Venue: Council Chamber - County Offices, Kendal, LA9 4RQ. View directions
Contact: Lynn Harker Email: firstname.lastname@example.org
Apologies for Absence
To receive any apologies for absence.
An apology for absence was received from Mrs S Crawford.
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).
There were no declarations of interest on this occasion.
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 9 July 2018 (copy enclosed).
With reference to minute no 24 – Healthcare for the Future of West, North and East Update ((2) – Maternity and Paediatrics) the fourth paragraph should read: ‘The Committee noted that initial work had been undertaken with paediatrics and obstetricians to agree what criteria would be used to identify those women who would have to travel to give birth’
RESOLVED, that with the inclusion of the above amendments the minutes of the meeting held on 9 July 2018 be agreed as a correct record and signed by the Chair.
To consider a presentation by the Director of Public Health, Cumbria County Council.
This outlines the draft framework for the Joint Health and Wellbeing Strategy and provides feedback from the Committee prior to it going out for consultation.
Members received a presentation from the Director of Public Health (Cumbria County Council) on the Joint Health and Wellbeing Strategy which was a statutory document exercised through the Health and Wellbeing Board.
The Committee were informed that the remit for the Strategy was to build on and not duplicate existing programmes, recognising each body’s contribution and identifying good practice. It was explained that it should address the wider determinants of health, how individuals and communities could be mobilised to change behaviours; how individuals could co?produce the design and operationalisation of new models of care; and how the health and care system, by being better integrated, could shift resources to tackle the necessary upstream activity.
The Committee were informed the current Strategy was coming to the end of its term and pre-dated the split in the Clinical Commissioning Groups and Integrated Care System Developments. It was noted that the most recent Care Quality Commission System Review had proposed an update of the Strategy.
Members highlighted the importance of the implementation of the Strategy acknowledging that this was a strategic issue and expressed their concerns at the lack of clear lines of descent for delivery. It was suggested that the Health and Wellbeing Forums could be a platform but it was anticipated that lack of funding would be an issue. It was agreed that work could be undertaken at different levels with the possibility of six implementation plans at district levels. It was highlighted that no new funding would be available and that existing funding would be shaped to progress things in the right direction.
The Committee emphasised that the development of Integrated Care Communities was absolutely key. Members highlighted that the structures did exist and that this was an opportunity to ensure they were fit for purpose.
Members drew attention to the importance of the use of technology and information and it was explained there was now better access to data than previously which helped to identify cohorts of people at risk and allowed processes to be put into practice.
The Committee welcomed the engagement process which would be undertaken and noted the consultation period was planned between October 2018 and January 2019 with the anticipation that the full Strategy would be ready by March 2019. It was highlighted that the key part of the consultation would be to identify and develop areas for immediate focus under each of the four core themes.
It was acknowledged that it was essential to ensure that local people were fully engaged and were afforded the opportunity to shape how the Strategy would be delivered over time. Therefore, the extensive engagement process would be developed involving a comprehensive mapping process to identify, reshape, align and enhance existing engagement activity, this would extend beyond the consultation period. The Committee were informed that engagement materials would also be shaped and influenced in consultation with Healthwatch Cumbria. During the course of discussion members emphasised the need for a user?friendly consultation which was accessible to the public ... view the full minutes text for item 33.
To consider a report by the Strategic Policy and Scrutiny Adviser (copy enclosed).
The Committee received a report from the Policy and Scrutiny Team 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 on the Joint Cumbria and Lancashire Health Scrutiny Committee. The possibility of the relocation of the Dual-energy X-ray Absorptiometry (DEXA) was highlighted and it was explained this would be considered formally if necessary.
The Committee received an update on the Joint Health and Adults Scrutiny Advisory Group which had met to scrutinise the report from the CQC Review of the Health and Care System in Cumbria and the action plan being put in place to address the issues which were highlighted. It was noted that the Group had made a number of recommendations which were fed into the Health and Wellbeing Board.
Members noted that the next meeting of the Group would be hosted at the Eden Integrated Care Communities Co?ordination hub and would focus on the implementation of ICCs across the North Cumbria and Morecambe Bay Health Care Systems.
The Committee received feedback from the Mental Health Service Stakeholder Group. It was explained that the listening events which had taken place had been well attended in Carlisle but not in Kendal. It was noted that there were a number of high level design workshops scheduled and anyone with a genuine interest in the topics was encouraged to attend. It was highlighted that the Group had expressed concerns regarding services disappearing from Carleton Clinic in Carlisle and this would be monitored.
The Committee were then informed of a report which had been considered at a recent Health and Wellbeing Board meeting regarding a change in Podiatry Services in North Cumbria. It was explained that a pilot site had been established in the Copeland locality and it had been suggested the data collected should be analysed and considered by the Cumbria Health Scrutiny Committee.
