ASH
80/16 | Cllr Norma Stephenson declared a personal non prejudicial interest in Agenda Item 7 - Drug Treatment Services as her son was employed by CJL. |
ASH
82/16 | Consideration was given to the minutes of the meeting held on 13th December 2016 and 10th January 2017. |
ASH
83/16 | The Committee considered a report that provided member with an update on initiatives that were being implemented to manage the demands on urgent and emergency care systems and how services were developing in order to improve outcomes and experience for patients.
The CCG had engaged with the Stockton-on-Tees Health and Well Being Boards and Adult Services and Health Select Committee where required throughout 2015 and 2016 to advise on plans for an Integrated Urgent Care Service (IUCS). The proposal for the service was in response to national guidance and best practice and also in response to local intelligence which outlined that service users were often confused about where and when to attend for urgent care needs and continued to present at accident and emergency services.
The new service would bring together a range of urgent care services including GP out of hours, minor injuries and walk in centre services to avoid service users making decisions and choices as to where the best place to attend would be and wouldbe delivered in two localities from 1 April 2017; University Hospital of Hartlepool and University Hospital of North Tees.
In November 2016, the procurement process concluded and the CCG Governing Body agreed the recommendation following a robust procurement process to award the new contract to North Tees and Hartlepool NHS Foundation Trust who would be working in partnership with North East Ambulance Services and Hartlepool and Stockton Health (GP Federation) to deliver the new Integrated Urgent Care Service (IUCS).
At the University Hospital of North Tees, the IUCS would be co-located at A&E and would ensure that service users were triaged and received appropriate treatment in the most appropriate setting, to avoid unnecessary attendances at the A&E Department.
The model would be focussed around GP led urgent care service provision 24 hours a day, 7 days a week, 365 days a year providing:
• Walk in and bookable appointments for
- Clinical assessment
- Face to face consultation
- Home visiting (OOH)
- Prison visiting services (OOH)
• Timely assessment and referral to appropriate mental health services
• Diagnostics and referrals
The expected outcomes of the revised service were:
• Timely, highly responsive, joined up care which was
- Clinically safe
- Streamlined
- Integrated
- Sustainable
• Responsive to patient needs
• Improved patient experience
• Being seen in the right place at the right time, by the most appropriate health professional
The benefits to the new service were wide ranging. The revised model would ensure that patient flow was streamlined, with a single call to get an appointment out of hours and a single ‘front door’ for patients accessing urgent care/A&E services in Stockton-on-Tees. Improvements were expected across data management, in terms of the provision of data between providers to improve patient care. Governance arrangements would be improved across local urgent and emergency care providers and there would be a clinical hub containing (physically or virtually) GPs and other health care professionals.
Members were provided with details on the communication and engagement plan and the 3 phases.
In addition Members were updated on the system for managing urgent and emergency care. The Accident & Emergency Delivery Board (A&EDB) replaced the Systems Resilience Group (SRG), a transformation that was mandated by NHS England in their correspondence to CCG Accountable Officers, dated 26th July 2016.
The A&EDB would focus on the recovery of the 4 hour target but also A&E Delivery Boards and with Sustainable Transformation Plan (STP) groupings, would focus on the longer term delivery of the Urgent and Emergency Care Review. Additionally the Local A&E Delivery Board coordinated and oversaw “Five Interventions” - developed by experts in the field of emergency care, with a focus on outcomes and processes.
System wide escalation plans had been developed and agreed in line with the new national framework with agreed local multi-agency triggers - including escalation and de-escalation.
Delivery against the new A & E Improvement Plan was also reported upon at each A&E DB with monthly data collection responsibilities shared with providers.
Members were given opportunity to ask questions/make comments that could be summarised as follows:-
- Could a new site map to show where services will be located be distributed? It was explained that once the new urgent care unit was up and running Member could organise a site visit.
- The paediatric element of A and E would be remaining in place, but some other children’s rooms would be moved elsewhere to accommodate the new service.
- Initial patient triage would be by a Band 7 Nurse.
- what would happen to the Walk In Centre at Tithebarn? It was explained that this would no longer provide a walk in service but would still be open and accessible tor registered patients.
- recruitment and staffing of the service would be via TUPE arrangements, a review of the skill mix needed, and GP support via the HASH GP Federation.
- an update was requested on the situation for patients attending James Cook/living in the South Tees CCG area.
-The AEDB would agree the spending of local SRG money. The Local Authorities were represented on the Board. |
ASH
84/16 | Members received information on the Reporting In Review - Sustainability of the Market for the Provision of Home Care.
