Adult Services and Health Select Committee Minutes

Tuesday, 20th January, 2015
4.00 p.m.
Jim Cooke Conference Room, Stockton Library, The Square, Stockton on Tees
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Cllr Kevin Faulks (Chair); Cllr Evaline Cunningham, Cllr Ray McCall, Cllr Mrs Sylvia Walmsley, Cllr Norma Wilburn, Cllr Mrs Mary Womphrey and Deborah Miller.
L Hanley, G Irving, R Papworth (CESC); P J Mennear, P K Bell (LD).
In Attendance:
Dr J MacLeod, N Atkinson, J Gillon (North Tees and Hartlepool NHS Foundation Trust) Dr Williams (CCG), G Turnbull (CASA), Natasha Judge (Healthwatch).
Apologies for absence:
Cllr Paul Baker and Cllr Elliot Kennedy.
Item Description Decision
The evacuation procedure was noted.
Cllr Ray McCall declared a personal interest as he was an Associate Hospital Manager for Tees, Esk and Wear Valleys NHS Foundation Trust and a Member on New Horizons Teesside.
The minutes of the meetings held on 30th October 2014 and 18th November 2014 were signed by the Chair as a correct record.
AGREED that the draft minutes of the meeting held on 16th December 2014 be approved.
AGREED that the information be noted.

AGREED that the update be noted.
AGREED that Tees Adult Safeguarding Board Annual Report be noted.
AGREED that the Work Programme be noted.
AGREED that the update be noted.
4.00 pm - 6.00 pm


Consideration was given to the draft minutes of the meeting held on 16th December 2014.
Members were presented with information on Care and Share Associates (CASA) in order to inform the review of Home Care. CASA was an example of an alternative delivery model for home care and related services.

CASA was based upon the model developed by Sunderland Home Care Associates. This was developed as an employee - owned social enterprise in 1994 to deliver home care in Sunderland.

CASA was set up to deliver franchise companies in other areas following the same model, and the CASA group comprised companies across the North including Newcastle, Knowsley, and Manchester. A briefing on the origins of CASA and their operating principles was made available to Members.

CASA Managing Director (Dr G Turnbull) was in attendance at the meeting and gave Members a presentation on the work of CASA.

It was reported that it costs providers approximately £150k to set up a home care branch on a standalone basis due to various regulatory requirements, and this would be a barrier for a local, standalone social enterprise. The central CASA company provides a range of services to support branches including accounting functions, training, and quality monitoring.

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

* Would Stockton Borough have a large enough user group to attract CASA?
* How does your customer group view your service?
* What is the approach to travel time and wages for CASA staff?

Dr G Turnbull responded that:-

* CASA would need to provide about 800 - 900 hours per week to make the proposition viable but CASA would have to complete a feasibility study
Home care is volume business and CASA need a certain level hours to provide a local service and grow as an overall proposition.

* CASA carries out a satisfaction survey which is positive but it had to be remembered that some users are very frail or at end of life and consultation in home care was often sensitive. It was also noted that consultation showed that clients did not necessarily notice the type of provider for their care.
* CASA try to cluster staff to reduce travel time and some staff are on zero contracts but this suits some employees and they also receive shares. Sick pay and holiday pay was paid. Dr Turnbull stated that use of zero hour contracts were reflective of the nature of the majority of home care contracts.

The company also offers interest free loans to staff and one third of the profit bucket after tax is re - distributed to the work force.

CASA stated its approach leads to low staff turnover and better continuity of care. Staff share ownership increases over time, and the company provide transparency with their staff in terms of the commissioning arrangements and their rate of pay, for example.

The Chair thanked Dr Turnbull for his attendance at the meeting.
Members considered an update on the Momentum Programme following the decision to ‘pause’ development work on the new hospital project.

On 23 October 2014, North Tees and Hartlepool NHS Foundation Trust’s Board announced it had decided to pause the development work on the new hospital. Whilst re - iterating its commitment to developing a new hospital, the Trust stated that it believed that any further progress in terms of key decisions from central government would be unlikely before the General Election in May 2015.

The Trust stated that ‘the board will keep this position under active review in the light of national developments and will continue to work closely with local NHS commissioners and with its partners in local government to improve the integration and quality of care for local people’.

At the meeting of 30 October 2014, Members requested an update on the Momentum Programme in light of this announcement. Members also requested an update on the progress of the development of community facilities in Stockton Borough that were an integral part of the Momentum vision.

Representatives of the Trust and from Hartlepool and Stockton-on-Tees and the CCG were in attendance.

A presentation was given that outlined the Trust’s Momentum Strategy that was still in place. It was noted that the majority of healthcare patient contacts occurred outside a hospital environment already. Due to the pause in the New Hospital Development work, the Trust was taking the opportunity to undertake focussed work on the Service Transformation element, and a range of improvements were described including increased capacity for home births, increased Children’s Services in community settings.

The Five Year Forward view had highlighted the range of possible service models, and this will need to include further collaboration, and the potential development of multi-speciality community based care.

* With regard to the CCG’s urgent care strategy, Stockton has an A&E Department, walk - in centre and an out of hours service. This can be confusing with some patients attending the wrong place. As a commissioner for this service, the CCG was reviewing this with the aim of a developing a new clearer single system to be procured. Engagement on this system would take place with the public, LA's and other stakeholders on the best way forward. Options would co-location if urgent care services with A and E, depending on the future location of the hospital.

* Going forward the plan was to still have a new hospital with a provision in the community for some urgent care and other appointments. This may include the proposed centre in central Stockton, but the CG would consider all of the estate available in the local health care sector to make best use of it. There was scope for increased involvement of consultants at community level, especially where little specialist equipment is required.

The role of primary care was key with the vast majority of care taking place in that setting. Options for more co-ordinated commissioning and service delivery of primary care were being developed.

* The Trust would have to continue to invest in the estate at both Stockton and Hartlepool hospital sites for the medium term. Any new hospital would not be completed for another 5-7 years.

Members still fully supported the building of a new hospital and after the general election a case could be put forward for a new hospital.
Members considered the 2013/14 Annual Report of the Teeswide Safeguarding Adults Board.

As part of the revised approach to monitoring the quality of local health and care services, the Committee received the annual report into Adult Safeguarding activity.

Attached was the 2013/14 Annual Report of the Teeswide Safeguarding Adults Board for Member’s consideration. This Tees-wide Board was the statutory Safeguarding Adults Board for the area as required by the Care Act 2014. Operational delivery in each locality was overseen by the relevant Local Executive Group.

The report provided an overview of adult safeguarding activity in the Borough, and information on the new arrangements.

Similar arrangements were in place to consider Children’s Safeguarding arrangements at Children and Young People Select Committee.

The number of organisations on the Tees-wide Board was above the minimum requirement.

It was noted that the categories of abuse were due to change to include self-neglect and modern slavery.

Members queried the variation in number of referrals and alerts across the Tees authorities and noted that common joint recording standards were being developed to ensure consistency.

In future services would need to actively screen for abuse, as opposed to waiting to receive a referral, due to the change in threshold for abuse following implementation of the Care Act.
The Scrutiny Officer requested that any items for future scrutiny topic be emailed to him.
The Vice-Chair explained he had been asked to chair the Committee until the elections in May.

Members discussed the outcome of a recent CQC report on a local provider and requested a meeting to discuss further.

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