North Yorkshire County Council
Scrutiny of Health Committee
Minutes of the remote meeting held on Friday, 18th June, 2021 commencing at 10.00 am.
A recording of the meeting can be viewed on the Council’s YouTube site via the following link - https://www.northyorks.gov.uk/live-meetings
Members:-
County Councillors: John Ennis (in the Chair), Val Arnold, Philip Barrett, Jim Clark, Liz Colling, Zoe Metcalfe, Heather Moorhouse, Chris Pearson, Andy Solloway and Roberta Swiers.
Co-opted Members:-
District and Borough Councillors: John Clark (Ryedale), Kevin Hardisty (Hambleton), David Ireton (Craven), Nigel Middlemass (Harrogate), Pat Middlemiss (Richmondshire), Jane Mortimer (Scarborough) and Jennifer Shaw Wright (Selby).
In attendance: County Councillors Caroline Dickinson, Andy Paraskos, Tony Randerson, Karin Sedgwick and Annabel Wilkinson.
Officers: Daniel Harry (Democratic Services and Scrutiny, NYCC), Louise Wallace (Health and Adult Services, NYCC), Simon Cox (North Yorkshire CCG), Wendy Balmain (North Yorkshire CCG) and Naomi Lonergan, Dr Tolu Olusoga and Martin Dale (Tees Esk and Wear Valleys Foundation Trust), Dr Stefan Serban, (PHE), Simon Hearnshaw and Debbie Pattinson, (NHSE and NHSI, Yorkshire and Humber).
Apologies: County Councillors Robert Windass and John Mann and Scarborough Borough Councillor Sue Tucker (Jane Mortimer attending)..
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Copies of all documents considered are in the Minute Book
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Minutes of Committee meeting held on 12 March 2021
That the Minutes of the meeting held on 18 June 2021 be taken as read and be confirmed and signed by the Chairman as a correct record.
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Declarations of Interest
There were none.
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Chairman's Announcements
The committee Chairman, County Councillor John Ennis, welcomed everyone to the meeting.
County Councillor John Ennis reminded the committee that the meeting was being held informally and that any formal decisions would need to be taken in consultation with the Chief Executive Officer using his emergency powers.
County Councillor John Ennis read out the following statement so that the status of the meeting was clear to all involved and viewing:
You will have seen the statement on the Agenda front sheet about current decision-making arrangements within the Council, following the expiry of the legislation permitting remote committee meetings. I just want to remind everyone, for absolute clarity, that this is an informal meeting of the Committee Members. Any formal decisions required will be taken by the Chief Executive Officer under his emergency delegated decision-making powers after taking into account any the views of the relevant Committee Members and all relevant information. This approach has been agreed by full Council and will be reviewed at its July meeting.
County Councillor John Ennis summarised discussions that had taken place at the Mid Cycle Briefing on 23 April 2021:
· Changes to the provision of hyper acute stroke services at Scarborough Hospital and the sequencing of updates being brought to the Scrutiny of Health Committee and the Scarborough and Whitby ACC · The response of the Tees Esk and Wear Valleys NHS FT to the CQC inspection that looked at 5 in-patient wards and which raised concerns about the complexity of the risk management process and how it was being implemented · The response of York and Scarborough Teaching Hospitals NHS FT to the CQC inspection of Scarborough Hospital which raised concerns about patient safety · Whether there are opportunities through the Local Plans and s.106 funding to support the development of health services in a housing growth area · A review of the committee work programme and the timings of matters coming to the committee.
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Public Questions or Statements
There were no public questions or statements.
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Hyper acute stroke services at Scarborough Hospital and the outcome of the regional review of hyper acute stroke services - Simon Cox, East Coast Programme Director, North Yorkshire Clinical Commissioning Group
Considered – a presentation by Simon Cox of the North Yorkshire Clinical Commissioning Group (CCG) and Neil Wilson of the York Teaching Hospital NHS Foundation Trust on the reconfiguration of stroke services provided by York Teaching Hospital NHS Foundation Trust at Scarborough.
