Agenda and minutes

Cumbria Health Scrutiny Committee - Monday, 16th May, 2016 10.00 am

Venue: Committee Room 2, 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.



The District Council representatives elected a Vice-Chair of the Committee from amongst their members.


RESOLVED,    that Mr R Gill be elected Vice-Chair of the Committee for the ensuing year.




Apologies for Absence

To receive any apologies for absence.



Apologies for absence were received from Mr J Bland and Mr R Gill.




Membership of the Committee

To note any changes to the membership of the Committee.



(1)       It was noted that Mr M Cassells, Ms V Taylor, Mrs GR Troughton and Mr A Toole were now permanent members of the Committee in place of Mrs D Seward, Mrs M Robinson, Mr M Hawkins and Mr D Fletcher.


(2)       Mr W Wearing attended in place of Mr J Bland for this meeting only.


The Chair welcomed everyone to the meeting.




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 131 KB

To confirm the minutes of the meeting held on 24 February 2016 and the Special meeting held on 13 April 2016 (copies enclosed).


Additional documents:


It was noted that the words ‘Cumbria’ should read ‘Child’ and ‘investigating’ should read ‘investigated’ in the penultimate paragraph on page 11.


RESOLVED,    that with the inclusion of the above amendments the minutes of the meeting held on 24 February 2016 and the Special meeting held on 13 April 2016 be agreed as a correct record and signed by the Chair.




Care Quality Commission Comprehensive Inspection of Cumbria Partnership Foundation NHS Trust pdf icon PDF 60 KB

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



The Committee received a report from the Chief Executive which contained an update from the Care Quality Commission (CQC) on their inspection of the Cumbria Foundation NHS Trust (CPFT) together with the CPFTs Response.



CQC Quality Report pdf icon PDF 521 KB

To consider the Care Quality Commission Quality Report (copy enclosed).


Members were informed that following inspections overall the CQC rated CPFT as ‘requires improvement’ and had identified some specific areas for improvement.  It was explained that two of the 13 specific services checked were rated ‘inadequate’ - community health services for children, young people and families, and wards for people with learning disabilities or autism.  The overall rating for services were as follows:-


Ø             safe – requires improvement

Ø             effective – requires improvement

Ø             caring – good

Ø             responsive – requires improvement

Ø             well-led – requires improvement


Members raised a concern regarding the lack of an invite to the Quality Summit and were informed an invitation had been afforded to the Authority via its Corporate Management Team.


The Committee had a detailed discussion regarding the Quality Report.  Members drew attention to restraint and the Committee were informed that the stand alone wards used domestic staff and porters who had been trained in the Prevention and Management of Violence and Aggression (PMVA) for restraint.  It was noted that the CQC were concerned about how this met with the requirements of the Mental Health Act Code of Practice in terms of de?escalating and restraining patients in accordance with positive behavioural support plans.  Members were informed that the CQC considered restraint as the last option and explained that all organisations had a restrictive pathways induction plan to be adhered to.


A discussion took place regarding the Trust audit which highlighted that patients were waiting longer than the nationally recognised three hour target between being brought to the health based place of safety and their commencement of assessment.  It was noted that the majority of those waits were by patients detained by the police in the late afternoon or early hours of the morning.  Members requested that figures on the waiting times for Health Based Places of Safety be circulated to the Committee.


The Committee were informed that following the inspection an action plan was drawn up and monthly meetings were taking place with the Trust.  It was also emphasised that both announced and unannounced visits would be carried out in areas where there were continued concerns.



CPFT Summary and Response pdf icon PDF 105 KB

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


Additional documents:


The Committee received a report which advised members of the outcomes of the Trust’s CQC comprehensive inspection.  The paper also provided a brief summary of the outcomes from the Quality Summit that had been held to discuss the findings from the inspection together with the responses of the Trust.  It was explained that the Quality Summit discussion supported the Trust to refine the action logs to address the 52 Requirement Notices, or ‘must do’ actions. 


Members attention was drawn to the following key areas:-


Ø             Clinical governance at the front line – the Trust confirmed significant progress had been made in terms of clinical governance at both a Trust?wide and network level, the next step was, therefore, working with front line teams to embed similar arrangements.


Ø             Paediatric resuscitation equipment in minor injury units – the correct equipment had been put in place.


Ø             Medical staffing on inpatient mental health wards - units were now staffed.


Ø             Safeguarding – additional members of staff had been trained.  The Committee emphasised the need for effective training with regular refresher training taking place.  Members were informed that the programme and style of training was being investigated by the Trust. 


Ø             Electronic patient record (EPR) and challenges of efficient and robust record keeping – improvements were taking place.  Solutions had been implemented in children’s, mental health and most of the specialist services.  It was noted there was still a need to confirm with partners future EPR for community services and it was agreed a timescale would be confirmed for this to be resolved in line with the moves to implement integrated services.


