Agenda for Overview and Scrutiny Committee (Adult Social Care and Health) on Tuesday 8th January, 2019, 6.30 pm

Agenda and minutes

Venue: Birkdale Room, Town Hall, Southport

Contact: Debbie Campbell,  Senior Democratic Services Officer

Items
No. Item

36.

Apologies for Absence

Minutes:

An apology for absence was received from Councillor Cummins, Cabinet Member – Adult Social Care.

 

37.

Declarations of Interest

Members are requested at a meeting where a disclosable pecuniary interest or personal interest arises, which is not already included in their Register of Members' Interests, todeclare any interests that relate to an item on the agenda.

 

Where a Member discloses a Disclosable Pecuniary Interest, he/she must withdraw from the meeting room, including from the public gallery, during the whole consideration of any item of business in which he/she has an interest, except where he/she is permitted to remain as a result of a grant of a dispensation.

 

Where a Member discloses a personal interest he/she must seek advice from the Monitoring Officer or staff member representing the Monitoring Officer to determine whether the Member should withdraw from the meeting room, including from the public gallery, during the whole consideration of any item of business in which he/she has an interest or whether the Member can remain in the meeting or remain in the meeting and vote on the relevant decision.

 

Minutes:

No declarations of any disclosable pecuniary interests or personal interests were received.

 

38.

Minutes of the Previous Meeting pdf icon PDF 148 KB

Minutes of the meeting held on 16 October 2018.

Minutes:

RESOLVED:

 

That the Minutes of the meeting held on 16 October 2018, be confirmed as a correct record.

 

39.

NHS Planning Guidance pdf icon PDF 3 MB

Presentation to be given by NHS South Sefton Clinical Commissioning Group and NHS Southport and Formby Clinical Commissioning Group.

Minutes:

Fiona Taylor, Chief Officer for NHS South Sefton Clinical Commissioning Group (CCG) and NHS Southport and Formby CCG, gave a presentation on the NHS Long Term Plan that outlined the following:-

 

  • The background to the matter;
  • How the NHS Long Term Plan was developed;
  • What the NHS Long Term Plan will deliver for patients;
  • Making sure everyone gets the best start in life;
  • Delivering world class care for major health problems;
  • Supporting people to age well;
  • Delivering the ambitions of the NHS Long Term Plan;
  • Doing things differently;
  • Preventing illness and tackling health inequalities;
  • Backing our workforce;
  • Making better use of data and digital technology;
  • Getting the most out of taxpayers’ investment in the NHS;
  • Next steps for Sefton;
  • What this means for staff, patients and the public; and
  • How to find out more.

 

Members of the Committee asked questions/raised matters on the following issues:-

 

·         How did the NHS Long Term Plan link with other plans already in existence, such as preventing unnecessary hospitalisation of patients? Reference was also made to the NHS RightCare system.

·         NHS RightCare looked at evidence to diagnose issues and identify opportunities. Both Sefton CCGs had peer groups which provided comparisons to identify any variants to the norm and develop solutions. An information session could be held on RightCare for Members of the Committee.

 

·         The future for primary care appeared to depend on information technology and not everyone had access to this.

It was acknowledged that it was necessary to use and explore multiple methods in order to direct patients to the best place. Pharmacists also had an essential part to play in primary care and face to face interaction.

 

·         Reference was made to staffing issues within the NHS and the pressures facing the workforce, including changes to nurse training. Factors such as student loans and the lack of a bursary were not encouraging the recruitment of student nurses.

The issue of the workforce was being considered across Cheshire and Merseyside collectively. There was some acknowledgement that progression within nursing had been lost and that nursing may have become too academic.

 

·         Education was important in order to help individuals to help prevent and control conditions.

Small investments with individuals could produce long term gains.

 

·         A number of figures were provided for major health problems nationally. Could the figures for Sefton be provided?

It was anticipated that further information on the NHS Long Term Plan and its implications for Sefton services would be submitted to the Committee in due course.

 

·         Reference was made to the aspiration within the NHS Long Term Plan to “give people more control over their own health and the care they receive”. It was considered that this approach would not work for all.

The Plan proposed offering choice back to individuals, rather than dictating what they should or should not do or making assumptions about what individuals wanted or needed.

 

·         Despite the fact that the NHS Long Term Plan emphasised prevention, there was no mention of additional resources for the Public Health function  ...  view the full minutes text for item 39.

40.

Medicines Management in Sefton pdf icon PDF 239 KB

Further to Minutes Nod. 28 (2) (b) and 34 (2) of 16 October 2018, the joint report provided by the Head of Medicines Management, NHS South Sefton Clinical Commissioning Group and NHS Southport and Formby Clinical Commissioning Group, is attached.