A discussion took place regarding the Work Programme and it was agreed that information regarding cancelled operations, digital records (including information on the existing paper based system and the challenges and costs incurred), appointments system (including accessibility to information by residents regarding availability of services in their localities) be included.
During the course of discussion concerns were raised regarding the lack of an update following the attendance of representatives of the Hard of Hearing and Deaf Community at a Health Scrutiny Committee in December 2017. It was agreed that a detailed update on the Hearing Loss Task Group be sought with regard to commissioning intentions for the Cumbria Deaf Association and how this reflected the recommendation by the Committee that a Group be established to explore the development of a Hearing Loss Strategy in Cumbria. It was highlighted that the current contract would expire in December 2018 and, to date, no future commissioning intentions were known.
(1) the following be noted:-
(a) the update on the Joint Cumbria and Lancashire Health Scrutiny Committee;
(b) the ... view the full minutes text for item 34.
To receive an update from North Cumbria University Hospitals NHS Trust (copy enclosed).
The Committee to examine the work which has taken place by the Trust Boards and the planning arrangements for the strategic business case.
The Committee received a report from the Cumbria Partnership NHS Foundation Trust (CPFT) and North Cumbria University Hospitals NHS Trust (NCUHT) which provided Members with a progress update on the proposals being developed by CPFT and NCUHT to explore opportunities to merge in order to form one provider organisation.
Members were informed of the context and process involved noting that since the Health Scrutiny Committee meeting in July, a small Programme Team had been established to explore options for a transaction and develop plans for work to deliver this.
The Committee drew attention to the Memorandum of Understanding (MoU) which had been in place throughout 2017/18 and noted that in addition, from April 2018, the Trusts had established aligned Board and Board Committee arrangements which supported fully joined up monitoring and assurance against delivery of key milestones and work programmes. Members requested that the latest version of the performance reports on key milestones for the aligned Board and Board Committee arrangements be made available to the Health Scrutiny Committee.
Members raised the question of demands of the Care Quality Commission (CQC) and their services and were informed that both organisations strived to make improvements to quality of care both inside and outside of hospital. It was agreed that specific implications for CPFT services delivered in South Cumbria for each of the proposed options would be included in a future report.
The Committee were informed that as the transaction was not going to affect the provision of services, and would only alter the management body delivering services there was no requirement for a full public consultation, however, the Trusts were required to engage with partners and governors throughout the process.
Members raised their concerns regarding the lack of public consultation and highlighted the positive effects of such engagement. Members were informed that the Engagement Strategy was in the development stages at present and was limited to staffing groups and Board of Directors explaining that the Success Regime formed the full consultation. Members highlighted that the merger of the two Trusts did not form part of the Success Regime and it was explained this emerged as a result of it. The Committee requested sight of the Engagement Strategy.
The Committee noted that engagement had taken place with NHSI on a regional and national basis, and they had engaged with the Competition and Markets Authority (CMA) on behalf of the two Trusts. It was explained that the CMA had confirmed that at this stage, they did not require a review of the potential merger from a competition perspective, but reserved the right to review this at a later date.
Members were informed that a programme governance structure and workstreams for Stage 1 had been developed and commenced with an identified indicative timeline. It was explained that a full options review would commence with both Boards of the organisations together with engagement with key partners and governors from CPFT in relation to progress and options which would be undertaken. The Committee welcomed the ... view the full minutes text for item 35.
To consider a report by the Cumbria Partnership Foundation Trust (copy enclosed).
This report sets out the progress in developing the Outline Business Case for proposed changes to the provision of Mental Health Services in Cumbria.
The Committee considered a report from Cumbria Partnership NHS Foundation Trust which provided members with a progress update on the agreements being developed by Cumbria Partnership NHS Foundation Trust (CPFT), Lancashire Care NHS Foundation Trust (LCFT) and Northumberland Tyne and Wear NHS Foundation Trust (NTW).
Members were informed that in early 2018 the two Clinical Commissioning Groups (CCGs) with commissioning responsibility for Cumbria, (Morecambe Bay CCG in the South and North Cumbria CCG in the North) had published their strategic commissioning intentions for services currently delivered by CPFT. It was noted they advised that from April 2019 the commissioning intention was for all services currently delivered by CPFT to be delivered into the integrated health and care systems covering North and South Cumbria from April 2019.
It was explained that those commissioning intentions were informed by a number of drivers to support best practice. The commissioning intentions stated that this would require ‘either direct delivery from, or at least very robust partnership arrangements with an external Trust’. It was highlighted that the CCGs were clear that future provision must:
· improve outcomes and quality of services for users and communities;
· improve the sustainability and resilience of services, particularly given national and local workforce challenges; and
· ensure transformation of services in line with agreed models of care developed across the Sustainability and Transformation Plan (STP)/Integrated Care System (ICS) footprints.
