Agenda and minutes

Cumbria Health Scrutiny Committee - Thursday, 15th October, 2015 10.00 am

Venue: Committee Room 1 - County Offices, Kendal, LA9 4RQ. View directions

Contact: Lynn Harker  Email:

No. Item


Apologies for Absence

To receive any apologies for absence.




Apologies for absence was received from Mr J Lister, Ms C McCarron?Holmes and Ms J Williams.




Membership of the Committee

To note any changes to the membership of the Committee.




It was noted that Ms J Williams had replaced Mr R Burns as the Carlisle City Council representative on the Committee on a permanent basis.




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).




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




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 83 KB

To confirm the minutes of the meeting held on 27 July 2015 (copy enclosed).




RESOLVED,    that the minutes of the meeting held on 27 July 2015 be agreed as a correct record and signed by the Chair.




Success Regime Update

To receive a verbal update from the NHS Trust Development Authority.




The Committee received an update from the Programme Director, NHS Trust Development Authority on the Success Regime.


Members were informed that area covered by North Cumbria University Hospitals NHS Trust was one of the three areas chosen nationally due to:-


Ø             fragile services

Ø             safety and quality concerns in services – in special measures for two years

Ø             CQC rated NCUHT’s acute medical services as inadequate in the West Cumberland hospital

Ø             severe recruitment problems

Ø             chronic history of non delivery of standards

Ø             financial deficit c£50m for health.


It was explained that the priorities for the Success Regime included the improvement of service delivery in the short-term, an urgent summit on workforce, the fusion of Northumbria and North Cumbria, analysis of freedoms and further engagement.  It was emphasised that tough decisions would need to be made and the current financial situation could not continue as services needed to improve.


The Committee were informed that a full programme of engagement had been drawn up and included four planned deliberative events, a series of market place events, staff and clinical engagement and the use of social media.  It was emphasised that full engagement would take place with the public on potential solutions.  There had been significant resources put into engagement and Healthwatch were part of the Programme Board and Working Groups to give advice on engagement.


It was explained that the Stakeholder Reference Group was part of the programme governance structure and would both inform and be informed by Programme Board activities.  The Group would include key representatives from across the area from all stakeholder groups, including the public, with the first meeting due to take place by the end of October.   A member of the Cumbria Health Scrutiny Committee was invited to site on the Stakeholder Reference Group as their representative.


The Committee were informed that the next steps included:-


Ø             initial clinical options (including short and long term solutions);

Ø             innovation around clinical models – national support

Ø             involvement of a Clinical Advisory Group

Ø             supporting longer term leadership of acute services

Ø             engagement

Ø             financial sustainability (an external financial advisor was now part of the Team).


The Committee had a detailed discussion regarding the Success Regime and were informed that already a fair level of strategic thinking had taken place with a strategy in place in the north.  There were concerns regarding certain services in the short-term but it was emphasised that safety was of the utmost importance with a view to longer term.  Whilst acknowledging there were no immediate solutions it was explained that acute medical services in West Cumbria was a priority because at present there were only two substantive consultants.


Members were informed it was important that the best use was made of the new hospital in West Cumbria and the vision for health services was to ensure they were available as locally as possible.  It was highlighted that at the present time there was no consistent approach to community and primary care services in  ...  view the full minutes text for item 29.


Outcome of CQC Inspection of North Cumbria University Hospitals Trust pdf icon PDF 58 KB

(a)       To consider a report by the Care Quality Commission (copy enclosed).


(b)       To consider a Quality Improvement Plan from North Cumbria University Hospitals NHS Trust (copy enclosed).



Additional documents:


The Committee received an update from the Care Quality Commission (CQC) on their follow-up inspection of the North Cumbria University Hospitals NHS Trust (NCUHT) which also contained the NCUHT’s Quality Improvement Plan.


(a)       Care Quality Commission


Members were informed that between 30 March and 1 April 2015 the CQC had carried out a follow?up inspection of NCUHT which had covered the Cumberland Infirmary, Carlisle and the West Cumberland Hospital, Whitehaven.  The inspection was a follow?up inspection to the comprehensive inspection that had been conducted between 30 May and 2 June 2014.


The key outcomes of the inspection included:-


Ø             overall, the Trust was rated as requiring improvement;

Ø             safety, effective, responsive and well led were rated as requiring improvement;

Ø             caring was rated as good.


