Venue: Conference Room A/B, Cumbria House, Botchergate, Carlisle, CA1 1RD
Contact: Lynn Harker Email: email@example.com
Apologies for Absence
To receive any apologies for absence.
Apologies for absence were received from Ms A Bradshaw, Mr M Cassells, Mrs R Hanson and Ms C McCarron?Holmes.
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).
(1) Mr C Whiteside declared a personal interest as his wife was employed at the West Cumberland Hospital.
(2) Mr N Hughes declared a personal interest as he had applied to be a 3rd sector representative on Eden Integrated Care Community.
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 8 October 2018 (copy enclosed).
RESOLVED, that the minutes of the meeting held on 8 October 2018 be agreed as a correct record and signed by the Chair.
To consider a report by the Strategic Policy and Scrutiny Adviser (copy enclosed).
The Committee received a report 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.
A discussion took place regarding the Lancashire and South Cumbria Integrated Care Systems (ICS) and it was explained that work had taken place within localities and provider organisations to prioritise clinical services which were fragile in terms of sustainability. Members noted that the fragility was due to workforce availability, current service model of delivery, or capacity demands. The Committee was informed that Head and Neck Services and Vascular Services had been identified by the Chief Executive Officers of the five provider organisations as clinically fragile services. It was agreed that briefings would be circulated to the Joint Committee and members.
Members discussed the former Alfred Barrow School site which was currently being redeveloped to create a new Primary and Community Health Centre. It was explained that it would integrate community, primary and social care services focusing on helping people to stay well within the community. The Committee noted that three local GP practices (Abbey Road Surgery/Atkinson Health Centre/Risedale Surgery) were proposing to relocate into the Alfred Barrow Health Centre in Spring 2019.
The Committee discussed the recommendation to put formal mechanisms in place to allow two?way learning on the approach to Integrated Care Communities across the two systems and it was suggested that Healthwatch be considered to facilitate public engagement events.
The Committee’s Work Plan was considered and it was highlighted that an integrated approach across all the Authority’s scrutiny boards was required to allow effective scrutiny to take place.
(1) the report be noted;
(2) a briefing will be circulated to members of the Committee to consider whether the Cumbria Health Scrutiny Variation Sub?Committee needs to be convened to consider the relocation into the Alfred Barrow Health Centre;
(3) briefings on proposals on vascular and head and neck services in the Lancashire and South Cumbria system be sent to the Joint Cumbria and Lancashire Committee and Cumbria members for information;
(4) the North Cumbria University Hospitals NHS Trust Care Quality Commission report and the Trust’s action plan be included on the agenda for discussion at the next meeting of the Committee in February.
To consider a report by Healthwatch Cumbria (copy enclosed).
The Committee welcomed Ricardo Ribeiro-Mendes and Odin Watson (service users) supported by Fay McEwan?Barry to the meeting. Ricardo and Odin gave members an overview of their personal experiences highlighting the barriers they faced which included employment, transport and the wider perceptions of people with learning difficulties. Members welcomed their recent positive employment experiences.
Members were informed of the challenges experienced when trying to engage employers to give job opportunities to people with learning difficulties. It was agreed that consideration needed to be given as to what could be done to encourage employers. It was explained that a Steering Group was being established, which would include representatives from a number of employment organisations, to give employers the confidence to employ people with learning difficulties.
Members then considered the report from Healthwatch Cumbria which, as a result of regular engagement with people with a learning difficulty, they had become increasingly aware over a number of months that their experiences reflected substantial variation in terms of access, choice, and quality of services across Cumbria. It was explained that as a result of this ‘What does a good life look like for people with learning difficulties in Cumbria?’ was developed to specifically explore those experiences.
The Committee was informed that the responses gathered from the respondents, particularly from people with learning difficulties, highlighted both positive and negative issues which they encountered in their day to day lives. It was explained that the underlying theme was that many felt they had insufficient choices and control over their own lives, with over a third of the participants feeling that they needed better support overall, and access to training and employment opportunities.
A discussion took place regarding the use of local transport in Cumbria for people with learning difficulties. The Committee’s attention was drawn to the Rural Community Council in the Eden area which was looking at the lack of transport in rural areas and welcomed contributions from Healthwatch.