Minutes:

Further to Minutes Nod. 28 (2) (b) and 34 (2) of 16 October 2018, the Committee considered the joint report provided by the Head of Medicines Management, NHS South Sefton Clinical Commissioning Group (CCG) and NHS Southport and Formby CCG, on medicines management in Sefton. The report introduced the matter; explained how pharmacy services were commissioned; set out details about the Sefton Medicines Management Team; together with details of key work undertaken. Links to additional information were also contained within the report.

 

Members of the Committee asked questions/raised matters on the following issues:-

 

·         Could GP surgeries put up notices of the nearest available chemists?

Although GP surgeries could not promote specific chemists, as they were independent businesses, Practice Managers at GP surgeries tended to be aware of this information and could provide it to residents.

 

·         What did “WTE” within the report mean?

Whole time equivalent.

 

·         How would pharmacies evolve?

Skills required by pharmacists had evolved in that they were now required to have consultation and examination skills. There was also increased collaboration with care/nursing homes and social services.

 

·         Reference was made to the number of prescription items dispensed in Sefton, together with the cost of drugs dispensed during 2017/18. Was data available to indicate whether these figures were acceptable, or whether there were variations in prescribing within Sefton?

Clinical leads worked alongside the Team in considering any variations and this data was reported to the CCG governing bodies. Information would be provided to the Senior Democratic Services Officer for circulation to Members of the Committee.

 

·         How did the Minor Ailment Scheme (Care at the Chemist) work?

This scheme allowed residents to obtain medicines and advice for certain illnesses from local pharmacies without having to go to their GP first. Where residents did not pay for their prescriptions, they would not have to pay for any medicines supplied through the scheme.

 

RESOLVED: That

 

(1)       the presentation together with the information provided on medicines management in Sefton be noted; and

 

(2)       the Chief Officer for NHS South Sefton Clinical Commissioning Group (CCG) and NHS Southport and Formby CCG be requested to provide additional information on any variations in data on the number of prescription items and the cost of drugs to the Senior Democratic Services Officer, for circulation to Members of the Committee.

 

41.

DNA Rates in Primary Care pdf icon PDF 197 KB

Further to Minute No. 34 (3) of 16 October 2018, a presentation to be given by the Governing Body Practice Manager Lead, Southport and Formby Clinical Commissioning Group.

Minutes:

Further to Minute No. 34 (3) of 16 October 2018, Colette Riley, Practice Manager Lead, Southport and Formby Clinical Commissioning Group (CCG) gave a presentation on missed appointments, known as Did Not Attend (DNA) rates, in Primary Care. Lynne Creavy, Practice Manager, South Sefton CCG, was also in attendance.

 

The presentation focussed on managing the impact of DNAs in general practice, based on experience at The Hollies Surgery, Formby, in particular. The presentation outlined the following:-

 

  • The position at the Surgery, based on an audit undertaken in April – July 2017;
  • What is the impact of a “DNA” on general practice?;
  • Why DNA?;
  • The GP view;
  • What options do we have to try to fix this?;
  • Lessons learned; and
  • Outcome.

 

Members of the Committee asked questions/raised matters on the following issues:-

 

·         Experiences at other GP surgeries were quite different from The Hollies Surgery, with comparatively large numbers of DNAs occurring. Concerns were held for those patients who were unable to obtain appointments and were attending A&E as a result.

Some GP surgeries were considerably larger than The Hollies and covered areas with pockets of deprivation, which could be a contributory factor. Some patients, having made an appointment, found it difficult to attend the consultation, for a variety of reasons.

 

·         Late arrivals could be due to no fault of the patient and this occurrence should be dealt with sensitively.

 

·         It was important to consider what all the Sefton GP surgeries were doing about the issue and to learn about and share good and best practice from each other. Committee Members wanted to support all the Sefton practices in this matter.

 

Fiona Taylor, Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG, emphasised that GPs did value patients. Patients who were consistent DNAs were approached by surgery staff. She considered that it was important to identify what the real issues were and what could be achieved, in considering this matter.

 

RESOLVED:

 

That the presentation and information provided on DNA rates in primary care be noted.

 

42.

Sefton Clinical Commissioning Groups - Update Report pdf icon PDF 255 KB

Joint report of NHS South Sefton Clinical Commissioning Group and NHS Southport and Formby Clinical Commissioning Group.

Minutes:

The Committee considered the joint update report of the NHS South Sefton Clinical Commissioning Group and the NHS Southport and Formby Clinical Commissioning Group (CCG) providing an update about the work of the CCGs. The report outlined details of the following:-

 

·         Review of urgent care in south Sefton;

·         Update on extended GP access services;

·         Working together to explore DNA rates in primary care;

·         Primary care development strategies;

·         Next phase of local health policies review to start;

·         Change to prescribing of over-the-counter medicines launched in self-care week;

·         National prescribing consultation; and

·         First governing body meetings of 2019.

