn Harker  Email: lynn.harker@cumbria.gov.uk

Items
No. Item

1.

Election of Vice-Chair

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.

 

Minutes:

It was agreed that this item would be deferred until the next meeting scheduled for 9 July 2018 when all District Council Committee appointments had been agreed following their recent elections.

 

2.

Apologies for Absence

To receive any apologies for absence.

 

Minutes:

Apologies for absence were received from Mr D Blacklock, Ms H Horne and Mrs J Riddle.

 

3.

Membership of the Committee

To note any changes to the membership of the Committee.

 

Minutes:

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

 

4.

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.

 

Note

 

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).

 

Minutes:

Mr R Gill and Mr C Whiteside declared personal interests as their respective wives were employed at the West Cumberland Hospital.

 

5.

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.

 

Minutes:

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

 

6.

Minutes pdf icon PDF 124 KB

To confirm the minutes of the meeting held on 26 February 2018 (copy enclosed).

 

Minutes:

With reference to minute no 44 – Sustainability and Transformation Partnership (South) it was agreed that:-

 

(1)       on page 18 (third paragraph, second line) there should be a ‘;’ after the word ‘now’;

 

(2)       on page 18 (fourth paragraph, second line) the word ‘siting’ should read ‘citing’.

 

RESOLVED,     that with the inclusion of the above amendments the minutes of the meeting held on 26 February 2018 be agreed and signed as a correct record.

 

7.

HealthCare for the Future of West, North and East Update pdf icon PDF 356 KB

To consider a report by the Chief Executive, NHS North Cumbria Clinical Commissioning Group (copy enclosed).

 

Minutes:

The Committee received an update on the progress since the decisions were made in March 2017 following the Healthcare for the Future Consultation.

 

(1)       Maternity and Paediatrics

 

It was explained that the Alongside Midwifery-Led Unit (AMLU) was developing well at the West Cumberland Hospital (WCH) and this had been informed by the valuable input of the Maternity Voices Partnership (MVP).  Members noted that the progress would be considered regularly by the Independent Review Group (IRG) which was chaired by Dr Bill Kirkup.

 

The Committee discussed the recruitment of staff for the Alongside Midwifery Led Unit and the Short Stay Paediatric Assessment Units.  Members were informed that recruitment was slow but there had been recent successes.  It was explained jobs were currently being redesigned to make them more attractive by linking them with teaching responsibilities and other opportunities.  Members noted that work was in progress to recruit staff from overseas acknowledging that this was a competitive process with other trusts around the country.  It was highlighted the recruitment to paediatric consultants posts had been successful and the Trust were in a better position than they had been for a number of years.

 

The Committee were informed that initial work with paediatricians and obstetricians to identify the 100-200 women who may be carrying babies which could be identified as potentially needing more paediatric input was ongoing.  It was explained that comprehensive work with a range of clinicians, including paediatricians, obstetricians, midwives and anaesthetists, would begin soon to analyse the data from those categories to work out further operational detail about which women would be advised to give birth at the Cumberland Infirmary in Carlisle (CIC).  A representative from Cumbria Health Scrutiny Committee had been invited to join three meetings in May, June and July when dates were confirmed.  It was unanimously agreed that Mrs R Hanson would represent the Committee.

 

Members were informed that work was progressing to establish Short Stay Paediatric Assessment Units at both the Cumbria Infirmary, Carlisle and West Cumberland Hospital, Whitehaven and positive feedback had been received.  It was explained that due to the remote and rural nature of the geography of the county a model had to be devised to ensure it worked for everyone.  It was noted this service would be phased in, highlighting that no changes would be made to overnight beds at WCH until phase 4 of the process had been reached.

 

The Committee raised their concerns with regards to children with severe asthma conditions or digestive disorder and asked for reassurances that those patients would be cared for appropriately and sympathetically with the right team and equipment.  It was confirmed to members that all the necessary support would be in place before progressing through each phase emphasising that no changes would be put in place without the appropriate clinical staff.  Members were informed that paediatric consultant roles had been re?designed and would be considered by the Royal College of Nursing before implementation.  It was explained that work was being undertaken across both  ...  view the full minutes text for item 7.

8.

Eating Disorders in Cumbria pdf icon PDF 373 KB

To consider a report by the Cumbria Partnership Foundation Trust (copy to follow).

 

Additional documents:

Minutes:

The Committee considered a report from Cumbria Partnership NHS Foundation Trust regarding Community Eating Order Services in Cumbria.

