Agenda and minutes

Cumbria Health Scrutiny Committee - Tuesday, 15th December, 2015 10.00 am

Venue: Committee Room 2, The Courts, Carlisle, CA3 8NA. View directions

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

Items
No. Item

34.

Apologies for Absence

To receive any apologies for absence.

 

Minutes:

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

 

 

35.

Membership of the Committee

To note any changes to the membership of the Committee.

 

Minutes:

It was noted that Mr W Wearing had replaced Mr J Bland for this meeting only.

 

 

36.

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.

 

 

37.

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.

 

 

38.

Minutes pdf icon PDF 135 KB

To confirm the minutes of the meeting held on 15 October 2015 (copy enclosed).

 

Minutes:

RESOLVED,    that the minutes of the meeting held on 15 October 2015 be agreed as a correct record and signed by the Chair.

 

 

39.

Cumbria Health Scrutiny Variation Sub-Committee

39a

Cumbria Health Scrutiny Variation Sub-Committee pdf icon PDF 49 KB

To receive the draft minutes of the Cumbria Health Scrutiny Variation Sub?Committee held on 12 November 2015 (copy enclosed).

 

Minutes:

The draft minutes of the Cumbria Health Scrutiny Variation Sub?Committee held on 12 November 2015 were noted.

 

39b

Terms of Reference pdf icon PDF 59 KB

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

 

Additional documents:

Minutes:

RESOLVED,    that the Terms of Reference of the Cumbria Health Scrutiny Variation Sub?Committee be agreed.

 

 

40.

Outcome of CQC Inspection of University Hospitals of Morecambe Bay Trust pdf icon PDF 58 KB

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

 

 

Additional documents:

Minutes:

The Chair congratulated the Trust on recently being taken out of special measures.

 

The Committee received a report from the Chief Executive which gave an update from the Care Quality Commission (CQC) on their follow?up inspection of the University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) together with a response from the Trust.

 

Members were informed that the CQC had visited the three main hospitals ran by the Trust (Furness General Hospital, Royal Lancaster Infirmary and Westmorland General Hospital) where inspectors had reported improvements in leadership, staffing levels, governance, incident reporting and risk management. 

 

The Trust informed the Committee that the latest inspection report from the CQC had found them to be making progress in all the areas which had been identified in its inspection in February 2014. 

 

It was explained that one particular area which had been identified for improvement was the High Dependency Unit at Furness General Hospital, with the CQC reporting that previous staffing issues in that area had been “comprehensively addressed, and there was sufficient staffing numbers of nurses to meet the needs of patients at all times”. 

 

Members were informed that overall the Trust had received a new rating of ‘requires improvement’ with all services rated as ‘good’ for caring and no services were rates as ‘inadequate’.

 

Whilst recommending that the Trust was taken out of special measures it was reported that it was apparent that it was on a journey of improvement and progress was being made both clinically and in the Trust’s governance structures. 

 

During the course of discussion the Trust explained they were gratified for the recognition of improvement but emphasised there was still a significant amount of work to be undertaken to ensure consistently high standards of care across all the services were provided.  The Trust gave examples of improvement including lower mortality rates which were amongst the best in the country and explained that harms caused to patients had fallen well below the national average.

 

The Committee were informed of the seven areas for improvement which had been identified by the CQC, and included:-

 

Ø             The Trust must ensure that all premises were suitable for the purpose for which they were being used and properly maintained – particularly physiotherapy and medical care services provided from Medical Unit One.

 

Ø             Sufficient suitably qualified, competent, skilled and experienced people must be deployed to meet the needs of the patients.  Staff should receive appropriate support, training and appraisal.

 

Ø             The Trust must ensure that staff understood their responsibilities under, and act in accordance with, the requirements of the Mental Capacity Act 2005 and associated code of practice.

 

Ø             Staff must follow policies and procedures around managing medicines, including intravenous fluids particularly in medical care services and critical care services.

 

Ø             Referral to treatment times in surgical specialities must improve.

 

Ø             The Trust must ensure that the resuscitation trolleys on the children’s ward are situated in areas that make them easily accessible in an emergency.  All staff must be clear on who  ...  view the full minutes text for item 40.

