Adult Services and Health Select Committee Minutes

Tuesday, 16th February, 2016
Jim Cooke Conference Suite, Stockton Central Library
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Cllr Michael Clark(In the Chair), Cllr Derrick Brown(Vice Cllr Mohammed Javed), Cllr Sonia Bailey, Cllr Carol Clark(Vice Cllr Evaline Cunningham), Cllr Kevin Faulks, Cllr Lynn Hall, Cllr Stefan Houghton, Cllr Sylvia Walmsley(Vice Cllr Mick Moore), Cllr Tracey Stott
Sarah Allen, Liz Hanley, Peter Kelly, Ruby Poppleton, Billy Park, Lynn Wightman(DAH), Jill Douglas, Ian Tranter(DHR,L&C), Roland Todd(DEGD), Peter Mennear and Kirsty Wannop(DCE).
In Attendance:
Sue Harris, Cath Robson(DWP), Karen Hawkins(CCG), Debbie Blackwood, Julie Gillon, David Emerton, Jean MacLeod, Lynn Kirby, Jane Barker, Ann Burrell(NTHFT), Cllr Beall (Cabinet Member for Adults and Health)
Apologies for absence:
Cllr Mohammed Javed, Cllr Evaline Cunningham and Cllr Mick Moore.
Item Description Decision
The minutes of the meeting held on 14th September 2015 were signed by the Chair as a correct record.
AGREED that the minutes be approved.
AGREED that the report be noted.
AGREED that the information be noted.
AGREED that;
a) the information be noted
b) the feasibility and purpose of a joint Scrutiny Committee be investigated
c) information on the usage of other Assisted Reproduction Units by Stockton patients be provided.
AGREED that:
a) the report be noted.
b) Consideration would be given to receiving a future update on the Service Transformation Strategy, including services for older people.
AGREED that the information be noted.
AGREED the information be noted.
The Minutes of the Health and Wellbeing Board held on 17th December 2015 were noted.


Cllr Kevin Faulks declared a personal non prejudicial interest in the item titled Review of Access to Services for People with Learning Disabilities and/or Autism as he was a volunteer at Daisy Chain.

Cllr Sonia Bailey declared a personal non prejudicial interest as she was a Peer Supporter at North Tees and Hartlepool NHS Foundation Trust
Consideration was given to the minutes of the meeting held on 15th December 2015 and 12th January 2016.
Members considered a report that provided the Committee with an update on NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group(CCG) development of an Integrated Urgent Care Service (IUCS)and an outline of next steps.
The Committee were provided with information relating to employment and welfare for those with learning disabilities(LD) and/or autism.

Members received a presentation from Durham Tees Valley Job Centre Plus Employer and Partnerships Teams. The main information provided included:-
- The jobcentre plus support that was in place to assist those with LD and autism included a Disability Employment Adviser(DEA), development of disability awareness with JCP Work Coaches, specifically regarding hidden impairments, DWP work psychologist provided training to Work Coaches, and a District Provision Took to identify whether support from other organisations in the local area would be beneficial.

- There was only one DEA in the Stockton area and these would work with those needing the most help. Work Coaches would work with those with less needs.

- Details of the options available to help claimants into work were detailed including:

Specialist Employment Support - this replaces the previous residential provision for those most in need, and providers include Shaw Trust, Remploy, and Kennedy Scott.

Work Choice - this was a four stage specialist programme to help people for period up to two years for those close to entering the job market, and provided through Remploy and Shaw Trust with other sub contractors including Action for the Blind

Access to Work - this enabled support such as adjustments to workplace or travel support for those about to start work or a trial.

Work Programme - Vulnerable clients taking part in the Work Programme would be identified by the Work Coach or DEA. The local providers Ingeus and People Plus should tailor individual support.

Work Trials, and Traineeships

- Each Jobcentre had a dedicated team who work with employers and provided to source opportunities for local people. The Employer Services and Opportunity Manager’s role included promoting the role of disabled people in the workplace, and World of Work project was aimed at raising knowledge or work amongst disabled clients. Employers were encouraged to hold interviews on JCP premises if that would assist.
- Details of the Disability Confident scheme that the Government had promoted to help halve the employment gap between disabled people and non-disabled people. There was due to be a Stockton launch within the next month.
- In relation to DWP-related benefits, there was a DWP Visits Team to visit the most vulnerable clients.

