Stockton-on-Tees Borough Council

Big plans, bright future

Adult Services and Health Select Committee Minutes

Date:
Tuesday, 13th September, 2016
Time:
16.00
Place:
Jim Cooke Conference Suite, Stockton Central Library
 
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Present:
Cllr Mohammed Javed(Chairman), Cllr Lisa Grainge(Vice-Chairman), Cllr Sonia Bailey, Cllr Evaline Cunningham, Cllr Kevin Faulks, Cllr Lynn Hall, Cllr Stefan Houghton, Cllr Allan Mitchell, Cllr Mrs Sylvia Walmsley
Officers:
Peter Mennear (Scrutiny Officer), Gayle Nertney (Governance Officer), Natalie Shaw, George Irving, Carol Malham, Ruby Poppleton,
In Attendance:
Joanne Heaney, Donna Owens, Karen Hawkins, Sue Greaves, Barbara Potter (CCG), Stuart Harper-Reynolds, Lindsey Robertson (NHS Trust)
Item Description Decision
Public
ASH
24/16
EVACUATION PROCEDURE
 
ASH
25/16
DECLARATIONS OF INTEREST
 
ASH
26/16
DRAFT MINUTES - 29TH MARCH 2016, 12TH APRIL 2016, 14TH JUNE 2016 AND 12TH JULY 2016
AGREED that the minutes be approved
ASH
27/16
REVIEW OF STOCKTON HEALTH CENTRE (TITHEBARN) REGISTERED PATIENT SERVICE
AGREED that:

1. the Committee supports the retention of GP services at Tithebarn through a Branch Surgery arrangement;

2. agree that the Committee's draft response be circulated to the Committee with agreement final submission delegated to the Chair and Vice-Chair;

3. agree to receive a further update following the CCG's final decision.
ASH
28/16
ASSISTED REPRODUCTION UNIT UPDATE
AGREED: that the update and next steps be noted.
ASH
29/16
COMMISSIONING OF INTEGRATED URGENT CARE SERVICE
AGREED that:

1. the report be noted.
2. further updates be received as the procurement process develops.
ASH
30/16
MONITORING THE IMPACT OF PREVIOUSLY AGREED RECOMMENDATIONS
AGREED: that the Action Plan be agreed.
ASH
31/16
ADULT CARE QUALITY STANDARDS FRAMEWORK (QSF)
AGREED that the update be noted and the information requested be provided.
ASH
32/16
SCRUTINY REVIEW OF DEPRIVATION OF LIBERTY SAFEGUARDS (DOLS)
 
ASH
33/16
BETTER HEALTH PROGRAMME
 
ASH
34/16
REGIONAL HEALTH SCRUTINY UPDATE
 
ASH
35/16
WORK PROGRAMME 2016-17
 
ASH
36/16
CHAIR'S UPDATE
 
16:00 - 18:00

Preamble

ItemPreamble
ASH
24/16
The evacuation procedure was noted.
ASH
25/16
There were no declarations of interest made.
ASH
26/16
Consideration was given to the minutes of the meetings held on 29th March 2016, 12th April 2016, 14th June 2016 and 12th July 2016.

Members requested that an amendment was made to the minutes from 12 April 2016, Item 4.

The minutes stated that members raised their disappointment with the trust for not sending staff to the meeting. Members requested that this be amended to highlight their frustration at not being able to carry out a full discussion at the meeting.

Members queried whether they had received answers to questions from the trust, from the meeting on 12 April 2016. It was agreed these would be re-circulated.
ASH
27/16
A report was presented to the Committee discussing the future use of Stockton Health Centre (Tithebarn).

There were two services provided from this location; a Walk-in Centre Service, and a GP Practice.

The GP service had 2019 registered patients, and the same provider also provided walk-in services for unregistered patients.

The contract expires on 31 March 2017. The Clinical Commissioning Group (CCG) have reviewed the registered patient service and have engaged on the proposal of this practice being delivered as a branch.

The CCG outlined to the Committee following information provided at previous meetings that the walk-in centre would be commissioned to be integrated with the new urgent care model also to be covered on the following agenda item.

Members asked for clarification of the opening times, and it was confirmed that this provider would be required to deliver core hours of a GP service. The committee were advised practices currently commission the 6 - 6.30pm period from an alternative provider through a sub contract arrangement and the new provider may also enter into the same arrangement.

Members requested information on what feedback had been received from patients on the reduction of the opening hours, and were advised that the report had been written using information from the engagement activity & the questionnaire , however patients that were present at the engagement event were happy that the service was returning to a traditional GP service, as they had experienced prior to the introduction of the walk-in service.

Members enquired as to what interest had been made in relation to the tender and were advised that it had not yet gone out to the market.

