Venue: Conference Room A/B, Cumbria House, 107-117 Botchergate, Carlisle, CA1 1RD
Contact: Lynn Harker Email: email@example.com
Apologies for Absence
To receive any apologies for absence.
Apologies for absence were received from Mr J Bland, Mr R Gill and Mr A Toole.
Membership of the Committee
To note any changes to the membership of the Committee.
It was noted that Mr W Wearing attended in place of Mr J Bland for this meeting only.
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.
To confirm the minutes of the meeting held on 13 October 2016 (copy enclosed).
With reference to minute 34 – Healthcare for the Future – WNE Cumbria it was noted that a question had been raised regarding where in the pathway CT scans took place. Also, with regards to the provision of an emergency ambulance service it was noted that NWAS specialist maternity ambulance staff also worked within the hospital to gain necessary experience.
RESOLVED, that with the inclusion of the above amendments the minutes of the meeting held on 13 October 2016 be agreed as a correct record and signed by the Chair.
To consider a report by NHS England (copy enclosed).
The Committee received a report which provided an update on the progress of implementing the reorganisation of vascular services.
Members were informed that ‘Improving Vascular Services: A Case for Centralisation of Vascular Services in Lancashire and Cumbria’ was published in March 2011. It was noted that the Review contained the recommendation of 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. 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 and these were the Royal Preston Hospital and the Royal Blackburn Hospital.
Members discussed the concerns which had been 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.
The Committee had also raised concerns regarding the identification of local rehabilitation beds for patients once their vascular inpatient stay was complete. 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. It was noted that 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.
Members were then given an update from Lancashire Teaching Hospitals NHS Foundation Trust (LTHT) and were informed that the surgical team now employed 11 surgeons with four dedicated vascular surgeons working in the Lancaster and South Cumbria area.
The Committee were informed that all were employed by LTHT but carried out regular clinics and day case lists in Barrow and Lancaster, with inpatient referrals when on?site, together with the introduction of regular clinics in Kendal.
Members raised their concerns regarding accessibility to both Barrow and Kendal and the need for more outpatient services outside those areas. It was explained that it was difficult to match all needs of individuals, taking into account travelling time for the surgical team but it was agreed to provide data on the number of patients from Cumbria and where they were treated over the previous 12 months.
A discussion took place regarding the structure for rural areas which were often difficult to reach due to public transport issues. A question was raised regarding what prevention measures were being undertaken to provide a framework to lead healthier lives. Members ... view the full minutes text for item 42.
To consider a report by Cumbria Clinical Commissioning Group (copy enclosed).
The Chair, on behalf of the Committee, raised his disappointment at the quality of response and lack of attendance at the meeting of Tim Rideout, Director of Commissioning Operations, Cumbria and the North East, NHS England. It was agreed the Chair would write to NHS England expressing the Committee’s concerns.
Members received a report which gave an update from the Cumbria Clinical Commissioning Group on its response to the NHS England assessment.
Members noted that NHS Cumbria CCG was one of 26 CCGs (214 CCGs in total) to be assessed as Inadequate overall. NHS England had placed formal directions (effectively regulatory requirements) on all CCGs assessed as ‘Inadequate’ overall for 2015/16.
It was explained that NHS England had provided a full explanation of all of the formal directions requirements to NHS Cumbria CCG. This provided further clarity on the specific requirements of the formal directions, and included a key requirement to submit a further iteration of the Improvement Plan, and the Financial Recovery Plan.
The Committee were informed that NHS England had commissioned PricewaterhouseCoopers (PwC) to review the CCG Improvement Plan during December 2016. It was noted the CCG would provide documentary evidence to PwC to demonstrate progress on the Improvement Plan on 9 December 2016 and NHS England would hold its quarterly assurance meeting with NHS Cumbria CCG on 26 January 2017.
A discussion took place regarding the Improvement Plan and members requested that a timeline and direction of travel be made available in future.
Members raised a question regarding the CCGs reliance on the delivery of the Success Regime and it was confirmed there was no reliance and highlighted that it was the CCGs responsibility to ensure a public consultation was undertaken in an appropriate and transparent way.
