Adult Services and Health Select Committee Minutes

Tuesday, 26th November, 2013
Ground Floor Committee Room, Town Hall, High Street, Stockton on Tees
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Cllr Mohammed Javed(Chairman), Cllr Kevin Faulks(Vice-Chairman), Cllr Evaline Cunningham, Cllr Ray McCall, Cllr Mrs Sylvia Walmsley, Cllr Norma Wilburn, Cllr Mrs Mary Womphrey.
Laurayne Featherstone(RES), Sean McEneany, Liz Hanley, Simon Willson (CESC), Dr John Canning (Secretary of Cleveland Local Medical Committee), Jo Linton, Philippa Walters(Tees Public Health Service), Sandie Hall, Jay Badenhorst, Peter Horrocks (Tees Local Pharmaceutical Committee), Peter Mennear and Kirsty Wannop(LDS).
In Attendance:
Liz Greer(Healthwatch Manager),
Apologies for absence:
Cllr Paul Baker, Cllr Elliot Kennedy, Deborah Miller
Item Description Decision
The evacuation procedure was noted.
AGREED the minutes be approved subject to minor changes.
AGREED the information be noted and further information be provided.
AGREED that the Progress Updates be noted and the assessments for progress be confirmed subject to the amendments outlined above.
AGREED the report be noted.
AGREED that the information and Members comments be noted.
AGREED the information be noted.


Cllr Mohammed Javed declared a disclosable pecuniary interest as he was employed by Tees, Esk and Wear Valleys NHS Foundation Trust. Cllr Javed had been granted a dispensation in this regard.

Cllr Ray McCall declared a personal interest as he was an Associate Hospital Manager and Governor for Tees, Esk and Wear Valleys NHS Foundation Trust.
Consideration was given to the minutes of the meetings held on 1st October 2013 and 15th October 2013.
During 2012-13, the Committee was updated on the commissioning of the local Healthwatch service. As part of the NHS and adult care reform agenda, Local Involvement Networks (LINks) were abolished and replaced with local Healthwatch services from April 2013. The Committee agreed to consider a progress report from the provider once the service had been established.

Following a tendering process, Pioneering Care Partnership (PCP) was awarded the contract for the delivery of Healthwatch Stockton-on-Tees, and representatives was in attendance.

The Healthwatch Manager provided the Committee with the following information:-
- Gathering the views of local people, service users, carers and interested parties;
- Ensuring that the views of local people and service users were represented in the planning and provision of services;
- Providing advice, information and signposting about health and care services.
- Local Healthwatch had the power to undertake Enter and View visits to local health and social care providers, and has statutory representation on the Health and Wellbeing Board.

Healthwatch had provided an overview of their progress in relation to key areas including their operations (issues such as accessibility, influence, advice and signposting, community voice and consumer champion roles), and relationships with key stakeholders.

It was noted that Members could request leaflets with information about Healthwatch for venues that would be suitable to display them in. The Committee also requested an information pack be sent to each Member.

It was suggested that pharmacies would be a good location to provide information.

Members also queried the number of public that have contacted Healthwatch. This would be circulated to Members.

It was reported that eleven volunteer Healthwatch Champions had been recruited to spread the word in the community. Members noted that this would need to be kept under review to ensure a good representation from across the Borough.

The Healthwatch work programme would be shared with the Committee once it had been shared with Healthwatch members.
Members considered the assessments of progress contained within the Progress Updates on the implementation of previously agreed recommendations. There were outstanding recommendations from the EIT reviews of Learning Disabilities and Adult Service Structures.

The Committee was informed that at recommendation 6 for the EIT Review of Learning Disability Services the assessment of progress stated it was fully achieved when it should be ‘on track’.

The Committee queried where the new community bases would be in Billingham, and noted that dedicated spaces at Billingham Forum and Billingham Environmental Link project were to be used.

It was noted that the process for assessing the appropriateness of placements of clients in out of borough and residential care was a long term process. The work on developing joint respite care and autism provision was scheduled for a later phase of implementation.
Members were provided with an overview of performance of Adult Social Care Services for Quarter 2 of 2013~14 (i.e for the period from 1st July to 30th September 2013), and of complaints received over the same period. Members received and update on the progress of the key performance indicators.

Members queried the Local 'Quality of Assessment' survey; 87% survey respondents were satisfied with their outcome compared to 98% for the previous survey, this was lower than the previous year and if it was to become a trend it would be looked into.

Members queried the level of personal budget uptake and noted the continued differentiation between client groups, for example lower uptake in mental health.

Members had previously queried the type of ratings used in the care home Quality Standards Framework and it was reported that the ratings would not be published until next year and further work would be undertaken with providers in the current year to get them up to the standards expected.

