Agenda and minutes

Cumbria Health Scrutiny Committee - Thursday, 4th June, 2015 10.00 am

Venue: Old Court Room, The Courts, Carlisle, CA3 8NA. View directions

Contact: Lynn Harker  Email:

No. Item


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.



It was agreed to defer this item until the next meeting of the Committee as only two district council representatives had been appointed following the recent elections.



Apologies for Absence

To receive any apologies for absence.



Apologies for absence were received from Mr J Bland and Ms C McCarron?Holmes.



Membership of the Committee

To note any changes to the membership of the Committee.



There were no changes to the Membership of the Committee on this occasion.



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 104 KB

To confirm the minutes of the meeting held on 2 March 2015 (copy enclosed).



A concern was raised regarding the lack of further information which had been requested on the actual number of transfers which had taken place regarding GI bleeds.  It was confirmed that of the figure quoted at the last meeting only one transfer had been as the result of a GI bleed.


With reference to minute 56(1) (Cumbria Partnership Trust Update - Performance) further information was requested on the allocation of clusters.  The Strategic Policy and Scrutiny Adviser – Health and Social Care agreed to investigate this and report back direct.


With reference to minute 59 (North West Ambulance Service – CQC Inspection) a concern was raised at the lack of a response referred to at resolution (2) and it was agreed to investigate this further and report back direct.


RESOLVED,    that the minutes of the meeting held on 2 March 2015 be agreed as a correct record and signed by the Chair.



North Cumbria University Hospital Trust - Patient Experience pdf icon PDF 1 MB

To consider a report from the North Cumbria University Hospital Trust (copy enclosed).



The Chair of North Cumbria University Hospitals NHS Trust and the Medical Director of NHS Cumbria Clinical Commissioning Trust gave a brief update on the recent announcement about the Success Regime in North Cumbria.


The Committee were informed that the announcement had been welcomed and it was seen as a great opportunity to look at the whole health economy.  It was felt that being part of the Success Regime would build on the joint working which had already taken place across organisations in North Cumbria and were looking forward to working with Monitor, NHS Trust Development Authority and NHS England to understand how to make the most of opportunities that would be available.


The Committee then received an update on patient experience until the end of March 2015.  The Committee were informed that feedback was requested from friends and family of patients and this had seen an improvement in scores since May 2013 – up to 74 (above the national average) compared to a baseline position in May 2013 of only 51. 


The Trust had taken actions to improve response rates, which included:-


Ø             weekly reporting of response rates by ward;

Ø             transparent sharing of results with patients, families and the public;

Ø             Trust Board commitment to the programme and dedicated response from the Chief Executive to ensure results were discussed and feedback acted upon.


Members were presented with the patient perspective data which was collated independently of the Trust and the information suggested that the Trust was above the NHS average of 83%.


A concern was raised regarding the figure relating to information about discharge for patients and it was explained that the Trust were aware of problems with communication, therefore, work would take place to look at systems to support teams to ensure appropriate information was available to patients.  The importance of robust checklists for discharge was highlighted and Members were informed that bespoke work was needed in a number of areas and this was being investigated.  The Trust highlighted the importance of follow?up for patients after discharge to ensure they received everything that was promised.  It was agreed that it was important to have a robust checklist on discharge


The Committee were informed that Patient Experience Time Out Sessions had been organised which involved a programme of ward based training which commenced in 2013 and focused on team working, communication, safety and quality of care.  It was explained that during 2014 112 sessions had been held which involved 1124 members of staff which represented 26% of the workforce.  It was highlighted that 95% of participants felt that the session would support them in improving patient experience in the future.


During the course of discussion the Committee were informed that training did not always involve patients but it was their aspiration to work more towards this in future.


RESOLVED,    that the update be noted.



North Cumbria University Hospital Trust - Major Internal Incident pdf icon PDF 55 KB

To consider a report from the Clinical Commissioning Group (copy enclosed).


Additional documents:


The Committee received an update from the Cumbria Clinical Commissioning Group on actions following the internal major incident affecting health and care services across North Cumbria in March 2015.


Members were informed that an internal major incident in North Cumbria had taken place from Wednesday 18 March until Monday 23 March 2015.  This was against a background of North Cumbria University Hospitals NHS Trust (NCUHT) experiencing severe pressures since mid January 2015, during which time it had been operating at ‘level four escalation’ (the highest level before a major incident was called).


It was explained that on the morning of Wednesday 18 March NCUHT had alerted NHS Cumbria Clinical Commissioning Group (CCG) and NHS England that they were under an extraordinary level of pressure.  The Trust did not have the bed capacity or the required staff numbers, predominantly at the Cumberland Infirmary, Carlisle to safely provide care for the number of patients presented.  Following discussions the NCUHT declared an internal major incident.


