Agenda and minutes

Cumbria Health Scrutiny Committee - Thursday, 14th December, 2017 10.30 am

Venue: Conference Room A/B, Cumbria House, Botchergate, Carlisle, CA1 1RD.

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

Items
No. Item

Mr I Douglas, Manager of Core Services (Cumbria Deaf Association), Ms J Parr, Project Manager and a number of people representing the deaf community attended for item 8 – Access to Health Services for Service Users with Hearing Loss (minute 29 refers).

 

22.

Apologies for Absence

To receive any apologies for absence.

 

Minutes:

Apologies for absence were received from Mr M Cassells, Mr R Gill and Mr S Wielkopolski.

 

23.

Membership of the Committee

To note any changes to the membership of the Committee.

 

Minutes:

It was noted that Mr M Wilson had replaced Mr M Hawkins as a member of the Committee on a permanent basis.

 

24.

Disclosures of Interest

Members are invited to disclose any disclosable pecuniary interest they have in any item on the agenda which comprises

 

1.         Details of any employment, office, trade, profession or vocation carried on for profit or gain.

 

2.         Details of any payment or provision of any other financial benefit (other than from the authority) made or provided within the relevant period in respect of any expenses incurred by you in carrying out duties as a member, or towards your election expenses.  (This includes any payment or financial benefit from a trade union within the meaning of the Trade Union and Labour Relations (Consolidation) Act 1992.

 

3.         Details of any contract which is made between you (or a body in which you have a beneficial interest) and the authority.

 

            (a)       Under which goods or services are to be provided or works are to be executed; and

 

            (b)       Which has not been fully discharged.

 

4.         Details of any beneficial interest in land which is within the area of the authority.

 

5.         Details of any licence (alone or jointly with others) to occupy land in the area of the authority for a month or longer.

 

6.         Details of any tenancy where (to your knowledge).

 

            (a)       The landlord is the authority; and

 

            (b)       The tenant is a body in which you have a beneficial interest.

 

7.         Details of any beneficial interest in securities of a body where

 

            (a)       That body (to your knowledge) has a place of business or land in the area of the authority; and

 

            (b)       Either –

 

(i)                 The total nominal value of the securities exceeds £25,000 or one hundredth of the total issued share capital of that body; or

 

                        (ii)        If that share capital of that body is of more than one class, the total nominal value of the shares of any one class in which the relevant person has a beneficial interest exceeds one hundredth of the total issued share capital of that class.

 

Note

 

A “disclosable pecuniary interest” is an interest of a councillor or their partner (which means spouse or civil partner, a person with whom they are living as husband or wife, or a person with whom they are living as if they are civil partners).

 

Minutes:

Mr C Whiteside declared a personal interest as his wife was employed at the West Cumberland Hospital.

 

25.

Exclusion of Press and Public

To consider whether the press and public should be excluded from the meeting during consideration of any item on the agenda.

 

Minutes:

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

 

26.

Minutes pdf icon PDF 123 KB

To confirm the minutes of the meeting held on 9 October 2017 (copy enclosed).

 

Minutes:

The following amendments were noted:-

 

(1)       page 13 (minute 17 – Healthcare for the Future Update) – the last three words on the fourth paragraph should read ‘major structural impact’ and not ‘major structure’;

 

(2)       page 16 (minute 18 – Cumbria Adult Age Mental Health Update) – the first line of the seventh paragraph should read ‘Partnership’ and not ‘partnership’;

 

(3)       page 17 (minute 19 – Organisational Leadership of Community Services in the Bay Area) – the first line of the second paragraph should read ‘Together’ and not ‘Trust’.

 

RESOLVED,     that with the inclusion of the above amendments the minutes of the meeting held on 9 October 2017 be agreed as a correct record and signed by the Chair.

 

27.

Cumbria Health Scrutiny Variation Sub-Committee pdf icon PDF 52 KB

To receive the minutes of the Cumbria Health Scrutiny Variation Sub-Committee held on 10 November 2017 (copy enclosed).

 

Minutes:

RESOLVED,     that the minutes of the Cumbria Health Scrutiny Variation Sub?Committee held on 10 November 2017 be noted.

 

28.

