Meeting documents

Also present at the invitation of the Chairman

Mr Simon Cox, Chief Officer, Scarborough and Ryedale Clinical Commissioning Group –for Items 4 to 6

No declarations of interest were made.

To approve as a correct record and sign the Minutes of the meetings held on (i) 3 February and (ii) 8 March 2016.  (Minutes attached).

The committee considered the minutes of the meetings held on 3 February and 8 March 2016.  In respect of the minutes of the meeting on 8 March 2016 and the call-in of the executive decision, Councillor Randerson asked for his concerns raised at that meeting about the process whereby the Executive Member attended the call-in meeting to be recorded in the minutes.

RESOLVED that, subject to the above amendment, that the minutes of the meetings held on 3 February and 8 March 2016 be approved as a correct record and signed by the Chairman.

The Chairman reported that no public questions had been submitted.

To receive a presentation by Simon Cox, Chief Officer, NHS Scarborough and Ryedale Clinical Commissioning Group

The committee received a presentation by Simon Cox, Chief Officer of Scarborough and Ryedale Clinical Commissioning Group which provided a progress report on the Urgent Care Centre at Scarborough Hospital.  Members were reminded that the UCC had opened in April 2015 and had undergone a phased implementation to full specification.  The Minor Injuries Unit was introduced later in 2015, and the 24 hour walk-in capability (after 10pm) in early 2016.  Some 40,000 patients had been treated at the UCC in 2015/16, but this number was expected to rise now that it was fully operational.  The UCC had received positive feedback from the hospital’s Emergency Department clinical lead, since there was now greater coordination and integration between the UCC and the ED which supported the further development and future sustainability of the ED.  The CCG would shortly be commencing a patient engagement exercise with Northern Doctors to gather feedback from patients and users.  Members then asked Mr Cox questions about his presentation.  In response, he commented that patient numbers at the UCC were overall fewer than the Castle Health Centre, but this was difficult to compare, since the CHC also had a list of registered users.  Mr Cox was not aware of any patient issues around access to the UCC after 6pm, but the results of the patient engagement exercise would provide more information.  Mr Cox added that he would welcome the opportunity to provide further updates to Members in the future about this and other matters.  As per the new governance arrangements to be introduced in May, this would probably be as part of the programme of public Member briefings.

RESOLVED that the presentation be received.

To receive a presentation by Simon Cox, Chief Officer, NHS Scarborough and Ryedale Clinical Commissioning Group

The committee received a presentation by Simon Cox, Chief Officer of Scarborough and Ryedale Clinical Commissioning Group on the recently introduced Stroke Divert service from Scarborough Hospital to York Hospital.  Members were advised that in early 2015, Scarborough Hospital had two consultants practising as stroke physicians, both of whom were soon to retire.  In light of the national and local difficulties in recruiting stroke physicians and the significant pressures on this service at the hospital, possible solutions were explored.  The outcome was the ‘Drip and Ship’ or Triage, Treatment and Transfer model which was introduced in June 2015.  According to this model, stroke victims underwent tests and received medication as appropriate at Scarborough Hospital, and then if hyper acute care was required, they were transferred to the larger specialist centre at York Hospital.   The new model had been externally assessed by NHS England’s National Clinical Director for Stroke, Professor Tony Rudd, who judged it to be a sustainable, safe and appropriate model for Scarborough Hospital. There was a considerable evidence base to suggest that outcomes dramatically improved for heart attack and stroke victims at larger, specialist centres.  Volume was another factor in maintaining a high quality of hyper acute care.  An optimum number was thought to be 600-650 stroke patients per year.  Previously, Scarborough Hospital had 300-350 stroke patients per year, and York Hospital had 400-450.  Further improvements to the service were planned, such as reducing the time it took for patients to access scans.  Members then asked Mr Cox questions about his presentation.  In reply, Mr Cox commented that a stroke clinic was still available at Scarborough Hospital, and wherever possible, the CCG would provide local access to clinics.  He wished to allay councillors’ concerns about the safety of the new model in respect of the distance and duration of the ambulance journey to York Hospital.  He confirmed that patients were stabilised prior to transfer, and where necessary, time-critical thrombolytic drugs were administered at Scarborough Hospital.  Mr Cox acknowledged that there was always an element of risk in transferring patients in this way, but the risks were far outweighed by the benefits of specialist stroke care at York Hospital.  Members welcomed his suggestion of arranging a local stroke clinician to speak to them in more depth on this matter.  It was still too early to compare the outcome measures of hyper acute Scarborough based stroke patients treated at York Hospital to those of York based patients.  Councillor Colling confirmed that one close relative was permitted to accompany the stroke victim on the journey to York Hospital, but the relative had to make their own transport arrangements to return to Scarborough.

RESOLVED that the presentation be received.

To receive a presentation by Simon Cox, Chief Officer, Scarborough and Ryedale Clinical Commissioning Group

The committee received a presentation by Simon Cox, Chief Officer of Scarborough and Ryedale Clinical Commissioning Group on the winter pressures on the Emergency Department at Scarborough Hospital in 2015/16.  Members were reminded that November 2014 – January 2015 was one of the most difficult winters for the ED at Scarborough, and across Yorkshire and Humber because of sustained pressure on services.  Process changes led to a much better position in January 2016 – still difficult but more controlled and managed.  However, February and March 2016 turned out to be extremely difficult months because of the outbreak of norovirus and subsequent closure of up to 116 beds.  Hospitals such as Scarborough with a smaller bed base were less resilient when faced with an outbreak of this magnitude.  Queuing ambulances and long waits for patients in the ED made the local news.  Mr Cox added that the position had significantly improved in the hospital over the previous week.  Investigation of the norovirus outbreak showed no recognisable patterns.  The CCG was working closely with York Foundation Hospital Trust, social services and other partners to improve out of hospital care to build more resilience into the system, but there was still much work to be done.  Mr Cox commented that there would be a more detailed review of the winter pressures on hospital services in three months’ time.  Members then asked Mr Cox questions about his presentation.  In reply, he acknowledged that more could be done to raise awareness among hospital visitors about hand hygiene and prevention of infection.  He believed that high standards of hygiene were applied consistently across clinical practice at the hospital, but one could never be too vigilant.  Mr Cox then explained more about the challenges of building resilience into the health system.  For the care of elderly people, the default location needed to be people’s homes.  The longer elderly people remained in hospital beds, the greater the impact on their health and independence, including loss of muscle strength.  The ‘Perfect Week’ exercise was a good example of how working together more effectively, could get patients discharged more quickly, but there had been problems embedding this good practice.  A more holistic approach to care was needed involving organisations outside the NHS, to enable patients to be discharged more quickly and safely with an appropriate care package in place at home.  The Chairman then thanked Mr Cox for his presentations to the meeting, and looked forward to his future engagement with Borough councillors, if not through this committee.

RESOLVED that the presentation be received.

To consider a report by the Director (LD) (Reference 16/111 attached).

The committee considered a report by the Director (LD) (Reference 16/111) in respect of the committee’s work programme for 2015/16.  At this last meeting of the committee, the Chairman thanked the Members for their contribution to the committee’s work.  Thanks were then returned to the Councillors Jeffels and Coulson for their chairmanship of the committee.

RESOLVED that the report be received.