 

Fiona Taylor, Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG, was present from the CCGs to present the update report to the Committee and respond to questions put by Members of the Committee. She highlighted that the Urgent Care Review in south Sefton was not a consultation process, rather it was an engagement process at present and that Healthwatch Sefton was assisting in the survey. Residents of Southport and Formby who occasionally used urgent care services in south Sefton were encouraged to complete the survey too. She was mindful that any changes to the service would need to be submitted to this Committee for consideration. A review of urgent care in Southport and Formby would follow in due course.

 

Members of the Committee asked questions/raised matters on the following issues:-

 

·         It would be helpful if any proposals arising from the Urgent Care Review in south Sefton were reported to the Committee prior to any decisions being taken, in order that the Committee could influence the outcomes.

Stakeholder engagement events would take place on 20 February 2019, 6 and 20 March 2019, plus one in April 2019. A Sefton Healthwatch Community Champion session would take place on 22 January 2019. Assurances were given that stakeholder information was up-to-date.

 

·         Would responses provided by the North West Ambulance Service be provided within the Urgent Care Review in south Sefton?

Conversations would be held with appropriate stakeholders.

 

·         Reference was made to parity of care between mental and physical health, as personal health care budgets on the grounds of mental health conditions appeared to be extremely limited.

The Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG would provide the link to the relevant governing body report(s) to the Senior Democratic Services Officer.

 

·         Were children’s skin care products, such as emollients, included within the national prescribing consultation?

The British Medical Journal had advised that there were no proven benefits to shower products, rather moisturiser was key and this could be provided, together with advice on the amount to be supplied.

 

RESOLVED:That

 

(1)       the joint update report submitted by the Clinical Commissioning Groups be received; and

 

(2)       the Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG be requested to provide information relating to the relevant governing body report(s) that provide data on personal health care budgets to the Senior Democratic Services Officer, for circulation to  ...  view the full minutes text for item 42.

43.

Sefton Clinical Commissioning Groups - Health Provider Performance Dashboard pdf icon PDF 555 KB

Joint report of NHS South Sefton Clinical Commissioning Group and NHS Southport and Formby Clinical Commissioning Group.

 

Further to Minutes Nod. 28 (2) (c) and 34 (2) of 16 October 2018, information on the monitoring of the new 7 day GP extended access scheme for both CCGs is included within the data.

Minutes:

The Committee considered the joint report of NHS South Sefton Clinical Commissioning Group and NHS Southport and Formby Clinical Commissioning Group (CCG), providing data on key performance areas, together with responses for the Friends and Family Test for both Southport and Ormskirk Hospital NHS Trust and Aintree University Hospital NHS Foundation Trust.

 

Further to Minutes Nod. 28 (2) (c) and 34 (2) of 16 October 2018, information on the monitoring of the new 7 day GP extended access scheme for both CCGs was included within the data.

 

Fiona Taylor, Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG, was in attendance to present the data, highlight key aspects of performance, and respond to queries from Members of the Committee.

 

Members of the Committee asked questions/raised matters on the following issues:-

 

·         Concerns were held regarding the presence of an end of life patient on the stroke ward at Southport and Ormskirk Hospital NHS Trust prior to Christmas, as this was considered to be traumatic for recovering stroke patients.

The decision to include the patient on this ward would only have been taken if this was the only option available at the time.

 

·         The results for the responses to the Friends and Family Test for Southport and Ormskirk Hospital NHS Trust remained concerning, particularly for the A&E response.

The national system dictated how responses could be acquired and Southport and Ormskirk Hospital NHS Trust tended to utilise text messages, with responses being low. Aintree University Hospital NHS Foundation Trust was consistently better at the Friends and Family Test and the Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG undertook to investigate the reason(s) for this.

 

RESOLVED: That

 

(1)       the information on Health Provider Performance be noted; and

 

(2)       the Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG be requested to investigate the reason(s) why Aintree University Hospital NHS Foundation Trust scores consistently better at the Friends and Family Test than Southport and Ormskirk Hospital NHS Trust and report back to the Committee on the outcome.

 

44.

Cabinet Member Reports pdf icon PDF 285 KB

Report of the Chief Legal and Democratic Officer

Additional documents:

Minutes:

The Committee considered the report of the Chief Legal and Democratic Officer submitting the most recent Update Reports from the Cabinet Member – Adult Social Care, and the Cabinet Member – Health and Wellbeing, whose portfolios fell within the remit of this Committee.

 

The Cabinet Member Update Report - Adult Social Care, outlined information on the following:-

 

·         Carers’ Strategy;

·         Financial Update:

o   Revenue Budget Position;

o   Winter funding; and

·         Adult Social Care and the Star Awards.

 

Councillor Cummins, Cabinet Member – Adult Social Care, had submitted his apologies for the meeting and any questions on his Update Report could be submitted to him via the Senior Democratic Services Officer.