Cumbria Health Scrutiny Variation Sub-Committee - Terms of Reference pdf icon PDF 55 KB

To consider a report by the Corporate Director – Resources and Transformation (copy enclosed).

 

Additional documents:

Minutes:

The Committee considered a report from the Corporate Director – Resources and Transformation which revised the Terms of Reference for the Cumbria Health Scrutiny Variation Sub?Committee.

 

RESOLVED,     that the revised Terms of Reference (referred to in Appendix 1 of the report) be agreed.

 

29.

Access to Health Services for Service Users with Hearing Loss

29a

Healthwatch Cumbria pdf icon PDF 351 KB

To consider a report by Healthwatch Cumbria (copy enclosed).

 

Additional documents:

Minutes:

The Committee received an update from the Chief Executive, Healthwatch Cumbria on Improving Access to Health Care Services for Deaf Patients in Cumbria. 

 

Members noted that in 2015, Healthwatch Cumbria (HWC) supported the Deaf Health Champion Project to highlight issues affecting the Deaf community when accessing health and social care services.  It was explained the project was designed to explore the extent to which access to GP surgeries and hospitals along with problems with poor communication resulted in unsatisfactory patient experiences.

 

The Committee were informed that the project focused on the profoundly Deaf, whose first language was British Sign Language (BSL) and were defined as Deaf with a capital ‘D’; deaf people with a lower case ‘d’ were those who had once had full hearing but now had reduced hearing.

 

It was explained that during the research HWC learned from members of the Deaf support groups that there were no up?to?date definitive numbers available of exactly how many Deaf people were living in Cumbria, however, an estimated figure was around 450.

 

The Committee noted that the final report provided the following recommendations:-

 

Ø   GP and hospital services should offer SMS text messaging service for Deaf patients to book appointments, receive reminders of their appointments and receive test results.

 

Ø   Service providers should ensure that Deaf patients had an equitable service by one or more of the following:

 

Ø   a member of staff was BSL trained;

Ø   service providers include Deaf Awareness training as part of their induction programme.  This should be in conjunction with a recognised organisation (such as Cumbria Deaf Vision);

Ø   deaf awareness training for staff member(s) should be reviewed annually.

 

Ø   Deaf patients to be treated with the same respect & dignity as hearing patients.  This to be carried out to meet the CQC Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 10.

 

Ø   A need for visual aids, number systems or vibrating pens/pads in waiting areas to inform patients when it is their turn.

 

Ø   Waiting areas to have Deaf appropriate information/literature available.

Ø   Reception staff to be trained or have written instructions of how to book recognised Qualified and Insured Interpreters.  When an interpreter was not available, then the use of recognised online interpreter services should be prioritised.  Interpreter names, addresses and contact number should be clearly visible in waiting areas.

 

Ø   Service providers should still book an interpreter when a Deaf patient refused the services of a recognised interpreter to safeguard themselves from any misunderstandings by either party.

 

Ø   All service providers should have a policy on how to support Deaf patients (a copy of guidelines on supporting Deaf patients can be accessed from Cumbria DeafVision).

 

The Committee were informed that the HWC project was carried out in 2015 and the report was presented in 2016 to their contact, the lead for Deaf Health Champion Project (DHC), who agreed its final content and advised its publication on their website.  However, the Project had closed on 24 December 2015, therefore,  ...  view the full minutes text for item 29a

29b

Cumbria Deaf Association pdf icon PDF 183 KB

To consider a report by Cumbria Deaf Association (copy enclosed).

Additional documents:

Minutes:

Members received a report and informative presentation from the Cumbria Deaf Association regarding the challenges faced by Cumbria in meeting the health needs of the deaf community. 

 

The Committee were given an update on:

 

Ø   The scale of the problem: identifying people with hearing loss.

Ø   Key themes: Health and access matters

Ø   Tackling the problems: What are the solutions.

 

It was highlighted to members that growing a population system would:-

 

Ø   Improve the experience of care for deaf children, young people, adults and their families and carers.

Ø   Support professional development.

Ø   Raise standards and promote equity.

Ø   Manage the complexity of provider and commissioning systems.

Ø   Manage the increase in demand on services.

Ø   Effective advocacy.

