Venue: Conference Room A/B, Cumbria House, Botchergate, Carlisle, CA1 1RD
Contact: Lynn Harker Email: firstname.lastname@example.org
The Chair, on behalf of the Committee, welcomed Ms S Crawford, Carlisle City Council representative and Ms A Bradshaw Copeland Borough Council representative to their first meeting.
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.
The District Council representatives elected a Vice?Chair of the Committee from amongst their members.
RESOLVED, that Ms C McCarron?Holmes be elected Vice?Chair of the Committee for the ensuing year.
Apologies for Absence
To receive any apologies for absence.
An apology for absence was received from Mr D Blacklock, Chief Executive, Healthwatch Cumbria.
Membership of the Committee
To note any changes to the membership of the Committee.
The following permanent changes in membership of the Committee were noted:-
(1) Ms S Crawford had replaced Mrs J Riddle as the Carlisle City Council representative.
(2) Ms A Bradshaw had replaced Mr R Gill as the Copeland Borough Council representative.
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 14 May 2018 (copy enclosed).
RESOLVED, that the minutes of the meeting held on 14 May 2018 be agreed as a correct record and signed by the Chair.
To receive the minutes of the Cumbria Health Scrutiny Variation Sub-Committee held on 21 May 2018 (copy enclosed).
The minutes of the meeting of the Cumbria Health Scrutiny Variation Sub?Committee held on 21 May 2018 were noted.
To receive an update from North Cumbria University Hospitals NHS Trust (copy enclosed).
The Committee considered a report regarding the Potential Merger Between 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 ad NCUHT to explore opportunities to merge in order to form one NHS Foundation Trust.
Members were informed that the exploration of a potential merger was part of the wider Integrated Health and Care System solution to address longstanding and significant challenges in delivering high quality and sustainable healthcare across North Cumbria. The Committee were informed of the steps which had been taken to work in a more integrated and collaborate way in order to create a population health and wellbeing system.
The Committee noted that a Memorandum of Understanding which would be made available to members had been in place throughout 2017/18 which had enabled both Trusts Boards to work closely together through a Joint Framework. It was explained that since September 2017, both Trusts had shared a Chief Executive, a joint Executive Director Leadership Team and had appointed a Non-Executive Director to work across both organisations. In addition, from April 2018 the Trusts established aligned Board and Board Committee arrangements which supported fully joined up monitoring and assurance against delivery of key milestones and work programmes.
It was anticipated that the merged organisation would have the ability to:-
Ø deliver integrated services and longer term service sustainability for communities through agreed clinical, care and health and wellbeing strategies;
Ø continuously improve services by growing and retaining the workforce needed, enabled by a common culture of effective collective leadership;
Ø make the best use of limited resources: human resources, financial resources and leadership;
Ø address key gaps urgently in health and care, wellbeing, service quality and financial performance to achieve national standards and address regulatory concerns over specific areas of organisational viability.
Members questioned the meaning of ‘key gaps’ and were informed these included financial pressures and improvement of Delayed Transfers of Care. The Committee were informed that work was taking place as part of the integrated support services to reduce the deficit by looking at more efficient and effective ways of working. Members were informed that the work programme identified through the Success Regime was being developed alongside the financial plan to bring the system back to financial stability acknowledging that this would take a number of years. It was explained that a full financial analysis would be undertaken to ensure the chosen option could be developed in line with strategies.
The Committee were informed that the Trusts had been working closely with NHS Improvement in order to establish formal programme arrangements that would support the development of proposals. It was explained that NHS Improvement had a statutory role within the NHS to approve transactions such as mergers and acquisitions and when considering proposals, NHS Improvement would ensure that all legal requirements set out within the NHS Act 2006 and their own Transaction Guidance had been followed.
The Trusts ... view the full minutes text for item 21.
