Stockton-on-Tees Borough Council

Big plans, bright future

Adult Services and Health Select Committee Minutes

Date:
Tuesday, 18th November, 2014
Time:
4.30p.m.
Place:
First Floor Committee Room, Town Hall, High Street, Stockton, TS18 1AU
 
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Present:
Cllr Mohammed Javed (Chair); Cllr Paul Baker, Cllr Evaline Cunningham, Cllr Kevin Faulks, Cllr Elliot Kennedy, Cllr Ray McCall, Cllr Mrs Sylvia Walmsley, Cllr Norma Wilburn and Cllr Mrs Mary Womphrey.
Officers:
L Hanley, G Irving, S Willson (CESC); P K Bell, P J Mennear (LD).
In Attendance:
B Carr, L Kirby, Dr J MacLeod, M Taylor, S Piggott (North Tees and Hartlepool NHS Foundation Trust).
Apologies for absence:
Deborah Miller and Natasha Judge.
Item Description Decision
Public
ASH
56/14
EVACUATION PROCEDURE
The evacuation procedure was noted.
ASH
57/14
DECLARATIONS OF INTEREST
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.
ASH
58/14
MINUTES FOR SIGNATURE - 16TH SEPTEMBER 2014 AND 23RD SEPTEMBER 2014.
The minutes of 16th September 2014 and 23rd September 2014 were signed by the Chair as a correct record.
ASH
59/14
DRAFT MINUTES - 7TH OCTOBER 2014
AGREED that the minutes of the meeting held on 7th October 2014 be approved.
ASH
60/14
NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST QUALITY ACCOUNT 2014-15
AGREED that the presentation and information be received, and the further information requested be provided.
ASH
61/14
SIX-MONTHLY ADULT CARE PERFORMANCE UPDATE
AGREED that the report be noted.
ASH
62/14
MONITORING OF IMPLEMENTATION OF PREVIOUSLY AGREED RECOMMENDATIONS
AGREED that the Progress Update be agreed.
ASH
63/14
CARE HOMES QUALITY STANDARDS FRAMEWORK
AGREED that the report be noted.
ASH
64/14
SCRUTINY REVIEW OF HOME CARE
AGREED that the report be noted.
ASH
65/14
WORK PROGRAMME
AGREED that the Work Programme 2014-15 be noted.
ASH
66/14
CHAIR'S UPDATE
The Chair had nothing to update.
4.30 pm - 6.30 pm

Preamble

ItemPreamble
ASH
59/14
Consideration was given to the draft minutes of the meeting held on 7th October 2014.
ASH
60/14
Members received a presentation from senior representatives of North Tees and Hartlepool NHS Foundation Trust's (NTHFT). The presentation covered the consultation into the priorities for inclusion in next year's Quality Account, progress on the current year's priorities, and an update on key issues as requested at the last meeting of the Committee.

NHS Acute Trusts were under a duty to produce yearly ‘Quality Accounts' and these were intended to set out:-

- what an organisation is doing well;
- where improvements in service quality are required;
- what the priorities for improvement are for the coming year;
- how the organisation has involved service users, staff and others with an interest in that organisation in determining those priorities for improvement

Providers were encouraged to engage with local stakeholders throughout the production of each year's Quality Account. Representatives from NTHFT were in attendance at the meeting and provided a presentation on progress so far this year and to consult on priorities for inclusion in the 2014-15 Quality Account.

For each Account, the relevant commissioning CCG would need to provide a statement of assurance. Health overview and scrutiny committees had a voluntary opportunity to comment on draft Accounts. The Committee would have the opportunity to comment on NTHFT's draft 2014-15 Account at the meeting on 10th March 2014.

Members were also provided with an update on performance against a number of quality indicators as requested, namely: Summary Hospital-level Mortality Indicator (SHMI), Cancer Referral to Treatment Times, and an update on staff survey results.

Members were given the opportunity to ask questions and make comment on the information that had been presented to them. The main issues that were discussed were:-

A number of actions were outlined to understand and improve the mortality data. The Trust was identified as an outlier for Summary Hospital-level Mortality Indicator (SHMI) and Hospital Standardised Mortality Ratio (HSMR), and this had been queried by the Committee. The Trust was also recorded as being within the best 30% of Trusts for the Crude Mortality Rate for HSMR.

Members noted it was therefore important to understand the data and take appropriate actions. The Trust had set up a Keogh Delivery Group to review key issues following the national Keogh Report, and undertook regular mortality reviews of individual cases.

Actions included more rigorous monitoring of changes in a patient's condition. The Trust was also rolling out its Early Warning Score system for vulnerable patients for use in the community, GPs and with ambulance staff to ensure early assessment of any deteriorating cases.

Patients were presenting with much more complex case mixes, particularly in relation to elderly patients and long term conditions. As well as presenting a clinical challenge, it was important that these cases were coded correctly to ensure there was better data to act upon.

The Trust recognised that it needed to do better in relation to palliative care, and some people should not necessarily be in hospital at the end of life stage.

* NTHFT share best practice with other NHS Foundation Trusts including in relation to its Emergency Assessment Unit.

