Stockton-on-Tees Borough Council

Big plans, bright future

Adult Services and Health Select Committee Minutes

Tuesday, 23rd September, 2014
Jim Cooke Conference Suite, Stockton Central Library, Church Road, 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 Evaline Cunningham, Cllr Elliot Kennedy, Cllr Mrs Sylvia Walmsley, Cllr Norma Wilburn, Cllr Mrs Mary Womphrey, Deborah Miller
Emma Champley, Jo Heaney(Public Health), Peter Mennear and Kirsty Wannop(LDS)
In Attendance:
Carl Parker, Graeme Niven(CCG), Ben Clark, Sue Metcalfe, Jenny Long(NHS England), Tracy Minns, Julie Gillon, Peter Tindall(North Tees & Hartlepool NHS Foundation Trust), Paul Liversidge, Mark Cotton, Ray Stephenson, Veronica Fletcher(North East Ambulance Trust), Tony Beckwith (Healthwatch Stockton-on-Tees)
Apologies for absence:
Cllr Paul Baker and Cllr Ray McCall
Item Description Decision

AGREED that the Action Plan be approved and further information and updates be received.

AGREED that:
1. The Committee concerns be noted.
2. The public consultation form be circulated.
AGREED that the information be noted.
AGREED that the information be noted.


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.
The Committee considered the Action Plan setting out how the agreed recommendations from the review of access to GP, urgent and emergency care would be implemented and target dates for completion. Members raised the following:-
- Although GP surgeries lists were not officially closed it had been raised from residents to Members when trying to register at a GP they were unable to register some people.

NHS England outlined that they would be undertaking a ‘deep dive’ review of some of the issues around GP recruitment and list closures.

NHS England outlined that complaints about an inability to register could be made to the NHS National Contact Centre, the Patient Registration Department at the Family Health Service, or that Healthwatch could be notified.
Members commented that it was important for patients to be aware of these methods as it was not thought that these were widely known.

Members queried how many issues had been reported to the Area Team and the information would be queried. Members noted that they were particularly concerned about vulnerable residents who had been unable to register.

Healthwatch representative commented that there was a need to promote NHS111 much better, and that patients should not be blamed for not understanding the complex picture of urgent care.

The CCG informed Committee that Minor Ailments Scheme would be commissioned, and a potential increase in prescribing pharmacists would be examined. Additional publicity on pharmacy would be rolled out from November.

North Tees and Hartlepool NHS Trust representatives commented that they would be keen to get involved in publicity promoting the options for urgent care.

The CCG outlined that they would be looking to formally monitor Ambulance response to non-emergency calls as part of the 14-15 contract monitoring. The Ambulance Service (NEAS) committed to provide response time data at the Local Authority-level across the Trust area. Members queried hospital handover delays in the Tees area and these had noticeably improved compared to the previous year.

The Cabinet Office was examining the trend of declining performance nationally and NEAS was one of only three Trusts currently meeting the 75% target for emergency calls.

However NEAS recognised that they had performance issues to address and a Recovery Plan had been agreed. It was noted that Workforce morale and the number of paramedics were recognised as key issues.

Until the service were able to recruit increased numbers of staff, third party providers would continue to be used to meet demand. These were mainly used to meet lower priority calls but would be sent to emergencies if they were the nearest available asset.

Increased clinical support to paramedics to deal with incidents at the scene had been piloted out of hours, and an in-hours service was being investigated.

Patient experience data commissioned from Ipsos MORI would be available in November.

NEAS reported that they continued to have operational meetings with the police and no ‘new’ issues had been identified. Issues raised during the period of the Committee’s review had been investigated and were mainly found to relate to the need to improve inter-service communication and improve the accuracy of records (for example, of potentially dangerous people). A trial of shared radios was to take place which would allow NEAS call handlers to speak directly with patients where possible.

It was recognised that the police faced pressured situations when dealing with incidents and waiting for ambulance response. NEAS stated that a Clinical Hub in the contact centre could raise the priority of green (non-emergency calls) where necessary and appropriate.

The chair noted that not all Stockton GP Practices had responded to the Committee’s recommendations. NHS England requested a list of those Practices that had not responded.
The Committee considered information regarding NHS England Area Team’s Review of Stockton Health Centre. The APMS GP contract was time limited and was due for expiry in 2015. The one affected Practice in the Borough was Stockton Health Centre. The review covered the registered patient element and there were 1859 patients registered. It did not cover the walk-in service provided at the location.

