Adult Services and Health Select Committee Minutes

Tuesday, 16th June, 2015
First Floor Committee Room, Town Hall, TS18 1AU
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Cllr Mohammed Javed(Chairman), Cllr Michael Clark(Vice-Chairman), Cllr Carol Clark (vice Sonia Bailey), Cllr Evaline Cunningham, Cllr Lynn Hall, Cllr Stefan Houghton, Cllr Mick Moore, Cllr Tracey Stott
Peter Kelly (Director of Public Health), Liz Hanley (Adult Services Lead), Peter Mennear (Scrutiny), Daniel Childs (DSU)
In Attendance:
Karen Hawkins, Gil Carton (Hartlepool and Stockton CCG), Jenny Long (NHS England)
Apologies for absence:
Cllr Kevin Faulks, Cllr Sonia Bailey, Deborah Miller
Item Description Decision
The evacuation procedure was noted.
AGREED that the information be noted and further updates be provided in due course.
AGREED that the Action Plans be approved.
1.the Review of Access to GP, Urgent and Emergency Care be noted and the assessments for progress be confirmed.
2. The Chair should write to NHS England / CCG in order to raise its ongoing concerns in relation to GP registration
3. Healthwatch be requested to provide information relating to their marketing activity in GP Practices, and what support is provided to residents who have issues registering with GP Practices.
AGREED that the report be noted.
AGREED that the report be noted.
Consideration was given to the Work Programme and it was noted that the following reviews had been agreed for the Committee during 2015-16:

- Review of Barriers to Access to Services for people with learning disabilities (including take up of Annual Health Checks)

- Review of Mental Health and Wellbeing


There were no declarations of interest.
Hartlepool and Stockton-On-Tees Clinical Commissioning (CCG) provided Members with an update and outline of the next steps of the Urgent Care Review

CCG Officers presented an overview of the Urgent Care Review, as had previously been presented to the Adult Services and Health Select Committee meeting of Tuesday, 10th March, 2015. The overview included the following elements:-
- The rationale behind changes to Urgent Care
- The contractual context: the APMS Walk in Centre contracts were due to expire by the end of March 2016, providing the CCG with the opportunity to review existing services, which would be procured and operational by April 2016.

Members heard that the CCG had undertaken a number of engagement exercises:-

- A market engagement exercise with potential providers had commenced on 8th May, 2015. The purpose of the market engagement was to identify any barriers and constraints to future service delivery, and also to determine the capability and capacity of the market to respond to the procurement that would be undertaken.

- Engagement with patients and members of the public had also been undertaken. Street surveys took place throughout the Borough and, upon completion on Friday 29th May, were couriered to an independent company for analysis. The results were not available at present.

- The CCG communications team was also undertaking an exercise to recruit patient representatives to assist in the development of the service model and evaluation of potential providers. Members were informed that Healthwatch would act to represent patient feedback.

Members were informed that reporting of Urgent Care developments would be based on a "You said, we did" theme, based on the results of the engagement exercises.

Following the presentation of the update review, a discussion took place. The discussion could be summarised as below:-

- Members queried the omission of North Tees and Hartlepool Foundation Trust (NTHFT) from the Urgent Care Review update. CCG representatives stated that NTHFT was broadly aware of the Urgent Care strategy but was not informed of specifics, as it was expected that NTHFT would be bidding to provide Urgent Care services, and the CCG could not share information that was unavailable to other bidders. At the time of the meeting, NTHFT only provided the local minor minor injury element. From April 2016, GP led Health Centres, Minor Injuries, and Out of Hours care would be unified as part of the Urgent Care restructuring.

- Members asked whether the premises of the Urgent Care service had been finalised. CCG representatives stated that the CCG was still discussing premises solutions. Members asked whether North Tees and Hartlepool Foundation Trust could refuse to house Urgent Care services on-site. CCG staff stated that NTHFT could refuse tenancy.

- Members asked whether Urgent Care staff would be employed by the CCG or by the provider. Members asked what would happen to staff if they were employed by the provider and the provider were to change. CCG representatives stated that such staff would be employed by the provider and that in the case of a change of provider, staff would be offered positions with the replacement provider and TUPE would apply.

- Members asked how patients would know where to receive appropriate treatment. CCG staff stated that at present there were three Urgent Care options, which led to confusion among patients. Under the new, integrated approach, it was envisaged that patients would see the appropriate professional in the first instance.

- Members enquired as to whether front-of-house staff would be medical professionals. CCG staff stated that patients would first see a clerk to ‘book themselves in’ before seeing a healthcare professional and being triaged. Members asked if the centre would have a range of clinical staff, including GPs, nurses and paediatricians. It was stated that this would be the case.
Members were presented with the Action Plan setting out how the agreed recommendations from the Home Care, and Licensing and Public Health would be implemented and target dates for completion.

Members considered the Review of Home Care. Officers stated that the current contracts due to expire in October 2015 were in process of being extended until 2016 and that contracts were to go to tender in October 2016 and the Council intended to commission a quality service. Following presentation by Officers, a discussion took place, it could be summarised as follows:-

- Members asked for further information on the implications of Action 8. A. Officers stated that the Council would work and engage with the voluntary, community and social enterprise sector, to enable volunteers to provide appropriate support. This would include reading, ensuring that heating programmed/functioning correctly, and providing organisational support. Where appropriate, it could include shopping.