A discussion took place regarding the improved outcomes and quality of services for users and communities. Members acknowledged that CAMHS was available to children and young people up to the age of 25 and requested evidence that waiting times were being monitored and tracked seeking reassurance that this would be tracked with a specific emphasis on children leaving care.
Members were informed that one of the key areas in the restructuring of CAMHS would focus on waiting time. It was explained that experts were investigating how children and young people entered the system and proceeded through it. It was acknowledged there was a need to look at the transition from children’s to adult services.
A discussion took place regarding the mainstream support which was available to children and young people. The need to look from birth to adult to support those children and young people was emphasised. Speech and language therapy services were highlighted as having positive long?term effects whilst it was acknowledged that a broad range of services were required to ensure children and young people could thrive and succeed.
Members discussed the prevention agenda in the context of NHS and Mental Health Services highlighting the link between physical and mental fitness. It was explained this had been discussed at some length with the County Council and the importance of building better resilience and capacity was acknowledged.
The Committee were informed that during 2018/19, significant steps had been taken to work in a more integrated and collaborative way in order to complete the due diligence. It was explained this had allowed a transparent review of agreed key domain areas across ... view the full minutes text for item 36.
To consider a joint report by North Cumbria Clinical Commissioning Group and Cumbria Partnership Foundation Trust (copy enclosed).
The report provides an assessment of how the new models are operating and an analysis of how the patient pathway operates within those new models and feedback from patients.
The Committee considered a joint report by NHS North Cumbria Clinical Commissioning Group and Cumbria Partnership NHS Foundation Trust which gave an update on Community Hospitals.
Members noted that the Community Hospital inpatient beds at Alston Moor, Maryport and Wigton were included in the Healthcare For the Future public consultation which highlighted the challenges in providing sustainable, high quality community inpatient provision in the north of Cumbria.
The Committee discussed the existing use of resources and were informed that staff had been through a management of change process to transition them into community roles or roles in other community hospitals. It was explained all health/administrative staff had been transferred to alternative posts without the need for an interview process and that their first or second choice of employment had been honoured. It was highlighted that a contribution of £250 towards driving lessons had been made to staff that could not drive.
Members received an update on catering and support staff:-
Ø 15 members of staff had been retained or deployed into alternate roles;
Ø 2 members of staff had taken community health care assistant posts;
Ø 5 members of staff had taken redundancy as a preference to redeployment or retraining.
A discussion took place regarding staff morale and members were informed that this varied, highlighting the enthusiasm of staff in Maryport where different types of service were being offered. It was explained that support staff in other ICC areas were working positively and sharing their skills.
Members were informed of the community services that had been developed which corresponded to some of the deliverable suggestions put forward in the Community Alliance Group Plans.
In conclusion the Committee noted that the project was managed through the Implementation Group. Members were informed that beds were formally closed in Alston Moor and reduced to 9 in Wigton and Maryport from April 2018, highlighting this period had been essential in starting the process of development and training for staff moving into the new community model. It was noted that beds formally closed in Maryport and Wigton in late September to October, moving to a community model. It was explained that the closures had gone smoothly but highlighted that the community models required time to embed and their effectiveness would be monitored through the Community Care Group governance process.
A discussion took place regarding Alston Moor data which outlined the increase of care at home. It was confirmed to members that patients did receive services at home but the figures outlined also included information on multiple contacts from the same service user in one day.
Members were informed that a number of community services had been developed both through the ICC work and through the Community Alliance plans. It was explained that, mapped against the original plans, it was clear that services were in place when the beds closed in Wigton and Maryport. It was noted that would contribute to the development and enhancement of community services and provide services closer to people’s homes ... view the full minutes text for item 37.
To consider a report by the Chief Operating Officer, NHS North Cumbria Clinical Commissioning Group (copy enclosed).
This report enables the Committee to monitor the implementation of changes, the audit’s being undertaken, the Co?Production Steering Committee and the Independent Review Panel.
The Committee considered a report by the NHS North Cumbria Clinical Commissioning Group giving an update on the progress made following the Healthcare for the Future Consultation.
(1) Stroke Services
Members were informed there were plans to modernise and improve the care provided to stroke patients by developing an enhanced service ‘Hyper Acute Stroke Unit (HASU)’ which had not previously been available across north Cumbria. It was explained this would mean all potential stroke patients would initially be brought to the Unit at Carlisle where access would be available to a specialist stroke team. It was highlighted this 24/7 treatment in the acute phase of the stroke had been proven to improve mortality and reduce long term disability.
The Committee noted the North Cumbria Health and Care System had also secured national support and input through the Building Health Partnerships to coproduce a pilot scheme in Copeland around preventing stroke and detecting those at risk from stroke.
