Meeting documents

Also present at the invitation of the Chairman

Mr Bernard Chalk (Programme Director for Health & Social Care Integration, Scarborough and North East Yorkshire Healthcare Trust) – for Item 4

Members are reminded of the need to consider whether they have a personal or prejudicial interest to declare in any of the items on this agenda.  If so, the nature of the interest must be declared at the start or as soon as the interest becomes apparent, of the meeting.  In addition, the attached form must be completed and passed to the Committee Administrator.  The Officers will be pleased to advise, if necessary, and any request for assistance should be made, in the first instance, to the Committee Administrator whose name appears at the end of this agenda.  Ideally, such advice should be sought before the day of the meeting so that time is available to consider any uncertainty that might arise.

No declarations of interest were received.

To approve as a correct record and sign the Minutes of the meeting held on 28 March 2012.  (Minutes attached).

RESOLVED that the minutes of the meeting held on 28 March 2012 be approved as a correct record and signed by the Chairman.

Public questions of which due notice has been given and which are relevant to the business of the Scrutiny Committee.

The Chairman reported that no public questions had been submitted.

To receive a presentation by the Director of Finance and Procurement, Scarborough and North East Yorkshire Healthcare Trust.

The Committee received a presentation by Bernard Chalk, Programme Director for Health and Social Care Integration at Scarborough and North East Yorkshire Healthcare Trust (SNEYHT) on the work of the Community Services Integration (CSI) Board.  Members were reminded of the challenges facing the local NHS highlighted by Professor Mascie-Taylor’s North Yorkshire Review: not only the scale of efficiency savings in the next five years but also the growth in elderly people requiring greater and greater support.   To meet these health needs on a steadily reducing budget, the traditional focus on secondary care was not sustainable.  By integrating health and social care services and focusing on delivering services in the community, patients would only stay in hospital for as long as they clinically needed to be there.  The aim was for patients to receive medical treatment in hospital, but then to return to independence as soon as they were well enough, either to an intermediate care facility or to home.  The longer elderly people remained in hospital, then the more dependent they became on secondary care.  Three key areas of work were being led by the Programme Director:

·        Development of integrated models of care to provide better, safer care for patients, promote self care and avoid unnecessary hospital admissions

·        Development of a strategic plan for each of the Community Hospitals by actively engaging with the new Clinical Commissioning Groups and Social Care colleagues in the development of their locality commissioning plans

·        Provide executive leadership input into the North Yorkshire Review.

Members were advised that with the winding down of Primary Care Trusts, Community Services for North Yorkshire and York PCT were put out to tender.  The contract for Scarborough, Whitby and Ryedale Community Services was awarded to York Teaching Hospital NHS Foundation Trust, commencing 1 April 2012 for three years.  From 1 July 2012, SNEYHT would become part of York Teaching Hospital NHS Foundation Trust.  The whole care pathway for Community Services would be commissioned by the Clinical Commissioning Groups (CCGs).  Through the CSI Board set up by SNEYHT, Mr Chalk was seeking to engage with a wide range of partners such as GPs, hospital consultants, voluntary sector, local authorities, mental health trusts, and of course, with patients, to obtain buy-in into this vision of ‘Right care, right place, first time joined up services’ and so develop new models of care.  The CSI programme was aiming for horizontal integration, that is, the integration of community and primary care with social care services.  Mr Chalk then outlined some of the CSI Board’s achievements so far.  A shared understanding had now been developed of the challenges faced by all organisations to deliver integrated health and social care.  He referred in particular to finance and ICT.  The national tariff and payment by results meant that hospital trusts were rewarded for the number of patients they treated.  Budgets were also ringfenced around health and social care.  In terms of information, more work needed to be done to understand exactly what Community Services  ...  view the full minutes text for item 4.

To receive a presentation by the Housing Manager.

The Committee received a presentation by the Housing Manager, Andrew Rowe on the Changing Lives Project – an innovative proposal for the joint commissioning of an intensive resettlement service for chaotic single homeless people in Scarborough.  Members were advised about the background to this project.  Although the Council in conjunction with its partners had achieved an overall reduction in homelessness through prevention schemes and housing options, in particular reducing homelessness significantly among young people, there remained a hard core of some150 local chaotic single people in Scarborough who were trapped in a cycle of failure: crime, prison, drug and alcohol addiction, tenancy failure, rough sleeping, poor health, exclusion and worklessness.  Welfare reform could well exacerbate the problem.  Homelessness support was one of a range of interventions which came into contact with this group – for example, drug and alcohol services at the Cambridge Centre, Castle Health Centre, hospital A&E, mental health services, Probation, Police – but there was no overall coordination of service provision for this group, no agreed local strategy of interventions, no local protocols between agencies in relation to street drinking or rough sleeping, and no single service that provided intensive management as well as intensive support.  The result was a relatively small number of people who constituted a huge drain on public resources, perpetuated a culture of anti-social behaviour and street drinking, and damaged the image of the Borough.  The proposal was to create a local ‘social investment pot’ to enable local joint commissioning of a new intensive resettlement service pilot aimed at breaking the cycle for these people.  Partners contributed either via funding or through enhancing their service provision to help meet agreed joint outcomes.  From the outset, each investor identified the key outcomes they wished to see from the project, for example, reduction in expenditure on temporary accommodation, and these outcomes shaped the overall service specification.  The new service was to be developed and commissioned as a two year pilot with the support of the Department for Communities and Local Government.  Mr Rowe then gave more detail about what the service could look like: single assessment process; local connection criteria; not a hostel but supported housing; an intensive management model with a ratio of one worker to around six chaotic people; tenancy training programme and link to employment and training opportunities.  Newburn House, a disused hostel on Alma Square, was a potential location for an intensive resettlement scheme.  Members then questioned Mr Rowe about his presentation.  Members welcomed the scheme, but were concerned at the extent of the challenge to change these people’s behaviours and the prospects of their finding employment given the bleak economic outlook.  Mr Rowe acknowledged that this intensive approach required a bespoke support and management package for each individual – both a carrot and a stick – which also retained some flexibility.  Support would not end abruptly after the two year period, but would be scaled back as the client progressed.  Asked about the rising number of  ...  view the full minutes text for item 5.