Members were then given opportunity to ask questions/make comments:-
- Do the workers get paid for the jobs they do? Yes they get paid a wage.
- The written claimant commitment that staff get people to sign, not all with LD and Autism would fully understand the commitment, also if they don't adhere to the commitment what would happen? When signing the claimant commitment it would be encouraged that their social worker or support worker have sight. The consequences of not adhering to the commitment would depend what benefits they were on. If the claimant didn't feel from the beginning they could adhere to the commitment it would be revised until a compromise could be agreed.
Social Justice Co-ordinators were in place in each office as a point of contact.
- How many people with LD and or Autism was the DEA working with? Approximately 20 people.

The Committee then received information from Lynn Wightman STEPs manager. The main information provided included:-
- All those that used the service had an assessed need through a Social Worker.
- STEPs staff ran its own work preparation service that included literacy and numeracy refreshers, assessing whether clients could turn up on time and dress appropriately.
- Once clients decided the job they wanted to do a Job Coach from the STEPs team would learn the job themselves to help the client.
- STEPs were supported by SBC in job carving making elements of job roles into smaller tasks so that clients were able to undertake aspects of the role that matched their abilities, often on a part time basis.
- STEPs also worked with a local special needs school to provide a service around work experience that had went down well with parents and carers.
- STEPS did not have a list of employers they only worked with, as there was an individual approach taken in each case
- There were twenty people in the Team that worked across all disabilities.

Members were then given opportunity to ask questions/make comments:-
- There had been some Members visits to STEPs and the work they were doing was brilliant and really worthwhile for what it does for the clients.
- Fifty-five people with learning disabilities were currently supported to be in work.

Members then received information from SBC's HR regarding its work for those with LD and or Autism. The main information provided included:-
- SBC worked in partnership with STEPs to offer opportunities for supported employment.
- there were 23 people employed in the supported employment roles covering a number of different work areas, 8 were undertaken by females and 15 undertaken by males, with an age range from 20 to 55.
- In wider recruitment the Council retained the two ticks accreditation symbol which guaranteed an interview for a disabled applicant who met the minimum criteria for a post advertised. The Council also had an active Disability Forum that met 4 times a year to raise awareness about disabilities within the workplace.
- Equality and diversity training was available to all employees and was a compulsory module of the corporate e-induction.
- 202 employees declared themselves as having a disability that equated to 6% of the workforce. There had been a rise in those that don't wish to declare if they had a disability, 263(8%) people did this. This was something that HR were mindful to keep an eye on in case staff felt unable to declare.

Members were then given opportunity to ask questions and make comments:-
- What was the retention rate for the supported employment? For individuals it was 70%, the jobs themselves were kept open should other clients become available to take them.

The Committee then received information from the Principal Employability Officer. The main information provided included:-
- The Principal Employability Officer was a strategic role.
- Public Health funding had helped 170 young people aged 16-24 across a range of client groups into apprenticeships.
- the 5 LA's across the Tees Valley had bid for European Social Fund funding of £17.5 million to help those aged 15-29 that were NEET and had barriers to employability through the Youth Employment Initiative. It was likely that delivery would start in April 2016.
- A consortium of Ground Work Trust and Disc with a number of VCSE organisations had been successful with their stage 1 application with gaining Lottery funding from the Building Better Opportunities fund, specifically targeting vulnerable groups aged 16+. They were required to submit a Stage 2 application by May and if successful delivery would commence in October 2016. £9m was available across Tees Valley.
- There would be other pots of European money that would become available over the next 12 months and would be commissioned by Tees Valley Unlimited(TVU). This included Skills Support for the Unemployed, Skills Support for Redundancy and Wheels to Work.

Members were then given opportunity to ask questions/make comments:-
- Of the 170 apprenticeships what areas did they cover? There was a wide range of apprenticeships from bricklaying to beauticians.
- Early funding for the STEPS Job Carving scheme had come from the previous Working Neighbourhoods Scheme.

Members then received information from the Welfare Rights Manager from SBC:-
- The Welfare Rights team provided advice to the Adults’ Client Property and Financial Affairs team behalf as DWP appointee or Court of Protection deputy where a person lacked capacity to manage their financial affairs.
-. The CP and FA team acts as DWP appointee for almost 400 clients, the majority have a learning disability.
The majority of these clients need to be assessed for employment support allowance and personal independence payment. The team complete the forms, manage reconsiderations and attended any appeals. The possible outcomes were no change and benefits stay the same, probable outcome would be an assessment at Christine House, the Welfare rights Officer would organise the necessary information for the assessment. If an appeal was needed they would support clients with that. In the last 2 weeks there had been 15 reassessments for ESA/PIP. This can cause a lot of distress to the clients and family especially if any benefits were stopped for a period of time. Other impacts included reduced funding for care, need for crisis support, and the involvement of officers across several services.
- Working with Horizons school to do a benefits check to make sure that families were claiming all they were entitled to, this process would be done at 5years of age, 7 years of age and again at 16, at 16 they claimants would be able to claim employment support allowance in their own right to see if they would be better on claiming this way.
- Welfare Rights had a free advice line to anybody within the Borough.