Members noted that as a result the project set out to examine a range of view?points to better understand what was working well and what could be improved to make service provision better for users including:
· People with learning difficulties
· Social workers
· Service providers and staff.
Members were informed that one of the most important themes highlighted were friends, relationships and loneliness, noting that there was very little mention of intimate relationships or friendships. It was agreed that support to enable intimate relationships and friendships should be investigated.
The Committee highlighted their concerns regarding poorer quality of health for people with learning disabilities than the rest of the population noting that of those people with learning disabilities 1 in 3 deaths was avoidable. Members were informed that they were afforded the opportunity for annual health checks explaining that the Cumbria Partnership NHS Foundation Trust was engaged with a health facilitation team to help with health issues.
In conclusion the project had provided further evidence to support the premise that more could and ... view the full minutes text for item 47.
To consider a report by the Chief Operating Officer, NHS North Cumbria Clinical Commissioning Group (copy enclosed).
The report provides ongoing monitoring of implementation of changes including the audits being undertaken and details of the Co-production Steering Committee and Independent Review Panel.
Members considered a report from North Cumbria Clinical Commissioning Group which provided an update on the progress made following the Healthcare For the Future Consultation.
(1) Stroke Services
The Committee noted that work continued to develop a Hyper Acute Stroke Unit (HASU) at the Cumberland Infirmary Carlisle. It was explained there was considerable work to ensure estates and equipment issues were resolved, as well as the ongoing challenge around staffing. Members noted that work with Building Health Partnerships to develop a stroke prevention and risk factor detection programme led by the community, and building on community assets, was underway.
It was highlighted that acute services for north Cumbria would not change until conditions to support the development were in place. Members were informed that it was unlikely that any change would take place in the early part of 2019. It was stressed that although this had been delayed current stroke services remained fragile, largely due to the difficulties encountered recruiting stroke specialists but it was hoped the new unit would be more attractive to consultants and improve services in the long-term.
The Committee agreed that progress on the development of the HASU would be considered by the Lead Health Member meeting in January.
The Committee were informed that currently there was no change to consultant?led services and no women were being advised to give birth in Carlisle that would previously have been advised to give birth at the West Cumberland Hospital.
It was explained that the Independent Review Group (IRG) had met in November to agree milestones over the coming months, including a review of staffing in obstetrics, paediatrics and anaesthetics; a review of the analysis of evidence on outcomes. It was anticipated the report for the CCG Governing Body would be ready in May/June.
Members noted there was work progressing at both hospitals to introduce transitional care; currently those babies were admitted to the Special Care Baby Unit (SCBU).
The Committee were informed that the number of mothers with complex needs that could potentially cause a risk to a newborn baby and would need to be transferred to the Cumberland Infirmary would be relatively small.
Members were reassured that all risk factors would be considered and mothers would not be sent to Carlisle until there was clear evidence that this would be beneficial.
The Committee were informed that currently there was no change to overnight beds at WCH.
It was noted that the Short Stay Paediatric Assessment Units (SSPAU) were working well on both sites with positive feedback from staff and service users.
Members were informed that work was underway to agree the information system to be used in the SSPAU and a specification was now in place.
The Committee noted that a positive audit of Royal College standards at both sites had taken place in the summer.
The Committee noted that the next meeting of the Working Together Steering Group, overseeing the working groups focusing on maternity and paediatric issues, was ... view the full minutes text for item 48.
To consider a report by Cumbria Partnership Foundation Trust (copy enclosed).
The report provides ongoing monitoring of the development of the outline business case for proposed changes to the provision Mental Health Services in Cumbria.
The Committee received a progress report which provided members with an update on the agreements being developed by Cumbria Partnership NHS Foundation Trust (CPFT), Cumbria Partnership NHS Foundation Trust (CPFT), Lancashire Care NHS Foundation Trust (LCFT) and Northumberland Tyne and Wear NHS Foundation Trust (NTW).
Members received details of listening events which had taken place and information on the recurring themes which had emerged from them which included dedication and high levels of care, access to services, assessment of need and delivery of services.
