Agenda and minutes

Cumbria Health Scrutiny Committee - Monday, 27th July, 2015 10.00 am

Venue: Committee Room 1, County Offices, Kendal

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

Items
No. Item

13.

Election of Chair

To elect a Chair for this meeting only.

 

Minutes:

RESOLVED,    that Mr M Wilson be elected Chair of the Committee for this meeting only.

 

14.

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.

 

Minutes:

The District Council representatives elected a Vice-Chair of the Committee from amongst their members.

 

RESOLVED,    that Mr R Gill be elected Vice-Chair of the Committee for the ensuing year.

 

15.

Apologies for Absence

To receive any apologies for absence.

 

Minutes:

Apologies for absence were received from Mr J Bland, Mr N Hughes and Mrs M Robinson.

 

16.

Membership of the Committee

To note any changes to the membership of the Committee.

 

Minutes:

It was noted that Mr J Bland had been replaced by Mr RK Bingham and Mr N Hughes had been replaced by Mr SB Collins as members of the Committee for this meeting only.

 

17.

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 R Gill declared an interest as his wife was an employee at the West Cumberland Hospital.

 

18.

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.

 

19.

Minutes pdf icon PDF 102 KB

To confirm the minutes of the meeting held on 4 June 2015 (copy enclosed).

 

Minutes:

With reference to minute no 9 – Proposed Changes to Respiratory High Risk Patient Pathway it was agreed that the following sentence should be added ‘A discussion took place about concerns regarding the number of transfers which had taken place’.

 

RESOLVED,    that with the addition of the above sentence the minutes of the meeting held on 4 June 2015 be agreed as a correct record and signed by the Chair.

 

20.

Success Regime

To receive a presentation from the Cumbria Clinical Commissioning Group.

 

Minutes:

The Committee received an update from the Interim Chief Operating Officer, NHS Cumbria Clinical Commissioning Group on the Success Regime which set out the challenges facing the health and care system over the next five years.  Members were informed that the North Cumbria health system one of only three areas who had been named nationally. 

 

It was explained that the Success Regime would be overseen jointly by NHS England, Monitor and the NHS Trust Development Authority, working closely with the Care Quality Commission across the whole health and care economies with providers, commissioners and local authorities to address systematic issues as opposed to merely focusing on individual organisations.

 

Members were informed that the aim of the Success Regime was to provide increased support and direction to the most challenged systems in order to secure improvement in three main areas:-

 

Ø             short-term immediate improvements agreed around standard of care including accident and emergency waiting time, referrals to treatment and the cancer waiting time standards;

 

Ø             medium and longer-term transformation, including the delivery of clinical standards and long-term financial stability;

 

Ø             developing leadership capacity and capability across the health system.

 

Members were informed there were a number of challenged local health and care systems where tackling those gaps would be difficult because the quality of care commissioned and provided to patients required improvement, services did not meet the expectations of the public and the cost of providing services was greater than the financial resources available.  Therefore, there were sustainability risks in the medium and long-term.

 

Concerns were raised regarding the continued failure to meet certain standards over the past five years with particular attention drawn to the Cumberland Infirmary in Carlisle.

 

It was emphasised that the financial situation across the whole health economy was unsustainable in the long?term, and there were significant issues regarding workforce, recruitment and retention. 

 

A discussion took place regarding recruitment and retention issues and concerns were raised regarding the number of locums employed by the NCUHT.  It was agreed that long-term permanent staff were of the utmost importance and it was highlighted that the distance from tertiary centres presented problems with recruitment.  The necessity to ensure that service models were attractive to clinicians was also emphasised.

 

During the course of discussion the lack of communication with staff was highlighted and it was agreed that engagement was important in order to retain permanent staff and ultimately improve services. 

 

The Committee were informed that a Programme Director would be appointed in August who would work on behalf of the three national organisations and be supported by other staff from those organisations.  There would be meetings convened with Chief Executives from all local partners including North Cumbria University Hospitals Trust.

 

The necessary support and challenge to health and care economies would be provided from diagnosing the problems, identifying the changes required and implementing those changes.  It would also seek to strengthen local leadership capacity and capability, with a particular focus on supporting transformation and developing collaborative system leadership.

 

There was  ...  view the full minutes text for item 20.

21.

Kirkup Report pdf icon PDF 58 KB

To consider a report by NHS England and University Hospitals of Morecambe Bay NHS Trust (copy enclosed).