Members were then given opportunity to ask questions/make comments:-
- When benefits were reinstated would it be back dated? Yes it would be
- How many people from this client group in the past year would have to appeal decisions? approximately 10.
- Members questioned issues with DWP and how they dealt with those with LD when the local authority were appointed to act on their behalf. Communication issues had been identified in some cases.
- DWP representatives noted that they could look into cases regarding PIP, but ESA claims were assessed separately from staff at the Job Centre.

The Committee thanked all that attended and the information provided.
The Committee considered information regarding North Tees and Hartlepool NHS Foundation Trust who provided an Assisted Reproduction Unit at the University Hospital of Hartlepool site. The Trust was proposing that it ‘will not provide licensed fertility treatments after 31st March 2016, however non licensed fertility treatments would continue to be provided’. It was explained the clinical risk and impact on safety and welfare of patients due to inability to recruit and retain embryologists.

The Trust were in attendance at the meeting in order to discuss the reasons behind the decision.

The main information provided included:-
- The ARU undertook an average of 250 cycles of licensed fertility treatments per year. Due to the nature of the licensed treatments some patients have more than one cycle of treatment.
- The Hartlepool and Stockton on Tees Clinical Commissioning Group (CCG) commissioned both unlicensed and licensed fertility treatments from the Trust as part of an annual contract.
- Due to the small number of staff working in the unit and specifically the number of embryologists, the unit had been the subject of continuous review to ensure a clinically safe, sustainable and financially viable service could be provided.
- The unit was subject to HFEA regulation and to a continuous monitoring of licensed fertility practice involving a four year inspection cycle and oversight of any service changes or challenges which could impact upon the Code of Practice.
- The CCG had been fully informed in the dialogue surrounding the risks to clinical sustainability and the options and decision making around short term risk mitigation and the future management of this service, including the reasons why the service needed to be varied.
- There were nine budgeted members of staff working in the ARU; a combination of skill mix to enable the delivery of appropriate treatments and care to patients. This included the budget for 2 whole time equivalent embryologists; it also included registered nurses, health care assistants and clerical staff. In addition there were a small number of sessions per week provided by Consultant medical staff.
- Details of local data was provided to give Members context of the size and operation of the unit.
- It was proposed that the trust would no longer provide licensed fertility treatments after the 31st March 2016. The Trust was working with other service providers to look at a way in which services may be provided in the future to ensure patients continue to receive the appropriate treatment.

There was a potential for a solution in partnership with other Trusts or private providers including the development of a ‘mother and satellite’ service. More recent discussions had been more positive than previously, and this could address some of the identified issues.

Members were then given opportunity to ask questions/make comments:-

- Was it known how many from Stockton Borough chose have treatment elsewhere? This was not known but could be found out and reported back.

- Of those receiving fertility treatment what was the split between licensed and unlicensed? 75% of patients received unlicensed treatment.

- It was stated that embryologists were predominantly from a laboratory background, and frequently sought new posts to develop their careers. Part time working had been an option but only one person had applied for that opportunity. Recruitment issues were common in the other North East units. Changes to the training regime may help in the future.

- Members queried whether the decision was premature, particularly in light of upcoming training changes. It was stated that a small service was not attractive to clinicians in terms of supervision and research opportunities for example.
The Trust stated that there preference was to partner with another provider to access their staff cohort and retain licensed treatments. They needed to avoid the potential for deterioration in patient outcomes.

-The CCG representative noted that they took the clinical safety issues seriously and would work to secure collaboration with another provider if that was possible.

- Members queried whether a resumption of the service was realistic.
The Trust outlined that there has been positive discussion on a number of models with Gateshead Foundation Trust, talks with South Tees Trust were continuing, and talks with a private provider had begun.

- Members noted the increasing requirements for people to travel to access types of care. Trust representatives stated that there was a strategy to develop clinical services but with provision in the community as much as possible, and this was where the majority of contacts took place.

- The CCG would be attempting to access an independent view from the Clinical Senate to assist with discussions, due to the number of concerns that had been raised about the proposal, particularly at Hartlepool Council.