Ø   Provide a strategic framework for service development.

 

The Committee’s support was requested to the following solutions:-

 

Ø   Strategic: Create a working party.

Ø   Skills: Address the skills shortage.

Ø   Innovation: Invest in online technology.

Ø   Participation: Consult, engage and know the population.

Ø   Communication: Ensure information is accessible.

Ø   Children and Young People: Further expand the role and influence of the Children’s Hearing Services Working Group.

 

In conclusion:-

 

Ø   There was a need to know the deaf community population to identify the problem.

Ø   It should be noted that the key themes for deaf people at all life stages continued to be barriers around Health and Access.

Ø   There was a need to address the wish list of actions set out in the report to address the needs of more than 113,000 Cumbrian people.

 

During the course of discussion it was highlighted that only three British Sign Language Interpreters were available for the whole of the county.  The lack of provision of an interpreter by the County Council at this meeting was highlighted as an example of the problems which they incurred.  It was noted that the Cumbria Deaf Association had two British Sign Language interpreters and they had provided the service for this meeting. 

 

The deaf community representatives highlighted the high costs and time?commitment involved in becoming a qualified BSL Interpreter.  It was explained there were a number of individuals who had the necessary skills but the costs deterred them from becoming qualified. 

 

The Committee noted that people with severe/profound hearing loss were not able to access information in the traditional manner.  It was explained that currently Deaf people, whose first language was British Sign Language, may not be able to understand information in written English.  As a consequence Deaf people were unaware of important health guidelines, and there was evidence this doubled the incidence of diabetes, high blood pressure and obesity with that of hearing people.  It was felt that the provision of customised information, as outlined in NHS England’s Accessible Information Standard, would facilitate early intervention and encourage healthy lifestyles, reducing the requirement for more critical health intervention. 

 

Members then heard a number of personal experiences by individual members of the deaf community which highlighted the following concerns:

 

Ø   The lack of direct communication during hospital visits  ...  view the full minutes text for item 29b

30.

HealthCare for the Future of West, North and East Update pdf icon PDF 221 KB

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

 

Minutes:

The Committee received a report from the Chief Executive, NHS North Cumbria Clinical Commissioning Group which updated members on the progress since the decisions were made following the Healthcare for the Future Consultation.

 

Members attention was drawn to a recent letter which had been received from the North Cumbria Clinical Commissioning Group following correspondence from the Secretary of State for Health regarding the referral from the Committee in relation to Maternity Services in West, North and East Cumbria.

 

The letter stated:

 

            ‘On behalf of NHS North Cumbria Clinical Commissioning Group (CCG) we were pleased that the Independent Reconfiguration Panel recognised the ongoing efforts to deliver Option 1, and the ongoing commitment to co-production with local communities and stakeholders.  The Independent Reconfiguration Panel specifically noted the importance of an ongoing engagement with the Cumbria Health Scrutiny Committee.  The CCG welcomes this recognition and we confirm our commitment to continue to work constructively with the Committee.  We would like to take the opportunity to meet with you, and as you judge appropriate further Members of the Committee, to discuss how we can most effectively work with the Committee through the next phase.

 

            We recognise that some members of the Committee, and indeed some members of the local communities and stakeholders, will be disappointed by the outcome of the referral.  We would like to discuss with you how the CCG can reasonably provide assurance to the committee and broader stakeholders as part of our ongoing engagement.

 

            We also want to confirm that we will carefully consider the whole content of the Independent Reconfiguration Panel Report.  Specifically, we note and welcome the view from the Panel that the timescale of the planned twelve month review period will need to be considered carefully, and not act as an arbitrary date.  For clarification, the twelve month review period has not yet begun, and we are giving careful attention to commencement of the review period.

 

            We also note that there may have been some misunderstanding, or insufficient clarity in communication, relating to the decision the then NHS Cumbria CCG Governing Body made on 8 March 2017.  We would like to take this opportunity to provide further clarity, and to restate three important commitments.

 

            Firstly, we have consistently confirmed our commitment to deliver Option 1, providing this could be delivered on a safe and sustainable basis.  We welcome the Independent Reconfiguration Panel Report in recognising the importance of the work undertaken so far and the very clear encouragement that all efforts should be made to succeed in this objective.