Ø             Estates – options for premises were being investigated.


Ø             Understanding and compliance with the Mental Capacity Act – a refresh of training had taken place.


Ø             Overview.


Ø             Reporting, monitoring and re-inspection.


The Committee were informed the Trust had produced an Action Plan which would be available once it had been agreed by the CQC.  Members highlighted that sight of this in advance of the meeting would have been advantageous and requested that a copy was circulated to the Committee once it had been agreed.


A discussion took place regarding leadership of the Trust, members raised their concerns requesting assurances that this matter was being investigated.  The Committee were given the Trust’s full assurance that they were paying particular attention to leadership issues.  It was highlighted that clinical leadership was problematic due to recruitment problems but the Trust were confident an improved picture would emerge.


Members raised their concerns regarding the safeguarding issues and were informed this had been recognised by the Trust prior to the CQC inspection.  It was explained that work had already taken place to train further staff in specialist safeguarding supervision skills and an additional 20 members of staff had received specialist training.  It was noted that the Safeguarding Policy had been updated and was being communicated.  The next steps were to implement the framework for all teams to have a named supervisor and to audit  ...  view the full minutes text for item 7b


Sustainability and Transformation Plan pdf icon PDF 61 KB

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


Additional documents:


The Committee received a report which gave an update on progress to date on the production of Sustainability and Transformation Plans (STP) for Cumbria.


Members were informed that in December 2015, the NHS had published guidance on the publication of Sustainability and Transformation Plans (STPs).  It was explained that every health and care system had been required to come together to create its own ambitious local blueprint for accelerating its implementation of the Forward View.  STPs would cover the period between October 2016 and March 2021, and be subject to formal assessment in July 2016 following submission in June 2016.


It was noted that in the guidance, authored by the six national NHS bodies, a clear list of national priorities was set out for 2016/17 and longer-term challenges for local systems, together with financial assumptions and business rules.  It reflected the settlement reached with the Government through its new Mandate to NHS England and, for the first time, it was solely for the commissioning system, but also set objectives for the NHS as a whole.


The Committee were informed that the guidance required the NHS to produce two separate but connected plans:


                a five year Sustainability and Transformation Plan (STP), place-based and driving the Five Year Forward View; and

                a one year Operational Plan for 2016/17, organisation-based but consistent with the emerging STP.


The guidance stated that as a truly place-based plan, the STPs must cover all areas of CCG and NHS England commissioned activity including:


(i)                 specialised services, where the planning would be led from the 10 collaborative commissioning hubs; and


            (ii)        primary medical care, and do so from a local CCG perspective, irrespective of delegation arrangements.  The STP must also cover better integration with local authority services, including, but not limited to, prevention and social care, reflecting locally agreed health and wellbeing strategies.


It was explained that the guidance required local health and care systems to consider their transformation footprint – the geographic scope of their STP.  Members were informed that taken together, all the transformation footprints must form a complete national map and it was noted that the scale of the planning task may point to larger rather than smaller footprints.


It was noted that where geographies were already involved in the Success Regime or devolution bids, the guidance expected them to determine the transformation footprint.  However, there was an expectation that there would only be 40 STPs for England, with areas covered by previous CCG 5-year plans merging.


It was explained that for Cumbria this meant that there would be an STP for the West, North and East (WNE) Cumbria, however, there would be an expectation to have alignment with the STP covering the North East of England.  It was also anticipated that the WNE Cumbria STP would align with the WNE Success Regime Clinical Strategy to avoid duplication.  There would then be one STP for the whole of Lancashire and South Cumbria which would include sub?plans for the more  ...  view the full minutes text for item 8.


Clinical Strategy Consultation Plans pdf icon PDF 56 KB

To consider a report by the Chief Executive (copy enclosed – Appendix to follow).


Additional documents:


The Committee received a report from the Chief Executive which outlined the planned approach to consulting on the Clinical Strategy for North Cumbria.


The Success Regime had conducted a major public and stakeholder engagement programme and developed an emerging vision which was ‘…to develop within West, North and East Cumbria an international centre of excellence for integrated health and care provision in rural, remote and dispersed communities.  Our ambition is to see the West, North and East Cumbria health community become an international beacon for integrated health and care provision for remote populations.’


Members were also informed that in conjunction with local communities and local stakeholders the Success Regime was also developing some clear proposals for future service development.  It was explained those proposals would take account the views obtained through the engagement undertaken to date and would be the subject of a formal public consultation programme which was planned to begin at the end of June/beginning of July 2016.


The Committee were informed, that at their request, there would be 16 public meetings, double the number originally proposed, and would include public meetings in all eight of the community hospital localities.


It was explained the options to be considered during the consultation would set out what was considered to be the best way to deliver sustainable and high quality services for the people of West, North and East Cumbria. 


