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.
Apologies for absence were received from Ms A Bradshaw, Mr M Cassells, Mrs S Crawford 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) Ms H Horne declared a pecuniary interest as she was a member of Healthwatch England Committee which was a Sub?Committee of the Care Quality Commission.
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 18 December 2018 (copy enclosed).
RESOLVED, that the minutes of the meeting held on 18 December 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 the developments in health scrutiny, the Committee’s Work Programme and monitoring of actions not covered elsewhere on the Committee’s agenda.
Members noted that a formal meeting of the Joint Cumbria and Lancashire Health Scrutiny Committee would take place on 26 March to consider the Better Care Together Work Programme for the next 12 months. It was highlighted that the existing Committee only scrutinised changes to Health Services for the Morecambe Bay area.
Members were informed that following the formation of 44 Sustainability and Transformation Partnerships (STPs) in 2016 covering the whole of England, in some areas, including Lancashire and South Cumbria those partnerships had evolved to form an Integrated Care System (ICS). It was explained that since then there had been an impending need to establish a Joint Health Scrutiny Committee between the two county councils and two unitary authorities within the Lancashire and South Cumbria footprint.
The Committee noted that Lancashire County Council was taking the lead on establishing the Joint Committee and, at this stage, the Cumbria Health Scrutiny Committee was asked to recommend that the Chair of the Committee liaise with the Chair of the Lancashire Health Scrutiny Committee and the Steering Group which was developing the terms of reference.
A concern was raised regarding the voice of rural Cumbria being lost as the predominance of members of the Joint Committee would be drawn from urbanised areas. Whilst this was acknowledged the importance of the Cumbria Health Scrutiny Committee being fully engaged in the development of the Joint Committee was also highlighted.
Members were informed that the next meeting of the Joint Advisory Group would take place on 12 April and would focus on Population Health Management Models which were being developed in the North and South Systems.
Members noted that the Committee would receive the Quality Accounts for each Trust at their next meeting. A discussion took place regarding the mechanisms for a response. Members were informed that Healthwatch Cumbria were engaging with Lancashire to investigate this and it was agreed more information on this would be made available to the Cumbria Health Scrutiny Committee.
(1) the report be noted;
(2) the Chair of Cumbria Health Scrutiny Committee be invited to the Lancashire Health Scrutiny Steering Group;
(3) the following items be added to the existing Work Programme:-
(i) Orthodontics in South Cumbria;
(ii) Digital Records Update.
To consider a report by the Chief Operating Officer, NHS North Cumbria Clinical Commissioning Group (copy enclosed).
The Committee considered a report from NHS North Cumbria Clinical Commissioning Group which provided an update on the progress made following the Healthcare For the Future Consultation.
(1) Maternity and Paediatrics
The Committee were informed that currently there were no changes to consultant?led maternity services and that work was continuing to establish transitional care.
Members were informed that the latest maternity survey published by the Care Quality Commission (CQC) in January 2019 had indicated that women who gave birth in north Cumbria last year felt they were treated with dignity, respect and kindness.
The Committee noted that the survey for North Cumbria University Hospitals NHS Trust (NCUH) covered the three maternity departments at the Cumberland Infirmary, Carlisle; West Cumberland Hospital, Whitehaven; and the birthing centre at Penrith Community Hospital. It was explained that the Trust had performed better than the national average for feeding and home care after birth as well as for 13 other questions. Members were informed that for the remaining questions the Trust performed about the same as the national average and did not score below average in any areas
The Committee was then informed that the Short Stay Paediatric Assessment Units (SSPAU) were working well on both sites and that positive feedback had been received from both staff and service?users.
Members noted that currently there was no change to overnight beds at the West Cumberland Hospital and that SSPAUs would continue to develop when the necessary resources were in place.
The Committee noted that following agreement in March 2017 by the CCG Governing Body for a 12 month review of progress regarding sustainability of consultant?led services as part of its decision?making process the review period had started on 1 April 2018 and would end on 31 March 2019. It was explained to members that the process of reviewing data would continue for some time after this date. It was noted that members of the Implementation Reference Group (IRG) had met several times and reviewed staffing, progress in recruitment and the Alongside Midwifery?Led Unit (AMLU) audit.
A discussion took place regarding the outcomes of an assessment of risk associated with distance. It was explained that a report had been commissioned by an external organisation to assess evidence regarding distance travelled and birth outcomes. Members noted this had been delayed but would be considered by the IRG in the first instance.
It was explained to members 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 admitted to the West Cumberland Hospital.
Members were informed it was anticipated the IRG would complete its review of data collected to the end of March with recommendations in May or June ready for consideration by the public CCG Governing Body meeting in June or August 2019.
It was agreed that once the Independent Review Group had published its findings and recommendations these would be made publically available in accordance with ... view the full minutes text for item 59.
To receive a presentation from North Cumbria University Hospitals NHS Trust (copy enclosed).
This report provides an update on the implementation of North Cumbria Primary Care Ltd (GP Alliance).
