Agenda and minutes

There were no declarations made.

(a)  15 July 2019 10am

(b)  15 July 2019 2pm

RESOLVED: That the Minutes of the Meetings held on the 15 July 2019 at both 10am and 2pm were approved as a correct record and signed by the Chairman.

Report of the Deputy Leader and Cabinet Member, Health Care and Wellbeing.

Alan White, Deputy Leader and Cabinet Member for Health Care and Wellbeing, Amy Evans, Commissioning Manager, and Taryn Poole, Commissioning Officer presented the report on the Adult Learning Disability 2022 Community Offer.  The report covered the Adult Learning Disability Services provided directly by Staffordshire County Council and the Carers Strategy ‘All Together for Carers’.

Part A of the report covered Staffordshire County Councils directly provided Learning Disability Services.  The report included the draft Cabinet report which was to be considered at its meeting on 18 September 2019.  Members were informed that the purpose of the Adult Learning Disability Community Offer 2022 programme was to establish the assessed eligible care and support needs of adults with a learning disability and or autism and ensure that there would be appropriate and sustainable services across the county to meet them.

The report outlined the services directly provided by the local authority and those externally commissioned respite services.  Options for each service had been evaluated following engagement with users, carers and staff.  Current and future demand had been considered along with the present market and the quality and availability of current services.

It was reported that over 80% of providers in the independent sector were rated outstanding or good by the Care Quality Commission (CQC) and there had been no provider failures in the last 24 months.

The Committee was informed that Greenfields was a residential care home with 8 residents located in Staffordshire Moorlands.  In 2007 Cabinet decided to reprovide the service however, this decision had not been implemented.  Care Act Assessments have indicated that the needs of the current residents could best be met in Supported Living.

Horninglow Bungalows were supported living, accommodating 15 tenants located in East Staffordshire and was rated Good by the CQC.  Again, the Care Act Assessments had indicated that the needs of the current residents could best be met in Supported Living.  Residents and carers had expressed strong support for the service to continue.  It was proposed that the commissioning of the care part of the supported living should be provided by the independent sector, to replace the care currently directly provided by the Council.

The Select Committee considered and commentated on the 18^th September Cabinet recommendations which were listed in the report as:

a)    Approves commissioning of a Supported Living service (care and accommodation), from the independent market, to replace the residential service currently provided by the Council at Greenfields House in Staffordshire Moorlands.

b)    Approves the commissioning of a Supported Living service (care only), from the independent market, to replace the care currently directly provided by the Council at Horninglow Bungalows in East Staffordshire.

c)    Approves consultation with staff (and recognised Trade Unions) on the proposed changes for Greenfields House and Horninglow Bungalow.

d)    Approves the revised Service Charter for the Complex Needs Day Services, including rebranding to “Staffordshire County Council Specialist Day Opportunities.

e)    Delegates the authority to implement any future changes to staffing and accommodation for the Staffordshire County Council Specialist Day  ...  view the full minutes text for item 21.

Report of the Clinical Commissioning Groups.

Marcus Warnes, Accountable Officer, Staffordshire Clinical Commissioning Groups (CCGs) attended the meeting to present the report and answer questions.

NHS England had a statutory duty to conduct an annual performance assessment of every CCG. The assessment, using the Improvement and Assessment Framework (IAF), is a judgement, reached by considering the CCG’s performance in each of the indicator areas over the full year balanced against the financial management and qualitative assessment of the leadership of the CCG.

The CCGs are assessed against 58 indicators in four categories defined as Better Health, Better Care, Sustainability and Leadership across the Integrated Care System.  Each CCG then receives an overall assessment that places their performance in one of four categories: outstanding, good, requires improvement, or inadequate.

Using the IAF, NHS England also assesses how effectively CCGs work with others (including the local Health and Wellbeing Boards) to improve quality and outcomes for patients as well as considering how they have contributed to the performance of their local systems as individual organisations.

In the 2018/2019 annual assessment, five of the six CCGs in Staffordshire and Stoke-on-Trent have been given an overall rating of Inadequate with only East Staffordshire CCG rated as good.

The key area of concern for the CCGs rated as inadequate, related to the continued financial challenges they have faced during 2018/19. Although NHS England noted that Stafford and Surrounds CCG and Cannock Chase CCG met their deficit control total this year, there has been a significant deterioration in the financial position for North Staffordshire CCG and Stoke-on-Trent CCG and the underlying deficit across Staffordshire and Stoke-on-Trent had exceeded £100million.  All CCG’s had struggled to meet the Quality Innovation Productivity and Prevention (QUIPP) savings.

