Adult Services and Health Select Committee Minutes

Tuesday, 4th October, 2016
Jim Cooke Conference Suite, Stockton Central Library
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Cllr Mohammed Javed (Chair), Cllr Sonia Bailey, Cllr Evaline Cunningham, Cllr Kevin Faulks, Cllr Lisa Grainge, Cllr Lynn Hall, Cllr Stefan Houghton, Cllr Allan Mitchell and Cllr Mrs Sylvia Walmsley.
Angela Connor and Liz Hanley (CESC), Peter Mennear and Sarah Whaley (DCE).
In Attendance:
Jane Hore (Healthwatch Stockton-On-Tees)
Apologies for absence:
Item Description Decision
AGREED that the report be noted.
AGREED that the Annual Report be noted.
AGREED that the suggested recommendations be included in a draft report and the draft report be brought to the meeting in November for approval.
AGREED that the Update be noted.
AGREED that the Minutes be noted.
AGREED that the work programme be noted.
4.30pm - 6.30pm


There were no Declarations of Interests made.
Healthwatch Stockton-on-Tees had recently undertaken a review of discharge from North Tees Trust for those with a care package, following work completed by Healthwatch Stockton in 2014 on ‘Arrangements for Discharge’.

Healthwatch spoke to patients in the community and at Rosedale Centre who had been discharged from University Hospital of North Tees with support.

The results were discussed with Committee members, and the main highlighted issues included both written and verbal communication and medication issues that resulted in discharge delays.

Within the report were details in relation to inappropriate incidents between November 2015 and February relating to medication and discharge.

The report detailed recommendations following the report, including a recommendation to review the procedure for supply and distribution of medication for discharge, as well as a number of recommendations in relation to improve communication.

The Committee were advised that these reports would be followed up and monitored what actions were put in place.

Members asked for clarification that should a referral be made late on a Friday, then the patient would not be visited till the following Monday, and were informed that yes, this was the case and that once the 7 day working was introduced then this issue would be addressed. Members stressed their concern over this issue. It was discussed that the NHS were looking to introduce the Discharge to Assess model, and that a Risk Assessment would be completed before allowing a person to return home. Stockton Borough Council would only be able to support this model when deemed to be safe for the client.

The Committee were advised that Healthwatch Stockton had been invited by the Senior Clinical Professional to attend a meeting to discuss the Delayed Transfer of Care Guidance which was being drafted at the time of the review.

The Committee were advised that the Hospital had been identified as an outlier in terms of the number of delayed discharges that were attributed to the NHS and/or the Hospital, and that the Chief Operating Officer (COO) had proposed some new codes in order to clarify where those delays were. A meeting had been arranged for Stockton and Hartlepool Councils to meet with the COO to clarify the proposed changes and how it could affect the performance data relevant to Healthwatch Local Authorities.

A Member raised an issue that a member of the public had spoken to them about, in relation to a cancer patient having to go and collect their own prescription from the pharmacy after receiving chemotherapy, as the medication was not able to be brought onto the ward. Officers were unaware of this but would investigate further after the meeting.

Members spoke about a recent visit to Rosedale, and how this report reflected comments made by staff, including inconsistent notes, wrong medication and discharged patients turning up without prior notification. Officers responded by advising that staff were keen to address the issues raised within the report, and that a meeting would be taking place to discuss the actions that would be put in place.

Members welcomed the recommendations, in particularly communication and delay over prescriptions, and look forward to improvements being made.

It was clarified that a response from North Tees and Hartlepool Hospitals NHS Foundation Trust, advised that they were working closing with Stockton Borough Council and the implementation of the new ‘Assessment and Rehabilitation Team’ in August 2016.

Members were reminded that discharge arrangements had previously been raised with the Trust as part of the Quality Account discussions and there would be an opportunity to discuss further in November.
The Healthwatch Stockton-on-Tees Annual Report 2015/16 was presented to the Committee.

