Agenda and minutes

Cumbria Health Scrutiny Committee - Monday, 2nd March, 2015 10.00 am

Venue: Committee Room 1, County Offices, Kendal

Contact: Lynn Harker  Email:

No. Item

(1)       The Committee asked that their best wishes for a speedy recovery be passed to Mr R Wilson, Chair, after his sudden illness.  Thanks were conveyed to the North West Ambulance Service for their prompt attendance to Mr Wilson.


(2)       It was noted that this was Mr G Garrity’s last meeting of the Committee and Members expressed their thanks and appreciation to him for his support to the Committee and wished him well for the future.


(3)       A request was made for the Committee to receive feedback from Lead Member meetings.



Apologies for Absence

To receive any apologies for absence.



Apologies for absence were received from Mr R Burns, Mrs J Raine, Ms H Wall and Mr R Wilson.



Membership of the Committee

To note any changes to the membership of the Committee.



It was noted that Mr R Wilson had been replaced by Mr SB Collins as a member of the Committee for this meeting only.



Disclosures of Interest

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


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


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


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


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


            (b)       Which has not been fully discharged.


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


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


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


            (a)       The landlord is the authority; and


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


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


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


            (b)       Either –


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


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




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



There were no disclosures of interest on this occasion.



Exclusion of Press and Public

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



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



Minutes pdf icon PDF 98 KB

To confirm the minutes of the meeting held on 29 January 2015 (copy enclosed).



RESOLVED,    that the minutes of the meeting held on 29 January 2015 be agreed as a correct record and signed by the Chair.



Healthwatch Update pdf icon PDF 429 KB

To consider an update report from Healthwatch (copy enclosed).



The Committee were provided with an overview of intelligence held by Healthwatch Cumbria (HWC) during the period from October 2014 to January 2015.  Members were informed that the main areas of concern related to:-


Ø             Hospital Parking

Ø             Cancer Services

Ø             Mental Health Services

Ø             Acute Hospital (in?patient and outpatient) Services


The report also included intelligence from the Independent NHS Advocacy Service.


(1)       Cancer Services Review


Members were informed that HWC had received concerns which had been raised at HWC district meetings, roadshows and through direct contact regarding the varying levels of cancer services provided across Cumbria. 


In an attempt to better understand the issues facing cancer patients and their families HWC, in conjunction with cancer patient advisory groups, had carried out a survey based on the National Cancer Survey which included input from the Cancer Advisory Panel (North and West Cumbria).  Further information would be contained in the Cancer Services Review report which would be published in the following two weeks and made available to Members.


(2)       Mental Health


The Committee were informed that HWC had received intelligence in relation to autism diagnosis, crisis mental health services, access to appropriate primary care and CAMHS.  They were also made aware of a significant number of concerns countywide which had been recorded through People First and NHS Complaints and made Members aware of intelligence received from SAFA regarding failures in the mental health referral system.  Members were informed that HWC were co-ordinating some follow-up activity which would include raising specific issues with appropriate providers.


(3)       Car Parking Task and Finish Group


The Committee were informed that HWC had submitted the car parking report to North Cumbria University Hospitals Trust (NCUHT) on 8 January 2015 and a response was due.  In the meantime a NCUHT task group had been established to focus and address the problem of parking at both the Cumberland Infirmary and West Cumberland Hospital.  It was explained that Healthwatch would continue to monitor the situation to ensure that targets were met.


(4)       HWC Independent Engagement Report of NCUHT Clinical Options Appraisal


Members were informed that HWC had been commissioned by NCUHT to provide a series of facilitated meetings with local communities to explain the proposed changes to hospital services in the North and West of Cumbria as set out in the Clinical Options paper produced by the Trust.  All views, including the results of an online and hard copy survey were used to capture the views of people and informed the final report which was presented to the Trust in January 2015. 


The Committee considered one of the biggest concerns with regards to Advocacy Services was relating to treatment and they welcomed the opportunity to discuss this in more detail with a Healthwatch representative from the service at a future meeting.


RESOLVED,    that the report be noted.



Cardiac and Upper Gastrointestinal Bleed Pathways pdf icon PDF 59 KB

To consider a report on Cardiac and Upper Gastrointestinal Bleed Pathways (copy enclosed).


Additional documents:


The Committee received a report from the NHS Cumbria Clinical Commissioning Group and North Cumbria University Hospitals NHS Trust which contained proposals for changes to upper gastrointestinal bleeds and cardiac pathways.