The CCG’s had asked NHS England why Stafford and Surrounds and Cannock Chase CCG’s had been rated inadequate, but a detailed response had not yet been received.

A Member asked if the £300,000 grant for suicide prevention had been received and what it would be used for.  A response would be requested and sent to the member for information.

Following a question on financial waste in the system and what was being done to reduce the figures, it was reported that too many people were being admitted into hospital, with 52% of people dying in hospital even if their wish was to die elsewhere.  North Staffordshire was also spending £26m on Muscular skeletal operations when evidence suggested that half of the procedures were of no benefit to the patient.  Pricing charges and how partners are choosing when to offer procedures to patients and their benefit was being monitored as there was often limited medical value.

There was a discussion around balancing the budgets, particularly regarding urgent care and hospital reconfiguration.  Timescales for hitting budget targets had slipped and was now 2023.  Everything was being reviewed including waste, efficiencies and expectations.

Prevention was the responsibility of Local Authorities and it was acknowledged that over recent years there had been some difficult decisions to make.  The NHS aspect of the prevention  ...  view the full minutes text for item 22.

Report of the Clinical Commissioning Groups.

Marcus Warnes, Accountable Officer, Staffordshire Clinical Commissioning Groups (CCGs) attended the meeting to present the report and answer questions.

The 62 day standard refers to the total pathway length, the number of days for patients beginning their first definitive treatment within two months of suspected cancer.  The Committee was informed that nationally, trusts were struggling to meet the 62 day standard.  All the Hospitals commissioned by Staffordshire CCG’s, with the exception of Dudley, were failing to meet the target.

There were a number of common issues amongst the Trusts including, Diagnostic pathways and a mismatch between demand and capacity; Pension Tax changes which were reducing the willingness of consultants to work additional sessions; and workforce shortages, similar to those in the rest of the county.

A number of strategies were being employed to reduce waiting times such as using the private sector. 

Following a question on who was monitoring the waiting lists to ensure patients were not being missed, the Committee was informed that as part of the contract monitoring, waiting lists were reviewed monthly. 

A Member raised the question of workforce, and how recruitment issues were raised at every Committee meeting.  What was the national strategy for improving this situation.  The Committee was informed that locally One in Ten NHS posts were vacant which included GPs and this was projected to rise in future years.  It was agreed that the working model for GP’s hadn’t been changed since 1948 and to make positions sustainable, different ways of working and changing the way contracts were offered was essential to increase interest. 

RESOLVED:  That the report be noted.

Report of the Clinical Commissioning Groups.

Marcus Warnes, Accountable Officer, Staffordshire Clinical Commissioning Groups (CCGs) attended the meeting to present the report and answer questions.

It was reported that a team called the Emergency Preparedness, Resilience and Response (EPRR) team had been established to lead the CCG’s contribution to NHS preparedness for leaving the EU without a deal.

Overall the following key areas were identified as being the most relevant to the NHS:

1.    Supply of medicines and vaccines;

2.    Supply of medical devices and clinical consumables;

3.    Supply of non-clinical consumables, goods and services (such as IT and telephones),

4.    Workforce;

5.    Reciprocal healthcare;

6.    Research and clinical trials;

7.    Data sharing, processing and access;

8.    Return of EU nationals to the UK in significant numbers;

9.    Shortages of health and social care staff;

10.Fuel shortages

11.Adverse impact on health due to food poverty.

The two main significant risk areas were Medical supplies and Workforce.  In mitigation, legislation had now been passed to enable pharmacists to supply clinically suitable alternative products; and all local NHS providers had conducted workforce assessments and have put in place contingency plans to mitigate risk of mass departure of EU national staff.  The risk associated with EU nationals working for health and social care providers such as domiciliary care and care home was highlighted.

A Member asked what the local strategy was for the supply of nuclear isotopes.  The Accountable Officer confirmed that a response would be sort and forwarded to the member.

It was reported that some of the discussions held nationally were confidential particularly around fuel however, at a local level, assurances were provided that locally Trusts would manage.

RESOLVED:

a)    That the report be received.

b)    That a response to the question on the local strategy for the supply of nuclear isotopes be sort form the Accountable Officer.

Report of the Scrutiny and Support Manager.

The item was deferred to the next meeting.

Report of the Scrutiny and Support Manager.

The Scrutiny and Support Manager presented the work programme.  Members were reminded that there was an additional meeting scheduled for 9^th October 2019 at 2pm to consider the Children and Mental Health Strategy. 

RESOLVED: That the work programme be approved.