41.

Upper GI and Cardiac Pathways Consultation Outcome pdf icon PDF 60 KB

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

 

Additional documents:

Minutes:

The Committee received a verbal update on the recent flooding in Cumbria.  Members were informed that the events had a huge impact on all the health services.  The Cumberland Infirmary and Royal Lancaster Infirmary had lost their power and had been running on generators.  It was explained that all elective surgery had been cancelled and an emergency surgeon had been located in the West Cumberland Hospital.  It was emphasised that at all times during the events every effort was made to ensure all patients, particularly those most vulnerable, were in receipt of the appropriate care.

 

The acute phase had ended and the strategic recovery group had stood down and taken over by recovery groups.  As part of the health and social care group both short and long-term issues would be identified and addressed appropriately.

 

The Committee then received a report from the Chief Executive which outlined the findings from a consultation which had taken place following a proposal to change the pathway for a small number of patients (estimated at 2.7 per week) with serious heart conditions.  It was also reported that it had not been possible to undertake a consultation on the changes to the Upper GI pathway.

 

It was explained that this meant a transfer from West Cumberland Hospital to Cumberland Infirmary to access 24 hour specialist care and outlined the figures showing the extent of transfer activity in both cardiac and upper GI pathways.  The report also included recent reassurances given by local and national NHS organisations about the future service provision at West Cumberland Hospital.

 

The Committee were informed that the pathways had been developed by local clinicians and been reviewed by independent clinicians from the Northern Clinical Senate.  The Senate was 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.

 

It was explained that the Cumbria Clinical Commissioning Group and the Trust had stated that the safety of patients must always be a priority for both commissioners and providers of healthcare.

 

Members were informed that the changes to both pathways equated to the transfer of around five patients a week from West Cumberland Hospital to Cumberland Infirmary.  This represented a very small proportion of patients with digestive problems and heart and circulatory problems.  It was highlighted that the majority of patients with those health problems continued to be treated at West Cumberland Hospital.

 

It was explained that reassurances had also been provided recently in an open letter from local and national healthcare organisations regarding their plans to ensure safe, high quality and deliverable services for the future.  This included reassurances that the continued delivery of a 24 hours a day, 7 days a week accident and emergency service at West Cumberland Hospital was non negotiable. 

 

It was emphasised there are no plans for further changes to any of the clinical services currently provided at West Cumberland Hospital until the Clinical Strategy had been developed  ...  view the full minutes text for item 41.

42.

Root Cause Review of the Internal Major Incident in North Cumbria - March 2015 pdf icon PDF 55 KB

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

 

Additional documents:

Minutes:

The Committee received a report from the Chief Executive which contained an update from the Cumbria Clinical Commissioning Group on actions following the internal major incident affecting health and care services across North Cumbria University Hospitals NHS Trust (NCUHT) in March 2015.

 

Members were informed that an internal major incident in North Cumbria had taken place from 18 to 23 March 2015.  It was explained that the Trust did not have the staffing required to maintain safety across the escalation beds that were needed to cope with patient numbers.  The safety concern was noted predominantly at the Cumberland Infirmary, Carlisle.  The pressures experienced were noted in part to be linked to a norovirus outbreak that had continued since mid-January and prolonged system?wide pressures. 

 

Following the internal major incident the national Emergency Care Intensive Support Team (ECIST) (a team with specialist knowledge in managing urgent and emergency care, bed pressures, surge and flow) were requested by the North Cumbria System Resilience Group, to undertake a Root Cause Analysis of the incident.  The ECIST had produced a report with recommendations and a suggested action plan at the beginning of July. 

 

Members were informed that a number of recommendations were already in progress or had been implement since July:-

 

Ø             Development of a system-wide escalation plan – this was already in place but not widely used and not up-to-date.

 

Ø             The implementation of a whole system (Senior Review, Assessment, Flow, Early Discharge, Regular Review) SAFER tool – implementation of this had commenced at NCUHT during ‘Breaking the Cycle’ week and was currently being further implemented and embedded into the organisation.

 

Ø             A workforce strategy was being developed through a Workforce Group as part of the wider Success Regime.