Within the report were details of the differing ranges of engagement activities held in order to gather the views and experiences of the local community. The Healthwatch Team engaged with local people, patients, service users, carers, community groups, organisations, service providers and commissioners.

The increase in engagement had led to an increase in intelligence received and also an increase in people making contact requesting support.

Enter and View Reports had been completed for the Woodbridge Practice, and Thornaby and Barwick Medical Practice. These visits would be followed up in due course.

In 2015/16, the services Healthwatch Stockton-on-Tees heard about most frequently through the information and signposting service were highlighted within the report, with GP’s being 34% and hospitals at 16%. Other area’s included Social Care, Mental Health Services, NE Ambulance Service, Dentist, Care Homes and Learning Disabilities Services.

The report also discussed the Survey regarding service provision at the University Hospital of North Tees. The information collected on communication had been summarised and presented to the Board. The Healthwatch team were in the process of conducting a ‘Virtual enter and View’, which could be done without having to re-enter the hospital as there were already sufficient information on how the service could be improved.

A highly commended piece of work was the ‘Shaping Mental Health Services Together’, which was a joint event with Healthwatch Redcar and Cleveland, Healthwatch Middlesbrough, Voices for choices and North East Together.

The Student Research Programme was a success, where students involved in access to Mental Health Services and gathered information from younger people. The report was on Healthwatch Stockton’s website.

Healthwatch Stockton had continued working closely with Care Quality Commission, and links had been developed for sharing intelligence.

The report detailed the Enter and View that was carried out at Roseville Care Home. The report was to be shared with all Care Homes in Stockton, starting with those that were Dementia Registered in order to share best practice.

The team had also visited the Dementia Hub service at Halcyon Centre and this had led to information being gathered that in turn led to an Enter and View visit being planned.

Plans for the following year (2016/17) were detailed within the report including an event on strengthening voices, mental health services, engaging with young people, learning disabilities/autism, North East Ambulance Service and NHS 111 Services, Care Homes and Older People and Black, Asian, Minority and Refugee Communities.

Members asked whether there were leaflets available at GP surgeries and were advised that there were, but that the Healthwatch team needed to revisit and do more work to raise awareness of Healthwatch and its role.

Members enquired about the response from schools and were advised that no work had been done with schools yet, but they had worked with Youth Direction and accessed youth clubs. The team planned on creating Youth Champions - young people who were interested in a career in health, and working with the champions to take into their schools.

Members asked whether the leaflets had been placed in other community spaces as well as GP surgeries, and were informed that they weren’t but that it would be beneficial to introduce.

Members noted that in the report on the Woodbridge surgery, it highlighted that the surgery had carried out some of the recommendations, and members enquired whether any follow up work would be carried out. It was stressed that the service did need to be monitored but that it was unsure how this would be done due to capacity - It may be that a 2nd follow up visit would be carried out by volunteers.

The Committee queried the budget shortfall of £3,052, and Members enquired why the staffing costs were so high and where the shortfall of money would come from. These questions could not be answered at this time but would be fed back to the Committee at a later date.

Members asked whether the team had enough members of staff to carry out their work effectively, and were advised that demand was currently being met, however the workload was expected to increase. Volunteers were an option however these would need to be coordinated and managed in the right way, as well as not being able to carry out all areas of work.

Members asked whether the work completed by the CQC complements that of Healthwatch, and was any work duplicated. The Committee were informed that the CQC carry out inspections, and Healthwatch carry out further investigations. The CQC where keen to use the evidence and intelligence obtained by the Healthwatch team which was all logged on a database. The CQC and Healthwatch were working together i.e. The CQC would advise what area they would be inspecting that year e.g. GP surgeries, care homes etc., and Healthwatch would forward any intelligence that may assist in the inspections.