 

Members were informed that eating disorders were severe mental illnesses with serious psychological, physical and social consequences.  It was explained that Anorexia Nervosa (AN) had the highest mortality amongst all psychiatric disorders and people with eating disorders commonly experienced additional mental health problems, particularly depression, physical illness, difficulties in intimate relationships and the interruption of educational/occupational goals.

 

The Committee noted that within Cumbria prevalence of eating disorders affected 1,374 of the population aged between 15 and 24.  However research suggested that approximately only 50% of the known population would access timely treatment for eating disorders.  It was explained that the delay in seeking help was often coupled with a year long period of waiting for diagnosis followed by periods of waiting for treatment often over 6 months.

 

The report outlined that following the publication of the Future in Mind report, NHS England had instructed local Clinical Commissioning Groups (CCGs) to produce transformation plans that aligned their local priorities of service improvement to the national priorities.  It was explained that the refreshed Local Transformation Plan for Cumbria had identified the initiation and development of an eating disorder service for Children and Young People as a key priority work stream.  The Plan clearly stipulated that by the end of March 2018, an Eating Disorder service would have been established across North and South Cumbria CCG boundaries.  Members noted that the establishment of such services would provide a platform to initiate movement towards the THRIVE, CAMHS redesign programme.

 

The Committee were informed that the local population health data from public health indicated that the capacity required for eating disorders across Cumbria for the 0-19 years population was approximately 50 referrals per year, divided as follows from a North and South Cumbria perspective:-

 

        31 referrals for North Cumbria

        19 referrals for South Cumbria.

 

Members were given an update on referral response times and were informed that the total amount of referrals received for eating disorders across Cumbria equated to 3.5% of the total number of cases open to CAMHS.  It was explained that whilst this may appear to be a relatively small percentage of the cases, the intensity of work required with eating disorders cases was great and took approximately 30% of available time from the existing workforce in Tier 3 CAMHS.  It was anticipated that if the service was open to self referral then the number of referrals would rise rapidly.

 

The Committee were informed that the limitations of the current service offer for children across Cumbria correlated with the outcomes of research nationally, that improvements were required for eating disorder services.  It was noted that specific limitations of the service offer in Cumbria at present were:

 

           small workforce across a large geographical area;

           limited data collection and analysis to evidence outcomes;

           variability in access times to treatment for routine appointments;

           urgent cases were waiting on average 3.2 weeks  ...  view the full minutes text for item 8.

9.

North Cumbria Primary Care Collaborative - Alliance Model Update pdf icon PDF 109 KB

To consider a report by the Programme Director for Integrated Health and Social Care – North Cumbria University Hospitals NHS Trust (copy enclosed).

 

This report provides a progress update on the ‘alliance’ model being developed with a number of GP practices in North Cumbria.

 

Additional documents:

Minutes:

The Committee considered a report by the Programme Director for Integrated Health and Social Care – North Cumbria University Hospitals NHS Trust which provided a progress update on the ‘alliance’ model being developed with a number of GP practices in North Cumbria. 

 

Members were informed that North Cumbria health and care partners had submitted a formal proposal to be in the next national wave of Integrated Health and Care Systems (ICS).  It was anticipated that the outcome of the submission would be known in the coming week highlighting there was the potential for additional funding to be made available if successful.

 

The Committee noted that one of the key components of being an integrated health and care system included demonstrating how improvements in primary care and delivering the ambitions set out in the General Practice Forward View would be fully achieved. 

 

It was explained that as part of the plans it had been recognised how the system mobilised to support general practice was fundamental to improving outcomes in care and reducing demand for acute services.

 

The Committee noted that General Practice across North Cumbria was facing increasing demands in relation to significant workforce sustainability challenges and access to services.  The difficulties with regards to recruitment of GPs was highlighted.  The aim of North Cumbria Primary Care Collaborative was to provide a sustainable solution for the future, through creating a model within which practices become ‘alliance’ practices in a salaried model, with estates/premises solutions and greater ability to achieve primary care at scale for the benefit of local populations.  

 

The Committee discussed the remuneration for GPs attendance at Alliance meetings and was informed that at present a locum was paid to cover the absence of a GP.  The new Alliance Model for practices would mean that GPs would be offered a salaried option and not be paid separately for attendance.

 

Members noted it was not anticipated that all practices would become part of the model and at present 38% had expressed an interest.  It was explained that work was being undertaken to make the proposals attractive.

 

The Committee were informed that across the NHS innovative models were being implemented whereby NHS Foundation Trusts and NHS Trusts were taking over the running of practices, integrating care vertically and providing networked/‘organised’ primary care for key populations.  It was also highlighted that the private sector solutions were being offered to general practices across the country.

