Agenda and minutes

Cumbria Health Scrutiny Committee - Wednesday, 24th February, 2016 10.00 am

Venue: Council Chamber - County Offices, Kendal, LA9 4RQ. View directions

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

Items
No. Item

48.

Apologies for Absence

To receive any apologies for absence.

 

Minutes:

Apologies for absence were received from Mr J Bland, Mr M Hawkins, Ms C McCarron?Holmes, Mrs M Robinson and Mrs D Seward.

 

 

49.

Membership of the Committee

To note any changes to the membership of the Committee.

 

Minutes:

It was noted that Mr R Bingham had replaced Mr J Bland for this meeting only.

 

 

50.

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.

 

 

51.

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.

 

 

52.

Minutes pdf icon PDF 117 KB

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

 

Minutes:

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

 

 

53.

Cumbria Partnership Foundation Trust Update pdf icon PDF 587 KB

To consider a report by the Cumbria Partnership Foundation Trust (copy enclosed).

 

Additional documents:

Minutes:

The Committee received a report from the Cumbria Partnership NHS Foundation Trust which updated members on current issues affecting the Trust including regulatory matters, service performance, system?wide partnerships and looking ahead.  (It was agreed that a glossary of all acronyms would be made available in future reports).

 

(a)       Regulatory Matters

 

The Committee were informed that the Care Quality Commission had undertaken its comprehensive inspection of the Trust.  The Trust had received a draft report for factual accuracy and it was anticipated the final report would be published during March/April.

 

The Committee were then given an update on the Trust’s financial governance and were informed that this was lower than desired as they were currently running a deficit forecast at £7.4m (4.5% of turnover) for the 2015/16 year.  It was noted this was being financed from cash reserves, however, it was emphasised there were only 14 months further capacity in the reserves.  The Trust, therefore, had put in place an efficiency programme to move back to financial balance and was working closely in the Success Regime and Better Care Together to identify service improvements.

 

It was noted that Quality Governance was improving with the Trust out of enforcement undertakings and in receipt of a “green” risk rating from Monitor.  It was explained this followed a period of restructure into four care groups from seven localities (community, mental health, children’s and specialist care groups) and stronger clinical governance structures. 

 

(b)       Service Performance

 

The Committee were given an update on service performance and were informed the key issues included:-

 

Ø             percentage of individuals who had a delayed transfer – Community Services (DTOC) – target 7.5%, actual 22.7%.  DTOC performance continued to be a high risk and high priority for the community and mental health services.  It was explained the Trust continued to seek a system level response to this with a specific focus on the north of the county via the System Resilience Group (SRG) overseen by the Success Regime Programme Board.

 

During the course of discussion members raised their concerns regarding delayed discharges and were informed that this matter was being investigated with all partners concerned.  It was highlighted that there had been significant improvements in the north and south of the county particularly around assessments and discharges.  The Trust acknowledged their were difficult issues which needed addressed and highlighted that recruitment difficulties (ie carers) was a major factor in the problem.

 

A discussion took place regarding issues of DTOC across county borders ie Lancashire back to Cumbria and it was agreed to investigate this further and reply direct to the Committee.

 

Ø             safeguard training – there was a marginal dip in performance due to staff holidays and major incidents.

 

Ø             six weeks referral to diagnostics (target 99%, actual 96%) – it was explained that patients waiting over six weeks at the end of December were expected to be seen in January 2016.

 

Ø             improved access to psychological therapies (target 50%, actual 46.6%) - the recovery rate had fallen again in  ...  view the full minutes text for item 53.

54.

Countywide Review of Maternity Services

54a

Cumbria Clinical Commissioning Group pdf icon PDF 239 KB

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

Minutes:

The Committee received an update report on the Maternity Services Review from the Cumbria Clinical Commissioning Group. 

 

Members were informed that the review had been commissioned from the Royal College of Obstetricians and Gynaecologists (RCOG) during Autumn 2014 by NHS Cumbria CCG and NHS Lancashire North CCG and reported in March 2015. 