Members queried the patient information sheet, where it stated that patients may experience a change to where they attend at the times that they could see a Doctor or nurse. It was explained that patients would have a choice of where they attended if another Practice took on Tithebarn as a branch, e.g. in central Stockton should this be more beneficial to them, but that the service would still be available at Tithebarn.

Members asked how the registered number of patients compared to another practice, such as Queens Park. It was explained that an average number of registered patients was around 10,000 per practice, but many exceeded that within the borough, with Queens Park being approximately 12,000.

Members asked about feedback from Healthwatch, but were advised that this information was not available and reports were currently being compiled.

Members enquired as to how hopeful the CCG were to find a provider, and what would happen should a provider not be found. It was explained that as it was being offered as a branch practice, then they were quite confident that provider would be found. Should a provider not be found, then the CCG would need to look at alternative options which was not a route that they would like to take, as it could result in a dispersal or a managed transfer, in order that patients do have a registered GP.
ASH
28/16
The Committee received a report from the CCG updating members on the Assisted Reproduction Unit consultation.

The report detailed the background of the events preceding the Court Order, the consultation preparation, the options and engagement and the outcomes.

A further report was presented to the Committee detailing the feedback from the Consultation, as well as the Equality Impact Assessment.

Procurement is expected to go out in October, and are expecting to award contracts December 2016/January 2017.

Members queried what would happen if an alternative provider could not be found, and were advised that as part of the pre procurement process a prior information notice had been published and that it had already generated quite a lot of interest. Interested parties must however meet the tender requirements, and were assured that there was a very robust process in place.

Should a provider not be found, then the CCG would need to reconsider their options.

Members enquired how many patients used the service. On page 65 of the Public Consultation Report, was a table detailing the number of cycles carried out which totalled 279. Number of cycles was not the same as number of patients as some patients can be commissioned up to 3 cycles.

Members asked how many private patients used the service, however this information is not collected as the CCG have no responsibility for private patients.
ASH
29/16
The Committee received an update on the Commissioning of Integrated Urgent Care Service for the Stockton and Hartlepool area.

In was proposed that the integrated service would include an Urgent Care Centre co-located with Accident and Emergency at North Tees Hospital.

Members had previously been advised of delays to the process at the meeting on 16 February 2016, however the procurement process has resumed and the service is due to start in April 2017.

It was stated that there was a rich provider market for these types of services.
ASH
30/16
An Action Plan was presented to the Committee following the Review of Access to Services for People with Learning disability and/or autism.

Item 1-5 of the action plan relates to Health check/health care issues, Items 6 onwards relates to improving services within the council and their partners.

The plan highlights under each recommendation, the proposed actions, progress, success measures, responsibility and the completion dates that each recommendation should be achieved.

Members asked whether there was a standard system used when making referrals from primary to secondary care, and were advised that different practices used different computer systems. Some do an electronic referral and some do manual referrals and that there is not an overarching system used. Members were advised that practices were being encouraged to complete electronic referrals, and that a piece of work had started this year to promote this, as electronic referrals were a lot quicker. 90% of practices use the same system, but the CCG were unable to stipulate which system practices should use.

Members queried the virtual ward, and how this worked. It was explained that the Liaison Nurses could flag a patient with Learning Disability status on the virtual ward, and it can easily be identified where they were located within the hospital, and as they moved location within the hospital. The system would be managed by the Learning Disability nurses within the Trust, but was available to everybody working within the hospital.
ASH
31/16
The Committee received a report summarising the final report of Phase 3 of the Council's Quality Standards Framework (QSF) for Home Care Providers.

The scope of Phase 3 of the QSF covered 12 homecare services; three of which are spot contract providers, 3 extra care schemes which include Community outreach, three enhanced providers, one care ready provider, 2 large community based providers.

The report detailed the final scoring for each provider following Phase 3 QSF visits in May 2016.

Providers were informed of their QSF outcome on 7 July 2016, along with the Appeals documentation giving a 28 day appeal schedule, with a deadline of 4 August 2016.

Two providers appealed their scores and were considered by an independent panel on 9 August 2016.

The main themes of this round were similar to previous phases, for example issues with medication management. The Teeswide Adult Safeguarding Board had commissioned a survey on medicines management and the results of this would inform future QSF work.

Nationally the home care market remained volatile, and some major providers had handed back contracts.

Members expressed their concerns over Direct Health and asked for clarification on what was currently under embargo. It was explained that no further referrals were allowed to be made through that provider whilst working with Direct Health on their service improvement plan.

Members asked what was the maximum score that could be achieved on a QSF inspection. The scoring had recently been revised and this is to be confirmed through Scrutiny and the Chairman.

Members enquired what was the difference between the QSF scoring and the CQC scoring e.g. Comfort Call scored outstanding on QSF, but CQC reported that it required improvement.

