North Yorkshire County Council
Scrutiny of Health Committee
Minutes of the remote meeting held on Friday, 11 March 2022 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) and Val Arnold, Philip Barrett, Liz Colling, John Mann, Chris Pearson, Andy Solloway, Roberta Swiers and Robert Windass.
Co-opted Members:-
District and Borough Councillors: Sue Graham (Ryedale), Wendy Hull (Craven), Nigel Middlemass (Harrogate), Jane Mortimer (Scarborough) and Jennifer Shaw Wright (Selby).
In attendance: County Councillor Andrew Lee, Michael Harrison and Annabel Wilkinson.
Officers: Daniel Harry (Democratic Services and Scrutiny, NYCC), Lisa Pope (Deputy Director of Primary Care, Community Services and Integration, North Yorkshire Clinical Commissioning Group), Rob Atkinson and Sonia Rafferty (Humber Teaching NHS Foundation Trust), Mark Steed (Director of Property and Asset Management at York Teaching Hospitals) and Neil Wilson (Head of Partnerships and Alliances, York and Scarborough Teaching Hospitals NHS Foundation Trust).
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Copies of all documents considered are in the Minute Book
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Minutes of Committee meeting held on 17 December 2021
That the Minutes of the meeting held on 17 December 2021 be taken as read and be confirmed by the Chairman as a correct record.
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Apologies for absence
Apologies were received from County Councillors Jim Clark, Zoe Metcalfe, Heather Moorhouse, Hambleton District Councillor Kevin Hardisty and Richmondshire District Councillor Pat Middlemiss.
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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 of 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 May 2022 meeting.
County Councillor John Ennis noted that this was the last meeting of the committee in this Council and reflected upon some of the significant and more sustained pieces of scrutiny work that the committee has undertaken over the past five years.
County Councillor John Ennis thanked committee members and officers for all of their support and also noted the contribution of County Councillor Jim Clark, who chaired the committee until May 2019.
County Councillor John Ennis summarised discussions at a recent meeting of the committee Mid Cycle Briefing that was held on 28 January 2022, where the focus was upon the development of the committee work programme, with a view to being able to handover a robust work programme for the committee members post the May elections.
At this point, County Councillor John Ennis asked Daniel Harry to read out a briefing note that had been received from Naomi Lonergan of the Tees Esk and Wear Valleys NHS Foundation Trust regarding the Esk ward at Cross Lane Hospital, Scarborough:
“There was a fire on Danby ward in January 2022 which had meant patients had to be moved to the empty Esk ward while major repairs take place on Danby ward. This is now almost completed, and patients will move back to Danby once this is complete and some planned anti-ligature work will commence on Esk ward, which is an essential part of improving safety on our wards.
We should be in a position to reopen the Esk ward by June 2022. To do this we have already recruited 7 nurses through our international recruitment programme to work in our Scarborough locality (inpatients) and are looking to recruit another 12. We have also put in place recruitment and retention premia across all our adult inpatient wards and are monitoring the benefit of these.
We have recruited a non -medical Approved clinician to support our medical workforce on Esk and Danby ward and we are recruiting to health care assistant roles in Scarborough. We are working to recruit a senior psychologist to work on Esk ward as well as a consultant psychiatrist and have reviewed all roles to improve how attractive they can be for candidates in the context of a very challenged workforce position across the region and nationally.”
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Public Questions or Statements
There were none.
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NHS response to and recovery from the pandemic - Verbal update - Wendy Balmain, North Yorkshire Clinical Commissioning Group
Considered – A presentation by Lisa Pope, Deputy Director of Primary Care, Community Services and Integration, North Yorkshire Clinical Commissioning Group.
Wendy Balmain was unable to attend the meeting.
The key points from the presentation are as summarised below:
· As at January 2022, the number of people accessing GP appointments is up on the same time last year · 66.5% are being held face to face, 52.2% are being held the same day as the appointment being made, there is a non-attendance rate of 3.1% · The sickness rate among staff at GP practices has increased over the winter period · Online consultations are still being used, which has helped with access. An online consultation involves an email being sent to a GP with a photo attached. The GP then phones the patient back for a discussion about treatment · All screening programmes have been re-introduced and the backlog is being reduced with the help of additional capacity through the private healthcare system · Referrals in for people with a suspected cancer have increased. This is a positive thing as it shows that people are not being deterred from seeking assistance at the first opportunity. National campaigns regarding prostate and urinary cancers have had an impact upon referrals · The numbers of people going through elective surgery is still being affected by the need to ensure infection control · Mutual aid is in place across hospitals in the Integrated Care System to help ensure the most effective use of bed spaces · There are higher rates of staff absence due to cvoid-19 infections and the need for NHS staff to self-isolate for 10 days unless there have been negative Lateral Flow Tests at days 5 and 6 · There is a strong focus upon GP recruitment and retention and looking again at the full range of services that can be delivered by primary care · Covid-19 vaccinations as a condition of employment in the NHS has been dropped nationally but it is still being actively encouraged · Locally, the Clinical Commissioning Group (CCG) is still on track to deliver it financial plan for 2021-22.