During 18 and 19 March a total of 11 patients were transferred out of county to Dumfries and Galloway, Newcastle and Northumberland.  There were twice daily calls during 18 and 19 March to monitor the situation and agree actions to cope with pressures.  It was agreed that the internal major incident would be stood down when the following objectives had been met:-


·               mutual aid from out of county hospitals were no longer required;

·               escalation beds at Cumberland Infirmary beds, Carlisle were either fully closed or safely staffed;

·               effective discharge processes able to manage the volume of patients were in place across the health and social care system;

·               there were no more 12 hour waits in A&E for a period of 48 hours.


During the course of discussion Members asked whether the closure of Reiver House had attributed to the incident and it was emphasised that this had not affected it and highlighted that there were more ‘hospital at home beds’ available since the closure.


Members questioned the availability of beds out of county in the future should further incidents occur and it was explained that although everyone worked very well together other hospitals also experienced significant pressures, therefore, this could not be guaranteed.  During discussion it was emphasised that there had been no deterioration of patients who had been relocated.


The Committee were also informed that as part of the escalation process use of the West Cumberland Hospital was made.  It was explained that part of the problem was the lack of resources available for the escalation beds.


Members were informed that on Monday 23 March it had been agreed to step down from the internal major incident but daily or twice daily system-wide calls would continue when required.  It was emphasised that during the period of the internal major incident all providers had worked together to relieve the pressures in the system and this had continued with an increased focus on transfers and discharges involving all partners.


The Committee were informed that in response to the  ...  view the full minutes text for item 8.


Proposed Changes to Respiratory High Risk Patient Pathway pdf icon PDF 58 KB

To consider a report by the Clinical Commissioning Group (copy enclosed).


Additional documents:


The Committee received a report from the Cumbria Clinical Commissioning Group (CCCG) regarding changes to respiratory pathways affecting a small number of transfers from West Cumbria to the Cumberland Infirmary, Carlisle.


Members were informed that the proposed changes would result in a small number of patients with serious respiratory conditions either being transferred from West Cumbria to the Cumberland Infirmary in Carlisle or being taken direct to the Cumberland Infirmary by ambulance to enable them to access 24 hour specialist care, because of the severity of their illness, their frailty or other complex conditions.


The Committee were informed that the high risk patient pathway referred to covered two groups of respiratory patients – acute respiratory and chronic respiratory conditions and overall it was estimated that the changes would impact upon 0.5% (less than 15 patients per year) of West Cumberland patients with respiratory conditions.  It was emphasised that services for the vast majority of respiratory patients who received care at the West Cumberland Hospital would be unchanged.


During the course of discussion concerns were raised regarding the significant impact this could have on patients’ families and carers and requested what measures were put in place to provide support to them when patients were transferred.  Members were informed that no guarantee could be made to transport relatives and carers but this was being investigated.  The Trust had finalised a travel plan which provided analysis of current travel patterns for patients, visitors and staff, with recommendations and actions aimed at improving car parking, as well as moving towards more sustainable travel arrangements in the future.  The Trust agreed to forward a copy of the travel plan to Members.


The Committee were informed that in order to ensure that people who lived in West Cumbria had timely access to urgent ambulances there had been discussions with North West Ambulance Service (NWAS).  As a result from April 2015, NHS Cumbria CCG had agreed to pay for an additional ambulance which was available seven days a week, 12 hours a day for six months when a further review would take place.


Members raised their concerns regarding delays in ambulances in West Cumbria and were informed that liaison did take place with NWAS and any delays were investigated.  It was highlighted that time limits had much improved recently.


A detailed discussion took place to consider whether this did constitute a substantial service change and whilst the whole Committee did not agree the majority of Members considered this not to be a substantial service change.  It was therefore


RESOLVED,    that the proposals did not constitute a substantial service change.



Maternity Services Review pdf icon PDF 56 KB

To consider a report on Maternity Services in Cumbria (copy enclosed).


Additional documents:


The Committee received a report from the Cumbria Clinical Commissioning Group (CCCG) on the outcome and actions following the independent review of maternity services.


Members were informed that a review had been commissioned from the Royal College of Gynaecologists and Obstetricians (RCOG) during autumn 2014 by CCCG and NHS Lancashire North CCG.  The purpose of the review was to provide independent and expert advice on the best way to arrange high quality, safe and sustainable maternity services in the future.  The review had taken place in November 2014 and reported in March 2015.