Members queried the reasons behind the pressure on meeting the Two-week Referral and the 62 Day Referral to Treatment standards particularly during the period April to August 2014.

The Be Clear on Cancer campaigns had seen an increase in referrals for investigations and screening programmes were now well established and had been extended. Pressure on services had resulted; for example, ten years ago there were six endoscopy sessions per week, and the Trust were now running sixty-three.

Public information campaigns, and sometimes double running of these, could have an impact on capacity of particular services, for example CT scanning, and there was liaison with Public Health England.

It was queried whether patients realised the importance of their appointments as not all attended within Two-weeks. It was recognised that some patients did not always attend due to issues such as holidays but it was emphasised that there were always individual reasons. GPs had a role to talk to patients about their awareness and availability for appointments, when making referrals.

A range of measures had been introduced by the Trust to improve the situation and this had resulted in better performance in September. These had included a review of each breach of the standard and extra sessions on weekends. An independent review of the Trust's cancer service had been positive.

* Screening sometimes resulted in identification of issues that were not cancer but could be a pre-cursor to cancer and still needed to be treated.

* MRSA remains at zero and Clostridium Difficile was within the target range and compared well to national and local figures, and the representatives from NTHFT felt this was still achievable with budget reductions. The Committee requested information on the numbers of hospital acquired infections compared to the data on community acquired infections, prior to admission to hospital.

A number of methods were outlined to ensure the Trust gathered the views of staff and acted upon concerns, including ‘you said, we did' feedback, staff events, and a new engagement strategy.

Members queried staff recruitment and it was noted that the Trust did well in some specialities such as surgery and chest services, but there was a recognised pressure on others and were dependent on trainee numbers and faced competition with other Trusts.
* Consultants take 10 years to train
* The NTHFT had made several recent appointments but were looking to produce packages to help make further appointments

The Chair thanked the representatives from NTHFT for their attendance at the meeting.
ASH
61/14
Consideration was given to a report that provided an overview of performance of Adult Social Care Services for Quarter 2 of 2014-15 (i.e. for the period from 1st July to 30th September 2014), along with information from some recent benchmarking of performance across North East Councils for the 2013-14 period.

As part of the Committee's agreed performance framework, it was agreed to present each year a mid-year performance update. Attached to the report was the 2014-15 Quarter 2 performance overview, covering performance indicators linked to priorities in the Council Plan, along with information from other sources of information about the performance and quality of services, including complaints.

As part of sector led improvement activity within the North East Region, a report had been produced benchmarking the performance of Councils in the region with regard to both Adult Social Care and Health & Wellbeing, based on a set of indicators which were linked, in the main, to national performance frameworks for these services. Attached to the report was a copy of the relevant sections of the regional report.

Members queried the level of admissions to nursing and residential care homes. It was reported that there was a resource panel in place to review each admission and ensure that it was appropriate. The levels of health and wellbeing showed that the area compared poorly to elsewhere and there could be a correlation.

A Market Position Statement was being developed which would set out the area's needs in relation to care home beds, and would be brought to a future meeting.
ASH
62/14
Members were asked to consider the assessments of progress contained within the Progress Updates on the implementation of previously agreed recommendations. The outstanding recommendations from the EIT reviews of Adult Mental Health Services, and Learning Disability Services were attached to the report.
ASH
63/14
Consideration was given to a report on the year's scores for Care Homes under the Council's Quality Standards Framework (QSF).

Members received an update on the operation of the Quality Standards Framework (QSF) for Care Homes in the Borough. The QSF was used by Stockton Council Adult Services' Commissioning Team to assess care homes against a range of standards including environment, management of staffing, individual care needs, and protection and safeguarding.

Attached to the report were the year's scores for the Members consideration.

Members were given the opportunity to ask questions and make comment on the information that had been presented to them. The main issues that were discussed were:-

* Churchview had been given a national award
* Participation in the Quality Standards Framework would be built into all care homes contracts from next year and would become mandatory
* There was over-capacity of care home beds in the Stockton area, and therefore a good level of competition between the local care homes

The difference in scoring between homes with the same owners was discussed and it was noted that the Registered Managers on site played a key role. Providers were encouraged to share good practice in the Provider Forums held as part of the QSF annual process.

* Some of the Commissioning Team had completed a Level 5 course on managing medication and the Local Authority works with pharmacies and CCG to help advise care homes and develop standards. Medication standards were assessed but had not been included in this year's ratings due to concern that all homes had not had CCG audit but would be included in future years.

* Weekly fees for care homes will be linked to a reviewed defined banding in future, and this may be linked to the CCG's CQUIN payment scheme which was about commissioning for quality clinical outcomes.
ASH
64/14
Members were requested to consider information provided in relation to the quality monitoring and improvement of local home care services.

Members were reminded that a set of key lines of enquiry (KLOE) had been drawn up to assist the review. Relevant key questions for the meeting's theme had been addressed by Adult Services and were attached to the report.

The results of Home Care and Extra Care User Surveys completed upon review, between June and October 2014 were attached to the report. These were used as part of the Quality Standards Framework for Home Care services.

The process and assessment standards for the Home Care QSF was also attached to the report.
ASH
65/14
Consideration was given to the Work Programme 2014-15.

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