Agenda and minutes

Apologies were submitted on behalf of Councillors Rosemary Claymore, Jill Hood and Ian Wilkes.

Councillor Ann Edgeller declared an interest as Partner Governor of the Midlands Partnership Foundation Trust (MPFT).

Report of the Clinical Commissioning Group

The Director of Primary Care and Medicines Optimisation provided a detailed report and presentation relating to improving general practice access and the GP action plan, she also gave an update on expansion of the booster vaccination programme announced on 12 December 2021 and what that meant for general practice over the coming weeks.

Committee noted the main messages as follows:

·       The activity in general practice over the last 4-5 months was compared data to 2019 levels, there had been a significant spike for demand on general practice.

·       Staffordshire and Stoke on Trent area had demonstrated the most improved access to GP practices, 62% of appointments were face to face and work to improve access was having an impact.

·       The majority of appointments were with GPs however practice nurses, advanced nurse practitioners and clinical pharmacists also had roles in practices.

·       180 staff had been appointed to new roles in the primary care workforce to increase the range of service and support new ways of working in practices, such as social prescribers, first contact physio’s and clinical pharmacists.

·       Winter plans were robust, there were 4 programmes of work: (1) 3 respiratory hubs for paediatrics;(2) Additional capacity in primary care potentially creating up to 4000 additional appts per week; (3) Selfcare support – e.g., providing BP monitors for patients to use at home (4)111 been commissioned to provide additional support to free up general practice capacity.

·       Levels of abuse, verbal and physical aggression against staff was having an impact and causing some to leave. The Together Against Abuse Campaign had been launched and could be accessed through the ‘Together We Are Better’ website. It aimed to inform public and staff to be patient and to have zero tolerance against abuse at work. There would be continued offer of support and training for staff.

·       359,000 booster vaccines to be delivered by 31 December, the majority of vaccines were provided in primary care.  CCG had stepped down a number of enhanced services to make capacity to deliver this, including the Quality and Outcomes Framework (QOF) and the improvement programme for PCNs. The vaccinations programme and emergency care were priorities which meant delays to other services including routine operations until after Christmas.

·       Communications were in place and additional help from Councillors was welcomed to get the message out to communities relating to the need to deliver the vaccinations, the pressure of the booster programme and need to have patience with GPs.

There followed a period of questioning. In response to Members questions and comments the following was noted:

Quality and Performance

·       A member had concerns that the Quality and Outcomes Framework (QOF) guidelines were suspended and asked whether safeguards were in place and of the longer term position from January onwards. CCG advised that Government had stepped down QOF until the end of March but that it had not been completely paused, monitoring of the most vulnerable patients and those at risk would be maintained. Further guidance from Government was awaited. It was explained that  ...  view the full minutes text for item 53.

Joint report of NHS Partners 

The ICS Director for Staffordshire and Stoke on Trent introduced the item and advised that partners from Integrated Care System (ICS), Clinical Commissioning Group (CCG), West Midlands Ambulance Service (WMAS), University Hospitals Midlands North (UHMN), University Hospitals Derby and Burton (UHDB) and Royal Wolverhampton Trust (RWT) were in attendance to provide detail and context to the paper and to respond to questions relating to the current pressures across the system.

The ICS Director gave thanks and recognition to the amazing work that front line and support staff in all setting from across the system were providing at present, had continued to provide through the pandemic, and were now being asked to provide again to deliver the vaccination booster programme by 31 December 2021. He welcomed that Partners were working together to get the system right for residents across Staffordshire recognising the pressures on all levels.

The ICS Director advised the public that the NHS remained open, and that people should come forward and get the care they need. He gave assurance that NHS and Partners were working hard to address the system pressures and apologised for any delay or inconvenience the public were experiencing which may be leaving people in pain and discomfort while waiting for procedures and tests. He presented the partnership response to the current pressures across the system and explained that the report set out to move away from organisational boundaries and looked in detail at three key stages: pre-hospital, in hospital and discharge. 

The Chairman thanked the ICS Director for the presentation and congratulated him on his recent appointment to Chief Executive of the Shropshire, Telford and Wrekin Integrated Care Board (ICB). He thanked him for all the work he had done in Staffordshire over recent years and for bringing colleagues together around the table at this meeting.

Committee noted the following comments and responses to questions:

Pre-hospital:

·       A member indicated that people had a personal responsible to look after themselves and also suggested that hazard analysis critical control points could be looked at, such as gritting the streets when icy to avoid accidents occurring.

·       WMAS highlighted calls for ambulance and handover delays.

o   delays to hand over patients at hospitals was a problem. At Royal Stoke Hospital 16% of time was lost compared to any other hospital in the area. The hospital was surrounded by rurality and there was no other hospital close for ambulances to go to, particularly out of hours when Stafford A&E site was closed. It was confirmed that WMAS were not suggesting Stafford be open at night and that was not the message to take from this.

o   high number of calls were made for ambulance service was a concern, particularly when there was nowhere else to phone or get advice from in the middle of the night. People could be encouraged to try other services before requesting an ambulance, such as a call to 111 for advice. There was also positivity about the effectiveness of the Community Rapid Intervention  ...  view the full minutes text for item 54.

Report of Cllr Julia Jessel, Cabinet Member for Health and Care

The Health and Care Cabinet Member introduced the report. She indicated that system pressures and recruitment of staff were an issue in home care which had already been referred to in the meeting today. She highlighted that there was also a 20% increase in demand for home care services and a backlog of assessments for homecare which was having impact on the individuals, on discharge from hospital, home first service and beyond. She advised that work was ongoing to look at the issues and that more strategic work was being done with regards to recruitment and retention to secure more home care staffs in the immediate, medium, and long term.

The Director of Health and Care advised that the twin pressures of rising demand for home care and challenges with the workforce were national problems.  The 20% increase in demand since July had created pressure in terms of supply workforce and it was getting more difficult to recruit staff to address the backlog and to increase homecare supply. He confirmed that Staffordshire County Council (SCC) was working closely with NHS colleagues to address issues and that it had received £2.8 million from NHS which would go out to care providers to fund loyalty schemes over the winter period.  There was also an additional £162m government fund for home care, of which SCC share was £2.5m. 

The following comments and responses to members questions were noted:

Outline of development of career pathways

·       The mitigations in the paper were short term, in the medium and longer term the intention was to encourage people into the care sector following a career path. Start in a care role, develop skills and training opportunities; potentially link with an NHS role and develop more knowledge and skills training. The object was to attract new people into the sector.

·       The development of the pathway was in early stages and possibly 6-9 months away from piloting with a few hundred staff members. The proposal was to develop different pathways to trial and evaluate to develop over time.

·       Health and Care work closely with the NHS, recognising that both had a role in the joint care of vulnerable people, there was recognition of need to work closely and potentially develop joint care career paths.

·       The Council would continue to plan for the future, working and supporting various providers but also trying new things, providing the best services with the resources we have.

·       To make a career in care the report refers to grants for training. The further education offer had changed recently, grants and training loans were available for people of any age. The County Council would take the lead on the career pathway, and an outline project plan had been drafted and considered by Cabinet to develop a career path linked to relevant qualifications.  There would be a period working with partners and providers and a period of finding out what would attract people to a career pathway which would be part of the project plan. The Cabinet  ...  view the full minutes text for item 55.