Members were informed that public consultation was running until 29th September 2014 and a copy of the main consultation document was provided. The Committee were also provided with the Stakeholder feedback form. Members highlighted their concerns regarding the form and the vocabulary used. They requested that a copy of the public consultation feedback form be circulated to the Committee. It was confirmed that all patients had been written to.

Members also raised their concerns regarding the possibility of closing the practise and having to move all the patients to other GPs in the borough. Although it had been explained that none of the GPs had closed their list, Members had heard from residents difficulties in getting registered. The Committee felt that closing this surgery would put increased demand on GPs in the borough and due to the location of the practice it would encourage people to use A&E rather than travel to see a GP.

The Committee also noted:
- Concerns about increased attendance at the Walk-in Centre based at the same location, and the viability of the walk in centre;
- The deprivation levels in the local area, and more complex health needs compared to other areas of the Borough;
- The need to pay for patient care wherever they are registered, and whether it was possible to reduce the cost of the current service;
- The projected increase in housing in the area;
- The good levels of access provided by the opening hours at the Practice.

The representative noted that the CCG considered the proposal to be a risk due to the potential increased attendance at urgent and emergency care services.

The Area Team noted that all views would be considered as part of the consultation, including the views of other Practices and the Hospital Trust. It was noted that the sustainability of primary care as a whole needed to be considered, taking into account GP recruitment, and recognising that smaller practice were not as attractive to trainees.

The Area Team would return to the Committee on future date to outline the results of the consultation and next steps.
The Committee considered the final evaluation report following the centralisation of critical care and emergency medicine services in 2013 at North Tees and Hartlepool NHS Foundation Trust to the North Tees Site. Members received a presentation that included the following:-

- The approach to the evaluation that included a Joint Overview Group to monitor the impact of the reconfiguration, use of existing Trust indicators to provide an overview of the impact and summary dashboard to provide over and assurance to the Oversight Group.
- Information from the dashboard set up to monitor the implementation regarding A&E, Referral to treatment, Health Care Acquired infections, Eliminating mixed sex accommodation targets and statics from during the move and into the new year 2014.
- Activity within A&E including attendances, emergency admission in A&E and the Emergency Assessment. The percentage of patients receiving first assessment on the Emergency Assessment within 2 hours of admission and percentage receiving Consultant review within 14 hours of admission.
- Occupancy of Critical Care and the Holdforth Unit.
- Transport utilisation by patients and visitors.

The Trust noted that overall the indicators showed that the reconfiguration had been smoothly implemented.

It was noted that the learning for the Holdforth rehabilitation unit would be used in discussions around the Better Care Fund.

Members queried the process for identifying ‘low risk’ patients suitable for elective care at the Hartlepool site. This continued to be closely monitored. It was noted that there had been a higher level of patients assessed as ‘high risk’ than anticipated.

Members noted that c. 30% of staff did not feel as though they were supported by their manager during times of change during the staff survey carried out at the end of 2013. Trust representatives noted that its Organisational Development department had been involved from an early stage and had ensured that staff were able to speak with someone other than their manager in private. The ‘6 Cs’ Team had undertaken work in particular teams to reinforce the compassion in care messages.

Two voluntary redundancies had arisen from the implementation of the proposals.
The Committee received information regarding the closure of nursery's at North Tees and Hartlepool NHS Foundation Trust(NTHFT). The main information provided included:-
- The service provided by NTHFT had been reviewed. The viability of the service and the effectiveness and efficiency was looked at, in the context of needing to prioritise health services.

- Discussions had taken place with a private nursery to see what could be done to make it viable. The issues with the nursery was it was running at a 56%-58% occupancy, and staff rates of pay were set nationally under Agenda for Change.

-To make it viable fees would have to be put up by around 30%. The Trust felt that as salaries had not increased for a number of years this was not an option. Half of the children at the nurseries had parents working at the Trust,

-In 2011-12 there had been a loss of £165k, and this had increased up until 2013-14. A loss of £226k was projected for 2014-15. Advertising for additional take up of places had not been successful.

The Committee queried the process of consultation and whether it was meaningful. The Trust responded that it was not providing options about whether it should close the nurseries, but was consulting on the process and possible redeployment options.

Members queried whether it was possible to amend staffing levels to match occupancy levels. The Trust outlined that they need to meet Ofsted standards and they did use their thirty five WTE staff in a flexible manner to match demand. Extra capacity was achieved through agency staff when needed.

- The Trust was working with staff to help with childcare.
The Committee noted its work programme. It was noted that the meeting of 14 October would be moved due to potential industrial action.
The Chair had nothing to update.

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