Meeting documents

Also present at the invitation of the Chairman

Dr David Ames (Medical Director, Castle Health Centre) – for Item 5

Ms Lorraine Naylor (Assistant Director for Primary Care, North Yorkshire and York Primary Care Trust) – for Item 5

Ms Tracey Vasey (Chairperson, Scarborough branch of the British Epilepsy Association) – for Item 4

Mr Stephen Wood (Executive Director, Stephen Joseph Theatre) –for item 8

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 of the meeting or as soon as the interest becomes apparent.  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.

There were no declarations of interest.

To approve as a correct record and sign the Minutes of the meeting held on 25 July 2012.  (Minutes attached).

RESOLVED that the minutes of the meeting held on 25 July 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 Tracey Vasey, Chairperson of the Scarborough branch of the British Epilepsy Association.

The  Committee received a presentation by Tracey Vasey, Chairperson of the Scarborough branch of the British Epilepsy Association (BEA) which covers not only the Borough but as far south as Bridlington and as far west as Helmsley.  Ms Vasey began by explaining that epilepsy was the most common serious neurological condition in the country with many different types.  One in 103 people in the UK had epilepsy with greater prevalence among children and the over 65s. The local branch campaigned to raise awareness about the condition, about the most appropriate response should a person have a seizure, and for the right care and support for people with epilepsy in hospitals and in schools.  An ambulance would only be required in a minority of incidences of seizure – if it was the person’s first, if it lasted more than five minutes, if one seizure appeared to follow another without the person gaining consciousness in between, or if an injury had been sustained.  In most cases, the mnemonic ACTION would suffice which included removing nearby objects, cushioning the head, looking for a medical bracelet which may give more information, and waiting for the seizure to end, to then put the person in the recovery position.  Given that it cost £81 for an A&E admission, and a further £1,045 for an admission from A&E to the hospital, there were significant savings to be made by reducing avoidable admissions.  Another means of doing this was to ensure that after experiencing their first seizure, the person was seen promptly by a specialist to help them manage the condition.  NICE guidelines recommended a maximum of two weeks.  At Scarborough Hospital the average waiting time was 11 weeks.  After a lengthy campaign, the BEA had succeeded in securing a specialist adult epilepsy nurse for the hospital (funded by the BEA), although Ms Vasey would like to see the nurse providing consultations more frequently than twice a month.  The current campaign was for a specialist paediatric nurse which Ms Vasey believed would significantly improve services by ensuring children received the correct care, reducing unnecessary hospital admissions and costs, take the pressure off paediatric specialists and smooth the pathway from child to adult care.  The development of proper care plans for every child would also improve communication and awareness in schools – another area of the local branch’s campaigning activity.  Ms Vasey maintained that every school should have an Epilepsy Policy in place, whilst very few did.  For many, epilepsy was still a taboo subject, associated mistakenly with mental illness.  Members then made comments and asked questions about Ms Vasey’s presentation.  Asked about the support the local branch received from other voluntary organisations, Ms Vasey explained that the Friends of Scarborough Hospital had contributed to the costs of the information area about epilepsy at the hospital provided by the BEA.  It was suggested that Scarborough Lions could help them publicise the medical bracelets.  Concerned about the lack of awareness in schools and the need for  ...  view the full minutes text for item 4.

To consider a report by the Assistant Director Primary Care, North Yorkshire and York Primary Care Trust (attached)

The Committee considered an update report on the Castle Health Centre (Equitable Access Centre) in Scarborough by Lorraine Naylor, Assistant Director for Primary Care at North Yorkshire and York Primary Care Trust, together with a presentation by the Centre’s Medical Director, Dr David Ames.  Members were reminded that in response to Lord Darzi’s report, in 2007 each PCT area was mandated to open an Equitable Access Centre to increase access to primary care services in areas of deprivation.  The Castle Health Centre which opened in October 2009 was designed to offer extended opening hours seven days a week, improved mental health provision, additional sexual health and family planning services, services for homeless people, drug and alcohol support services, and a walk in service for non registered patients. Dr Ames’ presentation then provided more details about these services, the effects locally, and the prospects for the continuation of the Centre after the current contract expires in two years’ time.  Dr Ames reported high patient satisfaction rates with over 97% of patients seen within one hour, a fall in A&E attendances (although only temporary), and a fall in the rate of under age pregnancies.  The number of registered patients had continued to rise to almost 2000, whilst in response to a directive from the PCT to reduce costs, the number of walk-in attendances had dropped in 2011/12 compared to the previous year.  Whether to continue the walk-in service, which cost some £1.3M pa, would be a decision for the new Clinical Commissioning Group, whereas decisions on the registered list and the advanced and auxiliary services provided would be for the Local Area Team of the NHS Commissioning Board.  Members then asked questions and discussed the report.  In response, Ms Naylor explained that in order to reduce the number of walk-in patients, the Centre’s policy was to question patients to understand why that had opted for the Centre instead of their registered practice, and then to feed back reasons to the other practice.  It was noted that since the Centre opened, other GP practices in the area had extended their opening hours.  Ms Naylor commented that against expectations, the number of registered patients at the Centre had continued to rise, but from a broad range of sources, thereby avoiding a destabilising effect on any one surgery.  It was very difficult to establish a direct correlation between the Centre’s services and the fact that overall A&E attendances had not risen at Scarborough Hospital, but more analysis was required.  Dr Ames added that there was anecdotal evidence that the new Centre had created demand, which was why the Centre had to be careful in managing the number of walk-in attendances, so that its resources could be targeted more effectively.  However, the Centre was now viewed as an exemplar of flexible and integrated services by the PCT, and able to cater for chaotic and vulnerable individuals and families, by bringing a range of different services and agencies, including MIND and the Citizens’ Advice  ...  view the full minutes text for item 5.