There followed a discussion with the key points as summarised below:
· The non-attendance rate of 3.1% is low but still equates to approximately 6,000 appointments missed · All GP practices are being encouraged to move to online prescriptions and the adoption of the NHS app · There are a range of different professionals at GP practices that can see people and assist them. People do not need to see a named GP on all occasions and certainly should be discouraged from going to Accident and Emergency, unless absolutely necessary · The missed appointments at GP practices are monitored and patterns tracked. Practices will speak to people who book appointments and frequently cancel, to understand what help and support they need · Planning is underway for the influenza vaccination campaign in the winter of 2022. It is not yet clear whether this will be directly linked with a further covid-19 vaccination campaign.
County Councillor John Ennis summed up, thanking Wendy Balmain for attending and responding to questions from the committee members.
Resolved:-
1) That Wendy Balmain provides an update on the local NHS response to and recovery from the pandemic at the committee meeting on 17 June 2022 2) Lisa Pope to circulate a copy of the current vaccination figures.
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Update on Covid-19 prevalence in North Yorkshire - Verbal update - Victoria Turner, Public Health, North Yorkshire County Council
Considered – A briefing by Victoria Turner, Public Health Consultant, North Yorkshire County Council.
Victoria Turner was unable to attend the meeting and so Daniel Harry read out the briefing, which had previously been circulated to the committee, as follows:
During January, COVID-19 rates peaked at the highest levels seen throughout the pandemic so far, with the 7 day rate for North Yorkshire reaching 2,046 cases per 100,000 people. Since then, case numbers have generally declined, although there was a further spike in children and younger people following the reopening of education settings after the Christmas break. The number of people in hospital with COVID-19 has also declined in recent weeks.
On February 24 2022, several changes were made to national legislation and guidance, including the removal of the legal requirement to isolate if identified as a positive COVID-19 case (although the strong advice remained to continue following self-isolation and testing guidance), and removal of national Test & Trace contact tracing system (individuals who test positive are now expected to inform their own close contacts). Further changes in COVID-19 guidance are expected from 1st April, including the removal of free testing for the general public, with more details on other measures such as face coverings yet to be announced.
Over the last week, both local and national COVID-19 case rates and hospitalisations have once again started to increase. Case rates are likely to be an underestimate of the current number of cases due to change in testing behaviours; however, it is expected that the relaxation of the test, trace and isolate guidance has led to an increase in community transmission. There is also potentially some impact of waning immunity for those whose booster doses were now nearly 6 months ago. As such the government has announced an addition to the COVID-19 vaccination programme where those over 75, those living in care homes, and those aged 12+ with a weakened immune system will be offered a second booster 6 months after their first.
More national guidance is expected from 1st April 2022 which will set out expectations for the public, workplaces, education and care settings on “living with COVID-19”. Locally we are reviewing our current approach to COVID-19 in light of the end of COVID-19 funding and the change in the national position. The UK Health Security Agency is reviewing expectations around outbreak management at a regional and local level. The public health team will also be looking at lessons learnt so far from the pandemic, plus identifying how the wider response can be stood back up again if needed in light of future variants or other escalations.
County Councillor Val Arnold asked whether details of the proposed second booster vaccination campaign for people aged over 75 years of age could be circulated to the committee.
Resolved:-
1) That Victoria Turner or Louise Wallace provide a further update at the meeting on the committee on 17 June 2022 2) Details of the proposed second booster vaccination to be circulated to the committee.
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Whitby Hospital - update on the redevelopment of the site - Rob Atkinson and Sonia Rafferty, Humber Teaching NHS Foundation Trust
Considered - a presentation by Rob Atkinson and Sonia Rafferty, Humber Teaching NHS Foundation Trust.
Rob Atkinson and Sonia Rafferty gave an overview of the progress made with the development of the Whitby hospital site, as summarised below:
· The presentation and You-Tube clip show what work has been done since the committee was last updated in March 2021 · The development has enabled much better use of space at the site · The start of the major structural work was planned for March 2020, when the pandemic hit and there was a national lockdown. Despite this initial setback, work was quickly underway · The front of the site will be cleared by June 2022 and that will mark the completion of the work · Staff have been loyal and resilient throughout the past two years and all of the changes to the site and working practices as a result of the development of the site and also the response to the pandemic · As of 15 September 2021, all patients were moved into the new build · Staff and patient feedback on the new build and the facilities has been excellent · Work is underway to have an Urgent Treatment Centre on site. This would be a significant up-grade from the existing Minor Injuries Unit. There have been delays due to the number of national NHS standards that have to be met.
County Councillors Val Arnold and Philip Barrett left the meeting at 11:15am.
There followed a discussion, the key points of which are as summarised below:
· Strong links with the community and community services are critically important as the aim is to support people in their own homes and the community for as long as possible · Councillors have received very positive feedback from local residents and services users about the quality of the development and the range of service available · The work to upgrade the existing Minor Injuries Unit to an Urgent Treatment Centre re-affirms the long term commitment to Whitby Hospital · A range of diagnostics are currently on site, including X-ray and ultrasound. More can be accommodated, subject to it being commissioned by the North Yorkshire CCG.