 

A discussion took place regarding the private sector solutions which were being offered to general practices across the country.  Members were informed that in the north of the county a number of practices had sold to private companies which could mean that one GP would be on contract for 20 practices.  It was highlighted that ‘for profit’ solutions were not encouraged as profits would be taken out of Cumbria.

 

The Committee discussed the Governance structure and were informed this would be a subsidiary company of the Foundation Trust, therefore, would run on a non?profit basis. 

 

A  ...  view the full minutes text for item 9.

10.

Future of Mental Health Services pdf icon PDF 156 KB

To receive a presentation from Cumbria Partnership Foundation Trust (copy enclosed).

 

This report provides members with the opportunity for early engagement in the development of and consultation on the Outline Business Case.

 

Minutes:

The Committee received a presentation from Cumbria Partnership NHS Foundation Trust (CPFT) regarding the future of mental health services highlighting the national focus on improving the quality of them.

 

Members were informed that the future of mental health, child and adolescent mental health and learning disability services in Cumbria would be addressed over the coming year.  It was explained that the commissioners of current services had confirmed that they needed to be delivered into the integrated health and care systems covering north and south Cumbria from April 2019.

 

The Committee noted that work had been undertaken with senior clinicians and commissioners to co?create a set of principles to guide this work.  It was explained that at present meetings had taken place with CPFT, commissioners, Northumberland Tyne and Wear NHS Foundation Trust and Lancashire Care NHS Foundation Trust to develop a plan for the next 12 months. 

 

A Mental Health Programme Board had been established to oversee the work to review the arrangements in the existing services and develop an outline business case and options appraisal for North and South respectively. 

 

The Committee were informed that the services in scope and due diligence included Mental Health (inpatient and community services), Learning Disability Services and Child and Adolescent Mental Health Services (CAMHS).  Members emphasised the need to support mental health services and highlighted the omission of the community eating disorders model.  It was explained that this came within the CAMHS remit and assured members this would not be forgotten.

 

The Committee noted that due diligence was being undertaken which consisted of the arrangements, risks and dependences of each service in more detail.  It was confirmed that a Stakeholder Advisory Group, which included representatives from a number of stakeholder groups (including health professionals, third sector organisations and service user and carers) was being set up and would be involved in the development of the plans and co?production.  It was emphasised that staff would be kept fully informed of all developments. 

 

A discussion took place regarding the formal influence of the Stakeholder Advisory Group.  Members were informed that the formal decision would ultimately be taken by the health commissioners but the Group, which would meet in public, would be structured to allow the views of all service users to be considered.

 

The timescale was set out for members with the anticipated commencement date of 1 April 2019. 

 

The Committee welcomed the presentation and asked what innovative models of service and delivery were being envisaged.  Members’ attention was drawn to the need to attract and retain health care professionals in Cumbria.  It was explained there was a need to develop new non?medical roles providing physical healthcare together with the development of GPs who had an interest in mental health.  It was felt that Cumbria had a unique set of opportunities to merge acute, primary and mental health care services. 

 

A discussion took place regarding early intervention work and where this was proposed to be placed in schools according to the commissioning intentions.  ...  view the full minutes text for item 10.

11.

Committee Briefing Report pdf icon PDF 59 KB

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

 

Additional documents:

Minutes:

The Committee received a report from the Strategic Policy and Scrutiny Adviser which gave an update on developments in health scrutiny, the Committee’s Work Programme and monitoring of actions not covered elsewhere on the Committee’s agenda.

 

The Committee received an update on the Cumbria Health Scrutiny Variation Sub?Committee and noted that it would meet on Monday 21 May 2018 to consider whether the proposal from the Cumbria Partnership Foundation Trust to close Flatt Walks Clinic and relocate patients and activity to Cleator Moor Health Centre constituted a substantial service change.  All members of the Sub?Committee were encouraged to attend the meeting.

 

A discussion took place regarding the existing Working Programme.  It was agreed that, following the earlier discussion regarding the Future of Mental Health Services, a further discussion on this item would take place at the meeting scheduled for October rather than July as originally agreed.

 

It was suggested that a two part item from both the North Cumbria University Hospitals NHS Trust and the University Hospitals of Morecambe Bay NHS Foundation Trust to discuss the cancellation of operations be scheduled for the next meeting of the Committee in July.

 

A discussion took place regarding an update on cancer services in both the North and South of the County.  It was agreed that further information would be sought by officers and circulated to members before a decision was made to discuss this at a future meeting.

