Agenda and minutes

Cumbria Health Scrutiny Committee - Thursday, 29th January, 2015 10.30 am

Venue: Council Chamber, Allerdale Borough Council, Allerdale House, Workington, CA13 3YJ

Contact: Lynn Harker  Email:

No. Item

The Chair, on behalf of the Committee, expressed thanks and appreciation to Tracey Ingham for her tremendous support and wished her well for the future.



Apologies for Absence

To receive any apologies for absence.



Apologies for absence were received from Mr R Burns, Mr M Hawkins, Mrs J Raine and Mrs V Rees.



Membership of the Committee

To note that Mr M Wilson will replace Ms M Telford as a permanent member of the Board.



It was noted that Mr M Wilson had replaced Ms M Telford as a permanent member of the Committee.


The Chair welcomed Mark Wilson to the meeting and expressed his thanks and appreciation to Mandy Telford for her support.


It was noted that Mrs J Raine had been replaced by Mr J Lynch as a member of the Committee for this meeting only.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 140 KB

To confirm the minutes of the meeting held on 16 October 2014 (copy enclosed).



Further to minute 26 (Membership of the Committee) it was noted that this should read ‘Mr J Lister had been replaced by Mr W Wearing as a member of the Committee for this meeting only’.


Further to minute 32 (Mental Health Services) it was agreed that the third paragraph from the bottom of page 14 should read: ‘A concern was raised regarding the lack of mental health services being available in the physical health team and it was agreed that this was a significant oversight and should be included in the team.’


RESOLVED,    that with the inclusion of the above the minutes of the meeting held on 16 October 2014 be agreed as a correct record and signed by the Chair.



NHS England Overview and Context

To receive a presentation from Dr Mike Prentice, Medical Director (Cumbria, Northumberland, Tyne and Wear), NHS England highlighting issues at a national and regional level which will have implications for services in West Cumbria followed by questions and answers with Members of the Committee.



Dr Craig Melrose, Assistant Medical Director, Cumbria and the North East presented the Committee with an overview of NHS England:-


Ø             Recent NHS England restructure – larger teams as from the beginning of the year.


Ø             Co-commissioning – commissioning primary care with the Clinical Commissioning Group (CCG) and a gradual move to the CCG setting the agenda and commissioning primary care. 


Ø             5 Year Forward Plan – ambition for the next five years which included the challenge of addressing a £30 billion gap for the whole of England by 2020.


Members were informed that the new models of care put a greater emphasis on out of hospital care and included:-


Ø             A multi speciality community provider which would involve GPs working in large groups covering whole communities and would include mental health teams, hospital consultants etc. 


Ø             A primary and acute care system where acute hospitals would provide primary care for a registered list of patients.


Ø             An urgent care network would ensure services such as accident and emergency, CHOC, minor injuries units etc work better together.


Ø             Viable smaller hospitals.


Ø             Specialist care networks.


Ø             Maternity services.


It was explained that at present Cumbria had strong primary care but was struggling and there was evidence of appetite for change. 


Members were informed that the North Cumbria University Hospital Trust was in the process of aligning and merging with Northumberland and challenges remained to make sense of two sites.  The quality of care, sustainability of financial and human resources, safe clinical care and accessibility all needed to be taken into consideration.  The University Hospitals of Morecambe Bay Foundation Trust continued to work on their improvement plan and were engaging fully with Better Care Together.  It was emphasised that maternity care was an issue for both Trusts.


In conclusion the following challenges were outlined:-


Ø             Social care was integral to success in five year forward view and Cumbria’s health care in future.


Ø             If high quality, safe sustainable care was to be achieved now and for the future there would need to be change.


Ø             Local community leaders were required to work in partnership with health leaders to solve problems.



Cumbria County Council/Cumbria Partnership Trust

To consider a joint presentation from the County Council and Partnership Trust providing some Cumbria level context highlighting upcoming changes which will have implications for services in West Cumbria followed by questions and answers with Members of the Committee.



Mr M Smillie, Director of Strategy and Support Services, Cumbria Partnership Trust presented the Committee with their overall plans for the future:-


Ø             Vision – people in our communities living happier, healthier and more hopeful lives.

Ø             Five Year Strategy.

Ø             Mission – delivering quality and best value for our patients.


The five year strategy outlined their three strategic goals:-


Ø             Quality Improvement Plan

Ø             People and Organisational Development Plan

Ø             Service Plans


The four key services were community, specialist, mental health and children and families with the overall approach being to work with partners. 


The Committee were informed that the Trust had commenced work on the Joint Mental Health Strategy 2015-2020 and would investigate ‘better mental health for all’ emerging commissioning priorities. 


The Trust were also investigating out of hospital services and were planning provision with partners and communities to improve quality at a lower cost which was sustainable. 


Members were then given an update on public health and their lead on the development of a countywide health and social wellbeing system for the adult population of Cumbria.  The aim of the system was to support people in Cumbria to live well, by addressing the factors that influence their health and well-being, and build their capacity to be independent, resilient and maintain good health for themselves and those around them.  The Public Health Challenge in Cumbria was that it was the seventh most underfunded public health department in the country compared with their need and the Public Health ringfenced budget should equal £45 per head of population, but settlement was equivalent to £31 per head.


