Adult Services and Health Select Committee Minutes

Tuesday, 14th January, 2014
4.00 p.m.
Jim Cooke Conference Suite, Stockton Central Library, Stockton on Tees, TS18 1TU
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Cllr Mohammed Javed(Chairman), Cllr Kevin Faulks(Vice-Chairman), Cllr Paul Baker, Cllr Evaline Cunningham, Cllr Elliot Kennedy, Cllr Ray McCall, Cllr Mrs Sylvia Walmsley, Cllr Norma Wilburn, Cllr Mrs Mary Womphrey, Deborah Miller
Peter Kelly(Public Health), Peter Mennear and Kirsty Wannop(LDS).
In Attendance:
Apologies for absence:
Deborah Bowden(Hartlepool & Stockton-On-Tees Clinical Commissioning Group), Lynn Kirby, Sue Piggott, Andrew Simpson, Karen Walker(North Tees and Hartlepool Foundation Trust), Susan Watson(South Tees Foundation Trust).
Item Description Decision
The Chair signed the minutes of the meetings held on 1st October 2013 and 15th October 2013 as a correct record.
AGREED that the minutes be approved subject to the above amendment.
1. the further information requested be forwarded to the Committee.
2. the information be noted.
AGREED the above response be sent as part of the consultation.


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 minuets of the meetings held on 26th November 2013.

Members agreed that within the minute entitled Scrutiny Review of Access to GP, Urgent and Emergency Care, the following paragraph:

'It had been reported anecdotally that GPs were turning away some of the difficult patients. Dr Canning explained that GPs had to record a reason why somebody was turned away if there was no capacity and this could be requested from GPs from NHS England. People who did not currently have a GP within the local area should not be turned away. Prospective patients should be treated on a consistent basis.'

be amended to:

'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.'
Members received a presentation in relation to Accident and Emergency at North Tees and Hartlepool Foundation Trust and the information included:-

- There was lots of information in the press relating to A&E crisis plans not being good enough, A&E facing serious problems and missing waiting time targets.
- Some of the issues facing A&E were the number of attendances to the department, discharging patients from other wards enabling those needing a bed from A&E access to the care needed, the new 111 system had caused issues but North Tees & Hartlepool FT was working with them to solve these. There was not enough senior medical staff, it took 8 years to train for this and there was not enough coming through the system for the needs, recruiting other medical staff was also a problem.
-Closure of Hartlepool A and E had alleviated staffing problems to an extent through centralisation, but staffing issues remained.
- The public were unclear on what out of hours services were available.
- Admissions had increased and more complex cases were being presented. The biggest attendance was from 18-40 year olds closely followed by under 18's. Regarding these younger age groups, it was felt that there had been a rise in the ‘worried well’ and those who did not know the most appropriate route for their care in relation to more minor issues.
- The change in licensing law that allowed pubs/clubs to be open later and for more hours had impacted on the timing of patients entering A&E, most of these patients that had consumed alcohol tended to take up more staff time than the average patient, and this demand was continuing up until 5am which was previously a much quieter time.
- Members were then provided with statistics regards A&E arrivals in a typical week, a comparison of arrival numbers and times throughout a Monday and a Saturday, Arrivals and Admissions from 1st November 2013 - 31st December 2013 and those that breached the 4 hour waiting target and performance from April 2013 - December 2013 against the 95% standard. Recent 4-hour performance was better than many areas although some Trust’s had performed better.
- Government had announced funding was available for A&E and for the Winter period but none was allocated to North Tees and Hartlepool Foundation Trust.
- The feedback from patients was mainly positive. The work with Mental Health patients was also very good. Sepsis care was improving and when CQC visited the department in January 2014 they had found very little wrong.

Members were also provided with statistics and information regarding South Tees NHS Foundation Trust and the main information included:-
- Statistics on ambulance arrivals at James Cook Hospital and ambulance handover delays, yearly admissions, yearly A&E attendances, year on year comparative data from 2012 and 2013 for admissions to the Acute Admissions Unit, A&E patients waiting times year on year, discharge numbers and inpatient waiting over 18 weeks to see specialists.

James Cook’s A and E is designed to cope with seventy five thousand attendances per year, and during 12-13 there were one hundred and five thousand attendances. The unit can accommodate two hundred and fifty attendances, and around seventy admissions per day, however there had regularly been over three hundred attendances and over eighty admissions during the busiest periods.

Increasingly busy hospitals lead to longer ambulance handover times as patients cannot be transferred in a timely fashioned.

The winter of 13-14 had seen less pressure to date, and it was thought that a combination of better weather and improved planning and resilience had contributed to this. Delayed discharges had improved since last year’s winter period, and there had been concerted working with social care.

The Trust had developed a seven year plan to develop its staff but had greater staff shortages compared to other Major Trauma Centres. There should be eight middle grade doctors but there were only five in place. Both Trusts were making greater use of advanced nursing staff.

Members raised the following points/comments/questions:-
- Members were surprised to learn that hospitals in some cases did not have access to patients records to give them the key issues of a patient’s health (allergies/medication) and agreed that this issue should be investigated further. It was reported that this was more an attitudinal issue rather than technology.
- More needed to be done to educate people on what services to use depending on what was wrong with, this would allow A&E to deal with patients that needed to be in A&E and couldn't be treated elsewhere.
- What more should be done to attract people to work for North Tees and Hartlepool Foundation Trust. It was reported that the Trust has a good training programme but there are still issues around recruiting to the area/certain specialities.

- The breakdown of A and E patients by their area of residence was requested for both Trusts.
- It was recognised that a whole system approach was needed and it was requested that the CCG’s Urgent Care Strategy be circulated to The Committee.
Members considered the update on the Call to Action. The Committee discussed the questionnaire as part of the consultation and agreed the following points should be made in response:
- It was recognised that the survey was intended to be prompt for further discussion, however it was not necessarily suitable should someone only see the survey and not attend a facilitated event;
- The survey was attempting to cover too many issues, and did not provide enough space if a respondent did want to provide feedback on all the issues raised;
- Members felt that mental health and learning disabilities should not necessarily be linked in the same section;
- It was not clear how the local survey fitted into the wider Call to Action process (for example, there was no ‘return by’ date included on the hard copy of the survey, or a ‘next steps’ section).
Members were reminded that an additional meeting of the Committee would take place on 25th March 2014.

At the next meeting of the Committee a representative from North East Ambulance Service and Cleveland Police would be in attendance.

The Committee was requested to consider suggestions for next year’s work programme, in addition to the outstanding review of Domiciliary Care, and Members suggested that a review of the Any Qualified Provider policy and practice be considered.
The Chair had nothing to update.

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