The Committee was informed of the development of the Outline Business Case noting that feedback from the listening events had helped to inform the drivers for change that were required to be addressed by the improvement work being considered by the three Trusts.
The Committee raised their concerns at the low number of people who had been consulted and suggested that the listening events could have been better advertised. Whilst it was felt that input from staff had been excellent members questioned whether there was a sufficient amount of communication with service users to enable a decision to be made. Representatives of CPFT acknowledged those concerns, highlighting poor attendance at a number of events as being an issue but agreed to investigate this matter further.
The Committee emphasised concerns regarding future services in the south of the county highlighting the lack of engagement from Clinical Commissioning Group (CCG) colleagues. Members were informed that until a decision was made on mental health services in the south CPFT would continue to improve the quality of service currently provided. It was explained that CPFT had also raised their concerns but highlighted that the transfer of services was ultimately the decision of the appropriate CCG.
(1) the report be noted;
(2) a summary of the Outline Business Case be provided to the Committee when it is available.
To receive an update from Cumbria Partnership NHS Foundation Trust and North Cumbria University Hospitals NHS Trust (copy enclosed).
To provide the Committee with a progress update on the work and key elements of the strategic case developed by the Trust Boards.
The Committee considered a report on the potential merger between Cumbria Partnership NHS Foundation Trust and North Cumbria University Hospitals NHS Trust which provided an update on the proposals being developed by the Trust. Members were informed that the Programme was in the early phase of developing and reviewing a Case for Change.
Members noted that as part of the goal to deliver an improved health system, the two NHS Trusts were formally exploring the possibility of becoming a single organisation. It was explained this exploration was part of the wider Integrated Health & Care System (IHCS) solution to address longstanding and significant challenges in delivering high quality and sustainable healthcare across North Cumbria. The Committee noted that during 2017/18 both Trusts took significant steps to work in a more integrated and collaborative way in order to create a population health and wellbeing system, and as part of this work those two organisations had also been taking steps to share resource, expertise and capacity to maximise potential.
It was explained to the Committee that the proposed transaction was an opportunity to create a larger organisation that aimed to provide more robust and resilient services for patients across North Cumbria and other communities where services were commissioned to be provided by CPFT. The move was considered a ‘natural progression’ of the vision of the two organisations and broader system to join up healthcare for patients, and improve efficiency by reducing duplication and bureaucracy.
During the course of discussion concerns were raised about potential staff redundancies following the merge. Members were informed that no redundancies were expected when the two trusts merged explaining that some back office roles had already merged and natural staff turnover would help avoid any redundancies.
It was emphasised to the Committee that the proposed merger was purely about the management provision for current services provided by the two organisations, not changes in services provided to the population of Cumbria.
The Committee were informed that since their last update the programme team had continued engagement with local partners and regulators on a regional and national basis to move forward the development of the Trusts Strategic Case. It was explained that work had taken place with NHS Improvement (NHSI) as the regulator for both organisations, to confirm that there was broad support for such a change between the two provider organisations before investing further time and funds into developing a full Strategic Case.
Members noted that a Strategic Case for Change based on the merge of the Trusts had been developed and would be presented for formal approval at the Trust Boards. It was explained that as part of developing a Strategic Case the two organisations were developing plans for how, if approved, they would deliver the next stage of the process. This included wider communications and engagement plans with the patients, staff, the public and partners.
It was recognised that at the same time as exploring opportunities to merge the Trusts, consideration was also being given to ... view the full minutes text for item 50.
Digital Records Update
To consider reports by the Executive Director of Finance, Estates and Digital, Cumbria Partnership NHS Foundation Trust and University Hospitals of Morecambe Bay NHS Foundation Trust (copies enclosed).
The Committee considered a report on the progress that was being made on digitising records and improving system interoperability across the West North & East Cumbria Integrated Care System (ICS).
Members were informed that there had been a system-wide Informatics/Digital workstream in place within WNE Cumbria since early 2016. A draft Digital Strategy (covering the period 2017-2021) was developed collaboratively and signed off by the system-wide Digital Care Board – aligned with relevant national strategies, Cumbria’s Local Digital Roadmap, Informatics Pre-Consultation Business Case submission and Trust Informatics strategies. It was explained that this digital strategy aligned to the NHS England initiatives to embrace digitisation and took major steps towards its vision to “operate paperless at the point of care”. The importance of developing a consent model was highlighted.