The Upcoming Changes to Social Care Services were then outlined and it was explained the complex system encompassed big issues such as the Implementation of the Care Act on 1 April 2015 and assessments for full fee payers for April 2016.


The Committee emphasised the importance of communication to ensure communities were made fully aware of all proposed changes.


The direction of Adult Social Care included:-


Ø             Prevention

Ø             Neighbourhood Care Independence Programme

Ø             Rehabilitation/Reablement to return to independence

Ø             Self/supported assessments

Ø             Strengthening relationships across the system


and the upcoming changes on the ground included:-


Ø             Risk stratification/care planning – primary care communities

Ø             Individual community plans for frequent visitors to A&E

Ø             Care planning support for Pathfinder and links to urgent care centres

Ø             Developing joint teams in acute and community hospitals

Ø             Fully aligning rehabilitation/reablement services

Ø             Building on current prevention services exploiting links to public health and voluntary organisations

Ø             Resolving issues of patient flow through the system.


The Committee had a detailed discussion regarding the information they had received. 


It was explained that wellness hubs were being considered for community hospitals with the aim of helping people remain as independent as possible which ultimately would help sustain services.


In response to a query raised regarding mental health services in acute Trusts Members were informed that all accident and emergency departments provided a crisis service both over  ...  view the full minutes text for item 44.


Clinical Commissioning Group - Update on Primary Care

To receive a presentation by the Clinical Commissioning Group updating the Committee on Primary Care services in West Cumbria followed by questions and answers with Members of the Committee.



The Committee firstly received an update from the Clinical Commissioning Group on primary care in West Cumbria which included recruitment/staffing issues and development of primary care communities in Allerdale and Copeland.  Secondly, together with North Cumbria Trust an update was provided on discussions regarding hospital services and other key issues such as feedback from discussions with the Northern Clinical Senate and issues concerning the North Cumbria Trust’s Options Appraisal paper.


A concern was raised regarding managing conflicts of interest if CCGs took on more of the role of commissioning GPs from NHS England with the introduction of ‘co?commissioning’.  It was explained that as only level 1 (lowest level, therefore, the area team of NHS England would retain responsibility for GP commissioning) had been applied for this was not a significant issue.  It was agreed that a copy of the ‘Managing Conflicts of Interest’ policy document would be circulated to the Committee for their information.


The Committee raised their concerns regarding the future of GP services in rural areas and it was acknowledged that flexibility was required to deal with individual community needs.


Members discussed the role of specialist nurse practitioners and were informed that extensive training had taken place which enabled nurses to take on certain GP roles but were assured that support was always available from GPs.  The problem with recruitment and retention of nursing staff was highlighted and it was emphasised this needed to be investigated as soon as possible as the situation was critical.


The Committee received feedback on discussions regarding the Options Appraisals paper which included:-


Ø             acute medicine

Ø             paediatrics

Ø             obstetric and midwifery care

Ø             planned care and outpatients


The Trust had sought views of the public and its staff through public roadshows facilitated by Healthwatch and an online survey which had also been analysed by Healthwatch.  The North Cumbria University Hospital Trust emphasised their commitment to continue engagement and update the Committee as necessary.


The Committee received feedback on discussions regarding hospital services with the Northern Clinical Senate which comprised independent senior doctors and nurses hosted by NHS England.  They were invited to provide advice about a small number of high risk patient pathways where it was thought seriously ill patients may benefit from transferring to Carlisle for their treatment ie heart problems, significant bleeding in the stomach or bowel, respiratory problems, stroke and very poorly older people when they were discharged from accident and emergency. 


Members were informed that with regards to the first two pathways the majority of patients with those conditions would continue to be treated at Whitehaven with a small number being transferred to Carlisle for 24 hour specialist care to improve their chances of survival.  It was emphasised that the patients who were transferred for treatment would be discharged home or returned back to Whitehaven as soon as possible.  Discussions continued with the Senate regarding the last three pathways.


During the course of discussion Members raised their concerns at the lack of communication between the CCG and  ...  view the full minutes text for item 45.


North Cumbria University Hospital Trust/Clinical Commissioning Group/Trust Development Authority

To receive a joint presentation from the Clinical Commissioning Group and North Cumbria University Hospital Trust on High Risk Pathways and other key issues followed by questions and answers with Members of the Committee.



The Trust gave a brief update informing Members that by the end of March 2015 they would be clear about their Strategy and the capacity that would be required to deliver changes, stressing that good care was of utmost importance.  It was explained that changes to elective care had already taken effect and the plan was for patients to travel less by increasing the availability of a number of services in local areas.


The Trust Development Authority emphasised that their priority was to assist North Cumbria University Hospital Trust to get out of special measures.


The Committee raised their concerns regarding the lack of communication and it was agreed that a separate meeting would be held with partners in the health system to reflect on better working together to ensure all processes were fully aligned.



Date of Future Meeting

To note that the next meeting of the Committee will be held on Monday 2 March 2015 at 10.00 am at County Offices, Kendal.



It was noted that the next meeting of the Committee would be held on Monday 2 March 2015 at 10.00 am at County Offices, Kendal.