Cancellation of Operations
The Committee received a report from North Cumbria University Hospitals NHS Trust on Cancellation of Operations. The report outlined the definition of non?urgent cancelled operations, 28 day breaches and provided statistical information regarding the number of cancelled operations.
Members were informed that non-clinical cancellations were operations that were cancelled by the fault of the hospital and included:-
· ward beds unavailable
· surgeon/anaesthetist/theatre staff/nursing staff unavailable
· emergency cases in theatre
· lack of theatre time
· equipment failure
· critical care beds unavailable
· patient case notes unavailable.
The Committee noted the reasons for non-clinical cancellations and requested further information on the lack of availability of patients notes and equipment failure.
The Committee were informed that across all the key measures of cancelled operations the Trust had made significant improvements comparing 2016/17 to 2017/18. It was noted there was a 27% year on year reduction in the number of operations cancelled on the day for a non-clinical reason, a 27% year on year reduction where the patient was not offered another appointment within 28 days, 18 urgent operations cancelled in 2016/17 compared to six in 2017/18 and no operations cancelled for the a second time round in 2017/18 compared to two in 2016/17.
A discussion took place regarding any possible seasonal issues and members were informed that those trends did not compare year on year, it was usually due to how busy the hospital was. Members attention was drawn to the rise in quarter 4 which then fell in quarter 1 and it was explained this was due to unprecedented pressures on a number of acute hospitals throughout the country.
During the course of discussion it was highlighted to the Committee that the last winter pressures were one of the worst that had ever been seen and the Trust were undertaking a lessons learnt analysis to seek to improve services next winter.
A question was raised regarding the number of cancelled operations for individual consultants and the Committee were informed that this data was not monitored.
Members requested that comparisons with national average figures be made available to the Committee in future.
(1) the report be noted;
(2) a breakdown of the causes of cancelled operations be provided direct to the Committee;
(3) national comparisons be made available to members in future reports.
(copy to follow).
The Committee received a report which outlined performance against the national headline 28 Day Cancellation Standard and local total Last Minute Cancelled Operations standard, benchmarked performance and the causes, implications and actions to resolve.
Members were informed that at 1.46% of patients not being offered a date within 28 days of a last minute cancellation, UHMBFT was the second best performer within the peer group in treating patients within 28 days of a last minute elective cancellation.
The Committee were informed that UHMBFT performance against the internal standard of last minute cancellations equating to no more than 0.8% of total theatre cases carried out in a month explaining that the spike in May 2018 related directly to the surge in trauma demand.
A discussion took place regarding the causes of last minute cancellations which included ward or critical care beds unavailable; surgeon, anaesthetist or theatre staff unavailability or sickness; running out of theatre time; administrative errors; cases overrunning for time; emergency case needing theatre; equipment failure; administrative error; anaesthetist unavailable; theatre staff unavailable and excess Trauma demand requiring theatre. It was explained that in the past three months, March to May 2018, the top 3 reasons for last minute cancellations were; lack of time in theatre, the demand of Trauma cases and the lack of a surgical bed available immediately following surgery.
The Committee discussed the lack of availability of patient cases and were assured that this was being investigated to ensure that correct processes and procedures were being followed to eliminate this issue.
Members noted the actions which were in place to maximise theatre throughput and reduce the potential for last minute cancellations. The Committee noted that one of the actions included maximisation of the theatre capacity across the three main sites, including the trial of the higher dependency, ASA 3 patients to be treated at Westmorland General Hospital (WGH) during the week commencing 23/07/18. It was agreed to provide feedback to the Committee on the outcome of that trial.
(1) the report be noted;
(2) Committee receive feedback on the outcome of the trial of the higher dependency, ASA 3 patients to be treated at Westmorland General Hospital.
To consider a report by University Hospitals of Morecambe Bay NHS Foundation Trust (copy enclosed).
To advise the Committee on engagement activity undertaken, the outcome and planned next steps.
The Committee considered a report from the University Hospitals of Morecambe Bay NHS Foundation Trust which gave an update on the Better Care Together Communications and Engagement Plan highlighting this was not a paper exercise.