 

The RCOG report had recommended that a project team must be established quickly and be led by a senior manager, with an external advisory obstetrician, local head of midwifery and patient representatives.  The Group must report in a short time frame (one year) on the viability of Options 1, 2a and 2b which were as follows:

 

Ø             Option 1 – the maintenance of 4 consultant-led maternity units with immediate development alongside midwifery led units at Royal Lancaster Infirmary (RLI) and Cumberland Infirmary Carlisle (CIC).

 

Ø             Option 2a (the review team’s second favoured option) - consultant-led maternity units at CIC and RLI and the development of midwifery-led units alongside each of the two consultant-led units.  This would result in the closure of consultant-led units at West Cumberland Hospital (WCH) and Furness General Hospital (FGH).

 

Ø             Option 2b – as 2a above but with the development of standalone midwifery-led units at WCH and FGH.

 

The report recommended that the Implementation Group should consider:-

 

Ø             staffing and activity projections for each unit;

Ø             modelling of future demand for services and 10-year activity for option 1;

Ø             assessment of deprivation and impact on transport issues;

Ø             antenatal and neonatal transport modelling;

Ø             midwifery services development – modelling of normal births;

Ø             paediatric availability or alternative for SCU provision.

 

The Committee were informed that data collection and initial baseline analysis had been undertaken and presented to the RCOG Working Group.  It was explained that preliminary demand had been forecast and consideration given to several scenarios based on option 1.

 

The data showed there was little material change expected in the population that would affect the need for maternity services in the future.  Modelling of demographic change was a result of new industrial developments, such as a proposed new plant at Sellafield, had indicated incidental material impact on the maternity system in Cumbria.

 

A discussion took place regarding engagement with service users and key stakeholders and it was acknowledged that valuable support had been provided by Maternity Services Liaison Committees and Healthwatch Cumbria.

 

Members were informed that engagement had targeted women of child bearing age and their families and the process had included a questionnaire, events and drop?in sessions.  The key themes included:-

 

Ø             the importance of continuity of care throughout the pregnancy, birth and postnatal period;

Ø             consistency and quality of information and communication;

Ø             postnatal support for breastfeeding;

Ø             support and information for women to make informed decisions and choices;

Ø             accessible services and choice, thinking about some specific issues such as young mums, women and specific needs, travel and place of birth.

 

The Committee were informed that following feedback it was agreed the University Hospitals of Morecambe Bay and  ...  view the full minutes text for item 54a

54b

Healthwatch pdf icon PDF 6 MB

To receive a presentation from Healthwatch (copy enclosed).

 

Minutes:

The Committee received a report from Healthwatch Cumbria working in partnership with the Maternity Service Liaison Committees.

 

Members were informed that Healthwatch Cumbria had worked in partnership undertaking intense engagement to ascertain the views of women and others regarding maternity services.  It was explained that a survey had been undertaken with 1,234 responses.  The survey had found there were generally high levels of satisfaction with the care received at all steps in pregnancy and after the birth of the baby, however, there were comments about how services could be improved.  The themes of most significance were the importance of continuity of care, consistency of information, postnatal support for breastfeeding, support to make informed choices and accessible, local services. 

 

The Committee held a detailed discussion regarding the survey and highlighted the high response in the Copeland area.  Members were informed that completion of the survey was out of their control but explained that generally the results were comparable to those in the national survey.

 

Members were given a definition of ‘enough time’ and ‘about right’ and raised their concerns that clients who had completed the survey would not have been aware of the meaning.

 

A discussion took place regarding engagement with the stakeholders and members felt that a number of the questions were open ended and did not take into account rurality of the county.  The Committee were informed that the Cumbria Clinical Commissioning Group had taken responsibility for the advertising of the survey which had been promoted through the media, press releases, websites, social media, community groups etc.  Whilst acknowledging that improvements to the questions could be made the difficulties in exploring all matters was highlighted.

