Agenda for Overview and Scrutiny Committee (Adult Social Care and Health) on Tuesday 26th February, 2019, 6.30 pm

Agenda and minutes

Venue: Committee Room, Town Hall, Bootle

Contact: Debbie Campbell,  Senior Democratic Services Officer

Items
No. Item

46.

Apologies for Absence

Minutes:

Apologies for absence were received from Councillors Bliss, Dawson, Bill Welsh and his Substitute Councillor Webster, Marianne Welsh and Roger Hutchings, Healthwatch.

 

47.

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.

 

48.

Introductions

Minutes:

Introductions took place. The Chair welcomed Matt Ashton, Director of Public Health, back to the Committee.

 

49.

Minutes of the Previous Meeting pdf icon PDF 127 KB

Minutes of the meeting held on 8 January 2019.

Minutes:

RESOLVED:

 

That the Minutes of the meeting held on 8 January 2019, be confirmed as a correct record.

 

50.

North West Ambulance Service - Data for Local Area pdf icon PDF 176 KB

Briefing paper submitted by the North West Ambulance Service.

 

Stuart Ryall, Sector Manager for Sefton and John Collins, Consultant Paramedic for Sefton, to attend from the North West Ambulance Service.

Additional documents:

Minutes:

The Committee considered the briefing paper submitted by the North West Ambulance Service NHS Trust (NWAS) that outlined the NWAS Strategy; changes to how performance was measured; Sefton performance; the Performance Improvement Plan; initiatives/partnership working; and hospital turnaround.

 

Stuart Ryall, Sector Manager (North) and John Collins, Consultant Paramedic, attended the meeting to report on recent developments at the Trust and to give a presentation that outlined the following:

 

·         Our Strategy – Delivering the right care, at the right time, in the right place;

·         Ambulance Response Programme Pilot (ARP);

·         Why ARP?;

·         ARP Objectives;

·         What are the changes?;

·         How do the Changes Benefit Patients?;

·         New Measures;

·         ARP 2.3 Response Standards;

·         How are we doing in Sefton? – performance figures;

·         Performance Improvement Plan;

·         South Sefton and Southport & Formby Clinical Commissioning Groups (CCG) Initiatives;

·         Wider NWAS Initiatives; and

·         Summary.

 

The NWAS representatives outlined initiatives being undertaken with South Sefton and Southport and Formby CCGs, as follows:

 

·         Appointment of Southport Community Specialist Paramedic;

·         Social prescribing pathways with third sector agencies;

·         Mersey Fire and Rescue Service (MFRS) referral scheme whereby NWAS clinicians could refer vulnerable individuals for home fire safety checks;

·         Partner working with frequent caller team to put in place anticipatory care plans;

·         A dementia hub meeting for service users planned for early March 2019, led by NWAS and involving other partners;

·         Regular attendance at Locality GP meetings over service modernisation and their collaborative working with NWAS;

·         Work with Queenscourt Hospice to assist with the roll-out of District Nurse verification of expected death;

·         Work with Lancashire Care NHS Trust and the CERT Team to look at pathways of care, particularly in the community setting;

·         Work with Southport District General Hospital to set up a “Care Home Forum” to facilitate training system changes to care home settings;

·         GP Out of Hours – Acute Visiting Service (AVS), where patients were suitable for a community based setting. There was currently no AVS in Sefton and paramedics experienced long delays in accessing an Out of Hours Provider. This could lead to unnecessary hospital admissions.

 

The following initiatives were also outlined:

 

·         Introduction of electric powered vehicles;

·         Planning permission in place for brand new build estate (Hub & Spoke/Make Ready model);

·         100% of paramedic grades trained in Manchester Triage System (MTS);

·         Introduction of Electronic Patient Records (access to Summary Care Records) (SCRs) Web-based access;

·         More Clinicians in EOC - (Team of dedicated Emergency Operations Centre (EOC) Clinicians in control rooms supporting patients and control room staff at the first point of patient contact); and

·         Early identification of most life-threatening calls by use of key words.

 

In addition, Aintree University Hospital NHS Foundation Trust was currently working with NWAS to identify changes to the hospital handover process, as part of the “Super Six” project across the NWAS footprint. The previous winter had been challenging across Cheshire and Merseyside and work had been undertaken to identify where paramedics could safely leave patients at A&E, where they could be supervised.

 

The Chief Officer for NHS South Sefton CCG and Southport and Formby CCG, reported  ...  view the full minutes text for item 50.

51.