Members were informed that at present there were two five day a week services at the West Cumberland Hospital (WCH) in Whitehaven and the Cumberland Infirmary in Carlisle (CIC) which included stroke rehabilitation and post-stroke services at both sites.
The Committee noted the service should have six stroke consultants, but in reality it had one substantive consultant at CIC and 2 agency locums - one at CIC and one at WCH. It was emphasised that with so few consultants it was impossible to offer seven day services or extended week day cover, therefore, a back?up service was provided by Tele stroke, which was staffed by stroke specialist from across the North of England as part of a joint agreement.
It was highlighted to the Committee that the Trust had struggled to recruit stroke specialist staff for several years noting there was also national shortage. Members were informed that the Trust was actively advertising for Stroke Consultants, Nurse and Therapist Consultants with a number of training posts for apprentice nurses being identified.
A concern was raised regarding the possibility that patients from West Cumbria who were experiencing an acute stroke were being transferred to Carlisle. The Committee were informed that officers were not aware of any such cases but would investigate this and provide members with reassurances that this was not happening or, if this was proven, figures and circumstances would be available.
(2) Update on Maternity and Paediatrics
The Committee were informed that work with paediatricians and obstetricians to identify the 100-200 women who may be carrying babies which can be identified as potentially needing more paediatric input had been completed. It was noted that planning was continuing but there was no date for this change to be introduced.
A discussion took place regarding the difference in paediatric staffing at both the CIC and WCH and concerns were raised that the consultation undertaken had been unnecessary. It was emphasised that the consultation was required in order to plan for any necessary changes. It was confirmed that the workforce was still ... view the full minutes text for item 38.
To receive a presentation by the Chief Operating Officer for NHS North Cumbria Clinical Commissioning Group and the Director for Integration for the North Cumbria Integrated Care System (ICS).
This presentation outlines potential for the current North Cumbria Integrated Care System to work with colleagues across the wider North East and North Cumbria aspiring to become an Integrated Care System.
The Committee received an update on progress in establishing the North Cumbria Integrated Health and Care System from the Chief Operating Officer, North Cumbria Clinical Commissioning Group and the Director of Integration for the North Cumbria Health and Care System.
Members were informed that due to changing demands the NHS had to undertake changes in order to provide better health and wellbeing, better standards of care and better use of staff and funds.
The Committee noted the national view of Integrated Care Systems (ICS) included:-
Ø redesign and integrate clinical and care pathways to better meet the needs of the local population;
Ø develop population health management approaches that facilitate the integration of services focused, in the first instance, on populations that were most at risk of developing acute illness and hospitalisation;
Ø work with key system partners and stakeholders including patients and residents and their democratic representatives, health and care staff, local government and the voluntary sector;
Ø take collective responsibility for financial and operational performance, quality of care (including patient/user experience) and health outcomes;
Ø create more robust cross-organisational arrangements to tackle the systemic challenges that the health and care system was facing;
Ø act as a leadership cohort, demonstrating what could be achieved with strong local leadership, operating with increased freedoms and flexibilities;
Ø commit to developing and disseminating learning, together with the national bodies that other systems could subsequently follow.
The Committee were informed that in North Cumbria a bid had been submitted in in November 2017 to become an Integrated Health and Care System with an announcement in May 2018 that they had been selected as one of the 14 shadow Integrated Care Systems. Members noted that the local priorities included:-
Ø Population Health
Ø Primary Care and Integrated Care Communities
Ø Mental Health
Ø Children and Young People (including Child and Adolescent Mental Health)
Ø Acute Service Review
Ø Financial Strategy.
It was explained that there would be a development of system governance arrangements to support commissioners during 2018/19 with implementation of the North Cumbria workforce strategy beginning in 2018/19 to provide system level workforce planning, including skills mix, supply and deployment. Members were informed that the decision?making process which currently existed would continue in the future.
A discussion took place regarding the STP footprint and members were informed that the North Cumbria STP area on its own was small but had been successful in their application to join up with the North East and deliver a more seamless service to their users. It was emphasised that this joint approach would strengthen any future funding allocations. Members were informed it was anticipated this would improve patient flows highlighting that at present approximately 100 outpatient appointments were scheduled in the North East daily. It was also felt that the successful North East Regional Centres of Excellence would provide future sustainability.
The Committee were informed that the intention was to form a North East and North Cumbria ICS which would cover 3.3 million people with ... view the full minutes text for item 39.
Date of Future Meeting
To note that the next meeting of the Committee will be held on Tuesday 18 December 2018 at 10.30 am at Cumbria House, Botchergate, Carlisle.
It was noted that the next meeting of the Committee would be held on Tuesday 18 December 2018 at 10.30 am at Cumbria House, Carlisle.