 

A discussion took place regarding the Helme Chase Maternity Unit at Westmorland General Hospital.  Members asked whether the temporary measures to move the Unit to an on?call cover overnight and at weekends had been addressed by the maternity review and were informed that this had not been included in the ROCG process.  It was explained that a report on the latest position had been requested by the Cumbria Clinical Commissioning Trust from the University Hospitals of Morecambe Bay Foundation Trust and it was agreed this would be made available to the Committee. 

 

The Committee discussed the low live birth figures for Helme Chase and it was explained this was due to a preference for a consultant-led unit.

 

RESOLVED,    that

 

(1)               the reports be noted;

 

                           (2)       the report from the University Hospitals of Morecambe Bay Foundation Trust on Helme Chase Maternity Unit be made available to the Committee.

 

 

55.

Update from North West Ambulance Service pdf icon PDF 1 MB

To consider a report from North West Ambulance Service (copy enclosed).

 

Minutes:

The Committee received a presentation from North West Ambulance Service NHS Trust (NWAS).

 

Members received a general introduction and an update on performance standards for 999 calls.  It was explained that all calls were prioritised to determine appropriate level of response.  The Committee were informed that all red calls were immediately life threatening with 75% of those calls being responded to within 8 minutes and 95% within 19 minutes.  It was noted that red calls were significantly high which was proving challenging.

 

The green calls were determined as less serious with no national targets set, however, NWAS did endeavour to respond as follows:

 

Ø             Green 1 – 20 minutes

Ø             Green 2 – 30 minutes

Ø             Green 3 – 3 hours

Ø             Green 4 – 4 hours

 

A discussion took place regarding the length of time for a green 3 or 4 response and members queried whether an ambulance actually arrived at the incident due to the time lapse.  The Committee were informed that the patient was initially contacted via the telephone to establish whether there were alternative options available.

 

A discussion then took place regarding performance and the Committee were informed that there had previously been a significant amount of over?activity, therefore, additional resources were being deployed to ensure both North Cumbria and Morecambe Bay hit their targets.  Members were informed that additional vehicles were due to become available and as part of the Success Regime joint roles were being investigated to recruit a wider audience into the role. 

 

Members were informed that ‘Hear and Treat’ meant that patients were referred to a clinical desk to consider alternative treatment.  With regards to ‘See and Treat’ an initial assessment was made by a clinician and a decision made as to the appropriate treatment ie referral to an alternative service other than accident and emergency. 

 

Concerns were raised regarding greater demand on CHOC due to the return of the NHS 111 service.  It was explained that the service was being developed and moving forward but highlighted the challenges around staffing issues which were being addressed.

 

A discussion then took place regarding the work which took place with Community First Responders (CFRs), volunteers who lived and worked in local communities.  It was explained they were trained and activated by NWAS to attend certain calls and provide support until the arrival of the emergency ambulance.

 

The Committee raised their concerns regarding funding for the CFRs service and were informed that NWAS provided training and reassessment of responders but were not in a financial position to provide any further funding.

 

The Committee discussed the evolving role of the service and it was anticipated there would be a community based provider of mobile urgent care and emergency health care.  It was explained it was envisaged patients would be safely managed at the scene, treating them at home or referring them to a more appropriate community based service with further opportunities to assess, prescribe and manage exacerbations of chronic illness, working closely with  ...  view the full minutes text for item 55.

56.

Interim Transfer Audit pdf icon PDF 2 MB

To receive a presentation from North Cumbria University Hospitals NHS Trust (copy to follow).

 

Minutes:

The Committee received a presentation from North Cumbria University Hospitals NHS Trust on the Internal Review of Transfers and a review of what had happened to outcomes as a consequence of transferring the high risk pathways.