 

            Secondly, we have consistently confirmed our commitment to consider any clinical risk that may pertain in the event that Option 1 cannot be delivered, leading to a requirement to move to either Option 2 or 3.  This includes specifically considering any risk that may relate to the distance and travel time for women living in West Cumbria, including those living south of West Cumberland Hospital.

 

            Thirdly, the consideration of any such pertaining risk will inform the final decision the  ...  view the full minutes text for item 30.

31.

Committee Briefing Report pdf icon PDF 59 KB

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

 

Additional documents:

Minutes:

Members received a report which updated the Committee on developments in health scrutiny, the Committee’s Work Programme and monitoring of actions not covered elsewhere on the Committee’s agenda.

 

The Committee were informed that the Secretary of State for Health had accepted the advice of the Independent Reconfiguration Panel regarding maternity services in West, North and East Cumbria that the referral was not suitable for full review because further local action by the NHS with the Committee could address the issues raised. 

 

The Committee noted the membership of the Joint Health and Adults Scrutiny Advisory Group and the work it would be undertaking.

 

A discussion took place regarding the Cumbria Health Variation Sub?Committee.  It was explained that following the resignation of Mr M Hawkins there was a vacancy for a representative from the Copeland area on the Sub?Committee.  Mr C Whiteside was nominated as Committee’s representative.

 

A discussion took place regarding Public Health Grants and it was agreed further information would be sought from the Director of Public Health and discussed at a future meeting if necessary.

 

Members were informed that a Green Paper on Transforming Children and Young People’s Mental Health Services to be published in early December would be circulated to members.

 

The Committee were informed that an inspection of the health and care system for the whole of Cumbria would be carried out by the Care Quality Commission in February 2018.

 

A discussion took place regarding attendance of a member of the Cumbria Health Scrutiny Committee at an event to discuss Co-production.  It was agreed that Ms C Driver be nominated to attend the event.

 

A member sought reassurance that scrutiny would be able to scrutinise local developments towards a potential Accountable Care System which would become operational in April 2018.  The Committee were informed that this had been scoped within the Joint Health and Care Group and a copy of the scoping document would be circulated to members.

 

RESOLVED,     that

 

                            (1)       the outcome of the Committee’s referral to the Secretary of State be noted;

 

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

 

                            (3)       Mr C Whiteside be appointed to the Cumbria Health Scrutiny Variation Sub?Committee;

 

                            (4)       Ms C Driver attend an event to discuss Co?production;

 

                            (5)       the existing Work Programme be noted and a report on Alliance Practice Partnership Model be included for the May Committee meeting.

 

32.

Sustainability and Transformation Partnership (STP) - North pdf icon PDF 1 MB

To receive a presentation by the Chief Executive – North Cumbria University Hospitals NHS Trust as West, North and East Cumbria Health and Care Partnership Lead.

 

Minutes:

The Committee received a detailed presentation from the Cumbria Partnership NHS Foundation Trust regarding the North Cumbria Integrated Health and Care System.  The presentation outlined:-

 

Ø   The journey – historic problems and the response to them.

 

Ø   How the principles of population health were translated into practice – system governance and overall approach.

 

Ø   How the most complex intractable problems were being tackled through quality improvements, co?production and social movements.

 

Ø   The new innovative partnership with primary care – ‘Alliance Practices’.

 

Members were informed that in north Cumbria there was a great deal of cohesive working.  It was explained that during the integration of the Cumbria Partnership NHS Foundation Trust and North Cumbria University Hospitals NHS there had been a number of successfully planned engagements with approximately 1,500 members staff.  Members noted that staff had been very supportive to embrace integration and working together. 

 

The Committee were informed that the aim of integration was to join up pathways across organisations and remove existing artificial barriers.  It was highlighted that one of the main barriers was the inability to share information, therefore, the introduction of compatible IT systems was essential to ensure integration was successful.  This was acknowledged as an immense challenge and the appropriate training was recognised to ensure the system was effective and efficient.

 

The Committee noted that the ambition was to have a population health system built on three layers:-

 

Ø   Integrated Care Communities – place based population health building blocks.