The Committee were informed that the Trust had a senior leadership team who were visible and approachable and committed to service improvement for the benefit of patients.  The clinical strategy for the future provision of services had yet to be agreed at the time of inspection as part of the wider health community transformation.  It was explained there was a comprehensive process for investigating serious incidents and investigation reports reviewed were of a good standard.  The staff were able to articulate the incident reporting process, however, the Trust remained a low reporter of incidents.  There had been improvement in the HSMR and the Trust were now within expected range with processes in place to review mortality at a corporate level.


Members were then informed that medical staffing levels remained a concern.  It was explained that recruitment of nursing staff had improved but was still a concern and that medicine continued to experience vacancies, therefore, the Trust was seeking new and innovative ways of working. 


A discussion took place regarding the actions which the Trust must take to improve, which included:-


Ø             ensure that medical staffing was sufficient to provide appropriate and timely treatment and review of patients at all times, including out of hours;


Ø             ensure that medical staffing was appropriate at all times including medical trainees, long-term locums, middle grade doctors and consultants;


Ø             ensure that nursing staffing levels and skill mix were appropriate particularly in medical care services;


Ø             action required to improve the levels of mandatory training compliance and improve the rate of appraisals completed;


Ø             improve patient flow throughout both hospitals to ensure patients were cared for on the appropriate ward for their needs and reduce the number of patient bed moves, particularly in the medical division.


The Trust were afforded 28 days to complete the ‘Must do’ Improvement Plan and submit it to the CQC.


The Committee were informed that the CQC would revisit the hospitals again at a date to be decided.


(b)       NCUHT Quality Improvement Plan


The Committee then had a detailed discussion regarding the NCUHT Quality Improvement Plan.  Members were informed that the Trust Board had approved a Quality Strategy for the Trust and had agreed a number of specific objectives for 2015/18 as part  ...  view the full minutes text for item 30.


Substantial Variation Protocol pdf icon PDF 61 KB

To consider a report by the Chief Executive (copy enclosed).



Additional documents:


The Committee received a report from the Chief Executive which contained proposals to agree a refreshed approach between the Health Scrutiny Committee of Cumbria County Council and NHS Organisations as to what constituted a ‘substantial variation’ of health services (referred to in appendix 1 to the report).


Members were informed that as part of the Health Scrutiny Development session which had taken place earlier in the year there were a number of recommendations made by the independent CfPS facilitator in respect to improvements that the Committee could make to the general effectiveness of how it might work.  The Committee agreed at its June meeting to take forward the examination of two proposals:-


Ø             a review and update of the toolkit which was currently used for identifying substantial variation;


Ø             scheme of delegation for using the toolkit to the Chair, Vice?Chair and Lead Members subject to a satisfactory set of steps being implemented to ensure that all members of the Committee were able to articulate why any decision had been taken.


A discussion took place regarding the report and the proposed Substantial Variation Protocol and it was agreed to amend it with reference to definitions of a temporary measure and what constituted a small number of patients (revised version referred to in the appendix to these minutes). 


Members raised their concerns regarding the number of service changes which had been agreed on a temporary basis with no final decision made to date on those services.  A further concern was also raised that the Cumbria Clinical Commissioning Group had had sight of the revised protocol before the Cumbria Health Scrutiny Committee.


A suggestion was made to delegate the use of the toolkit to a Sub?Committee consisting of a Health Scrutiny Committee member from each local area as opposed to the suggested Chair, Vice?Chair and Lead Members.  At this point the meeting was advised by the Chair that this decision was against officer advice because of the resource implications.  On being put to the vote it was


RESOLVED,    that


                           (1)       the amended protocol (referred to in the appendix to these minutes) be agreed;


                           (2)       the first stage of the protocol be delegated to a Sub?Committee comprising of:-


                                       Allerdale - Ms C McCarron-Holmes (as Ms McCarron?Holmes was absent from the meeting it was proposed the Mr J Lister be appointed if she did not accept the appointment)

                                       Barrow - Ms D Seward

                                       Carlisle - Ms J Williams

                                       Copeland – Mr M Hawkins

                                       Eden – Mrs M Robinson

                                       South Lakeland – Mr M Wilson


(It should be noted that Ms D Seward and Ms J Williams were not present at the meeting at this point).




Committee Briefing Report pdf icon PDF 82 KB

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



Additional documents:


The Committee received an update from the Policy and Scrutiny Project Officer which updated members on developments in health scrutiny, the Committee’s work programme and monitoring of actions not covered elsewhere on the Committee’s agenda. 


Members received an update on the CAMHS Scrutiny Review.  It had been agreed that there would be a joint review between the Children and Young People’s Scrutiny Board and the Health Scrutiny Committee and members were asked to express an interest if they wished to be part of the Task and Finish Group.  It was agreed that the task and finish review should be entitled ‘CAMHS and Autism Service’.