The Committee received a presentation on North Cumbria Primary Care (NCPC), a new not for profit model for primary care in which GPs became salaried, with surpluses reinvested with patients and the third sector joining the Partnership Board.
The Committee were informed that a small team of four, funded by the Trust, had been established to set up the model. Members raised their concerns regarding the lack of resources.
During the course of discussion the Chief Executive of Healthwatch Cumbria suggested that he contact NHS England highlighting the need for funding for additional resources.
The Committee were informed that the non for profit model would have strong financial control and clinical governance. It was explained that surpluses would be invested to improve patient care and support staff with the Partnership Board including nurses, third sector, patient and manager representatives. Members noted that staff would transfer under TUPE regulations. It was emphasised that the model had been legally protected to ensure that it could not be sold off in the future.
Members highlighted the increasing use of the third sector and emphasised the need for good co?production to be supported. The Committee drew attention to the need to ensure that the third sector were supported, suggesting that they at least be afforded expenses to cover their costs. Officers agreed with the concerns of members but highlighted the lack of financial support at present.
Members were informed that a partnership was made up of the practices themselves, UCLAN medical school, Cumbria Health on Call, local NHS Trusts, patients and the third sector. It was explained that to date 13 practices had expressed an interest with more showing an interest.
A discussion took place regarding the structure and the Committee noted that the NCPC was constructed with two GPs as shareholders which gave it the ability to hold GMS contracts and NHS pensions. It was explained that the aim was to increase the numbers of shareholders to GPs from each locality. A discussion took place regarding the Shareholders Agreement and it was agreed to share this in confidence with the Committee.
A discussion took place regarding the risks of a monopoly in Cumbria and members were informed that they were not opposed to competition. It was explained that there would still be a mixed model in North Cumbria for the foreseeable future as not all practices had expressed an interest in moving to the new model.
The Committee noted the reasons for the NCPC included:-
Ø Developing a multi-speciality multi-disciplinary model of primary care.
Ø Improving patient care access and experience.
Ø Improving staff experience and morale.
Ø Creating the ability to work at scale.
Ø Developing workforce model at scale.
Ø Recruiting young doctors.
Ø Strengthening the patient voice.
A discussion took place regarding the strengthening of the patient voice and members were informed that the model had been shared with patient groups and that they had a formal seat on the Strategic Partnership Board. It was explained that the model ... view the full minutes text for item 60.
To consider a report by North Cumbria University Hospitals NHS Trust (copy to follow).
This is the North Cumbria University Hospitals NHS Trust Care Quality Commission report together with the Trust’s Action Plan.
The Committee received a presentation from North Cumbria University Hospital NHS Trust (NCUHT) giving an update on the Care Quality Commission.
Members noted that following an inspection of NCUH in 2018 there had been 29 ‘must do’ actions and 51 ‘should do’ actions identified. It was explained that care groups were actively engaging in the progression of the actions raised by the CQC with each care group developing a Quality Improvement Plan (QIP) which were incorporated into a wider Trust QIP that would ultimately feed into the Trust?wide objectives.
The Committee were informed of the joint governance arrangements which included improvements being managed by care groups, with support around progress through monthly meetings with care groups and leads which were chaired by the Executive Systems Chief Nurse and Interim Chief Operating Officer.
Members noted that the new joint Trust CQC assurance processes were being rolled out during February 2019 and would utilise annual external peer reviews, internal quarterly self?assessment, 4?6 weekly department checklists and a re?launch of the weekly 15 Steps programme with all assurance activity reported to the Joint Compliance Board.
The Committee welcomed the areas of improvement but raised their concerns regarding the urgent and emergency services. It was suggested that future reports include a RAG rating to show improvements required were being actioned.
During the course of discussion a member raised her concerns regarding staff reporting. It was highlighted that following this being raised at a joint annual general meeting last year it had been agreed to invite Derek Eland, whose work examines the human condition particularly in stressful and challenging situations, to a future meeting but, to date, this had not taken place. It was agreed that this would be investigated.
The Committee were informed that there was a ‘Freedom to Speak Up’ policy in place and all staff were encouraged to use this. Whilst officers acknowledged the enormous pressures which staff were under during the winter months they raised their concerns regarding staff feeling they could not speak up about issues. It was agreed that the comments would be fed back the Trust’s Executive Team.
A discussion took place regarding the recent experiences of an in?patient at the Cumberland Infirmary, Carlisle and it was agreed this would be investigated further.
(1) a detailed spreadsheet outlining the progress made against each of the ‘must dos’ be circulated to the Committee;
(2) concerns regarding staff reporting be raised at the Trust’s Executive Board.
To receive an update from Cumbria Partnership NHS Foundation Trust and North Cumbria University Hospitals NHS Trust (copy enclosed).
The Committee considered a report from the Cumbria Partnership NHS Foundation Trust (CPFT) and North Cumbria University Hospitals NHS Foundation Trust (NCUHT) on the potential merger of the Trusts.