The Committee were informed that the pathways had been developed by local clinicians and reviewed by independent clinicians from the Northern Clinical Senate.  The Senate were satisfied that the proposed changes would be in the best interests of a small number of seriously ill patients to improve their chance of a good clinical outcome and survival.


The NHS Cumbria CCG and Trust emphasised that the safety of patients must always be a priority for both commissioners and providers of healthcare.  It was anticipated that the changes would equate to the transfer of around five patients a week from West Cumberland Hospital to Cumberland Infirmary which represented a very small proportion of patients with digestive problems and heart and circulatory problems.  The majority of patients with those health problems would continue to be treated at West Cumberland Hospital.


The concerns of the Committee were recognised regarding consideration of incremental changes and understood it may be the view of Members that a number of such small changes, when considered together, would constitute a significant variation.


The Committee had a detailed discussion regarding the proposals. 


The Committee’s main concerns were regarding the availability of transport to transfer patients and it was recognised by all concerned that ambulance capacity was an issue and needed to be resolved.  It was emphasised that the transfer of patients would not be supported until there was clear agreement that NWAS had the resources to deal with the change.


With regards to the transfers it was confirmed there was a transport protocol which included the provision for escort arrangements to be made available if this was deemed necessary during assessment of the patient.


A Member raised concerns regarding the actual number of transfers which it was believed to have taken place.  The Trust considered the suggested figure to be unusually high but agreed to investigate this further and report back direct.


Members discussed the additional pressures the proposed changes could have on the Cumberland Infirmary and it was confirmed that additional resources had been put in place.


On being put to the vote it was


RESOLVED,    that


(1)               the proposals constitute a substantial service change;


                           (2)       an interim change in the pathways to promote patient safety and outcomes, pending the outcome of consultation, be agreed;


                           (3)       Lead Health Members meet with the Clinical Commissioning Group and North Cumbria University Hospital Trust to discuss the appropriate public consultation arrangements.



Efforts to Alleviate Pressures on Acute Hospitals Across Cumbria pdf icon PDF 504 KB

To consider a report by the Director of Strategic Planning and Performance, Cumbria Clinical Commissioning Group (copy enclosed).



The Committee received an update from the Cumbria Clinical Commissioning Group on steps being taken to alleviate pressures in hospitals particularly over the winter period.


It was explained that the NHS usually experienced increased pressures during winter with an increasing number of people going into hospital A&E departments and then being admitted.  Members were informed that although there had been local challenges in meeting the standard during the year within Cumbria, over the Christmas and New Year holiday period NHS England had reported unprecedented pressures affecting many hospital across the country with most hospital trusts across the country failing to meet the standard in the last week in December 2014.


The situation regarding Cumbria was that the standard was not met by the CCG in May, October, November and December 2014.  In December it was met by the University Hospitals of Morecambe Bay NHS Foundation Trust but not by North Cumbria University Hospitals NHS Trust.  However, efforts to achieve the standard had been a major focus across the health and care system and there were ongoing concerted efforts to reduce pressures on the two acute hospital trusts.


Members were informed that hospitals and partner organisations across the health and care system had been working closely to manage the increased pressures on hospital services.  An example of this was GPs working with North West Ambulance Service to manage patients in the community to reduce attendance at A&E.  This included the NHS Pathfinder scheme which existed in south Cumbria and had been running overnight and at weekends in north Cumbria with plans in place to extend it during the day in north Cumbria from early March 2015. 


Concerns were raised regarding the impact this could have on GPs and were informed that this would primarily involve GPs but qualified paramedics would also attend call?outs.  A further concern was raised regarding hospital admittance for patients and the Committee were assured that paramedics used specific assessment guidance to determine whether that was necessary or if there were alternative ways to manage a condition.  It was emphasised that a patient would never be left in an unsafe situation and ultimately a patient would be admitted to hospital if there was any doubt about safety.  It was agreed that the Committee would need to continue to monitor performance.


The Committee were informed that the scheme was resulting in a significant reduction in the number of people who were taken to A&E departments.


Members drew attention to the transfer of six beds from Wigton Community Hospital to the West Cumberland Hospital and were assured that this was a temporary measure due to recruitment problems and they would eventually re?open again at Wigton.


A query was raised regarding the use of resilience money and the Committee were informed that the CCG were making a case for additional funding for Cumbria.


RESOLVED,    that the report be noted.



Cumbria Partnership Trust Update pdf icon PDF 220 KB

To consider a report from the Cumbria Partnership Trust (copy to follow).