- Members noted that high numbers of zero-hour contracts among Home Care staff and asked how the Council may be able to reduce the number of staff on such contracts. Officers stated that the Council could use contractual means to ensure that good HR practice was followed. It was considered that the amount of activity should enable providers to ensure staff were guaranteed a minimum number of contracted hours.

- Members raised questions around travel distance and time between properties those properties where they had appointments. Officers stated that the Council had to balance having a geographical patch-based contract, with the need for service users to have a choice in their homecare arrangements.

Members considered the Review of Licensing and Public Health. Officers noted that the Action Plan was sparsely populated. Members heard that this was due to staffing issues, and future reports would be much more detailed. Officers elaborated on the review, the additional information can be summarised as follows:-

- Action 2:
Referring to a potential health-impact assessment of alcohol in the local area, Officers noted that authorities in Middlesbrough track hospital admissions by address and are able to cross reference this data with the nature and location of alcohol dispensing businesses in the area. Data can show a direct link between geographical areas and alcohol related hospital admissions. Such data is used to inform licensing decisions. Officers in Stockton-On-Tees Borough Council (SBC) are investigating the possibility of adopting this approach in the Borough.

- Actions 3 and 7 were delayed significantly by the election which took place in May 2015.

- Action 6: Officers suggested that a more detailed overview of SBC Training Standards Department's monitoring of the position of the price of local alcohol sales and appropriate action that could be taken when alcohol was sold for less than the cost of duty plus VAT.

Following the presentation of the reviews, a discussion took place. The discussion could be summarised as follows:-

- Members queried how long it would take to realise any potential plans to gather/utilise information regarding alcohol/health impacts and licensing zones. Officers stated that the system would take some time to become operational, but once implemented the information could be accessible almost immediately, depending on ICT systems and other considerations. Licensing would be able to access and reflect on data when considering applications and re-applications. The timing of any action would be dependent on the timing of licensing applications.

- Members asked about options for the licensing of Hot Food Takeaways. Officers stated that existing Hot Food Takeaways could not be closed. In addition, it was stated that licensing had little power to refuse applications. The Council could in future develop Cumulative Impact Zones in which desirable numbers of off-licenses and Hot Food Takeaways could be defined and enforced within specific areas. Members asked if Officers would propose Cumulative Impact Zones within the Borough. Officers stated that this was being considered, but it was yet to be decided if they were appropriate for the area.
Consideration was given to the most recent assessments of progress on the implementation of recommendations from the Scrutiny Review of Access to GP, Urgent and Emergency Care.

Officers presented the Progress Report. Subsequently, there was a discussion which could be summarised as follows:-

- Members queried the process for employing numbers of clinical staff for Out of Hours services. CCG representatives stated that a number of the staff were employed directly by the service provider, while other staff were drawn from a pool of local clinical staff.

- Members noted concern that, although no GP patient lists were officially closed, it had again been reported that patients were being refused registration at GP surgeries. The NHS England representative stated that to date there are currently no practices in Stockton with and approved closed lists and added that the NHS England would work with patients to resolve any issues. Where patients raised an issue with a particular surgery, NHS England would contact the surgery directly to resolve the matter. Members asked what members of the public ought to do should they be told that they were unable to register with a surgery. The NHS representative stated that information should be available via practice leaflets, which ought to be available online and on-site, if requested. Members asked who checked whether such information was available in practices and heard that such information was submitted by the practices themselves, NHS England advised that practice leaflets are assessed as part of a contractual annual declaration submitted by practices. Members stated that they had heard complaints from residents who had not been able to register practices which did not officially have closed lists. It was speculated that this may be because GPs have a full workload and are not able to take on any more patients even though the list remains open. Members were concerned as to how members of the public would be aware of their rights and the help available to them.

- Action 6: CCG representatives stated that the CCG was working with NHS England and Public Health to better utilise pharmacies.

- Members and Officers raised concerns relating to the commissioning of GP services in Tithebarn, and how this linked to the Urgent Care proposals. CCG representatives stated that the CCG and NHS England were jointly responsible for commissioning arrangements, and decisions had not yet been made. This would be discussed by the CCG and NHS England Joint Co-commissioning Board and this also had Council representation.

Officers stated that concerns surrounding the changes were linked to a relatively high population with low levels of healthcare provision couple with a large catchment area for alternative practises. Members worried that patients would be distant from GP practices, which could result in increased use of and pressure on A&E services.

- Noting that the number of paramedics available to the Ambulance Service in the Borough was lower than full strength, Members sought further information relating to training and the number of paramedics in service. Officers said such information has been circulated to the Tees Valley Committee and would be circulated.

- Referring to Action 13, Members and Officers noted that they had been informed that partnership working between Cleveland Police and the North East Ambulance Service had improved.
Members were provided with an update on the Teeswide Adult Safeguarding Board and its Plan 2015-16.

Officers highlighted details of the Board's new structure and that responsibility for funding the Board and its plans was shared between statutory agencies. Officers informed Members that, although the Board had previously published Teeswide plan, the Plan 2015-16 was the Board's first statutory plan under the Care Act 2014.
Members considered a report highlighting recent inspection reports relating to local health and care services. Following the report, a discussion took place. It could be summarised as follows:-

- Members expressed a desire to meet with representatives of the Care Quality Commission and Healthwatch be encouraged to attend meetings of the Committee.

Chair welcomed new Members and discussed the scrutiny role of the Committee, and also highlighted the Council's responsibilities as a provider and commissioner of care.

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