County Councillor John Ennis thanked Rob Atkinson and Sonia Rafferty for attending the meeting and answering the questions of the committee members.
Resolved:-
1) That Rob Atkinson and Sonia Rafferty attend a future meeting of the committee to provide an update on the ongoing development and use of the site, with particular reference to what services can be devolved down from neighbouring hospitals.
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Urgent & Emergency Care Development Project and other Site Development Projects at Scarborough General Hospital - Report of Mark Steed, York Teaching Hospitals Facilities Management
Considered - a presentation by Mark Steed, Director of Property and Asset Management at York Teaching Hospitals.
Mark Steed gave an update on the Urgent and Emergency Care development project and other site development projects at Scarborough General Hospital, as summarised below:
· A total of £47m capital investment is going Scarborough General Hospital · The new building will provide a combined Emergency Department, Same Day facilities and Acute Medical Unit; combined level 1, 2 and 3 Critical Care facilities; and improved site resilience and flexibility for expansion to support future developments at Scarborough General Hospital · The Trust has to follow HM Treasury and NHS England processes around the submission of a three different business cases at different points in time. The last of these, the Full Business Cass (FBC), is awaiting approval (expected March 2022) · In the interim, details designs and specifications have been drawn up · Enabling work is now underway and full construction is due to start April 2022 (subject to FBC approval) · The new development is expected to be fully in use by January 2024 · A new helipad has been built for air ambulances and air sea rescue services.
There followed a discussion, the key points of which are as summarised below:
· The development is welcomed and there will be opportunities to do more diagnostic work locally · There is a strong focus upon creating a modern environment that is a good place to work and to be treated · There will be more space gained as some of the existing services are moved around · Confident that the project can be delivered on time. The construction partner is very experienced and enabling works are underway which will help claw back some time · There is an opportunity to pull in a broad range of diagnostic, assessment and outpatient services from Hull and York, which would then reduce the need for people to travel, which has always been a local concern in and around Scarborough.
County Councillor John Ennis summed up and thanked Mark Steed for attending the meeting and answering the questions of the committee members.
Resolved:-
1) That Mark Steed attends a future meeting of the committee to provide an update.
Following the update on progress with the redevelopment of Scarborough General Hospital, Neil Wilson, Head of Partnerships and Alliances, York and Scarborough Teaching Hospitals NHS Foundation Trust gave a brief presentation on hyper acute stroke treatment data. The update was taken under this item, as opposed to Other Business, as it related to Scarborough Hospital.
This data had previously been requested by the members of the Scrutiny of Health committee.
Neil Wilson gave the presentation, with key points as summarised below:
· Between 1 April 2021 and 23 February 2022, there were 144 instances of patients being transported between Scarborough and York with a final working impression of Stroke · The average travel time was 1hr 3mins, with the shortest transfer time at 30mins and the longest being 2hr 33mins · Approximately one third of patients are discharged to rehabilitation services in other hospitals, as opposed to directly home · A proportion of patients are still self-presenting to the Scarborough General Hospital with symptoms of stroke. This increases the time take to undertake a scan and admit them to the hyper acute stroke unit, which means that opportunities for thrombolysis may be missed. Further local information and awareness campaign work required · Further work with social care is needed to improve timeliness of discharge · A local performance dashboard is in development that should enable some of the following metrics to be captured: stroke admissions; Thrombolysis and Mechanical Thrombectomy; arrival and thrombolysis; and 6 month follow up.
There followed a discussion with the key points arising as summarised below:
· Rapid repatriation, after specialist treatment at a hyper acute stroke unit, home or to a nearby hospital has always been a big selling point for the changes to the hyper acute stroke pathway but a significant minority seem to need in-patient rehabilitation at Bridlington · The lack of community social care placements is creating some delays with repatriation · Further work could be done to communicate the pathway more clearly. As it stands, for some those who are not repatriated home, are going to go to Bridlington · The performance framework that is under development will help the committee better understand the overall performance and impact of the hyper acute stroke pathway · It would be helpful to have a view across Harrogate-York-Leeds and Scarborough-York-Hull.
County Councillor John Ennis summed up, thanking by Neil Wilson and colleagues for attending and responding to questions from the committee members.
Resolved:-
1) That by Neil Wilson provides an update on the performance of the hyper acute stroke pathway to the committee meeting on 9 September 2022.
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Committee Work Programme - Report of Daniel Harry, Democratic Services and Scrutiny Manager, North Yorkshire County Council
Considered – the report of Daniel Harry, Democratic Services and Scrutiny Manager, regarding the committee work programme.
Daniel Harry introduced the report and asked Members to review the work programme and make suggestions for any 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
County Councillor John Ennis took the opportunity to thank all the committee members and officers for their support over the past three years and to wish those standing good luck in the forthcoming elections.
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The meeting concluded at 12.30 pm.