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Declarations of Interest
The Chairman welcomed Jackie Owen the Staffordshire Healthwatch Manager who would now be attending meetings as a non-voting observer. He also welcomed Councillor J Oates to the Committee.
There were no declarations of interest made at the meeting.
A Member asked if any information had been received which the Committee had requested at previous meetings. The Scrutiny and Support Manager agreed to chase the information and forward it onto the Committee as soon as possible.
RESOLVED: That the Minutes of the meeting held on 3 December 2018 be received as a correct record and signed by the Chairman.
Joint Report of the Director of Health and Care and the Accountable Officer, Staffordshire and Stoke on Trent CCG’s.
The Committee considered a joint report of the Director of Health and Care and the Accountable Officer, Staffordshire Clinical Commissioning Groups (CCGs).
The Director of Health and Care, Mr R Harling and the Senior Commissioning Manager for Staffordshire CCGs, Ms Gemma Smith attended the meeting to present the report and answer questions.
The Director of Health and Care summarised the report and informed the Committee that there had been both a national and local move to get people out of hospital and cared for in their own homes or in their local communities. There was national best practise on how this could be achieved and ‘Discharge to Assess’ was one of the models of care suggested. It was explained that the model required the following services and functions:
· A ‘Track and Triage’ service to accept complex referrals from the wards, determine whether they need ongoing reablement and support, determine the most appropriate setting [home or bed], and make the necessary arrangements to put interim care in place.
· Home First services to providereablement and support at home. These include intermediate care, palliative care,night sitting and reablement.
· Community beds for people who are unable to return home for interim care. These require a Trusted Assessor function to enable timely transfers, as well as GP and rehabilitation cover to ensure active therapy and avoid deconditioning.
· Active management of Home First services and community beds to ensure that people move on.
The Discharge to Assess model had been working in the North of the County for approximately 12 months and had seen reductions of delayed discharges of 50 %. This model of care now needed to be rolled out to the rest of the County. Critical to the rolling out was the development of the track and triage service and the CCG’s have to commission an additional 4200 hours per week of reablement Home First services.
Discharge to Assess to support Queens and Good Hope hospitals remained under development and there were ongoing issues with Delayed Transfers of Care (DTOC). The position was however, was getting better and it was hoped that the following developments would see significant improvement:
· Home First,
· commissioned hours increasing
· an agreement of funding and,
· the development of standard opening procedures for transfer of people from Queens and Good Hope into Community beds at Robert Peel and Samuel Johnson hospitals.
Discharge to Assess to support County Hospital was close to maturity. Support for Walsall Manor, New Cross and Russell’s Hall hospitals remained under development. Improvements to date include the County Council commissioning an additional 732 hours reablement Home First services per week, and New Cross hospital using non-recurrent funding form the Better Care Fund (BCF). There had also been a modernisation of the Track and Triage service to manage Community beds in care homes in the South of the County.
The Director of Health and Care informed the Committee that there was still a delay in getting people home from New Cross and Cannock Hospital. The ... view the full minutes text for item 56.
Report of the Executive Chief Nurse and Director of Governance and Communications
Tosca Fairchild-Moyo, Director of Governance and Communications and Mike Carr, Divisional Manager of University Hospitals of Derby and Burton (UHDB) gave a presentation to the Committee on the recent merger of the two hospitals and the progress being made towards integrating services to benefit patients. The presentation also covered information on the Cancer performance targets which the Committee had requested at the Accountability session in July 2018.
The presentation covered:
· The story so far – the ‘Big Conversation’; investing in maternity services; Joint Advisory Group (JAG) accreditation; and increased capacity over winter.
· The Merger principles – Sustaining clinical services at Queens Hospital Burton: Developing tertiary (specialist) services at Royal Derby; and Making the best use of community hospitals in Lichfield, Tamworth and Derby.
· Six clinical deep dives – Cardiology, Trauma and Outpatients, Stroke, Renal, Urology (Cancer) and Radiology.
· Next stages – A further six deep dives into Ophthalmology, Dermatology, Gynaecology, Vascular Surgery, Critical Care and Head and neck.
· The development on the Outwood’s site (Queens Hospital) and the capital funding of £21.88m received from the Department of Health and Social Care.
· Cancer performance – the 62 day cancer referral standard remained a challenging target.