Members noted that in December 2017 Bay Health & Care Partners (BH&CP) had approved, via its Sustainability Board, an Engagement and Communications Strategy: ‘The Hard Truths - The Big Conversation’ Programme. It was explained that the programme of work was to start a conversation with a number of key audiences highlighting this was not a consultation or pre-consultation engagement nor was it formal pre?engagement with local authorities as was required for any proposed service change.
The Committee were informed a Consultation plan for any proposed service change had not been constructed but it was envisaged that a 6-9 month period following a pre-consultation engagement process would be required. It was explained the initial programme of work could contribute towards pre?consultation engagement.
Members noted that prior to the launch of the engagement exercise a meeting had taken place which involved Healthwatch and approximately 40 invited members of the public who represented local interest groups or bodies and presented the hard truths with feedback sought from them on the language being used and whether the message was understood.
The Committee were informed that Healthwatch Cumbria and Lancashire were commissioned to undertake a listening exercise with members of the public across the Morecambe Bay area. It was explained that the Method chosen was to utilise the Healthwatch ‘chatty van’ and an on?line survey which ran from 26 February to 18 March. Healthwatch also developed a survey and produced a report capturing its results which were made available to members. It was noted that during the period of engagement Healthwatch had spoken to 655 people, received 222 online responses and in excess of 200 cards had been completed.
The Committee raised their concerns regarding the locations visited by the ‘chatty van’ and were disappointed at the lack of visits to rural areas. A general discussion took place regarding the lack of communication with the rural areas and the enormous challenges and it was acknowledged that improvement was required. It was suggested that town and parish councils should also be contacted with a view to improving communications.
Members drew attention to the pressures which GPs in rural communities were experiencing. It was acknowledged that health care services had to be more accessible highlighting an advice and guidance process which was in place to allow GPs to seek advice from specialist clinicians to reduce the number of patients having to travel to appointments. Members also noted that a video conferencing facility, as well as virtual reality by a GP in the Barrow area, was also being piloted.
During the course of discussion a member raised an issue regarding self care and the air pollution in urban areas. The Committee were informed that the issue of air pollution was being addressed through the public health agenda.
A discussion ... view the full minutes text for item 23.
To consider a report by the Chief Executive, NHS North Cumbria Clinical Commissioning Group (copy enclosed).
The Committee received an update on the progress made following the Healthcare For the Future Consultation.
Members were also informed that the North Cumbria area had been included in the next national phase of Integrated Care Services with the potential for additional resources to be made available from Central Government.
(1) Stroke Services
Members were informed that plans to modernise and improve the care provided to stroke patients by developing a Hyper Acute Stroke Unit (HASU) was underway with the ambition to have the Unit open in early 2019. It was highlighted that 24/7 treatment in the acute phase of a stroke had been proven to improve mortality and reduce long term disability. It was noted that at present there were two five day a week services at the West Cumberland Hospital and Cumberland Infirmary with stroke rehabilitation and post?stroke services at both sites.
A discussion took place regarding the revised anticipated opening date of early 2019 for the Unit highlighting this had originally been Autumn 2018. The clear commitment to open the Unit was emphasised to members but the three challenges which had caused delays were highlighted as being appropriate clinical workforce, physical space and location of the Unit in the hospital and access to the appropriate diagnostics, most importantly, the CT scanner. Members were informed those challenges were currently being mapped out in anticipation of the 2019 opening of the Unit. It was emphasised that until those issues were resolved there was commitment to continue the current service at the West Cumberland Hospital.
The Committee noted the opening of the new Unit would mean all potential stroke patients would initially be brought to the Unit at Carlisle where they would have access to a specialist stroke team made up of consultants, nurses and therapists 24 hours a day 7 days a week. It was explained that admission to the Unit was likely to be for a maximum of 72 hours at which point the patient could be discharged home, or if additional further support was required and they were from West Cumbria, they could be transferred to the West Cumberland Hospital with patients from the north of the county remaining in Carlisle.