One of the recommendations of the Adult Services & Health Committee Review of Home Care in February 2015 was:
The Council should work with commissioned providers to ensure that, wherever possible, zero hour contracts were not used, taking into account best Human Resources practice, to ensure due consideration was being given to the use of minimum guaranteed hours contracts for staff;
The Council should continue to work with and engage the VCSE sector further to develop its services in this area of provision, including non-personal care support where appropriate, and this should include facilitating the development of mutual service providers in the Borough; and
Emerging good practice examples of VCSE sector provision be reported to the Committee as part of the monitoring process.
The Council had engaged with local and regional partners to identify models of working and had used this intelligence to develop a pilot project with a local VCSE organisation (Five Lamps) that would test community based models of home care.
The service started in November 2016, and was growing as planned. Monitoring of the key elements of social value was being undertaken alongside the monitoring of the quality of service delivery by commissioners. Some service users had substantial care packages.
An officer-led Reporting-In Review on the Sustainability of the Care Market (focussing on the development of services following the Home Care Review) was scheduled for the ASH Work Programme for 2016-17.
Following this interim update on the setting-up of the service, an in-depth report outlining performance and outcomes would be provided for the Committee, when this information became available once the project was established.
The work was testing what level of core hours was appropriate, and the next update would provide a staffing breakdown. Copies of home care contracts were also requested.
Members were given opportunity to ask questions/make comments that could be summarised as follows:-
- Staffing was monitored to ensure as much consistency as possible for clients, with 2-3 workers linked to a client currently, in future this may increase to 6-7 but with the aim of ensuring as much continuity of carers as possible.
- There was an early focus on the contribution of volunteers and links were made to the Five Lamps Lunch Clubs, as an example. This would be developed further. |
ASH
85/16 | This report outlines some of the demographics and outcomes from adult drug misuse within the Borough of Stockton on Tees. It describes how these are measured and some of the complexities which impact on achieving those outcomes.
Treatment for adult drug misuse was provided by CGL - Change, Grow, Live (formerly known as CRI) situated in William Street, Stockton. They were the sole Provider for adult drug misuse services within the Borough of Stockton on Tees.
Members were provided with the performance measures for the services that included numbers of people in treatment, number for opiate and non opiate users, numbers of those exiting treatment and also performance benchmarking against other local authority areas.
Members were given opportunity to ask questions/make comments that could be summarised as follows:-
- Members highlighted that the service provided was good but its environment needed improving. It was reported that a full recovery hub was being built at Brunswick Court and this should provide the best facilities in the north east.
- Prison health care was commissioned by NHS England and transition into the community was key. The CRC probation providers managed all exits from prison and community treatment was included in rehab plans where necessary.
For new prisoners entering the system, their treatment plans were transferred to the prison provider from CGL.
- It was noted that heroin use was reducing, as it was perceived that other drugs were ‘safer’, but there was still some use in prison. Many Stockton users had been introduced to drugs whilst in prison. Usage of spice had increased. |
ASH
86/16 | The Committee was provided with feedback from for the various site visits undertaken by Members. Members commended the work of the Personalisation Service and the decision to bring the service in-house. It was noted that an out of hours visit could be made to the new drug treatment facilities when completed, and the new Urgent Care facility at North Tees hospital. |
ASH
87/16 | The Committee considered an update on the work of Better Health Programme Joint Health Scrutiny Committee.
The minutes of the meeting on 1 December were provided.
The most recent meeting was on 19 January and the presentation from the meeting were also provided. These included information on the workforce challenges faced by the local NHS.
The next meeting was on 9 March. This would consider the level of local authority engagement with the Programme to date (including with social care), and the plans for consultation and engagement during the public consultation period (June/July onwards). |
ASH
88/16 | The Committee considered an update on the work of the Tees Valley and Regional Joint Health Scrutiny Committee.
Tees Valley Joint Health Scrutiny Committee
The minutes of the meeting on 21 October were provided.
The Committee met on 26 January and received an update NHS Commissioned Learning Disability Respite services in the Tees area. The project was gathering feedback on views of current services. The Committee requested details of the information gathered and the CCG’s next steps in developing proposals.
Members queried whether the Council was involved in this process, and the Assistant Director confirmed that the Council had received information, and would feedback that Committee Members would be concerned in relation to any future loss of service. It was noted that the Council would refer to these services as ‘Short Breaks and Carer Support’.
The Committee was also sent information in relation to suicide rates in the Tees Valley, as part of its work on children and young people’s mental health. This would be shared with People Committee to inform its review of mental health and wellbeing.
North East Regional Health Scrutiny Committee
Hartlepool BC was currently supporting the Committee. There had been no further meetings since the update in November. |
ASH
89/16 | The minutes of the Health and Wellbeing Board held on 21st December 2016 were noted. |
ASH
90/16 | The Committee noted its work programme. |
ASH
91/16 | The Chair had nothing to update. |