 

Members discussed the Communications and Engagement Plan for the Better Care Together and it was agreed further information would be circulated to members.

 

The Committee agreed that further information regarding the Eating Disorder Services in South Cumbria would be made available to members.

 

Members referred to the discussion which had taken place at the  meeting held on 14 December 2017 regarding Access to Health Services for Service Users with Hearing Loss (minute 29 refers).  It was agreed to investigate the commitment made by the former Corporate Director – Health, Care and Community Services (Cumbria County Council) to consider the establishment of a Multi-Agency Task Group to develop a local action plan on hearing loss, involving key partners and taking into consideration the report compiled by the Cumbria Deaf Association.

 

During the course of discussion concerns were raised regarding the lack of attendance at meetings of the Cumbria Health Scrutiny Committee by the Barrow Borough Council representative.  It was agreed that, if necessary, the Chair would write to the District Council after receipt of their nomination following the recent local elections.

 

RESOLVED,     that

 

                            (1)       the update on the Variation Sub Committee be received;

 

                            (2)       the arrangements for the Joint Health and Adults Scrutiny Advisory Group be noted;

 

                            (3)       further information on cancer services in both the North and South of the County be sought by officers and circulated to members prior to a decision being made to discuss this matter at a future meeting of the Committee;

 

                            (4)       further information on the Communications and Engagement Plan for the Better Care Together be  ...  view the full minutes text for item 11.

12.

Public Health Strategy pdf icon PDF 352 KB

To receive a presentation by the Director of Public Health (copy enclosed).

 

This presentation provides information on the Public Health Strategy for Cumbria.

 

Minutes:

The Committee received a presentation from the Director of Public Health (Cumbria County Council) on the Public Health Strategy.

 

Members were briefed on the current Council Strategy and the broader approach. 

 

A discussion took place regarding the Wider Determinants Strategy which included:-

 

Ø   Natural Capital – a high quality environment that provided opportunities for engagement with the natural world.

 

Ø   Human Capital – the skills, knowledge and experience that gave people the capacity to take part in society and have meaningful and fulfilling lives.

 

Ø   Social Capital – networks and institutions that allowed people to build human capital in partnership with others.

 

Ø   Manufactured Capital – physical infrastructure including housing, transport, food distribution networks and other services.  Following discussion it was agreed that data should also be included.

 

Ø   Financial Capital – the means of owning and trading the other types of capital; adequate financial resources fairly distributed.

 

The Committee were informed that, following on from the success of the Healthy Weight Declaration with district colleagues, the Strategy was being developed in consultation with the six district councils. 

 

The Director of Public Health welcomed the opportunity to attend District Council scrutiny meetings to discuss the proposed Strategy.  He also accepted that the public should be involved and informed members that the next step was to ensure that when local committees developed their area plans they would include the Strategy.

 

A detailed discussion took place and the Committee asked how adequate green space could be maintained, particularly in urban areas, when taking into consideration the extent of recent local authority funding cuts and the need for more housing, highlighting in particular affordable housing.  Members emphasised the need for the Authority to ensure that this was included in the Local Development Frameworks to allow the provision of good quality housing highlighting this was a determinant of good health.

 

The Committee drew attention to a previous discussion regarding eating disorders in Cumbria and asked to what extent those issues would be incorporated into the Plan.  It was acknowledged that healthy weight was an immensely complex Public Health issue but members were assured that work was being undertaken with a wide range of partners to investigate this matter to ensure appropriate action was taken. 

 

A District Council representative raised her concerns at the lack of knowledge of the proposed Plan.  It was confirmed that at present this was mainly being considered by officers from district councils but in the future it would be looked at by the Public Health Alliance which included district council elected member representation.

 

The Committee asked how the Joint Public Health Strategy would fit with the Cumbria Joint Health and Wellbeing Strategy which was being considered by the Health and Wellbeing Board later this year.  Members were informed that the Health and Wellbeing Strategy was also being reviewed, therefore, there was the potential for them to work well together.

 

The Chair, on behalf of the Committee, welcomed the presentation and looked forward to receiving further feedback as the Strategy developed.  ...  view the full minutes text for item 12.

13.

Date of Future Meeting

To note that the next meeting of the Committee will be held on Monday 9 July 2018 at 10.30 am at Cumbria House, Botchergate, Carlisle.

 

Minutes:

It was noted that the next meeting of the Committee would be held on Monday 9 July 2018 at 10.30 am at Cumbria House, Botchergate, Carlisle.