Additional documents:


The Committee received a report from the Cumbria Partnership NHS Foundation Trust updating Members on performance, finance and the 5 Year Strategy.


(1)       Performance


The Committee were informed there were newly identified data quality issues relating to referrals across all community mental health teams (adult and older adult) and Crisis resolution and home treatment which would have a negative impact on the results.  Members were informed that at present 85% of patients had been allocated into clusters and were receiving care.


A discussion took place regarding Payment by Results (PbR) and the Committee were informed that this was a national scheme for mental health services and payment was made in accordance with the individual needs of the service users.  Cost-effective services were being designed and linked to the Mental Health Strategy.


Concerns were raised regarding the effects of the financial decline on mental health services and Members were informed of the recent investment in resources to ensure service users received safe care.  It was anticipated that ultimately there would be a need to have in?patient units with a ratio of 1 staff to 8 service users to meet the best economy of scale.


The Committee discussed the delay in the transfer of mental health patients and were informed that one of the main service users this affected was dementia patients due to their challenging behaviour and delays in finding suitable safe places to stay.  The Trust explained that those levels would reduce as close working relationships were continuing with organisations such as care homes to alleviate situations.


(2)       Finance


Members were informed that overall the Trust had been able to deliver a small surplus in each of its previous years since being formed in 2007.  However, increasing costs and decreasing income gave a forward view that was much more challenging and the Trust was therefore planning with their partners to reform how services were delivered to be more effective and efficient overall in future.


In response to concerns raised regarding how services would be affected with the increasing deficit it was explained they would have to become more effective and efficient by reducing bureaucracy, making better use of electronic systems etc.  It was emphasised that recruitment of staff was crucial to ensure more joined up working took place with hospitals and communities.  Early intervention with service users was important in order to gain stability which would fundamentally make better use of public resources.


RESOLVED,    that the report be noted.



University Hospitals of Morecambe Bay Foundation Trust pdf icon PDF 275 KB

To consider a report by the Associate Director of Communications, University Hospitals of Morecambe Bay NHS Foundation Trust (copy to follow).


Additional documents:


The Committee received a report from the University Hospitals of Morecambe Bay Foundation Trust which updated Members on key areas at the Trust.


(1)       Better Care Together Strategy


The Committee were informed that the Better Care Together Clinical Strategy which set out how services would be transformed over the next five years had been shared with staff, governors, volunteers and stakeholders.  It was explained that Better Care Together was the response of the CCGs, Cumbria Partnership and Lancashire Care NHS Foundation Trusts as to how improvements could be made to future health and care services across Morecambe Bay.  It was emphasised that the Strategy was not a consultation document but had been produced to provide staff, local communities and regulators with an overview of the work of the programme, and to share recommendations based on the work carried out to date and provide a focus for further discussion about the future of local health and care services.


(2)       Trust Five Year Strategy


Members were informed that the Trust had created a Five Year Strategy which included better care together, combined with the areas that needed to be addressed independently ie quality standards, workforce development, estates, IT and finance.


(3)       Care Quality Commission (CQC) Improvement Plan


The Trust informed the Committee that they would be re?inspected by the CQC in May 2015 and were progressing well against the Improvement Plan.


A concern was raised regarding the improvements highlighted by the CQC for the High Dependency Unit (HDU) at the Furness General Hospital.  It was explained that the HDU now had a dedicated medical lead with overall responsibility for the Unit, which was based on the best practice of Salford Hospitals NHS Foundation Trust staffing model.


(4)       Staffing and Recruitment


The Committee were informed that recruitment of front line clinical staff continued to be a high risk for the Trust, as it was for many NHS hospital trusts throughout the country.  To address the problem reviews were made of medical vacancies together with nursing and midwifery recruitment campaigns.


Members discussed the recruitment of staff, specifically midwifery, and were informed that delays were around identifying and recruiting the appropriate staff.  There had been an increase in recruitment of resources from overseas which had resulted in a longer lead-in before staff were in place. 


A concern was then raised regarding the high turnover of staff and the Committee were informed that there were a number of factors associated with this which included a change in the configuration of some specialist services.


(5)       Operational Performance


The Committee received an update on operational performance which included:-


Ø             Referral to Treatment (RTT)/18 weeks: the Trust had achieved all 3 RTT standards at Trust level for December 2014.  The standards were not fully achieved in a small number of specialities and the Trust were addressing this.