To consider a verbal report by the Strategic Director (Hilary Jones)

The Committee received a verbal report by the Strategic Director, Hilary Jones on the work the Council was doing to address the challenges brought about by the Welfare Reform Act, together with changes introduced under other pieces of legislation such as fixed term tenancies and the localisation of business rates, through the formation of the Facing the Future Working Group.  Facing the Future embodied a coordinated approach to mapping these multiple new developments, their timelines and the combined effects they may have on particular sections of the community.  By profiling our communities, the Council could then identify where the changes were going to hit hardest, the gaps in service provision, and so reallocate resources accordingly.  In some instances a balancing act was required; for example, in certain cases the Council could not afford to maximise the collection of Council Tax if it was going to drive people into homelessness.  Ms Jones also referred to her involvement in the Government’s Troubled Families Programme, in which the Government incentivised upper tier authorities to identify problem families and then work to ameliorate their lives through joining up services, including with district councils.  Up-front ‘attachment fees’ from Government allowed the services delivered to these families to be expanded and transformed.  Ms Jones expected to provide more details about Facing the Future and the project’s progress to the next meeting of the Committee in January 2013.  Councillor Abbott then raised his own concerns about particular vulnerable members of the community whose circumstances were likely to deteriorate in the coming months: pensioners coping with the increasing costs of food and energy; hardworking people who are not on benefits but are in low paid work and on the breadline; and the four out of five children who attend school in the morning without having had breakfast.  He also asked what the Council’s stance was towards the soup kitchens he expected to increase, and the growing numbers of rough sleepers.  Ms Jones undertook to relay his comments and concerns back to the Facing the Future Working Group.

RESOLVED that:

(i)                 the report be received; and

(ii)               a further report be submitted to the next meeting of the Committee in January.

To consider a report by the Overview and Scrutiny Manager (attached)

The Committee considered a report by the Overview and Scrutiny Manager which outlined the Committee’s response to the recent consultation on the Health and Wellbeing Board’s draft Joint Health and Wellbeing Strategy (JHWBS) for North Yorkshire.  The Chair of the Task Group which had been delegated the task of formulating the Committee’s response, Councillor Billing, introduced the report.  The Health and Wellbeing Board had sought views on a number of areas: the key challenges facing the health and wellbeing of people in North Yorkshire; the strategic principles underpinning the JHWBS; the strategy’s five priorities and the areas for focus within each priority.  The approach adopted by the Task Group was first to assess how well the specific health issues in Scarborough District’s Joint Strategic Needs Assessment were reflected in the strategy’s priorities and areas of focus; then to consider the deliverability of the strategy in the remaining section of the questionnaire.  Although the Task Group recommended the adoption of a robust performance management framework covering both quantitative indicators and qualitative outcome measures to help the Health and Wellbeing Board track progress, Councillor Billing noted the difficulty in achieving this when such measures as childhood obesity and life expectancy could only be evidenced in the longer term.  Councillor Billing thanked officers for their support in producing the response and commended it to the Committee.

RESOLVED that the Committee note the response agreed on its behalf to the consultation on the draft Joint Health and Wellbeing Strategy by the Member Task Group established for this purpose.

To consider a report by the Head of Tourism and Culture (Reference 12/494 attached)

The Committee considered a report by the Head of Tourism and Culture (Reference 12/494) which reviewed the Scarborough Theatre Trust’s activities and performance in 2011/12.  The report advised that the Trust had met all the requirements set out in the Funding Agreement with the Council, and continued to provide a high quality repertoire both at the Stephen Joseph Theatre and on tour, as well as an extensive outreach programme to promote the engagement of young people.  Members received a presentation by the theatre’s Executive Director, Stephen Wood which outlined the economic impact of the theatre in the Borough in 2011/12.  Theatre customers spent £800K in the Borough in addition to the price of their tickets, whilst the total economic impact of the theatre’s operation in the same period amounted to £7.9 million.  Customers pre-booked tickets and arranged their stays from across the country (from Truro to the Outer Hebrides) and from around the world – Brazil, USA, India, Australia, Japan and Europe.  Members then made comments and asked questions about Mr Wood’s presentation.  In reply, Mr Wood regarded the Borough Council’s reductions in funding to the Trust in recent years as equitable and in proportion to the funding constraints the Council was experiencing.  However, he added that if the Borough Council were to implement a reduction of the same magnitude as that of North Yorkshire County Council (over 80%), then this would raise questions in the Arts Council’s mind about the future viability of the organisation.  Mr Wood further commented that the theatre provided great value for money, with tickets for most performances available at £10.  The Chairman commended Mr Wood for the Trust’s work and thanked him for a very enlightening presentation.