The chair requested that any further queries be sent to the Scrutiny Team following the meeting.
Members considered information provided by representatives of the Local Medical Committee, the Tees Pharmaceutical Committee, and Public Health Shared Service.

The main issues discussed were as follows:

- The average patient receives five consultations per year, and approximately one million consultations taking place each year in Stockton Borough;
- There was a lack of GPs due to various reasons including many working part time hours, workload, and fewer people choosing to be a GP, following training.
- Various appointment systems had been used over the years and although nothing was perfect, the ‘Doctor 1st’ pilot was showing promising results with a reduction in some cases of ‘did not attends’ from ten percent to nil.
- it was noted that demand was increasing and many people did not need to see a doctor or pharmacy. Research comparing Republic of Ireland with Northern Ireland had shown that the same outcomes were being achieved with half the GP consultation rate in the Republic compared to the North.
- As of next year patients could stay registered at the GP of their choice even if they move area i.e. Middlesbrough to Stockton. They would be unable to have a home visit in those circumstances.
- Local Authorities had to publish a Pharmaceutical Needs Assessment (PNA) of services provided in the area. The PNA looked at the need of the area and not the viability of a pharmacy. At the last PNA Stockton Borough had 36 pharmacies that had now increased to 41. This was deemed to be a sufficient amount of pharmacies although they could provide more services. The current PNA also identified that there was sufficient out of hours pharmacies within the borough in the different localities. Work had begun on the new version.
- Many minor issues made with GP's could be dealt with elsewhere i.e. in a pharmacy. It had been reported that 1/5 of GP appointments could be dealt with at a pharmacy and this in theory could save around £260k.
- Many people think that the staff serving at the pharmacies were general sales assistants but they were highly trained staff who could deal with some issues that hospitals, Walk in Centre's and GP's were dealing with. Some good work had taken place locally with the Healthy Living Pharmacy Project, but more could be done.

Members raised the following:-
- It had been reported anecdotally that GPs were turning away some of the difficult patients. Dr Canning explained that prospective patients may be turned away in circumstances where the GP practice considered itself to be at capacity. It was noted that GPs have to record a reason why somebody was turned away if there was no capacity and this information could be requested from GPs by NHS England. All prospective patients in this situation should be signposted as to how to access alternative providers and any decisions fully explained. Whilst GPs may have limited capacity, people that did not currently have a GP within the local area would not be turned away. Prospective patients should be treated on a consistent basis and should not be treated differently on the basis of their needs.
- More needed to be done to raise the public's awareness of the services available at pharmacies. It was also noted that work needed to be done for people who didn't pay for perscriptions to enable the pharmacies to be accessible to them direct. This could be commissioned by the CCG, similar to a scheme in Newcastle.
The Committee considered an update on the work of the North East Regional Health Scrutiny Committee, and Tees Valley Joint Health Scrutiny Committee.

Regional Health Scrutiny Committee

The Regional Committee met on 4th November. The Committee received an update on the national review of congenital heart services from the Director of Systems Policy at NHS England, following the suspension of the Safe and Sustainable children’s heart surgery review. Members were provided with the NHS England board paper considered at the meeting. An update was provided on the regional rollout of NHS111, and a widespread publicity campaign was planned from mid-November. Information on customer satisfaction and complaints was discussed, and relevant reports would be requested to inform the Committee’s review of access to GP, urgent and emergency care.

North East Ambulance Service provided an update on the A and E review. This related to the mix and location of urgent and emergency response vehicles across the region. The conclusions were being reviewed in light of more recent information on demand and resources, and any significant amendments would be reported back to health scrutiny. It was noted that overall pressure on the service had increased in recent years, although the number of life threatening situations had not changed significantly.

Tees Valley Joint Health Scrutiny Committee

The minutes of the meetings of 29 July and 16 September were provided.

At the meeting of 28 October, the Committee considered the changes proposed at the Friarage Hospital, Northallerton in relation to children’s and maternity services, and the impact on the Tees Valley health system. The options were:
Option 1 - Establish a midwifery led unit (MLU) and paediatric short stay assessment unit, with a full outpatient service and enhanced services in the community.
Option 2 - Establish a midwifery led unit, and provide paediatrics on an outpatient basis and enhanced services in the community.

A response to the consultation was being prepared and would focus on: ambulance availability for emergency transfers to consultant-led units (eg. Darlington or James Cook), transport for visitors, sustainability of services (and avoiding scenarios such as the current suspension of maternity care at Bishop Auckland), triage of sick children and increasing awareness of ‘what to do’ amongst local families, and capacity at Darlington and James Cook hospitals.

Stockton Council was chairing and supporting the Joint Committee during 2013-14.
Members were informed that the next meeting would focus on emergency care at North Tees Trust and South Tees Trust, including waiting times at A&E.
The Chair had nothing to update.

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