Sefton Clinical Commissioning Groups - Update Report pdf icon PDF 166 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: -

 

  • Deal to Expand GP Services Welcomed by Local Health and Care Leaders;
  • Sefton Residents Urged to Take Part in Europe’s Biggest Healthcare Survey;
  • Designated Clinical Officer Appointed;
  • Annual 360-Degree Stakeholder Survey;
  • Assessment Results for Clinical Priority Areas;
  • Patient and Community Engagement Assessment;
  • Next Stages of Urgent Care Review in South Sefton;
  • Reductions in CCG Running Costs;
  • National EU Exit Guidance;
  • Update on Local Health Policies Review;
  • Help Us Help You by Choosing Pharmacy First; and
  • Next Governing Body Meetings.

 

Fiona Taylor, Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG, was in attendance to present the update report to the Committee, to highlight particular aspects of it, and to respond to questions put by Members of the Committee. Regarding the Urgent Care Review in South Sefton, she reported that it was possible that the review could result in a different model of Urgent Care which would require the CCGs to consult with this Committee on a substantial variation or development of the service. For this reason, the Chair of the Committee would no longer be requested to attend a series of co-design events, to avoid any conflict of interests.

 

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

 

  • Regarding the Update on the Local Health Policies Review, how would this affect residents, including those who required continuous glucose monitoring?

The review would largely focus on changes in clinical evidence about the effectiveness of certain treatments, to help ensure the best use of limited NHS funds. The review would also focus on individual funding requests, based on criteria, rather than the norm. A clinical panel meets to consider cases via the Individual Funding Request process. Additional information on the review could be shared with Members of the Committee.

 

  • Was there a risk that the panel established to consider requests would cost more than the treatment?

The panel would only meet when it was required to do so and would consider a number of requests.

 

  • Regarding the Deal to Expand GP Services Welcomed by Local Health and Care Leaders and the investment to employ physician associates, would these be qualified doctors?

They were not fully qualified doctors, rather they were trained to a certain level of practice in specific areas and this was the next phase of their training/development.

 

  • Where housing developments were built, how did the CCGs monitor the need for additional GP capacity?

CCGs were not yet responsible for the commissioning of general practice, nor the appropriate budget, until 1 April 2019 when such commissioning would be fully delegated from NHS England. Where there was an increase in the population, including the establishment of nursing homes, this was reflected in the GP contract as GP surgeries were paid per head of  ...  view the full minutes text for item 51.

52.

Sefton Clinical Commissioning Groups - Health Provider Performance Dashboard pdf icon PDF 640 KB

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

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.

 

Information on the monitoring of the new 7 day GP extended access scheme for both CCGs was also included within the data.

 

Further to Minute No. 43 (2) of 8 January 2019, information on approaches taken regarding the collection of data for the Friends and Family Test by both Southport and Ormskirk Hospital NHS Trust and Aintree University Hospital NHS Foundation Trust, 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. Regarding the Friends and Family Test at Southport and Ormskirk Hospital NHS Trust, she reported that she had discussed with the A&E Consultant at the Trust the use of patient experience tokens in A&E.

 

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

 

·         Regarding the 7 day GP extended access scheme, which GP practices were making referrals and which were not? The latter category could result in unnecessary attendance at A&E.

A heat map of Sefton, showing the location of GP practices and correlating referrals, could be used to provide this information.

 

·         Would Southport and Ormskirk Hospital NHS Trust consider the use of mobile texts and other approaches adopted by Aintree University Hospital NHS Foundation Trust for the Friends and Family Test (FFT)? Southport and Ormskirk should trial the use. Neither Trust recorded responses from outpatients.

The demographics of patients using Southport Hospital might not lend them to respond using texts. The number of patients responding for Southport and Ormskirk Hospital NHS Trust was relatively low, but a significantly high rate of respondents was recommending the Trust. The principle of the FFT was good, although only one element of patient experience was measured and in that respect, the system was not ideal. However, this was the system in place and it would be useful for Committee Members to raise the issue with Southport and Ormskirk Hospital NHS Trust at forthcoming meetings on draft Quality Accounts when Trusts could be challenged on performance.

 

·         Non-attendance (DNAs) for both CCGs’ 7 day GP extended access scheme could be improved, particularly in South Sefton. Was this a transport issue?

The Liverpool City Region Combined Authority Transport Committee was currently looking at the issue of buses and bus routes. Patients in Southport and Formby were more likely to use vehicles to access the facility.

 

·         The locations of the new 7 day GP extended access scheme were not ideal, particularly in the north of the Borough. More patients were likely to be familiar with the Litherland Town Hall site in south Sefton. This issue could be  ...  view the full minutes text for item 52.

53.

Cabinet Member Reports pdf icon PDF 68 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:

 

·         Financial Update:

o   Revenue Budget Position;

o   Winter Funding;

·         Performance;

·         Workforce Development;

·         Carers’ Survey Results - Initial Overview;

·         Commissioning Projects:

o   Adult Social Care Domiciliary Care Services;

o   Supported Living;

o   Extra Care Housing; and

o   Fee Strategy.

