Adult Social Care and Health Select Committee Minutes

Tuesday, 21st July, 2020
Remote meeting via Microsoft Teams
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Cllr Evaline Cunningham (Chair), Cllr Clare Gamble (Vice-Chair), Cllr Jacky Bright, Cllr Luke Frost, Cllr Lynn Hall, Cllr Mohammed Javed, Cllr Paul Weston, Cllr Bill Woodhead MBE
Emma Champley, Gavin Swankie, Rob Papworth (A&H), Kerry Anderson (F&BS), Gareth Aungiers (Xentrall), Michael Henderson, Judy Trainer, Gary Woods, Rebecca Saunders-Thompson (MD)
In Attendance:
Peter Smith (Healthwatch Stockton-on-Tees), Michael Houghton (Tees Valley CCG)
Apologies for absence:
Cllr Kevin Faulks
Item Description Decision
AGREED that the minutes be approved as a correct record and signed by the Chair.
AGREED that the Healthwatch Stockton-on-Tees - Annual Report 2019-2020 be noted.
AGREED that the Care Quality Commission (CQC) Inspection Results - Quarterly Summary (Q4 2019-2020) report be noted.
1) the Action Plan be approved;

2) a list of the Borough’s care homes who have expressed interest in acting as pathfinders for implementing the dementia guide and to serve as ambassadors for other homes
AGREED that the revised scope and project plan for the Scrutiny Review of Hospital Discharge be approved.
AGREED that the Adult Social Care and Health Select Committee Work Programme 2020-2021 be noted.
AGREED that the information be noted.


There were no declarations of interest.
Consideration was given to the minutes from the Committee meetings held on the 25th February 2020 and 10th March 2020.
The Vice-Chair of Healthwatch Stockton-on-Tees presented their Annual Report for 2019-2020 to the Committee, key elements of which included:

• Message from our Chair
• About us
• Highlights from our year
• How we’ve made a difference
• NHS Long Term Plan
• Helping you find the answers
• Our volunteers
• Our finances
• Our plans for next year

Members were reminded that Healthwatch represents the views of service-users, and consists of a small team of three full-time equivalents (FTEs) and 15 volunteers.

The core aspect of the work undertaken was based on analysing feedback from service-users and a network of organisations (e.g. CQC, CCG, Local Authority). Visits to services, hosting of focus groups, talks to local groups, and the facilitation of 1:1 discussions are also an important part of Healthwatch’s remit. Although there was a need to work differently since the emergence of Covid-19, the focus remains on the identified priorities (page 4 of the Annual Report), and plans for 2020-2021 are still in place despite the current pandemic.

The main issues discussed were as follows:

• Members commended the layout and content of the Annual Report, and were particularly impressed with the stated improvements in local care homes, a product of both the efforts of Healthwatch itself and the Committee’s recent care home-focused work.

• Whilst the report was very positive, the Committee sought views on what areas could be improved upon, and what challenges Healthwatch face. In response, the operational impact of Covid-19 was referenced (though it was noted that staff had been able to continue working since March 2020), specifically the need to work more in isolation as staff cannot currently meet individuals / focus groups, or conduct Enter and View visits. Increasing the number of volunteers would be helpful, and the organisation is trying to work / engage more with younger people.

• The Committee drew attention to the current situation in key areas including sensory impairments (hearing aid clinics not currently open) and care homes (mental health of residents and their need to see relatives / friends). Adapting the protocol for access to GP surgeries was also suggested in light of these being shut during the pandemic - this will be taken back to the Healthwatch Lead to examine as part of an overarching piece of work to understand the local impact of Covid-19.

• In terms of care homes, Healthwatch has a different role to the CQC regarding inspections, and any work in this area will focus on responses from the general public. Information-gathering has taken (and continues to take) place, and it was noted that a specific Covid-19 report will be presented to the Committee in the coming months.
The Committee was presented with the latest quarterly summary regarding CQC inspections within the Borough. Introduced by the Council’s Procurement Manager (Adults, Public Health, CYP), the report outlined results for inspections undertaken during the period of January to March 2020 for Adult Services (including services such as care homes, care homes with nursing, and care in the home), Primary Medical Care Services, and Hospital and Community Health Services (including mental health care).

The following aspects of the report were highlighted:

•Woodside Grange: Experienced Manager now in place who has handled the Covid-19 situation well - signs of progress in addressing previously identified concerns.

•St Mark’s: A number of developments since this report was collated - provider is working with the CQC regarding breaches, and an Action Plan is in place which is being overseen by the Responding to and Addressing Serious Concerns Group who have taken on the responsibility for driving improvements. Another supportive professional group (Care Home Protection Operational Group) is looking at the impact of Covid-19 on the care home. No longer under contract with the Council - provider did not apply to come onto the contract framework from the 1st April 2020, therefore the Council will not make any further placements to the care home (but will monitor existing placements).