 

The NCUHT had also developed a comprehensive action plan to reduce the risk of spread of norovirus through improvement of infection control measures.  This work had been progressing since and had significantly reduced the risk of spread. 

 

A number of other actions and events had taken place since the report was completed that impacted on North Cumbria and, in effect, many of the recommendations would be taken forward as part of the programmes of work.

 

In conclusion, the Committee were informed that the Incident had been multi-factorial in nature but had also a feature experienced by several other health economies in England.  It was explained that due to the particular challenges faced in North Cumbria additional support, assistance and oversight had been provided by NHS England and the Department of Health through the Success Regime and subsequently the Emergency Care Improvement Programme.  It was highlighted that West, North and East Cumbria’s health and social care system needed to ensure that it was able to utilise this additional support to implement evidence based initiatives that would effectively reduce the pressures experienced last winter.  A significant level of work had already taken place and was in progress and needed to continue at a pace to enable winter 2015/16 to be effectively managed.

 

In discussing the report  ...  view the full minutes text for item 42.

43.

Radiotherapy, Oncology and Chemotherapy Provision pdf icon PDF 55 KB

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

 

Additional documents:

Minutes:

The Committee received a report from the Chief Executive outlining the approach of NHS England for the provision of oncology services, including radiotherapy and chemotherapy delivery to the population of Cumbria.

 

Members were informed that concerns had been expressed by North Cumbria University Hospitals Trust (NCUHT) that it was not able to continue to provide their radiotherapy service indefinitely.  It was explained that the linear accelerator stock was now over 10 years old and this was the usual timeframe for replacement of the equipment.  It was noted that the increasing likelihood of breakdown presented a risk to the service, but it was emphasised that the equipment was considered safe at present.

 

NHS England informed members that there were difficulties in recruiting medical staff which had given rise to concern about the fragility of the wider Oncology service.  It was explained that this had been addressed in the short term by support from Newcastle?upon?Tyne Hospitals NHS Foundation Trust’s specialist cancer centre; but there was a need for a permanent solution.  It was accepted that the solution to the current problem would not be found in securing radiotherapy provision alone and should, therefore, include the full Clinical and Medical Oncology service. 

 

It was explained to members it had been established at an early stage that a move to a lead-provider model to create a “networked” service based on collaborative partnerships was the key to delivery of a sustainable service.  Such a model would ensure that the skills and expertise necessary for the provision of treatment to the specified standard across the cancer pathway were available to the local population.  Whilst the lead provider was likely to be an existing major cancer provider outside of Cumbria, it was considered essential that the service would continue to be delivered locally; in particular the existing co-location of some inter–linked services on the Cumberland Infirmary site was deemed a major consideration.

 

During the course of discussion concerns were raised regarding the pathology service at the Cumberland Infirmary.  The Committee were informed that part of the overall strategy was to incorporate various services, including pathology, in the whole pathway.

 

The Committee were informed that due to the governance process they were unable identify the new provider but would update members as soon as the details were available.

 

RESOLVED,    that

 

                           (1)       the report be noted;

 

                           (2)       an update be made to a future meeting when the new provider had been identified.

 

 

44.

Complaints Process pdf icon PDF 53 KB

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

 

Additional documents:

Minutes:

The Committee received a report from the Chief Executive regarding a joint Healthwatch Cumbria and Cumbria Health Scrutiny Committee task and finish group regarding the handling of complaints by health and social care providers in Cumbria.

 

The Committee were informed that Phase 1 of the work of the Group focused on developing an understanding of how complaints were handled in health and social care organisations across Cumbria through a series of presentations.  The Group had expanded its membership to include members of the public and moved on to Phases 2 and 3 considering whether:

 

·              Managers and staff in services which had been the subject of a complaint were aware of what had happened and also whether any changes in practice had been implemented as a result.

 

·              Customers who had complained had been kept informed about how their experience had helped to improve practice. 

 

It was explained that to assist with this part of the project, the NHS Complaints Advocacy Service was asked to provide the Task and Finish Group with data that had been supported through the service in relation to each of the health and social care organisations.  It was emphasised that customer confidentiality and appropriate permissions was paramount to this work.