To consider a report by the Head of Tourism and Culture (Reference 12/282) attached.

The Committee considered a report by the Head of Tourism and Culture (Reference 12/282) which provided figures and information on attendances at the Council’s indoor leisure facilities in 2010/11 and 2011/12.  Members were reminded that this item had been referred to scrutiny because of concerns raised at Cabinet last October about the reduction in the number of attendances between July and September 2011 compared to the same period the year before.  The Chairman of the Scrutiny Committee agreed to wait until the end of 2011/12 before receiving a report so the figures for the whole year could be considered and compared with 2010/11.  The numbers demonstrated a 4.5% decrease for Scarborough Indoor Pool, a 8% decrease for Scarborough Sports Centre (SSC), but a 7% increase for Whitby Leisure Centre (WLC), compared to 2010/11.  A variety of factors were cited in the report.  The considerable investment in facilities in Whitby, the co-location of dry and wet facilities, and the lack of the competition in the town, were all likely explanations for Whitby Leisure Centre’s upward direction of travel, with the reverse true in Scarborough.  Whitby Leisure Centre had also built strong links with the NHS, with patients being referred to the facilities for rehabilitative exercise.  There was greater support by GPs for the GP referral scheme in Whitby than in Scarborough.  However, the Head of Tourism and Culture had recently arranged with the NHS for pulmonary rehabilitation to be offered at SSC instead of the local hospital.  Steps were also being taken to arrange GP visits to the Council’s leisure facilities in Scarborough.  The dilemma remained whether to invest in SSC when the new Leisure Village was now on the horizon.  That said, if state of the art fitness equipment were installed in SSC, then this could be transferred to the Leisure Village.  Indeed he was considering making an Invest to Save bid for a ‘Wellness’ System at SSC.  Members then discussed Mr Bennett’s report and asked questions.  In response, Mr Bennett felt it unlikely, given the state of the Council’s budgets, that the Council could offer a discount scheme for youngsters to replace the County Council ‘Me Too’ scheme; however, he acknowledged that the current Leisure Saver Scheme offering concession rates for disadvantaged residents was considerably undersubscribed.  This needed to be addressed, either through better targeting (the Council’s Community Information System segmentation tool could perhaps be used) or through offering greater discounts, or both.  Now that the Council had taken over the management of Pindar Leisure Centre, the management of this and SSC needed to be reconsidered.  The manager position at SSC had previously been deleted.  By contrast, WLC had benefited from strong dedicated management.  Secondary spend was not significant at the leisure facilities, but was higher when facilities were co-located on the same site.

RESOLVED that the report be received.

To consider a report by the Head of Legal and Support Services (Reference 12/223 attached)

The Committee considered a report by the Head of Legal and Support Services (Reference 12/223) to assist Members in planning the Committee’s work for 2012/13.  The Strategic Director, Hilary Jones updated Members in respect of the project to reduce the number of inappropriate A&E attendances at Scarborough Hospital.  At the March meeting, the Committee had requested that the results of the A&E data analysis and the emerging action plan be reported to this meeting.  Although the data analysis had just been completed, largely confirming the initial findings reported in March, the Action Plan was still in progress.  It was therefore proposed that a report come to the October meeting of the Committee.  In relation to the new health service framework and the Borough Council’s emerging role within it, Ms Jones proposed a detailed briefing session for Members of the Committee 11:30 – 12:30 on the date of the next meeting, 25 July.  Consideration to nominating a Task Group to undertake a review could then be given at the Committee meeting itself which would commence at 2pm.  The Overview and Scrutiny Manager, St John Harris then drew Members’ attention to various new items on the work programme which had been agreed with the Chair and Vice-Chair.  As referred to by Mr Chalk under Agenda Item 4, the stakeholder event around the future shape of health services in Whitby had been scheduled for 12 June, thereby entailing the deferral of the report on healthcare services in Whitby to the next Committee meeting on 25 July.  As requested by the Committee, Mr Harris had invited the Primary Care Trust to present a report which evaluated the impact of the new Castle Health Centre Polyclinic.  This matter had not been considered by the County Council Scrutiny of Health Committee.  The original request had been made for 25 July, but given the size of the agenda for that meeting, Mr Harris suggested that this report be scheduled for the October meeting.  Mr Harris also referred to the new Government initiative to tackle loneliness in old age which had been raised by the Vice-Chair, Councillor Evans.  A toolkit for tackling loneliness in old age was expected to be issued by the Department of Health shortly for use by Health and Wellbeing Boards.  A local response to this initiative had therefore been requested for the October meeting.  Lastly, Mr Harris had invited Seamus Breen, Assistant Director (Health Reform and Development) at the County Council to give a report on the new Shadow Health and Wellbeing Board to the Committee’s meeting on 24 October.  When presentations were given to the Committee, Members requested that they see the slides in advance to enable them better to prepare questions.

RESOLVED that, subject to the above amendments, the report be received.