 

Councillor Cummins, Cabinet Member – Adult Social Care, attended the meeting to present his Update Report and highlight particular aspects of it.

 

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

 

·         Stop Smoking Service Contract Extension;

·         Medically Managed Residential Detoxification;

·         Smoking at Time of Delivery (smoking in pregnancy);

·         Health Inequalities Report;

·         Well Sefton;

·         NHS Health Checks;

·         Blood Pressure Checks to be Delivered in Workplaces Across Cheshire and Merseyside;

·         Money Advice in Central Southport;

·         Public Health Annual Report;

·         Prevention is Better than Cure – Government Vision on Prevention;

·         Swim Pilot Update; and

·         Leisure Update.

 

Councillor Moncur, Cabinet Member – Health and Wellbeing, attended the meeting to present his Update Report and highlight particular aspects of it.

 

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

 

  • Had the Adult Social Care Service coped with demand over the winter period?

The service had coped although there had been challenges, particularly with domiciliary care and re-ablement. An outbreak of the Norovirus at Southport Hospital had made matters particularly difficult. Officers at the Council and the Clinical Commissioning Groups (CCGs) had collaborated as much as possible to deliver services for residents.

 

  • Could the Committee receive more information regarding the Swim Pilot Update?

Finance for the scheme had been secured via external funding, the majority of which had been spent on infrastructure, such as changing facilities, etc. This had resulted in increased use and income to the Council which had benefitted from the pilot, whilst the lessons learnt on what would encourage more people to swim would be applied at a national level.

 

  • Could personalised healthcare budgets be used for swimming, if it was considered to maintain health?

Limited criteria applied in these circumstances.

 

  • What were the reasons for non-attendance (DNAs) for NHS Health Checks? Did issues of inequality apply?

The new model of health checks was still in the pilot stage, and in redesigning the service, Public Health had been careful to consider issues around inequalities such as location of services, accessibility and transport routes. The Director of Public Health offered to share this learning with the CCGs around their DNA rates for urgent care appointments.

 

  • Cycling was an activity residents could enjoy, whilst achieving health benefits. Would cycle routes be improved?

Cycle routes came under the Locality Services Portfolio. Additional funding was likely to be obtained via Mersey Travel for improvements to coastal cycle routes.

 

RESOLVED:

 

That the  ...  view the full minutes text for item 53.

54.

Work Programme Key Decision Forward Plan pdf icon PDF 89 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 consideration of any new Working Group(s) to be deferred until 2019/20; identification of any items for pre-scrutiny by the Committee from the latest Key Decision Forward Plan; requesting the arrangements made for the scrutiny of draft Quality Accounts for 2019 to be noted; requesting the progress to date by the Joint Health Scrutiny Committee for Cheshire and Merseyside (Orthopaedic Services) and the Member representatives on the Joint Committee for 2018/19 to be noted; and requesting the arrangements made for a site visit to Aintree University Hospital NHS Foundation Trust, in order to view facilities in relation to A&E and older people’s care, at the Trust to be noted.

 

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.

 

Further to Minute No. 45 (2) of 8 January 2019, the Committee was requested to note that it had previously agreed to defer consideration of a working group on missed primary care appointments (DNAs) until the following Municipal Year.

 

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

 

The report outlined the process to be undertaken for the scrutiny of draft Quality Accounts during May 2019.

 

Progress to date by the Joint Health Scrutiny Committee for Cheshire and Merseyside (Orthopaedic Services) was outlined within the report, together with Member representatives on the Joint Committee for 2018/19.

 

The report also set out the arrangements made for Members to attend a site visit to Aintree University Hospital NHS Foundation Trust during June 2019, to view facilities in relation to A&E and older people’s care, at the Trust.

 

RESOLVED: That

 

(1)       the Work Programme for 2018/19, as set out in Appendix A to the report, be noted;

 

(2)       the following item be included within the Committee’s Work Programme for 2019/20, to be included on the agenda for the next meeting on 25 June 2019, as outlined in Minute No. 52 (2) (a) above:

 

the Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG be requested to provide a review of the 7 day GP extended access scheme to the June 2019 meeting of the Committee; to invite the Providers to attend the meeting; and to include a heat map of Sefton, showing the location of GP practices and correlating referrals;

 

(3)       the previous decision of the Committee to defer consideration of any new Working Group(s) until 2019/20, be noted;

 

(4)       the contents of the Key Decision Forward Plan for the period 1 March – 30 June 2019, be noted;

 

(5)       the arrangements made for the scrutiny of draft Quality Accounts for 2019 be noted;

 

(6)       the progress  ...  view the full minutes text for item 54.