The Committee was informed that the current Strategy was to be delivered by March 2021 and national funding would continue to be sought for it.
In conclusion, it was highlighted to the Committee that the collective digital aim was to provide clinical and corporate colleagues with the systems and equipment to work anywhere across the county in a seamless manner in order to provide the best possible outcomes for citizens. It was emphasised that integrated health and care could only be transformed through applying the right digital solutions to the right pathways of care and that the journey was underway through the identification and digitisation of manual processes. It was explained that the Trust was moving forward in connecting their related systems and would continue to seek national funding for digital to help the county and meet their vision.
Members discussed the key outcomes achieved noting that staff working in unscheduled care settings (such as A&E and minor injury units) now had access to information regarding vulnerable children and young people to enable them to help and protect them. It was explained that access was also available to GP records.
The Committee discussed patients taking ownership of their own records and how this could be encouraged. It was explained there was a big drive for patient held records, highlighting a number of different facets such as large records, where a decision would need to be made as to what could be kept to ensure a true and accurate record was created.
The reports outline what progress is being made on digitising records across the system and improving system interoperability. As well as a description of how current systems operate across the two health and case systems and the challenges this creates (financial and otherwise).
The Committee received a detailed report from the University Hospitals of Morecambe Bay NHS Foundation Trust which gave members an insight into the history of collaboration and planning of the health informatics agenda between NHS organisations in Morecambe Bay.
Members were informed that following the completion of an Electronic Patient Record (EPR) Optimisation Programme a new governance model was implemented for Informatics and Information, replacing the Clinical Design Authority and EPR Delivery Board with a Digital Strategy Board which had extended membership to include senior clinicians and managers from Morecambe Bay Clinical Commissioning Group to consider the following remit:
(a) Ensure the EPR system was fully functioning and safe for all users (in and out of hospital);
(b) Determining and delivering the agreed priorities for integrated health and social care technologies, particularly the hospital and GP interface;
(c) Determining and delivering the agreed priorities for self-care, including patient navigations and home monitoring.
The Committee noted that a Working Group had been established to identify ‘gaps’ in the EPR and to prioritse the EPR developmenet accordingly. It was explained that digital leaders within Bay Health and Care Partners were collaborating on a sixth version of the IT Strategy, which would span the local health system. The Strategy which was aligned with Regional and National strategy was based on five themes and was expected to be published before March 2019.
Members were informed that digitisation of patient records had started the journey some time ago with 80% of records for outpatients already electronic and patients records beginning to be digitised. It was explained that a pilot scheme was being undertaken with pregnant ladies who would have access to all their information on an APP rather than in a written format. It was emphasised that electronic records were being encouraged.
During the course of discussion concerns were raised regarding consent with regards to another body ie 3rd sector representative in ICCs requiring access. Members were informed that the recent introduction of General Data Protection Regulations (GDPR) had given greater flexibility to the sharing of information for the purposes of health and care but patient consent was still very much a key enabler. It was noted that advice was still being sought on this matter and it was anticipated an information sharing agreement would be in place within 12 months.
The Committee raised their concerns regarding discrimination against patients who were not digitally minded, failure in the system and security of information by allowing external access. Whilst recognising those concerns it was felt allowing patients to advocate their records would be positive and that digital inclusion would be valuable. It was explained that business continuity plans with investment in cyber security to ensure robust measures were in place.
Members welcomed the update but drew attention to the issues regarding the rurality of the county and the lack of access to broadband highlighting the necessity to work with providers to improve digitisation.
(1) the updates be noted;
(2) a further report ... view the full minutes text for item 51b
Date of Future Meeting
To note that the next meeting of the Committee will be held on Tuesday 26 February 2018 at 10.30 am at County Offices, Kendal.
It was noted that the next meeting of the Committee would be held on Tuesday 26 February 2019 at 10.30 am at County Offices, Kendal.