Members spoke about delays in getting appointments at GP surgeries, in particular at the Woodbridge surgery, sometimes taking up to 3 weeks for an available appointment. A matron had recently been appointed to meet demand. Many appointments were wasted with patients not attending. Many surgeries also had this problem, however it was felt that the implementation of simple things could help alleviate this problem such as the text reminder service, and an automated service so that anyone wishing to cancel appointments can get through and appointments freed up. There could be a cost involved in these types of systems.

Members praised the way the reports were written and statistics presented by Healthwatch Stockton-on-Tees.

Members welcomed further work to be done around mental health, and would like to concentrate on children’s mental health. There were concerns over the demand on the CAMHS service, and the lack of communication between Mental Health Teams and the young person’s school. Healthwatch advised that they also had an interest in this area, and did advise that the work recently done with Youth Clubs questioned emotional health, and the team were looking at including additional questions on questionnaires as well as other work to be done.

The team were keen to create a link with the Mental Health Trust and welcomed any suggestions of how this could be improved. Contact details of the Local Children’s Services were to be passed to Healthwatch.

It was also agreed that work needed to be done with schools to speak about mental health issues and address the stigma associated, as well as promoting services that were available.

It was noted that there were long waiting lists to see a clinical psychologist however this is a nationwide problem, and not just Teesside due to a shortage of Psychologists.
Members received a report summarising the evidence received to date during the review, to assist Members to consider draft recommendations.

It was currently planned that a draft report be considered at the meeting on 15 November 2016, and the review is scheduled to report to the meeting of Cabinet on 1 December 2016.

The Committee were advised that a request had been made for survey feedback from friends and family of those affected by DoLS, and that it would be circulated once received, in order that Members can consider as part of the review.

Evidence included the Mental Capacity Act Deprivation of Liberty Safeguards (DoLS), the process of Managing Authorities, the national impact of the increase in workload following the Supreme Court Judgement, the local impact, Stockton Borough Council's response, the Care Quality Commission, the Clinical Commissioning Group, Tees Esk and Wear Valleys NHS Foundation Trust, North Tees and Hartlepool NHS Foundation Trust, and the Care and Nursing homes survey.

A list of suggested areas for recommendations was circulated for discussion, and Members agreed for a final report to be drafted and brought to a future meeting for agreement.

Members noted that on the site visits to the DoLS Administration Team, Members had noted that additional resources such as office space and increased printer access may be needed, and could these be included in the recommendations.

The suggested recommendations included support for the resourcing of the DoLS function, but this referred to the overall financial allocation. Officers noted that the feedback on the operational elements of the team's work had been very useful and was being considered further already.

The Committee were advised that a separate report was to be submitted to the same Cabinet meeting in relation to the improvement work completed and planned and to make the case for substantive funding for the overall DoLS function, and that the two reports would complement each other.

Members enquired about the backlog of DoLS assessments, and it was confirmed that there were currently 92 outstanding cases the Council was aware of and that they were on target to be undertaken by December.
The Committee were provided with an update on the work of the Better Health Programme Joint Health Scrutiny Committee.

Minutes of the meeting held on 21 July were circulated, and the last meeting was 8 September, in which presentations were available for the Committee. The next meeting was to be held on 13 October 2016.

Members advised that there was a lot of information included in the update, and not a lot of time to discuss further at the meeting.

Members asked for clarification on the membership of the Board, and whether there would be no elected members involved. It was confirmed that there were no elected Members on the Better Health Boards, as this was an NHS-led project with governance arrangements that meant the CCG's must have ultimate decision making powers.

Local Authority views were being gathered via norminated regional officer representatives on stakeholder panels, and various consultation and engagement activities. The Better Health Committee would be seeking further detail on Local Authority input as part of its work.
The minutes on the Better Health Programme Joint Health Scrutiny Committee held on 21 July 2016 were noted.
The next meeting would be held on 18 October 2016 for the annual overview of Adult and Public Health services.
The Chair outlined that update meetings between the Chair and Vice-Chair and the Deputy Chief Executive at North Tees Foundation Trust had been arranged in line with previous practice.

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