 

Additional documents:

Minutes:

The Committee received a report from the Chief Executive of University Hospitals of Morecambe Bay Foundation Trust (UHMBT) which contained responses from NHS England and UHMBT to the recommendations contained in the Kirkup Report.

 

Members were informed that the Kirkup Report had been commissioned to investigate the management, delivery and outcomes of care provided by the maternity and neonatal services at the UHMBT from January 2004 to June 2013.

 

It was explained that the investigation was reported in March 2015 with a series of 44 recommendations – 18 of which were specific to UHMBT and the remainder relating to the wider health system (referred to in appendix 1 of the report).  NHS England and UHMBT had provided a series of reports which set out context and governance for the actions they had subsequently taken, together with an update on progress against the recommendations (referred to in Appendices 2 to 8 of the report).

 

The Committee were informed that the report highlighted that the maternity department at the Furness General Hospital was dysfunctional with serious problems in four main areas:-

 

Ø             Clinical competence of a proportion of staff fell significantly below the standard for a safe, effective service.  Essential knowledge was lacking, guidelines not followed and warning signs in pregnancy were sometimes not recognised or acted on appropriately.

 

Ø             Poor working relationships between midwives, obstetricians and paediatricians.  There was a ‘them and us’ culture and poor communication hampered clinical care.

 

Ø             Midwifery care became strongly influenced by a small number of dominant midwives whose ‘over-zealous’ pursuit of natural childbirth ‘at any cost’ led at times to unsafe care.

 

Ø             Failures of risk assessment and care planning resulted in inappropriate and unsafe care.

 

The report also criticised the internal governance arrangements of UHMBT, in particular:-

 

Ø             there was a grossly deficient response from unit clinicians to serious incidents with repeated failure to investigate properly and learn lessons;

 

Ø             there were poorly developed systems of clinical governance within the Trust which meant that there was little formal oversight of safety or other quality matters in clinical services;

 

Ø             a resultant failure, at a Board level, to consider the evidence of systematic failing;

 

Ø             the Trust did not commission the Fielding Review (an independent review instigated by the SHA) to investigate, as was originally intended, the previous incidents to ascertain whether there were systemic failings; and

 

Ø             there was an element of conscious suppression of the Fielding report, both within the Trust and externally.

 

Members were informed that as well as criticisms of the Trust there were also criticisms of the wider NHS system and its failure to identify issues earlier.  The report indicated that investigations into serious incidents as far back as 2004 would have raised the alarm but it was not until five serious incidents occurred in 2008 that the reality began to emerge.  The investigation found at least seven significant missed opportunities to intervene over the three years from 2008 (and two previously), across each level – from the Furness  ...  view the full minutes text for item 21.

22.

Committee Briefing Report pdf icon PDF 70 KB

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

 

Additional documents:

Minutes:

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 not covered elsewhere on the Committee’s agenda.

 

Members were informed it was proposed that five nominated members from the Committee (excluding Lead Health Members) be appointed Member Champions to take the lead on each of the Trusts and the Cumbria Clinical Commissioning Group.  It was explained this would involve reviewing the Board minutes for the organisations, attendance at meetings and reporting back to the Committee as necessary.

 

RESOLVED,    that

 

                           (1)       the following member champions be appointed to four Trusts and the Clinical Commissioning Group:-

 

                                       North Cumbria Hospitals Trust – Carlisle City Council

                                         representative

                                       University Hospitals of Morecambe Bay Trust –

                                         David Fletcher

                                       Cumbria Partnership Foundation Trust – Debra Seward

                                       North West Ambulance Service –

                                         Carni McCarron-Holmes

                                       Cumbria Clinical Commissioning Group –

                                         Christine Wharrier

 

                           (2)       the arrangements for scrutinising the Better Care Together Programme through the Joint Cumbria and Lancashire Scrutiny Committee be noted;

 

                           (3)       the work programme be noted.  The ‘Outcome of the CQC Inspection of the University Hospitals of Morecambe Bay NHS Foundation Trust’ be deferred to the meeting in December;

 

                           (4)       a half day desk top review take place on vascular services.

 

23.

Date of Future Meeting

To note that the next meeting of the Committee will be held on Thursday 15 October 2015 at 10.00 am at County Offices, Kendal.

 

Minutes:

It was noted that the next meeting of the Committee would be held on Thursday 15 October 2015 at 10.00 am at County Offices, Kendal.