Following the presentation, a Member asked how much choice a GP had when referring patients to hospitals and speed at which information was transferred between Community Hospitals and Acute hospitals. In response Members were informed that a new digital website was being developed and one aspect of this incorporated more choice for GP’s and patients. It was acknowledged that integrated communication between the community and acute hospitals was a particular issue and was a valid concern which officers would take back to the trust.
A Member felt that transport between Burton and Derby Hospitals was problematic for some patients. A bus service between both sites was in place and car parking was increasing with an additional 517 parking spaces on the Derby site provided for staff with further car parking development planned for the Burton site which would facilitate additional spaces for patients.
A question was asked on the cancer service and screening for cancers such as prostate cancer and how this was a challenge to get people to take up screening. Imaginative ways were already happening led by Miss Shah – Consultant Urologist and this had been covered nationally in the press such as attending football matches to carry out screening.
A Member asked how the hospitals were managing their financial deficit, and how they were managing recruitment and retention of staff. In response, it was agreed that the deficit was very challenging, and services were being reviewed all the time to ensure that services were operating as efficiently as possible. The STPs for both Derbyshire and Staffordshire were also working together to drive efficiency. With regard to recruitment/retention and budget pressures, it was explained that during the merger, there had been no redundancies with all staff finding a position in the new organisation and the Hospitals were continually recruiting into all posts. The Committee ... view the full minutes text for item 57.
Report of the Scrutiny and Support Manager
The Scrutiny and Support Manager presented the report which outlined the activity the Borough and District Councils since the last meeting.
It was reported the at the last meeting of the Cannock Chase District Councils Health Committee they had received presentations on Healthy lifestyles and Public Health. Clarity was requested on the duties of both the District/Boroughs and the County Council when carrying out Health Scrutiny. It was explained if an item concerned one Borough/District alone, then that local authority was able to look at it. If an issue had a wider detrimental effect, then the County Council would consider it.
The Committee were informed that at Lichfield District Councils last meeting, the items of business were Rough Sleepers and the prevention and support offered to them.
The South Staffordshire District Council Member explained that their Committee had received presentations from the South Staffordshire CCG and the Well Being Clinic.
The Stafford Borough Council representative added to the information in the report by informing the Committee that during a recent Planning Development application for approximately 1,500 new homes, the CCG had failed to respond on health implications or considerations.
The Committee acknowledged a Planning Authority could not legally require Health to respond and there was no statutory requirement to consult with Health on planning applications under 500 houses, but it was felt that in order to plan effectively for the populations wellbeing, Health partners should have an input and therefore legislation should be changed to require a response. There was also concern that any planning conditions that are added to permissions can be removed by way of challenge at appeal if they fail to meet the tests set out by the Government in the Planning Practice Guidance Note.
It was felt that Local Authorities need to look at health from a collective viewpoint as development size or number of properties add up and have considerable impact on health. The County Councils infrastructure plan was also in the process of being developed and it was hoped that health was a part of this.
There was also a discussion on whether raising the item at a meeting of the Chief Executives and Leaders Forum could help to ensure that health implications are considered and on whether District and Borough Councillors could add pressure on Planning Committees when applications come before them at a local level.
The representative from Tamworth Borough Council informed the Committee that their last meeting had contained a presentation from the University Hospital of Derby and Burton. The next meeting would be considering Mental Health issues; the First Response Service and GP provision across the Borough.
a) That the Chairman write to the Secretary of State for Communities and Local Government explaining that Scrutiny Committees are powerless to scrutinise the wider determinants of health if Health Partners are not a statutory consultee when dealing with planning applications.
b) That the Chairman write to District and Borough Councils to ensure that they are considering Health implications with the same ... view the full minutes text for item 58.
Report of the Scrutiny and Support Manager
The Scrutiny and Support Manager presented the Committee Work Programme report. The dates for the two Joint Scrutiny Committee meetings with Stoke on Trent City Council were confirmed as 13 February at 10am and 11 March at 2pm.
At a previous meeting the issue of the mobile Breast screening clinic in Tamworth was discussed and the Scrutiny and Support Manager had secured a response from NHS England. The Chair asked Members if the removal of screening facilities was an issue is other areas of the County. It was agreed that more information on the removal of screening facilities throughout the County was needed.
a) That the work Programme be approved.
b) That the Scrutiny and Support Officer write to NHS England to establish if Breast Screening facilities in the County are reducing.