Ø             Emergency Care four hour standard – the 95% four hour standard had been achieved in November.  It was explained that the Trust’s new system of four-times daily patient flow meetings  ...  view the full minutes text for item 57.


Care Quality Commission (CQC) Update

To receive a verbal update from Care Quality Commission.



The Committee received a verbal update from the Care Quality Commission (CQC) on the two acute trusts.


Members were informed that the CQC had met with the University Hospitals of Morecambe Bay Foundation Trust and had inspected all areas that required improvement looking at evidence which demonstrated compliance.


The situation was similar with regards to the North Cumbria University Hospitals.  The CQC would visit both sites and look at areas which had been deemed inadequate as a result of the inspection.


A concern was raised regarding the amount of overtime staff were required to undertake and Members were assured that the CQC would look at the needs of patients and determine whether they were being met in the most appropriate way.


Members raised their concerns at the lack of any representation from the CQC regarding the inspection of the North West Ambulance Service and asked that an update be made available to the Committee.


RESOLVED,    that


                           (1)       the update be noted;


                           (2)       information regarding the CQC inspection of the North West Ambulance Service be made available to the Committee.



North West Ambulance Service - CQC Inspection pdf icon PDF 66 KB

To consider a report by North West Ambulance Service outlining the Cumbria specific aspects of the CQC findings and the proposed actions (copy enclosed).



The Committee received a report from the North West Ambulance Service NHS Trust (NWAS).  The Trust were pleased to confirm it had received a positive report from the CQC following its inspection in August which was the first pilot of the newly styled inspection regime for all ambulance services.  The outcomes of the pilot would inform the future inspection arrangements for ambulance trusts.


Four CQC teams, comprising over 60 inspectors, undertook a thorough and extensive review of the Trust’s operation and services, interviewing patients and staff as well as visiting stations, control rooms and speaking to partners.  In addition to the visit in August, there was a follow up unannounced visit in September.


The main themes of the inspection looked at whether NWAS was safe, effective, caring and responsive to patients’ needs and well led. 


The Committee welcomed the action relating to access to controlled drugs from pharmacies across a large rural area.  Members were informed the action relating to this had been addressed by way of staff information, audit of paramedic knowledge and a strategic piece of work in place to consider access to a wider supply chain. 


Members raised concerns regarding the availability of ambulances in West Cumbria and NWAS agreed there was a lack of vehicles but assured the Committee that an ambulance would always be despatched to emergency calls with resources being moved between areas to compensate for this.  It was suggested that a courtesy call be made to alert patients to any delays, therefore, reducing anxiety. 


NWAS recognised there was a funding gap and were aware that more resources were required confirming that targets would not be achieved if more resources were not made available. 


The Committee raised concerns regarding delays for the ambulance service due to the lengthy hand?over process involved when taking patients to hospital.  NWAS agreed with the concerns raised and informed Members that this was being investigated emphasising that the care of the patient was paramount.  It was agreed that the percentage of time ambulances spent waiting at hospitals would be circulated to the Committee.


Members discussed the use of private ambulances including the training they received and it was agreed to circulate further information regarding the level of training and costs involved.


A discussion took place regarding the use of a telephone App to monitor a patient suggesting this could ultimately result in a better informed decision being made when triaging a patient.  It was confirmed there was no platform to allow this to take place in the immediate future but NWAS agreed to investigate this further.


Concerns were raised regarding the difficulties experienced when replacing First Responders.  The main concern was the lack of training available from NWAS and it was agreed to investigate this further and report back direct.


RESOLVED,    that


                           (1)       the report be noted;


                           (2)       further information on first responders, ambulance waiting times, costs and level of training for private ambulances be made available to Members.



Committee Briefing Report pdf icon PDF 82 KB

To consider the Briefing report (copy enclosed).


Additional documents:


The Committee received an update report from the Policy and Scrutiny Team which outlined the developments in health scrutiny, the Committee’s Work Programme and monitoring of actions following previous scrutiny recommendations not covered elsewhere on the Committee’s agenda.


RESOLVED,    that


                           (1)       the update be noted;


(2)               the scrutiny support arrangements be noted;


                           (3)       the review of public health inequalities be postponed until the completion of the Mental Health Services Task Group Review.



Date of Future Meeting

To note that the next meeting of the Committee will be held on Monday 18 May 2015 at The Courts, Carlisle.



It was noted that the next scheduled meeting of the Committee would be postponed and this date would be used for a Scrutiny Development Day.  Members would be informed of a revised date for the Committee in due course.