•Appendix 2 (Overall Position for Commissioned Services): Overall performance is steadily improving, with no homes graded ‘inadequate’ in the last quarter (January to March 2020).

The main issues discussed were as follows:

•Recognising the risks posed by Covid-19, Members queried if the management at Woodside Grange has sought the Council’s support regarding infection control. Officers gave assurance that infection control was a high priority at present, and that the Council had provided funding to care homes to address any shortcomings in this area (which they had to report back on in terms of what it had been spent on). In addition, an infection control checklist had been developed by Public Health colleagues which was sent out to all of the Borough’s care homes - responses were RAG-rated in order to identify any specific support that was required.

•The Committee requested clarity on who is involved in the supportive professional groups previously noted, and whether they link back to residents / families. It was stated that an advocacy representative is present on the Care Home Protection Operational Group, and that work is already underway regarding support for care homes in relation to visits from families to their residents.

•Concerns were expressed regarding repeated medication shortcomings within some care homes, along with challenges around leadership. The Committee was informed that ongoing issues involving low pay in the care sector and high levels of staff turnover do not help matters, but that the Council and its partners need to continue to support local homes to meet these challenges and drive up standards. Members reinforced their role in this process, specifically in raising concerns, but added that local care home staff were doing a great job in the current circumstances.

•Members observed that issues with the recording of medication can often let a care home down, but were reassured by the general improvement of ratings across the Borough. The impact of the Well Led Programme was noted as being a key driver behind this.

•National proposals on putting in place a key GP within each nursing home were highlighted as a positive development in helping to understand residents’ needs.
Members were presented with the Action Plan setting out how the agreed recommendations from the Scrutiny Review of Care Homes for Older People will be implemented, and target dates for completion.

The Committee sought clarity on the ‘Henpower’ project in relation to recommendation 2 (That the importance of personalised care be promoted through all contacts the Council and partners have with Care Homes; in particular the development and deployment of a varied activities programme tailored to individual needs and co-ordinated by a designated member of staff), and was informed that this involves the provision of hens for care homes, allowing residents to build coops, raise hens, etc. - another tool in enabling residents to determine what they want to do.

It was noted that, in relation to recommendation 4 (That contract monitoring and quality assurance systems ensure that appropriate staffing levels are maintained in care homes), there was now a remote PAMMS assessment available which the Council is aiming to use once staff are trained - how robust this is will become clearer once it is in use.

Regarding recommendation 6 (That all care homes be required to work towards Dementia Friendly accreditation as part of the new contract arrangements), the Committee requested a list of those care homes who will be used to act as pathfinders for implementing the dementia guide and to serve as ambassadors for other homes.
Ahead of Select Committees resuming their reviews, the Council’s Executive Scrutiny Committee recommended that consideration was given to amending, where necessary, review scope and plans to take into account the emergence and impact of Covid-19. As such, the Committee was asked to consider a revised scope and plan for the Scrutiny Review of Hospital Discharge following the suspension of this work due to the Covid-19 pandemic.

The main changes to this review were proposed as follows:

• Since hospital discharge to care homes during the pandemic had been in the national spotlight, it was felt that this element should be incorporated into the Committee’s review.

• To respect the originally agreed scope which focused on hospital discharge to an individual’s own home (not care homes), it was therefore proposed to split this review into two distinct phases. Phase 1 would involve a short, focused piece of work on discharge to care homes (providing an interim report to Cabinet later in 2020). This would then be followed by phase 2 - the resumption of the originally agreed work on discharge to an individual’s own home.

• The phase 1 element of the review would focus on the national guidance and process around hospital discharge to care homes, and any potential learning ahead of an anticipated second Covid-19 surge.

In order for phase 1 to be undertaken in a timely manner, it was also proposed that an additional Committee meeting was scheduled for September 2020 for evidence-gathering - this should allow for an interim report to be available for consideration by Cabinet within the timeframe outlined in the revised scope and project plan.
Consideration was given to the Committee’s current Work Programme. The next Committee meeting was scheduled for the 15th September 2020, though an additional meeting may be arranged for early-September 2020 in relation to the Scrutiny Review of Hospital Discharge (phase 1).
The Chair informed the Committee that the CQC had very recently written to the Council’s Director of Adults and Health stating that they had selected Stockton-on-Tees to be part of a Provider Collaboration Review. This review would be carried out virtually (with the intention to complete by August 2020), and aims to:

• Support providers across systems by sharing learning around the positive impact of partnership efforts, resulting in improved experiences and outcomes for those who have used services during the Covid-19 pandemic.
• Share the learning of approaches underway to support preparation for re-establishing services.
• To share learning with DHSC, providers and stakeholders at local and national levels in advance of any subsequent Covid-19 peaks and pre-winter 20/21, driving improvement.

The programme will commence with a focus on health and social care services for the over 65 population. This will include a focus on their access to and experiences of urgent and emergency care services.

Members were notified that the Council are presently arranging for interviews to take place with the CQC, and have been asked to supply information on the Borough’s care homes.

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