The key points from the presentation are as summarised below:
· There is documented evidence of the improved patient outcomes associated with the centralisation of specialist hyper acute stroke services · National clinical guidance suggests that hyper acute stroke units should see a minimum 600 patients per year to provide the appropriate level of workforce expertise and critical mass of resources · There have been persistent shortages in staff at Scarborough hospital, which has impacted on the ability to provided specialist stroke services there · The ‘drip and ship’ model was introduced at Scarborough hospital in 2015. This meant that people with a suspected stroke were first assessed at Scarborough hospital, stabilised and then transferred to York hospital · In 2020 a direct admission model was put in place, replacing the ‘drip and ship’ model · The direct admission model results in quicker access to specialist treatment at the Hyper Acute Stroke Unit (HASU) at York hospital (known as ‘door to needle’ time and so better long term patient outcomes · The Humber, Coast and Vale Integrated Care System (ICS) conducted a formal review of hyper acute stroke services in the area in 2020/21. The review found that the direct admission model was safe, efficient and able to deliver better outcomes than the previous ‘drip and ship’ model. These findings were verified by regional and national stroke leads in the NHS · The community-based rehabilitation services for people who have suffered a stroke are being reviewed to improve patient outcomes and enable earlier, planned and supported discharge from hospital · There is a renewed focus upon prevention and there is a key role for primary care in the identification and management of risk.
Simon Cox asked the committee to formally endorse the direct admission model.
There followed a discussion, the key points of which are as summarised below:
· Stroke is a preventable disease and there needs to be a greater focus in primary care upon identification and early intervention · There will need to be more joint work between health and social care in managing the rehabilitation of people who have suffered a stroke and been discharged from hospital. In particular, around speech and language therapy · Paramedics are key in making the first assessment when someone presents with a suspected stroke. They need to be trained appropriately and supported.
County Councillor Liz Colling asked whether the change from the ‘drip and ship’ model to the direct admission model, which the committee were being asked to endorse, was going to be a permanent change.
In response, Simon Cox said that this would be a permanent change as there was no other viable alternative. In line with NHS guidance, no formal public consultation is required as there is no viable alternative to what has been in place since 2020. The final decision would be made at the next meeting of the York Teaching Hospital NHS Foundation Trust Board.
Ryedale District Councillor John Clark thanked staff at York hospital for the excellent care and support that had been given to a friend who had suffered a severe stroke. He said that the challenge was now around discharge and rehabilitation services in the community that help ensure positive long term outcomes.
County Councillor John Ennis summed up and said that in view of the information, data and analysis that had been considered by the committee over the past 18 months, the similar and successful changes made at Harrogate hospital to stroke services, the outcome of the regional review of hyper acute stroke services and the views expressed by the committee members that the direct admissions model be endorsed for permanent adoption.
Resolved:-
1) That the permanent adoption of the direct admission model for hyper acute stroke services is endorsed, as there is no other viable alternative 2) That an overview of what stroke services are in place for the population of North Yorkshire is given at the committee meeting on 17 December 2021 3) That an update on outcome data is provided at the committee meeting on 17 December 2021.
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Development of mental health services in the county and the response to a recent CQC inspection - Naomi Lonergan, Director of Operations North Yorkshire and York, Tees Esk and Wear Valleys NHS Foundation Trust
Considered – reports and presentations by Naomi Lonergan, Martin Dale and Dr Tolu Olusoga of the Tees Esk and Wear Valleys NHS Foundation Trust (TEWV) regarding progress with improvement actions in response to recent Care Quality Commission (CQC) inspections, the progress with enhanced community services, the community mental health hubs for Northallerton and Selby and the rectification work being undertaken at Roseberry Park.
The committee Chairman asked Naomi Lonergan to first provide an overview of the response to the findings of the recent CQC inspection and then respond to questions relating to the other areas of work being undertaken by TEWV to improve mental health services.
Naomi Lonergan provided an overview as follows:
· In January 2021 there was a CQC inspection of three acute wards for adults of working age and psychiatric intensive care units which raised concerns about risk management processes, which were found to be complex and difficult to follow · The CQC rated the wards as ‘inadequate’ for both safe and well-led. The overall trust CQC rating remains ‘requires improvement’ · An improvement programme has been developed and it is reviewed by an external quality assurance board · New, simpler, safety (risk management) summaries and safety plans for our patients in both inpatient and community settings have been introduced and risk management training and audits put in place · A practice development team has been established · Recruitment is underway to address some persistent work force shortages · A peer review was undertaken in May 2021 · A CQC inspection is currently underway and will be completed at the end of July 2021.