 

Ø   Clinical Networks – teams without walls spanning acute and community.

 

Ø   Accountable Care System – the platform, leadership, architecture, culture and the right set of system rules and behaviours.

 

The Committee discussed the governance arrangements and were informed an in?built governance already existed and work was underway to build governance of existing mandate arrangements.  It was explained there would be incremental progress with engagement taking place over time to increase alignment. 

 

Members were informed that working with the community was very much part of the plans but it was acknowledged that links with the district councils needed strengthened.  The Committee highlighted the active existing district health and wellbeing boards and suggested this could be a link to aid integration.

 

The Committee discussed the recent statement by NHS England that STP leaders would be given more ‘decision rights’ that would allow them to ‘recommend changes to the configuration or governance of constituent statutory organisations’ which would include CCGs.  Members were informed that CCGs across Cumbria and the North East were working more closely together highlighting the need for co?working on key regional issues.  The advantages of mandatory local rather than regional governance was highlighted.  It was explained that the timeline of the North East coming together was not agreed, but it was expected this would be in approximately 15 months, therefore, there was an urgency to mandate local governance.

 

During the course of discussion a concern was raised regarding central rural Cumbria and members asked if assurances could be given to ensure equality of  ...  view the full minutes text for item 32.

33.

Co-Production - Alston, Wigton and Maryport pdf icon PDF 365 KB

To consider a report by the Chief Executive of the Cumbria Partnership NHS Foundation Trust (copy enclosed).

 

Minutes:

The Committee received a report which described how a co?production model had been used to develop the community plans in the communities of Wigton, Maryport and Alston following the decision in March 2017 to close community in?patient beds in those areas.  The report detailed successes, described the challenges and issues encountered and recognised during the process.

 

Members noted that the decision to close beds at Wigton, Alston and Maryport had been made, however, the Clinical Commissioning Group (CCG) recognised the work and ideas that had been presented by the Alliance groups and asked that the work continued and expanded to develop new models that would compensate for losing beds.  It was noted the work had continued over the last few months and had developed to produce commissioning service models for those areas, working in a co-productive manner with the communities but also to align planning to the Integrated Community Care (ICCs) strategy, recognising that planned changes to community hospitals linked directly to the development of ICCs.  It was explained that community hospitals with or without a bed base would be a significant asset in the delivery of integrated out-of-hospital care particularly in the context of the development of ICCs.

 

The Committee were informed that the decision to consolidate beds in community hospitals was to enable implementation of the ICC business case, and aligned with Cumbria County Council plans to provide more extra care housing, more personalised care choices and a strong focus on rehabilitation and reablement.  It was explained that it ensured the key quality issues identified in community hospitals currently experienced such as the challenges related to recruitment, high numbers of delayed transfers of care and variation in practice would be addressed.  In addition it was felt it contributed in part to the delivery of a more efficient and economical system recognising the need to meet financial sustainability. 

 

Members noted that the Community Alliance Group met regularly with the involvement of a range of stakeholders.  It was explained the aim of the Group had been to utilise the skills of individuals to develop service plans that compensated for bed loss and a draft commissioning plan for Wigton and Solway had been developed. 

 

The Committee were informed that engagement with the local community in Wigton had proved more difficult than other areas.  There was a recognition that the work carried out had to be shared with the local community, therefore, engagement was planned. 

 

Members discussed the consequences of unsuccessful engagement with regards to the community in Wigton.  The Committee were informed that whilst this was challenging a great deal of effort was taking place to encourage more community engagement.  It was explained that GPs and community teams already worked together and those strengths were being built upon.

 

The Committee were informed that County Council, Town and Parish councillors were involved but it was highlighted that attracting lay members was proving difficult.  Members were informed of a recent positive engagement event and the Group in Wigton had voluntarily evolved  ...  view the full minutes text for item 33.

34.

Date of Future Meeting

To note that the next meeting of the Committee will be held on Monday 26 February 2018 at 10.30 am in Conference Room A/B, Cumbria House, Botchergate, Carlisle.

 

Minutes:

It was noted that the next meeting of the Committee would be held on Monday 26 February 2018 at 10.30 am in Conference Room A/B, Cumbria House, Botchergate, Carlisle.