Members queried the transfer of patients to the West Cumberland Hospital after 72 hours. It was explained the decision would always be based on a clinical judgement of the individual patient based on their best clinical interest.
The Committee raised their concerns that a dedicated ambulance vehicle to transfer stroke patients from West Cumbria to Carlisle was not part of the NHS Masterplan. The Chief Operating Officer confirmed that this was not included in the Plan highlighting that the infrequent use of the vehicle would not be a good use of resources.
The Committee noted that considerable work had been undertaken alongside the work to develop a HASU to ensure that robust Early Supported Stroke Discharge (ESSD) teams supported patients at home, or closer to home, more quickly which was in line with national best ... view the full minutes text for item 24.
To consider a report by the Strategic Policy and Scrutiny Adviser (copy enclosed).
The Committee received a report from the Strategic Policy and Scrutiny Adviser which updated members on developments in health scrutiny, the Committee’s Work Programme and monitoring of actions not covered elsewhere on the agenda.
Members raised their concerns regarding the non attendance of any Barrow Borough Council representative at any Committee meetings during the last 18 months. It was agreed that the Chair would write to Barrow Borough Council to express the concerns of the Committee.
The Committee were informed of the proposal to relocate the DEXA scanning service from the rheumatology clinic at the Royal Lancaster Infirmary to Westmorland General Hospital. It was explained that as this was a proposal which affected both Cumbria and Lancashire it could not be considered by the Cumbria Variation Sub?Committee. Members noted that the first step would consist of a meeting between the Chairs of the Cumbria Health Scrutiny Committee and the Lancashire Health Scrutiny Committee to discuss the proposal and agree whether to convene the Joint Cumbria and Lancashire Health Scrutiny Committee.
Members received an update on the Joint Health and Adults Scrutiny Advisory Group and it was agreed the actions notes would be circulated to members of the Cumbria Health Scrutiny Committee and Scrutiny Advisory Board – Adults.
The Committee received a positive verbal update from the Chair on the Mental Health Service Stakeholder Group. She explained the vibrant Group were keen to work on shaping services.
Members requested an update from the 0-19 Task and Finish Group and were informed this was still outstanding but would be investigated by the Strategic Policy and Scrutiny Adviser.
Further to a meeting of the Committee on 14 December 2017 members were informed that details on the agreed 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 would be circulated to members.
(1) Ms S Crawford be appointed as the Committee’s Carlisle area representative on the Cumbria Health Scrutiny Variation Sub?Committee;
(2) the Chair write to Barrow Borough Council to express concern that their representative has not attended a Committee meeting for 18 months and no substitute has been provided;
(3) the action notes from the Joint Health and Adults Scrutiny Advisory Group be circulated to members of the Cumbria Health Scrutiny Committee and Scrutiny Advisory Board – Adults;
(4) the update on the Mental Health Service Stakeholder Group be noted;
(5) following review of the existing Work Programme the following be added for discussion at the October meeting of the Committee:-
(a) North Cumbria University Hospitals NHS Foundation Trust and Cumbria Partnership Foundation Trust Workforce Plan be considered as part of the report on the examination of the strategic case for potential merger;
(b) Delivery of 40-70 age health checks;
(6) Medical Records Update be added to the Work Programme for a consideration at a future meeting.
Joint Health and Adults Scrutiny Advisory Group Update
To receive a verbal update by the Strategic Policy and Scrutiny Advisor (copy enclosed).
This item was discussed at minute no 25 – Committee Briefing Report.
Date of Future Meeting
To note that the next meeting of the Committee will be held on Monday 8 October 2018 at 10.30 am at County Offices, Kendal.
It was noted that the next meeting of the Committee would be held on Monday 8 October 2018 at 10.30 am at County Offices, Kendal.