County Councillor John Ennis asked for clarification of the scale of the workforce shortages across TEWV and what progress was being made with the work to recruit to vacancies.
In response, Naomi Lonergan said that the issues with staffing varied across the geography covered by and services provided by TEWV. There were particular issues around the Scarborough, Harrogate and Selby areas. In addition to a renewed recruitment drive, work is being done the develop nurse apprenticeships with education providers and social work placements.
Dr Tolu Olusoga said that there are also challenges in recruiting to medical and clinical positons as there was a great deal of competition and other areas may be more attractive to work in. This is particularly the case in psychiatry.
There followed a discussion about the other areas of work being undertaken by TEWV to improve mental health services.
District Councillor Kevin Hardisty said that the community hub in Northallerton had progressed well and welcomed the fact that it would be a modern and purpose built facility.
County Councillor Heather Moorhouse said that the problems with recruitment were understood, known and common to many organisations working in North Yorkshire. County Councillor Heather Moorhouse asked how the work was progressing with the rectification of the Roseberry Park site.
In response, Naomi Lonergan said that significant progress had been made and a further two blocks will be handed over to the service in September 2021.
County Councillor John Ennis asked what was driving the increase in referrals to the crisis team.
Noami Lonergan said that demand for mental health services is rising. This may be due to the impact of prolonged social isolation and economic hardship associated with the pandemic. Many of those people seeking help are previously unknown to mental health services. The situation is being closely monitored as whilst demand is rising, the capacity of the service is largely fixed. The aim is to do more work with partner agencies and organisations that will build capacity in prevention and early intervention.
Martin Dale said that it would be possible to show committee members around the North Moor House community hub on 6 August 2021. Daniel Harry agreed to help Martin Dale co-ordinate this.
County Councillor John Ennis summed up and thanked all for attending.
Resolved:-
1) That Naomi Lonergan keeps the committee informed of the outcome of current CQC inspections and the progress being made with regard to the implementation of the improvement plan that is in place. A further update is given to either the committee meeting on 10 September or the that on 17 December 2021 2) That there is no need for any further updates to the committee on the development of the community mental health hubs (Northallerton and Selby) 3) That Naomi Lonergan provides an update on patient outcomes for the enhanced community services to the committee meeting on 17 December 2021 4) That there is no need for any further updates to the committee on the progress being made with the rectification works at Roseberry Park 5) Martin Dale and Daniel Harry to liaise regarding the visit to Northallerton community hub on 6 August 2021.
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Access to and provision of NHS dentistry - Dr Stefan Serban, PHE, Simon Hearnshaw and Debbie Pattinson, NHSE and NHSI, Yorkshire and Humber
Considered – A report and presentations by Dr Stefan Serban, Public Health England (PHE), Simon Hearnshaw and Debbie Pattinson, NHS England (NHSE) and NHS Improvement (NHSI) Yorkshire and Humber regarding how NHS dental services are commissioned, some of the problems associated with that process and how services are recovering from the pandemic.
County Councillor John Ennis welcomed County Councillors Annabel Wilkinson and Tony Randerson to the meeting. They had an interest in NHS dental service for Looked After Children and recent changes to provision in Scarborough, respectively.
Dr Stefan Serban, Public Health England (PHE), gave a presentation on children’s oral health in North Yorkshire compared to elsewhere in Yorkshire and Humber and nationally, as summarised below:
· One fifth of under 5-year olds in the county have tooth decay · Of those, by the time they are 5 years old they will have had nearly 3 teeth decayed extracted or filled · Children living in the more deprived area of the county are most at risk of and affected by tooth decay and extractions · Tooth decay is almost entirely preventable · The situation in North Yorkshire is better than the averages for Yorkshire and Humber and England · Tooth decay is still the most common reason for hospital admissions in the 6-10 year-old age group · Hospital extractions for children’s teeth cost around £40 million/year to the NHS in England · Reducing sugar consumption, regular brushing with fluoride toothpaste, routine visits to dentists will help promote good oral health.