It was explained that there were two different but complementary frameworks; one focused on care standards and one focussed on the commissioning specification. Members were advised that regular liaison meetings took place between QSF and CQC inspectors to discuss the scoring and the outcomes, and each other's approach to monitoring services.

Overall the scores needed to be seen in context rather than purely a league table approach.

Members queried what impact the extra support given to the providers had had on the service, and were advised that the Commissioning team had been reviewed, and had a team work on business development and performance (including the QSF), and a team dealing with quality and compliance. It would continually be monitored in order that standards and quality of service would be maintained. The team was however relatively small with a high workload.
ASH
32/16
The Committee received information from the CCG and the North Tees Trust, and how the Cheshire West Supreme Court Ruling had affected the Trust.

A lot of work had been done by the trust in relation to Capacity Assessments, and updating policies and processes following the ruling.

NTH Trust has worked with staff to raise awareness of understanding patient capacity, (including when it can appear to change due to a patient's fluctuating conditions, for example delirium in the early stages of dementia), and inclusion of DoLS status on handover records.

It was explained that the Trust had seen increasing numbers of DoLS applications. The new ruling had a significant impact on the number of applications now being made and during 2015/16 had been significantly higher with 688, comparing to 166 in 2014/15. This was a 414% increase which was in line with NHS organisations locally and nationally.

The paperwork was quality checked before being issued to the local authority, ensuring that all details were correct and that families had been informed. All details were recorded on their computer system, stating when the DoLS was applied and when it expired. This would be highlighted on the ward reports.

Three times a week, all 'live' DoLS authorisations were checked that the patient was still under the hospitals care, and the coroner notified of any deaths, and the local authority of any patients that had returned home.

DoLS were now included in the mandatory training, and staff were required to complete every 3 years.

Members asked whether there was any reason that the North East had a higher number of DoLS reported, and it was understood that the NE are reporting more, and are appropriate referrals and the majority granted. Some authorities had taken the decision not to process DoLS or limit the number of referrals.

The number of applications from North Tees Hospital previously made up approximately 11% of the total number of referrals however this has now doubled to 20-23%. People staying in a hospital setting are more likely to have a shorter stay than those in a care home, which meant that the authorisation period tends to be shorter, and if the person is not discharged within the estimated time frame, then a further standard authorisation would be needed.

The Committee were advised that the DoLS team are looking at carrying out some improvement work with the hospital around referrals. An initial review of improvement opportunities between NTH Trust and SBC suggested that processes are working well. The Trust felt they worked well with its Local Authorities. The Council had attended Trust Safeguarding Champion sessions.

Members enquired when applications came from North Tees are the people admitted to the ward then leaving to go to care homes. Applications came from managing authority and would be an urgent authorisation. Some delays can takes place with an assessor going out, & it is now general practise to request an extension & that should it be required, then this would avoid a further delay in waiting for an extension request. Where possible Best Interest Assessors and Mental Health Assessors work together & delay within the legal framework completing assessments as the person could be close to being discharged and as soon as an assessment is started it is classed as a ‘not granted‘, not a ‘not progressed'.

The Committee also received information from the CCG. CCG's were commissioners of NHS health services, and had responsibilities in relation to the MCA/DoLS applied by commissioned providers.

Since Cheshire West, there was a much wider definition of DoLS than previously, and this meant that the CCG have responsibility to ensure that continuing healthcare patients were not deprived of their liberty whilst in their own home or other settings.

The CCG were currently working with a Solicitors firm in Leeds to complete an implementation plan of how Court Orders would be applied in the future. The Committee were advised that each application to the Court of Protection would have a financial implication and there were currently approximately 50 people in Stockton nad Hartlepool who may need to have action taken. The CCG were liaising with other trusts to share what works; a visit was due to NHS Sheffield, who were piloting a scheme.

There were c.300 people receiving care in their own home commissioned by Stockton Council where a deprivation of liberty may apply. This was being progressed via the legal team and applications to the Court of Protection. Normally the Court would approve an interim order before looking at a case in more detail.

Members queried what would happen if somebody was at risk of harming others, for example driving a car when not capable and a risk, and if a family member prevented this from happening. It was advised that the Court Order would be issued with restrictions on their liberty, for example locking doors, hiding keys, not having access to certain rooms etc.
ASH
33/16
The Committee received an update on the Better Health Programme.

Consultation was planned to take place from November but this had been delayed to early 2017 due to national approvals being needed for key elements of the Programme.

Next meeting planned for October, papers to be circulated.
ASH
34/16
The Committee were advised that there had been no recent meetings.
ASH
35/16
The Committee noted its work programme.
ASH
36/16
The Chairman had nothing to update.

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