There was recognition of the strong community support for the continuation of current services by maintaining four consultant-led units.  It highlighted that deprivation in some areas reinforced the need to provide services that were convenient but such services had to meet current safety standards.  Current working practices of a number of doctors within the four consultant-led units were not sustainable and a choice of birth arrangements for women could be improved by the gradual development of (alongside, near to or on the same site) midwifery-led units.  A long-term strategic plan for development of maternity services was needed which increased competencies of primary care, including community midwifery to increase normal birth and develop new working relationships for medical staff.  It was emphasised that the future much include active community engagement and a better understanding by the public and staff of true safety and access data.


The outcome of the review had recommended that three options should be considered.


            Option 1 – Four consultant-led maternity units at Carlisle, Whitehaven, Barrow and Lancaster with the immediate development of ‘alongside’ (on the same site or next to) midwifery?led units at Carlisle and Lancaster and in the longer term to evaluate the development of the same at Barrow and Whitehaven.


            Option 2aTwo consultant-led units at Carlisle and Lancaster and developing two alongside (on the same site or next to) midwifery?led units at Carlisle and Lancaster.  This was the assessors’ second favoured option should it not be possible to achieve option 1.  It would mean the closure of consultant?led units at Whitehaven and Barrow.


            Option 2b – Two consultant-led units at Carlisle and Lancaster, developing two on the same site or next to midwifery?led units at Carlisle and Lancaster and converting the consultant-led units at Whitehaven and Barrow to become ‘free-standing’ midwifery-led units, which meant they have no consultant obstetrics services on site.


However, the preferred recommendation was option 1 and it recommended that a project team be established reporting to a nominated governing body member appointed by the two CCGs to lead the project on the viability of options 1, 2a and 2b.


The Committee were informed that the CCG, NCUHT and UHMBT had formally confirmed that they accepted the review’s recommendations of the preference for option 1 and confirmed this would not have an impact on Penrith and Kendal.  It was explained that for this option the change in experience for mothers would be minimal.  ...  view the full minutes text for item 10.


Committee Briefing Report pdf icon PDF 78 KB

To consider a report by the Strategic Policy and Scrutiny Adviser (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 not covered elsewhere on the Committee’s agenda.


Members discussed the notes from the Mental Health Task and Finish Group held on 12 May 2015 to consider the draft Cumbria Mental Health Strategy.


The Group had discussed the development of the Strategy, its programme plans and main work streams, with representatives from the Health and Care Directorate of the County Council and the North of England Commissioning Support Unit.  Following those discussions Task Group Members agreed a number of points to formally feed back to the County Council and Clinical Commissioning Group on the Draft Strategy. 


The Health Scrutiny Committee Members agreed with the issues highlighted by the Task Group Members (referred to at Appendix 1 to the report) but requested that the paragraph referring to ‘care into the custody chain’ include the words ‘making reference to best practice undertaken elsewhere’ at the end of the paragraph.


A discussion took place regarding the workshop report from the Health Scrutiny Development day held on 18 May 2015.  Concerns were raised regarding the proposal to consider a scheme of delegation for using the toolkit to be made to the Chair, Vice-Chair and Lead Members as it was stated by some Members that responsibility would be taken from the majority of Committee Members.


The Committee discussed an update report regarding the preparations for consultation on changes to cardiac and upper gastro intestinal pathways which it was anticipated would affect around five patients a week 


Members were informed that North Cumbria University Hospitals NHS Trust was currently preparing a list of patients from both pathways who had transferred to the Cumberland Infirmary for 24 hour specialist care.  In due course letters would be sent to patients offering them the opportunity to take part in in?depth telephone interviews or focus groups as part of the consultation.  It was also hoped that some family members/carers would also wish to participate.


It was explained that arrangements were also being made for similar discussions to take place with patients who were taking part in cardiac rehabilitation sessions in West Cumbria.


To ensure a level of independence, the interviews or focus groups would be carried out by a community and voluntary sector organisation.  Discussions were underway with an organisation to agree a brief and timescales for the work.  It was expected that the engagement activity would take place during June and July 2015.  Once feedback had been collated and a report received from the community and voluntary sector organisation and considered by the relevant NHS organisations, this would be shared with the Committee.


Members highlighted the importance of including as many groups and individuals as possible, particularly carers groups.


RESOLVED,    that


                           (1)       the report be noted;


                           (2)       the submission by the Cumbria Mental Health Task Group on the draft Cumbria Mental Health Strategy be agreed after the words ‘making reference  ...  view the full minutes text for item 11.


Date of Future Meeting

To note that the next meeting of the Committee will be held on Monday 27 July 2015 at 10.00 am in County Offices, Kendal.



It was noted that the next meeting of the Committee would be held on Monday 27 July 2015 at 10.00 am in County Offices, Kendal.