There followed a discussion and during the course of which the following points were made:
· The levels of sugar consumed by young children and much higher than expected and shocking · More could be done to enable access to NHS dental services by Looked After Children · The high costs associated with a hospital admission to have an extraction of a decayed tooth of a child could be saved if a fraction of that money was invested in prevention in those areas most at risk · More targeted work could be done with schools · Local authority Public Health has a lead role to play in prevention and early intervention work.
There then followed a discussion about the commissioning of and access to NHS dental services, based upon the report that had been provided by Debbie Pattinson of NHS England.
County Councillor Tony Randerson raised his concerns about the closure, at short notice, of the NHS dental practice at Eastfields in Scarborough, which is one of the most deprived areas of the county. County Councillor Tony Randerson said that all people deserved easy access to NHS dental healthcare near to where they live. He said that this had been a problem with NHS dental provision in Eastfields for the past 17 years and that the Council needed to bring pressure to bear upon the government. He then asked what more could be done to encourage greater NHS dental provision in the area.
In response, Simon Hearnshaw said that work was underway to re-procure those NHS dental services in Eastfields that had been lost. A limiting factor was the persistent workforce shortages on the east coast, something that affected all health services.
County Councillor Val Arnold asked when the NHS dental provision for Helmsley would be recommissioned.
Debbie Pattinson said that the pandemic had posed particular problems for dentistry as dentists were at heightened risk due to the nature of the work. During the pandemic the focus had been upon emergency procedures and pain relief. Much of the routine work and check-ups has been stopped and is only slowly being re-instated.
Debbie Pattinson said that it is important to note that dentistry is not free but a subsidised service that is delivered by commercial providers. Dentists are businesses and so will prioritise private work.
Debbie Pattinson outlined the work that is underway to provide NHS dental services in areas of the county where services had recently been withdrawn, as summarised below:
· In Helmsley, NHS dental services have been re-procured for urgent and emergency work and pain relief. A procurement exercise is being planned for Helmsley, which should be able to cover the populations in Kirbymoorside, Pickering and Malton · In Eastfield, work is underway to re-procure those NHS dental services. An urgent and emergency service will be in place as of 1 July 2021, elsewhere in Scarborough that people from Eastfields can access · Procurement work is also underway to restore services in the Sherburn and Tadcaster area.
County Councillor John Ennis queried what progress was being made with the review of the national contract for NHS dental services that was underway. Also, whether the commissioning of NHS dental services would be absorbed into the new Integrated Care Systems (ICS) or whether it would stay part of NHS England.
Debbie Pattinson said that there was no clarity as of yet about whether dental health commissioning would be taken on by the ICS. Also, that the national review was underway but at its very early stages.
Simon Hearnshaw said that the 2006 contract had caused most of the problems with access to NHS dental services. Primary legislation would be needed to change the existing contract and whilst the issue of NHS dentistry has gained a renewed focus politically, it may take some time.
County Councillor John Ennis summed up, noting that the discussion had been informative and open. He said that the problems arising from the 2006 NHS contract could not be resolved by the committee or colleagues from commissioning but that it was an issue for government.
Resolved:-
1) That Debbie Pattinson keep the committee informed of the development of the ICS and any implications for NHS dental commissioning 2) That Debbie Pattinson and colleagues feedback to NHE and NHSI the concerns of the committee about the 2006 contract and address the problems that have arisen as a result of that contract 3) Debbie Pattinson to keep local members updated on progress with the procurement of NHS dental services 4) That the role that the Council’s Public Health team has to play in prevention of and early intervention in oral health is further looked into.
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White Paper and Integrated Care Systems - Wendy Balmain, Director of Strategy and Integration, North Yorkshire Clinical Commissioning Group
Considered – A presentation by Wendy Balmain, Director of Strategy and Integration, North Yorkshire Clinical Commissioning Group on the Health White Paper and Integrated Care Systems.
The key points from the presentation are as summarised below:
· The ICS will be responsible for developing a plan that addresses the wider health, public health and social care needs in the area · There will be a NHS ICS board. It and local authorities will have regard to that plan when making decisions · The Humber Coast and Vale ICS (HCV) will operate through two strategic partnerships, ‘North Yorkshire’ and ‘York and The Humber’ · It will take on the commissioning functions of CCGs and be directly accountable for NHS spend and performance within the system · There will be a strong focus upon place-based services and integration · Also upon collaboration between NHS services rather than competition · Structures are being developed and shadow arrangements put in place · There is a strong focus upon continuity to services during this period of organisational change · The necessary legislation is excepted to be enacted in January 2022, with the ICSs being established as legal entities in April 2022.