 

Members were given an update on the transfers which had taken place from the West Cumberland Hospital and Cumberland Infirmary, Carlisle as follows:-

 

Ø             85 (10%) of the transfers between April-September 2015 had been identified;

 

Ø             high risk surgery, cardiology, GI bleed, respiratory;

 

Ø             coding identified 62 files for auditing:-

 

·               53 patients were identified as ambulance transfers

·               6 patients were discharged from West Cumberland Hospital accident and emergency but to attend Cumberland Infirmary, Carlisle the following day;

 

Ø             49 transfers were deemed to be an immediate clinical necessity and 42 transfers were considered unavoidable;

 

Ø             “avoidable” transfers – clinical decision made in patient’s best interest at the time;

 

Ø             19 patients did not receive surgery upon arrival to Cumberland Infirmary, Carlisle; some of those patients were discharged with intention to admit for surgery at a later date;

 

Ø             no patients died during their transfer or as a consequence of their transfer;

 

Ø             there were audit limitations.  The lack of specific Trust transfer forms was making assessment difficult but this was being addressed through improved documentation.

 

The Committee were informed that there were improvements in outcomes by transfers of care for orthopaedic related trauma, emergency general surgery, heart disease and intestinal (GI) bleeding.

 

A discussion took place regarding the transfer of patients from the West Cumberland Hospital to the Cumberland Infirmary and members were informed this would take place if it was identified in a pathway.  It was noted that a significant number of patients did not fit into a specific pathway and this needed to be addressed.  During the course of discussion the Trust emphasised it was not their intention to remove any further clinical expertise out of the West Cumberland Hospital.

 

Members raised concerns that patients transferred from West Cumberland Hospital accident and emergency department would need to be re?admitted to accident and emergency at the Cumberland Infirmary which was both time consuming and had resource implications.  It was acknowledged that this did happen in certain circumstances but pathways should be identified prior to transfer to avoid re-admittance to accident and emergency.  The Committee were informed that modifications were being investigated to ensure that patients were transferred to a specialist ward in the majority of cases.

 

Members were informed there was evidence to show that changes in those high risk pathways had saved lives.  There was currently an independent review of transfers taking place by the North East Quality Observatory. 

 

It was acknowledged there were improvements to be made and included the transfer of documentation together with investigations being carried out to allow more local treatment to be carried out at West Cumbria to eliminate the need to travel.

 

The Committee were informed that the Trust were working very closely with the Success Regime and that announcements of the work undertaken would  ...  view the full minutes text for item 56.

The Chair left the meeting at this point and Mr R Gill took the Chair.

 

 

57.

Committee Briefing Report pdf icon PDF 88 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.

 

During the course of discussion a number of members raised their concerns regarding the short length of time allocated to discuss each item of business.  They went on to raise their concerns regarding the length of time which representatives from the individual Trusts were waiting whilst also emphasising the costs this involved.

 

Members highlighted the importance of the business of the Committee and it was agreed that an average of 45 minutes should be allocated for discussion of future substantive items.

 

RESOLVED,    that

 

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

 

                           (2)       the scope and arrangements for the Scrutiny Review of Health and Care Integration (Integrated Care Communities) be noted;

 

                           (3)       Mr J Bland be appointed as the Cumbria Health Scrutiny Committee’s representative to the Complaints Handling Implementation Group.  It was agreed that as Mr Bland was absent from the meeting if he was unable to take up the position Mrs C Wharrier would represent the Committee;

 

                           (4)       the work programme be noted, a six monthly update on vascular services be included and an update on Better Care Together be available before early summer;

 

                           (5)       the arrangements for dealing with the West, North and East Cumbria Success Regime’s Clinical Strategy (referred to in paragraphs 5.1 and 5.3 of the report) be agreed;

 

                           (6)       visits to Carleton Clinic, Carlisle and Haverigg Prison be arranged;

 

                           (6)       following receipt of information from the Cumbria Clinical Commissioning Group an additional meeting of the Committee be arranged for early April to consider the Clinical Strategy;

 

                           (7)       an average of 45 minutes should be allocated for discussion of future substantive items.

 

 

58.

Date of Future Meeting

To note that the next meeting of the Committee will be held on Monday 16 May 2016 at 10.00 am at The Courts, Carlisle.

 

Minutes:

It was noted that the next meeting of the Committee would be held on Monday 16 May 2016 at 10.00 am at The Courts, Carlisle.