 

Members were informed that the work included telephone interviews and the use of the statutory Enter and View function afforded to local Healthwatch organisations to visit wards and other service delivery areas to determine how learning from complaints had been embedded.

 

The report had been shared with Chief Executive Officers and Complaints Managers of all the organisations that were studied during the delivery of the project for accuracy.

 

RESOLVED,    that

 

                           (1)       the joint report be endorsed;

 

                           (2)       Healthwatch write a letter to the organisations who use the procedures;

 

                           (3)       Healthwatch write formally to organisations covered by recommendations and responses communicated to the Committee.

 

 

45.

Cumbria and Lancashire Vascular Services Review pdf icon PDF 59 KB

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

 

Additional documents:

Minutes:

Members received a report from the Chief Executive which provided an update on the progress of implementing the reorganisation of vascular services.

 

The Committee were informed that a review of the services contained a recommendation from the Vascular Clinical Advisory Group to have three arterial centres, one in the north of Cumbria and two for the southern part of the geography.  It was explained that at the time it was recognised that the population base for a service in north Cumbria would be below the level recommended by the Vascular Society but the AAA Screening programme agreed that an arterial centre could be commissioned in Carlisle.  After a collaborative procurement exercise two hospitals were selected by commissioners from Cumbria, Lancashire and Wigan - Royal Preston Hospital and Royal Blackburn Hospital.  The Joint Cumbria and Lancashire Overview and Scrutiny Committee (OSC) accepted the recommendations as not requiring further consultation.

 

However, in January 2013, the project was referred for review to the Independent Reconfiguration Panel (IRP) by Cumbria’s Health Scrutiny Committee.  In July 2013, the Secretary of State for Health, Jeremy Hunt, responded advising that a formal review into the process was not required and that the process would benefit from a jointly agreed programme of public information. The NHS had reported the progress of implementation of the reorganisation of services to on a quarterly basis to the Vascular Task Group established by Cumbria’s Health Scrutiny Committee.

 

During the course of discussion concerns were raised regarding the availability of specialised vascular nurses in south Cumbria and it was explained that at present nurses were being relocated on a temporary basis from the Royal Preston Hospital.  It was acknowledged that there was a need for permanent nurses to be based in south Cumbria but recruitment was proving difficult.  NHS England confirmed that the matter would be investigated further.

 

Members then raised concerns regarding the identification of local rehabilitation beds for patients once they had completed their vascular inpatient stay.  It was explained this matter had been raised with all four acute trusts and the specialist and local commissioners as there was a lack of intermediate care beds across the region.  This was resulting in prolonged inpatient stays in the vascular centre (following amputation) when this cohort of patients did not require specialist vascular input and it would be more appropriate for the patient to be treated locally. 

 

In summary, members were informed that measured against the original stated aims of the Review it could be seen that there had been considerable achievements made to date.

 

RESOLVED,    that

 

                           (1)       a further update be made on specialist nurses and rehabilitation beds;

 

                           (2)       a further update, including information on patient satisfaction and outcome data, be made to a future meeting of the Committee;

 

(3)               the Task and Finish Group be not re?established.

 

 

46.

Committee Briefing Report pdf icon PDF 74 KB

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

 

Additional documents:

Minutes:

The Committee received a report 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.

 

A discussion took place regarding the Joint Cumbria and Lancashire Health Scrutiny Committee and it was agreed that formal terms of reference would be drawn up.

 

Members discussed the future work programme and it was agreed the North West Ambulance Service should be invited to a future meeting to discuss Changes to Service which arose from the Clinical Strategy for North Cumbria.

 

RESOLVED,    that

 

                           (a)       the report be noted;

 

                           (b)       the North West Ambulance Service be invited to a future meeting of the Committee to discuss Changes to Service arising from the Clinical Strategy for North Cumbria.

 

 

47.

Date of Future Meeting

To note that the next meeting of the Committee will be held on Wednesday 24 February 2015 at 10.00 am at County Offices, Kendal.

 

Minutes:

It was noted that the next meeting of the Committee would be held on Wednesday 24 February 2016 at 10.00 am at County Offices, Kendal.