The Cabinet Member noted that it would be preferable to develop a future model with South Tees Trust if possible as it was closer than Gateshead. South Tees Trust was also used by many in Stockton for a number of service already.

The Chair requested that the possibility of a joint Scrutiny Committee with Durham and Hartlepool be investigated, in order to examine the issues further.
Members considered a report that that provided information regarding North Tees and Hartlepool NHS Foundation Trust inspection by the Care Quality Commission (CQC) in 2015 and the inspection report had been published. The Trust were in attendance the meeting and outlined the results of the inspection and actions taken. The overall rating for the Trust was 'Require Improvement', each domain in the organisation was given a rating. The following overall rating were applied to the trust:-
- Good - Safe, Caring and Responsive.
- Requires Improvement - Effective and Well Led.

It was explained that where 2 or more domain were rated as required improvement the overall rating was deemed to be required improvements. an action plan was being pulled together to address the issues raised by CQC and would be shared with the Committee.

-Members highlighted that it was raised the issues around recruiting staff. The Trust confirmed that this had been an issue but recruitment had taken place with nurses from Romania and Philippines, and additional care support workers.

Immigration rule changes had impacted on the Trust plans for recruitment. Nurses now had a temporary exemption. The staff attrition rate was 10% so the Trust planned to recruit over and above the staff establishment to plan for this.

The Committee along with the lead Cabinet Members raised concerns regarding the recruitment of nurses from the UK. The Health and Wellbeing Board had requested Health Education North East (HENE) to attend a meeting to discuss the issue. Annual projections were provided to HENE to inform commissioned training places. The Trust noted that there were twenty thousand registered nurses in the north east who were not actively looking for work, for various reasons, mainly aged 45 and over.

There was a need for nurse leadership positions but not all nurses wanted to go down that route. The Trust did have a better nursing vacancy rate than neighbouring Trusts. The Trust explained that nursing had changed and the patients coming through the doors were now increasingly older people with a range of health needs.

The Trust was developing its services in order to better cater for the cohort of older people with specific needs.

- An extra three senior staff had been recruited for A and E.

- The specific issue relating to cleanliness had been addressed, and matron-led spot checks were taking place.

- The Trust was in the process of amending its Risk Assurance framework but this has not been completed by the time of the inspection. The CQC had used the work developed since as an exemplar.

The implementation of clinical guidance was being driven by assigning clinicians to each issue as they were published.

- Members queried how staffing levels were set. There were red rules outlining a minimum of two registered nurses on a ward, and further staffing would be determined by patient acuity.

- Bank staff were accessed using NHSProfessionals, and so very often they would be NHS staff that worked for other Trusts. NHSP had robust enrolment procedures. Additional checks were made if staff were recruited via agencies. Members noted the benefits of growing and retaining the Trust’s own staff.

- The Chair noted that the buildings were clean and functional but not suited to modern clinical care. The Trust representatives agreed, and noted that due to lack of new hospital, £25m of funding had been secured to undertake necessary electrical works, and that further funding was being sought to upgrade clinical areas within the constraints of existing buildings. A and E was in particular need.

- A query was raised about breast feeding support. The Trust noted that its services such as maternity assistants needed to work with support groups.

The Chair noted the positive messages in the report and hoped that these would be passed on to all staff, and noted that improvements would be made to address the issues raised by the report.
The Committee considered an update on the work of the Tees Valley and Regional Health Scrutiny Committee.

Tees Valley Joint Health Scrutiny

Redcar and Cleveland Council Chair and support the Joint Committee during 2015-16.

At the meeting on 21st January the Committee covered a Number of issues:
- South Tees NHS Foundation Trust CQC Inspection Report
- Child and Adolescent Mental Health - Transformation Plans
- South Tees Urgent Care Consultation
- Better Health Programme
- Tees, Esk and Wear Valleys NHS Foundation Trust Quality Account Update
- North East Ambulance Services Monitoring Report

Papers for the above had been circulated and were available on request.

A local update on the Better Health programme would be provided to the Committee in March.

North East Regional Health Scrutiny

Hartlepool BC was currently supporting the Committee until October. The Committee met on 6th January to discuss Transforming Care for People with Learning Disabilities, and specifically the North East Fast Track project. The Joint Committee agreed to monitor the Fast Track project on an ongoing basis.

A briefing had been provided separately to the Committee as part of the review of access to services for people with Learning Disabilities and / or Autism.
The Committee noted Members feedback from Site Visits. Future site visits were highlighted.
The Committee noted its Work Programme.
The Chair had nothing to update.

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