County Councillor John Ennis noted that there White Paper was largely an NHS document and very little mention of social care was made.
In response, Wendy Balmain said that collaboration is key to the success of the ICS model, with success being measured as to how well the local health needs of the population are met and how health inequalities are reduced.
County Councillor Heather Moorhouse asked how the existing funding, based upon specific geographies, currently managed by the CCGs would be allocated by the ICSs.
Wendy Balmain said that the money would be kept in the ICS area. Work would then be undertaken to understand the health needs across the area and how resources could then be best allocated to respond to those needs.
County Councillor Jim Clark raised concerns about the speed with which the changes were being introduced, the large geographical area being covered by the ICS and the scale of the financial challenge.
County Councillor John Ennis thanked Wendy Balmain for attending and asked for an update on progress with the implementation of the ICSs at a future meeting.
Resolved:-
1) Wendy Balmain to attend a future meeting of the committee and update on progress with the implementation of the ICSs, in the summer or autumn of 2022.
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NHS response to and recovery from the pandemic - Wendy Balmain, Director of Strategy and Integration, North Yorkshire Clinical Commissioning Group
Considered – A presentation Wendy Balmain, Director of Strategy and Integration, North Yorkshire Clinical Commissioning Group regarding the NHS response to and recovery from the pandemic.
The key points from the presentation are as summarised below:
· NHS recovery planning has six elements, including developing primary care, supporting and retaining staff, rolling out the vaccination programme and building upon lessons learned from the pandemic and new ways of working · Waiting lists for elective procedures have increased as a result of the response to and recovery from the pandemic · Work to reduce waiting lists and times is prioritised according to risk · Hospitals are planning to be able to deliver 85% of pre-covid activity levels by July 2021 · There has been a strong focus upon restoring all cancer services and the aim is to reduce the number of patients waiting over 62 days for treatment to pre-pandemic levels · There is increased demand for primary care services and face to face appointments and digital interactions are now back to almost pre-covid levels, albeit that there may be local variations across the county.
County Councillor John Ennis asked when the 100% recovery target for elective procedures would be met.
Wendy Balmain said that the focus was upon 85% at present. As of September, a new target would be set with accompanying guidance.
County Councillor John Ennis noted that NHS would need ongoing support as the pace of work in the NHS had not let up since February 2020 and there was still some way to go with responding to and recovering from the pandemic.
Resolved:-
1) That Wendy Balmain provides an update on the local NHS response to and recovery from the pandemic, with a focus upon the work to support people with ‘long-covid’ at the committee meeting on 10 September 2021. |
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Update on Covid-19 in North Yorkshire - Verbal update - Louise Wallace, Director of Public Health, North Yorkshire County Council
Considered – A verbal report by Louise Wallace, Director of Public Health, North Yorkshire County Council regarding Covid-19 in North Yorkshire
Louise Wallace updated on progress with the vaccination programme in the county, as follows:
· By 31 July 2021, all 1st doses of cohorts 1-12 as well as the majority of 2nd doses will have been completed · Preparations are in hand for covid-booster vaccinations and the annual flu vaccinations for all over 50s · Making sure that everyone has had two doses of the vaccine is important as is adhering to the standing advice ‘hands, face, space’.
Louise Wallace said that Public Health was working with various organisations to support the response to local outbreaks. Also, to support the continuation of large scale public events, where it can be done in a covid-safe way.
Resolved:-
1) That Louise Wallace provide a further update at the meeting on the committee on 10 September 2021.
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Committee Work Programme - Report of Daniel Harry, Democratic Services and Scrutiny Manager, North Yorkshire County Council
Considered – Daniel Harry, Democratic Services and Scrutiny Manager, North Yorkshire County Council, introduced this item and asked Members to review the work programme and make suggestions for areas of scrutiny for inclusion.
Resolved:-
1) That the committee review the work programme.
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Other business which the Chairman agrees should be considered as a matter of urgency because of special circumstances
There was no other business.
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The meeting concluded at 1.05 pm.