The Committee were then informed that the Joint Cumbria and Lancashire Health Scrutiny Committee continued to scrutinise the development and implementation of the ‘Better Care Together’ Programme with the next meeting scheduled to take place in mid November.


Members were then given an update on the GP Practice at Glenridding Health Centre.  The Committee were informed that since agreement with the Lakes Medical Practice to deliver services in Glenridding following the retirement of Dr Smith, due to unforeseen circumstances, they had decided they could no longer take on the practice at the present time.  It was emphasised that NHS England were committed to maintain services in Glenridding and it was confirmed that Cumbria Healthcare On Call (CHOC) had agreed to take on responsibility for the contract and provide GP services to the patients of Glenridding Health Centre for a temporary period until 30 April 2016.  The interim arrangement would allow time for NHS England to determine the future of the service from Glenridding after 30 April 2016.


A discussion then took place regarding the CQC inspection visits to GP practices and particular attention was drawn to the Lowther Medical Centre being classed as ‘inadequate’ and placed in special measures for a period of six months.  The practice had provided a detailed action plan which NHS England and the Clinical Commissioning Group (CCG) would monitor them against.


Members were informed that the CQC had highlighted issues at the Lowther Medical Centre concerning services in respect of being safe, effective, responsive to people’s needs and well led services, but it was emphasised that the practice was good in respect of delivering caring services.


Concerns were then raised regarding vascular services.  It was highlighted that when this had been referred to the Secretary of State the Committee had been assured that once acute cases had been dealt with there would be a simultaneous upgrade in the prevention policy with the assurance of better services.  The importance of a preventative policy was emphasised.  A discussion regarding the possibility of consultants working in hubs in the communities had also taken place but there had been no further update on this. 


It was agreed that the half day desktop review on vascular services would take place in the near future and the outcomes would be reported to the Cumbria Health Scrutiny Committee.


RESOLVED,    that


                           (1)       the scope for the joint Task  ...  view the full minutes text for item 32.


Date of Future Meeting

To note that the next meeting of the Committee will be held on Tuesday 15 December 2015 at 10.00 am at The Courts, Carlisle.




It was noted that the next meeting of the Committee would be held on Tuesday 15 December 2015 at 10.00 am at The Courts, Carlisle.



Substantial Variation Protocol





This protocol has been developed to facilitate a common approach between NHS Organisations and the Health Scrutiny Committee of Cumbria County Council as to what constitutes a ‘substantial variation or development’ of health services.


It is intended to promote early discussions on potential substantial variations as they are initially considered, prior to any formal consultation, so as to facilitate a more collaborative and joined up approach to substantial variations. The protocol is about working together, within the legal framework, to improve the experience of patients. Whilst concentrating on substantial variations or developments of health services, a recurrent theme is the need for the NHS Organisations and the Health Scrutiny Committee of Cumbria and opportunities to improve their care.


It is not intended that this protocol shall prejudice, conflict with or affect the exercise of the statutory functions, powers, rights, duties, responsibilities or obligations arising or imposed under any legislative provision enactment, bye-law or regulation whatsoever, nor shall it fetter the exercise of any discretion the Council or any NHS Organisation may have.


Legislative & Constitutional Context


Section 244 of the National Health Service Act 2006 authorises the Secretary of State to make regulations in relation to health scrutiny.


Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 (The Regulations) place an obligation on NHS Organisations to consult with the Council where they are considering any proposal for substantial developments or substantial variations to health services other than where a decision must be made as a result of the risk to safety or welfare of patients or staff.


The Council may issue a report to the Secretary of State where:


a.             the Council is not satisfied that consultation on any proposal has been adequate in relation to content or time allowed;

b.             the Council is not satisfied that the reasons given by the NHS Organisation not to consult are adequate; or

c.             the Council considers that the proposal would not be in the interests of the health service in its area.


Other than in relation to the University Hospitals of Morecambe Bay NHS Foundation Trust the Council has delegated its role in relation to the above regulations to Cumbria Health Scrutiny Committee (CHSC). This Protocol shall not apply in relation to the University Hospitals of Morecambe Bay NHS Foundation Trust whose substantial variations shall be addressed in accordance with the Council’s Constitution.


Stage 1 - Substantial Variation Determination Procedure


There is no definition within the Regulations of what constitutes a substantial variation or development and as a result proposals for service change should be discussed with the CHSC at an early stage to attempt to reach a common position between the NHS Organisation and CHSC where possible.


Without limiting the previous paragraph the parties will, where appropriate, use the following procedure:


1.             When an  ...  view the full minutes text for item 33.