A discussion took place regarding the Formal Directions which had been placed by NHS England and it was explained that they would decide whether any of the directions could be removed or varied. It was noted that if they were not removed by April 2017 they would pertain to the future CCG in North Cumbria.
Whilst discussing the Executive Summary members noted the steps which had been taken to address the scope of the challenge and questioned the period of significant cultural change across the organisation. The Committee were informed that one feature of the Improvement Plan was the implementation of an Organisational Development Strategy which would involve a number of cultural changes to improve services. In response to a query raised regarding availability of resources to implement the changes it was confirmed that the proposed boundary change would contribute to a significant restructure within the organisations which would afford the opportunity to focus capacity where it would have the largest impact in the future.
The Committee discussed the proposed boundary changes and whilst the concerns of members were acknowledged it was emphasised that in future the two Clinical Commissioning Groups would continue to have a close working relationship. Members were informed that NHS England had provided additional financial resources ... view the full minutes text for item 43.
To consider a report by the Policy and Scrutiny Team (copy enclosed).
The Committee received an update on progress to date on the production of Sustainability and Transformation Plans (STP) for Cumbria.
To consider a report by the Director of Finance and Strategy (copy enclosed).
The Sustainability and Transformation Plan (STP) Co-ordinating Director presented a report on the West North East (WNE) Cumbria STP.
The Committee were informed that the Plan had been prepared in line with national requirements and fully reflected the Cumbria Health and Wellbeing Strategy and the Clinical Strategy for Health Services developed within the WNE Cumbria Success Regime. It was noted that building on the major public engagement activity associated with the Success Regime and current public consultation the STP was subject to the ongoing and transparent process of consultation and decision?making underway.
Members were informed the STP had been developed by the senior practitioners and staff from the key statutory organisations and it was noted that by working closely together, the partners had reflected in the STP the key issues for both Health and Health and Care Services for West North and East Cumbria.
The Committee noted that in contrast to the national process for STPs, the substantial use of the Cumbria Health and Wellbeing Strategy and the Clinical Strategy for Health Services developed within the WNE Cumbria Success Regime meant that the STP was fully based on existing and openly available plans, or ones that were being transparently developed at the present time. It was explained that on this basis the STP did not introduce new themes into strategic planning but instead reinforced those that were already well known to the public and other stakeholders. It was highlighted to members that the partners were fully committed to future local STP development being undertaken within the full partnership of the Cumbria Health and Wellbeing Board and to active engagement with communities in the further development of the STP in future.
The Committee discussed the effects of the proposed STP and were informed it was felt they were vital for the future, highlighting the importance of services working together irrespective of national priorities. Members noted that a number of service changes set out in the proposed STP were part of the Success Regime and may need to be amended depending on the final outcome.
Members discussed potential funding constraints and were informed it was intended to use the existing NHS allocation earlier to avoid a crisis. It was agreed that a better use of funding was needed in partnership with the Public Health and Social Care budget held by the Local Authority to prevent ill?health. Members highlighted the importance of the integration of services.
A discussion took place regarding the Integrated Care Community (ICC) pilots in the north of the county where it was explained the concept of the ICCs had been taken forward with further pilots planned for the future. It was noted there was a similar, but more developmental approach, in the south of the county which had received local enthusiasm.
Members noted the growing concerns regarding delayed discharges due to the reduction in residential care beds and it was agreed this would have a detrimental effect on the implementation of the new system.
The Committee ... view the full minutes text for item 44a
To consider a report by Healthier Lancashire and South Cumbria (copy enclosed).
The item was deferred until the next meeting of the Cumbria Health Scrutiny Committee scheduled for Tuesday 28 February 2017 due to the lack of attendance of the appropriate officer.
The Committee emphasised their disappointment at the lack of attendance of the Director – Healthier Lancashire, highlighting the importance of members being updated of all issues.
Members agreed that the proposed key lines of enquiry on the South Cumbria and Lancashire STP be forwarded to the Director requesting a written response.
To consider a report by Cumbria Partnership Foundation Trust (copy to follow).