RESOLVED that:

(i)                 the report be received;

(ii)               a visit by the Committee be arranged to the theatre.

To consider a report by the Head of Tourism and Culture (Reference 12/493 attached)

The Committee considered a report by the Head of Tourism and Culture (Reference 12/493) which reviewed the operation of the Council’s Leisure Card, providing a discount to resident users of Scarborough Sports Centre, Scarborough Indoor Pool and Whitby Leisure Centre in 2011/12.  Members were reminded about the background to the scheme which was designed both to increase income and usage of the Council’s indoor leisure facilities.  Although income from the scheme was less than originally envisaged, the annual total number of attendances and annual total income across the three sites had remained static over the three years of operation, whilst the number of non card holders had steadily reduced as expected.  Since the scheme started, 20,545 cards had been issued, equating to 19% of the population of the Borough.  In presenting the report, the Leisure and Community Services Manager, Andrew Williams drew attention to a typing error in Appendix A: the figures for the total attendances at Scarborough Indoor Pool and Whitby Leisure Centre in 2011/12 should be transposed – 169,264 for the former, and 161,912 for the latter.  Mr Williams also commented more generally on factors which had reduced usage of the facilities: competition with the private sector, decline in disposable income, inclement weather, and paradoxically sporting events like the Olympics which induce people to stay at home and watch television.  However, sports at which Team GB had excelled, such as cycling, had benefited after the Olympics by encouraging participation.  Members asked how the scheme could be further promoted, and could users who had stopped using the card be asked why?  Mr Williams replied that the scheme had had a high profile launch, but it was difficult to sustain this level of publicity because of funding constraints; however, the Council had attempted to take advantage of the Olympic effect through advertising, and was looking to start email promotions.  Mr Williams believed that data on card usage and those who had ceased using their cards was available, if resources could be found to access and make use of it.

RESOLVED that the report be received.

To consider a verbal report by the Environment and Parks Manager

The Committee received a presentation by the Environment and Countryside Manager, Steve Reynolds in respect of the Council’s investigations to identify and remedy incorrect private sewer connections which were causing pollution in Bagdale Beck, Whitby.  Further to the last report to the Committee in January 2012, the Council’s investigations had focused on private sewer connections to a number of properties in Windsor Terrace.  Legal Services had advised that the Building Act 1984 did apply, and so formal action had been instigated against the property owners.  Unfortunately, subsequent work had identified more properties further up the hill which had been wrongly connected to the beck, requiring more formal action.  In reply to Members’ questions, Mr Reynolds explained that the property owners were liable for repairs which may be eligible for support from their insurers, since it was unlikely the Council could take action against the original building contractors.  Of the owners contacted so far, all were willing to comply, and there may be an easier technical solution which would reduce the cost for each owner when spread across so many properties.  The remedial work should be completed by January 2013.

RESOLVED that the report be received.

To consider a report by the Head of Legal and Support Services (Reference 12/312 attached)

The Committee considered a report by the Head of Legal and Support Services (Reference 12/312) to assist Members in planning the Committee’s work for 2012/13.  The Overview and Scrutiny Manager reported that the progress report on the Council’s allotments provision had been deferred to April 2013, to enable the necessary liaison etc to take place which other pressures had precluded.  The Strategic Director, Hilary Jones, reported on the project to reduce inappropriate A&E attendances, an update and evaluation of which had been scheduled to come to the Committee in January 2013.  The data analysis had been undertaken and the results had been shared with practice managers and the Clinical Commissioning Group.  In light of the data, GPs had decided to adopt a more individual, one-to-one approach, and so the project was not taken any further.  The Strategic Director proposed the Government’s Troubled Families Progamme and the Borough Council’s involvement (as reported under Item 6) as a suitable topic for the next pre-committee Member briefing on 23 January.  More generally, the effects on the community’s health and wellbeing of welfare reform and the ongoing reduction of the Council’s budgets continued to cause the Committee concern, necessitating perhaps an additional meeting before the next scheduled meeting on 23 January at which an update on the Facing the Future Group was to be reported.  It was agreed that this would be for the Chairman in conjunction with the Strategic Director and Overview and Scrutiny Manager to decide.  Possible future areas for in-depth scrutiny were suggested: action plans flowing from the Joint Health and Wellbeing Strategy, and Clinical Commissioning Groups’ action plans.  Following concerns raised by Councillor Backhouse about North Yorkshire and York Primary Care Trust’s current deficit and the projected end of year deficit of £50-60M, it was agreed to invite Locality Director, Simon Cox to the meeting on 23 January to give the Committee an update on the PCT’s financial position and the structural transition to Clinical Commissioning Groups.

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