The key principles that would be used to guide the consultation programme were as follows:


·               it would be as visible as possible

·               it would be open and transparent

·               it would be engaging and accessible

·               it would be proportionate

·               it would give respondents an opportunity to express wider views as well as to indicate specific preferences

·               key stakeholders would be involved in determining the details of the consultation programme

·               the consultation process would have an honest intention.  The consultor would be willing to listen to the views advanced by consultees, and would be prepared to be influenced when making subsequent decisions

·               the consultor would also be honest in explaining to the consultees that decisions would be influenced by a number of factors of which the result of the public consultation is just one.


It was explained that the consultation would be anchored in best practice including key guidance documents and the Consultation Team would seek guidance and advice from the Consultation Institute.


The Committee discussed the consultation on the Strategy and were informed that this would be carried out as a whole and it was anticipated results would be available in early November.


Members were informed that during the formal consultation period monthly stakeholder briefing meetings would take place and would include County Council representatives.  The Trust would seek to encourage the widest possible involvement in the consultation process and would respond to ad hoc meeting requests (for example from parish councils, town councils, patient groups etc) in an appropriate and proportionate manner.


A discussion took place regarding the option or options that would be taken to public consultation  ...  view the full minutes text for item 9.


Update on Commissioning of Primary Care in Cumbria pdf icon PDF 51 KB

To consider a report by the Chief Executive (copy enclosed) and receive a presentation from NHS England.



The Committee received an update on the Commissioning of Primary Care in Cumbria.


Members were informed that NHS England was responsible for the direct commissioning of services outside the remit of clinical commissioning groups, namely primary care, public health, offender health, military and veteran health and specialised services.  Whilst in some areas CCGs had full or partial delegated responsibility for the commissioning and contract management of primary medical care (Co-commissioning), this was not the case in Cumbria.


It was explained that Cumbria’s General Practice was undergoing the most significant changes it had seen since the inception of the NHS.  In Cumbria there were plans to develop change across the whole health and care system.  In the south, Vanguard (Better Care Together) were looking to integrate health and social care across north Lancashire and south Cumbria and in the north the Success Regime (Together for a Healthier Future) was likely to see similar proposals.


The GP Development Plan was about creating a robust General Practice system across Cumbria that could provide the foundation for a new approach to integrated health and social care.  It was highlighted that a programme of activities had to be adopted that delivered quickly, therefore, helping practices to address problems in the short terms, as well as activities that may take longer. 


The specific challenges for Cumbria were highlighted and they included:-


Ø             unavoidable small and/or isolated practices ie Seascale and Coniston;

Ø             disparate sites and large boundaries;

Ø             challenged health economy;

Ø             clinical networks;

Ø             relatively few at-scale organisations;

Ø             severe recruitment difficulties;

Ø             vulnerable practices.


The Committee discussed the challenges which lay ahead and, in particular, the lack of GPs in the county.  Members were informed that work had been undertaken with local businesses to promote that area but highlighted that recruitment was a problem.


A discussion took place regarding the quality of GP practices, and in particular, treatment of elderly patients.  NHS England requested that they be informed direct of any particular issues which it was considered were not being addressed.


The Committee discussed the Challenge Fund for GPs to extend hours and it was confirmed that practices in Cumbria had applied for funding which would be locked for three years.


A concern was raised regarding the rurality of the area and in particular the central Lake District.  It was highlighted that GPs in those areas had experienced a reduction in registered patients but experienced enormous pressures due to the number of tourists.  Members were informed that the problem had been attributed to due to the number of part-time GPs and the problems experienced in recruitment.  It was noted that NHS England were investigating the issues and would report back.


RESOLVED,    that the report be noted.




Committee Briefing Report pdf icon PDF 95 KB

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


Additional documents:


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 agenda.


RESOLVED,    that


                           (1)       the method by which the variation protocol would be discharged with respect to the Success Regime Clinical Strategy (referred to in the report) be agreed;


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


                           (3)       Jim Bland and Mike Cassells be appointed as the County Council’s representatives on the Joint Cumbria and Lancashire Health Scrutiny Committee;


                           (4)       the arrangements for the next meeting of the Cumbria Health Scrutiny Variation Sub?Committee be noted;


                           (5)       Neil Hughes, Gillian Troughton and Mike Cassells be appointed as the County Council’s representatives on the Cumbria Health Scrutiny Variation Sub?Committee;


                           (6)       the progress update for the Scrutiny Review of Health and Care Integration (Integrated Care Communities) be noted;


                           (7)       the following items be added to the work programme for the December meeting:-


                                       Cumbria Partnership Foundation Trust CQC follow-up

                                       Hospices and End of Life Care

                                       Primary Care Development Plan.




Date of Future Meeting

To note that the next meeting of the Committee will be held on Monday 25 July 2016 at 10.00 am at County Offices, Kendal.



It was noted that the next meeting of the Committee would be held on Monday 25 July 2016 at 10.00 am at County Offices, Kendal.