Members received an update from the Cumbria Foundation NHS Trust (CPFT) on the implementation of their action plan to address key areas of improvement highlighted in the recent Care Quality Commission (CQC) report.
The Committee were informed that the overall CQC rated CPFT as ‘requires improvement’ and had identified specific areas for improvement. Members noted 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. It was emphasised that although there were areas for improvement identified, there were no enforcement notices served on the Trust as part of the inspection. The Committee noted that the CQC would re?inspect Trusts and services where they received an ‘inadequate’ or ‘requires improvement’ rating following their comprehensive inspection.
A detailed discussion took place regarding the Key Areas for Improvement: CQC Requirement (or ‘must do’) actions.
Whilst members welcomed the report they questioned the lack of direction of travel and it was agreed that the Committee would be provided with more in?depth information.
The Committee noted a series of recommendations regarding the safeguarding report and were informed that essentially a significant amount of work had been undertaken over the past two years. It was noted a root cause analysis had been undertaken to ensure the proposed action plan could be delivered. It was acknowledged there were delays in providing care packages due to the lack of providers in the County with the necessary experience.
Members discussed patient safety and in particular Deprivation of Liberty Standards (DoLS) emphasising the importance of mandatory training for all concerned. It was explained that individual core skills and acceptable standards were being reviewed together with the acceptable level of transferrable skills. The Committee asked for clarification on who was responsible for meeting DoLS.
A discussion took place regarding the closure of Kentmere Ward and it was confirmed that further discussions were planned with the Cumbria Clinical Commissioning Group regarding permanent closure. It was noted that longer term this would be considered as part of the Mental Health Consultation.
The Committee noted that nurse call alarm bells were currently awaiting to be fitting in the Acorn Unit and members would be provided with further information.
A brief discussion took place regarding the Ellerbeck Ward at Workington Hospital and it was agreed that any further information on the status of it would be circulated to the Committee as soon as it was available.
A discussion took place regarding Community Services and the staffing levels and skills mix which was available on wards. Members were informed that all wards were currently staffed 1 qualified member of staff to 8 patients but it was explained this ratio was flexible and could increase to 12 patients if necessary. It was highlighted that ratios were considered on a daily basis emphasising that safety and quality were of the utmost importance.
The Committee discussed the unannounced inspection on Edenwood as part of the re?inspection ... view the full minutes text for item 45.
To consider a report by the Policy and Scrutiny Project Officer (copy enclosed).
Members received a report which gave an update 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 future of pharmacies in the county and members emphasised the importance of their role particularly in respect to rural and isolated urban areas.
The Committee discussed the outcome of the Cumbria Clinical Commissioning Group’s proposals arising out of their consideration of the consultation on Healthcare for the Future and it was agreed a special meeting should be arranged for mid March if necessary.
A discussion took place regarding Lead Member meetings and it was agreed that all information should be made available to the Committee.
(1) the arrangements for scrutinising the Better Care Together Programme be noted;
(2) the minutes of the Lancashire Scrutiny Committee on the Better Care Fund be circulated to members of the Committee;
(3) feedback from recent scrutiny site visits be noted;
(4) the Cumbria Health and Wellbeing Board report on ‘Funding of Pharmacies’ be circulated to the Committee;
(5) a letter from the Cumbria Health Scrutiny Committee be sent to NHS England expressing its concerns regarding the future of pharmacies;
(6) the progress made on the recommendations of the Sight Loss Services Task Group be noted;
(7) Healthwatch be invited to submit questions to contribute to the key lines of enquiry developed in advance of each Committee meeting;
(8) a Special meeting be organised, if necessary, to discuss the CCG’s proposals arising out of their consideration of the consultation on Healthcare for the Future;
(9) the work programme be noted;
(10) all future meetings of the Committee be scheduled for a full day with pre-meetings 9.30am-10.30am and public meetings starting at 10.30 am.
Date of Future Meeting
To note that the next meeting of the Committee will be held on Tuesday 28 February 2017 at 10.00 am at County Offices, Kendal.
It was noted that the next meeting of the Committee would be held on Tuesday 28 February 2017 at 10.00 am at County Offices, Kendal.