Members were informed that in the last 12 months, the trusts had joined up more care they provided to patients and the way it was delivered behind the scenes. It was explained this was already proving to be positive for patients and a more efficient and cost effective way of working.
The Committee noted that to be able to fully join up future works and secure the long term future of health and care services for the population they served, the two trusts were proposing to formally merge into a single organisation.
It was explained to members that this was a necessary part of wider plans to join up all of health and care services across north Cumbria and beyond. It was noted that North Cumbria was already one of 14 national integrated care systems and was working as part of the larger aspirant north Cumbria and north east integrated care system. It was highlighted that this way of working had been endorsed nationally in the newly published NHS Long Term Plan which set out integration as one of the requirements to drive an NHS fit for the future.
The Committee were informed that the boards of both trusts had approved the ‘strategic case for the proposed merger’ on 20 December 2018. A business case had been submitted to NHS Improvement as the regulator responsible for approving the merger, with the support of the main commissioners of the two Trusts – NHS North Cumbria Clinical Commissioning Group (NCCCG) as well as the NHS North Cumbria System Leadership Board. It was explained that the ambition was to approve a full business case by June 2019 with a view to the merger taking place on 1 October 2019.
Members were informed that at the same time as planning to merge, CPFT was preparing to transfer the provider of mental health services in the county to larger, more specialist mental health trust(s). It was felt important that this work took place at the same time to ensure that the organisations delivering health and care services in north Cumbria continued to be viable.
Members welcomed the report but concerns were raised regarding the risk levels of failure of trusts as a potential concern for local authorities. The concerns of associated risks, including financial pressures and performance targets was acknowledged and it was explained that a risk register had been developed for the potential merger that identified key risks. It was explained that this would be managed by the Programme Team and reviewed regularly by the Executive Scrutiny Group.
The Committee raised particular concerns regarding the south of the county and it was acknowledged that work was still required. Members emphasised the need to ensure that patients in both the north and south of the county received the same quality of service when they were transferred. ... view the full minutes text for item 62.
To consider a report from NHS England (copy enclosed).
This report provides information from NHS England as the Commissioner of Cancer Services on where improvements can be driven into the systems.
The Committee considered a report on cancer care in north Cumbria. Members were informed that cancer was a priority in North Cumbria with a goal of increasing cancer survival rates by reducing inequalities, delivering the best possible outcomes for every patient affected by cancer and the best possible patient experience.
Members were informed that the key feature of the demographic profile for north Cumbria was the proportion and future growth of the population aged over 65 years. It was explained that across Carlisle, Eden, Copeland and Allerdale districts there were almost 14,500 more people over 65 years of age living in Cumbria when compared to the England age profile. It was emphasised that a sustainable solution was needed to address the fact that Cumbria had a ‘super-ageing’ population, whose health concerns would only become more complex in the coming years. It was anticipated that by 2020, nearly 25% of the North Cumbria population would be aged over 65 which would impact on the demand for health care services.
The Committee were informed that currently there were approximately 2,450 new cases of cancer diagnosed every year within North Cumbria, 20% higher than the rest of the country. It was explained that, in conjunction with this, the number of emergency presentations of cancer was 108 for every 100,000 people, which again, was significantly higher than the rest of the country, although it was emphasised that the proportion of early deaths from cancer was comparable to the rest of England.
Members noted that smoking was the single biggest contributor to avoidable cancers, but overweight, excess alcohol consumption and lack of exercise were also contributors.
A discussion took place regarding screening and members were informed that participation within the region was higher than the national average. Whilst members acknowledged the uptake on screening they felt that active encouragement was still required. Officers appreciated there was room for improvement with regards to screening, highlighting in particular vulnerable groups and those areas in Cumbria which had higher cancer mortality rates. It was explained that it was anticipated screening programmes would be available as part of ICCs.
The Committee raised its concerns regarding higher mortality rates in deprived areas and members highlighted the need for engagement to take place to promote screening programmes and reduce disparities. It was explained that the longer term endeavour for ICCs was to shift population health to change lifestyle, highlighting the need to get ahead of demand. Members noted that this was also being considered as part of the Population Health Framework which would be considered by the Cumbria Health and Social Care Working Group.
During the course of discussion concerns were raised regarding the south of the county and it was felt that a fifth element should be added to the Public Health Strategy to include data.
The Committee then received an update on the cancer centre and were informed that NCUHT intended to build a modern, state of the art, cancer facility at the Cumberland Infirmary, Carlisle which would serve ... view the full minutes text for item 63.
Date of Future Meeting
To note that the next meeting of the Committee will be held on Wednesday 22 May 2019 at 10.30 am at County Offices, Kendal.
It was noted that the next meeting of the Committee would be held on Wednesday 22 May 2019 at 10.30 am at County Offices, Kendal.
Members were informed that this would be the last meeting of the Committee that Gina Tiller would attend in her capacity as Chair of the North Cumbria University Hospitals NHS Trust.
The Chair, on behalf of the Committee, thanked her for her contributions and wished her well for the future.