 

The Cabinet Member Update Report – Health and Wellbeing outlined developments on the following aspects of Public Health:-

 

·         Health Checks;

·         Flu Vaccination;

·         Cancer Prevention;

·         Obesity;

·         Suicide Report;

·         Public Health Outcome Framework;

·         Public Health Commissioned Services; and

·         Public Health Annual Report.

 

Councillor Moncur, Cabinet Member – Health and Wellbeing, was in attendance at the meeting to present his Update Report and highlight particular aspects of it. He reported that the Public Health Team was now almost fully staffed.

 

Members of the Committee asked questions/raised matters on the following issues:-

 

·         The figures on the reduction in deaths under the Suicide Report in the Cabinet Member Update Report – Health and Wellbeing were queried.

The figures for 2015 and 2016 should be transposed.

 

·         Further to Minute No. 35 of 16 October 2018, reference was made to the necessity of having phased deliveries of the flu vaccine in 2018/19, which had created an apparent shortage of the vaccine in the Southport area.

The supply of the vaccine had been one of the main difficulties this winter and this issue was not confined to Southport nor to Sefton. The issue would need to be reported back to Public Health England, in order to avoid similar problems next winter.

 

·         With regard to data on demographics for suicide rates, was there any variation in Sefton compared to national high-risk categories?

Sefton was broadly in line with national comparators. Work was also underway to roll out a programme to all Cheshire and Merseyside local authorities on children and young people suicide and self-harm prevention training. A one day mental health first aid course was available and information would be sought on this.

 

RESOLVED: That

 

(1)       the update reports from the Cabinet Member – Adult Social Care, and the Cabinet Member – Health and Wellbeing be noted;

 

(2)       Members of the Committee be invited to submit any questions on the Cabinet Member Update Report - Adult Social Care via the Senior Democratic Services Officer; and

 

(3)       the Senior Democratic Services Officer be requested to obtain information regarding mental health first aid training, for circulation to Members of the Committee.

 

45.

Work Programme Key Decision Forward Plan pdf icon PDF 240 KB

Report of the Chief Legal and Democratic Officer

Additional documents:

Minutes:

The Committee considered the report of the Chief Legal and Democratic Officer, seeking the views of the Committee on its Work Programme for the remainder of 2018/19; requesting the identification of potential topics for scrutiny reviews to be undertaken by any Working Group(s) appointed by the Committee; identification of any items for pre-scrutiny by the Committee from the Key Decision Forward Plan; and consideration of the process to be undertaken during 2019 regarding draft Quality Accounts.

 

A Work Programme for 2018/19 was set out at Appendix A to the report, to be considered, along with any additional items to be included and agreed. Potential items for the next Committee agenda included an invitation to the North West Ambulance Service to attend the meeting and an item on the Joint Strategic Needs Assessment.

 

Further to Minute No. 34 (3) of 16 October 2018, the Committee was invited to consider any potential scrutiny review topics to be undertaken during 2018/19 and a Criteria Checklist for Selecting Topics for Review was attached to the report at Appendix B. The Sefton Clinical Commissioning Groups (CCGs) had recommended that work to explore missed primary care appointments (DNAs) be deferred until after 1 April 2019, as it was hoped that the CCGs would assume delegated responsibility for the commissioning of general practitioner services after this date.

 

There were three Decisions within the latest Key Decision Forward Plan, attached to the report at Appendix C that fell under this Committee’s remit, and the Committee was invited to consider items for pre-scrutiny.

 

The report also sought views on the process to be undertaken for the scrutiny of draft Quality Accounts from NHS Trusts during 2019. The report set out the process adopted during 2018 and proposed following the same procedure in 2019. It was reported that the Chair and Vice-Chair of the Committee had met with Healthwatch Sefton representatives and had proposed consideration of the draft Quality Accounts from Mersey Care NHS Foundation Trust, insofar as the Trust provided community health services in the south of the Borough; Lancashire Care NHS Foundation Trust, as the Trust provided community health services in the north of the Borough; the Royal Liverpool and Broadgreen University Hospitals NHS Trust; and Southport and Ormskirk Hospital NHS Trust. A provisional date to consider the draft Quality Accounts would be confirmed in due course. In addition, an annual event was usually hosted by one of the Merseyside Clinical Commissioning Groups on draft quality Accounts and details would be confirmed, once they were available.

 

RESOLVED: That

 

(1)       the Work Programme for 2018/19, as set out in Appendix A to the report, be agreed, together with the proposals on items for the next meeting, namely an invitation to the North West Ambulance Service and an item on the Joint Strategic Needs Assessment;

 

(2)       the appointment of a Working Group on missed primary care appointments (DNAs) be deferred until after 1 April 2019;

 

(3)       the contents of the Key Decision Forward Plan for the period 1 December 2018  ...  view the full minutes text for item 45.