North Yorkshire County Council
Scrutiny of Health Committee
Minutes of the meeting held on Friday, 4th November, 2022 commencing at 10.00 am.
Members:-
County Councillor Andrew Lee in the Chair, plus County Councillors Liz Colling, Caroline Dickinson, Richard Foster, Sam Gibbs, Paul Haslam, Nathan Hull, Peter Lacey, John Mann, Heather Moorhouse, Andrew Murday, David Noland, Clive Pearson, Andy Solloway and Steve Shaw-Wright (sub).
Co Opted members:-
District and Borough Councillors Nigel Midlemass (Harrogate) and Jane Mortimer (Scarborough) .
Officers present: Louise Wallace, (Director of Public Health, NYCC) Christine Phillipson
and Daniel Harry (Democratic Services and Scrutiny, NYCC).
Other Attendees: Wendy Balmain, Place Director, Humber and North Yorkshire Integrated
Care Board. Brian Cranna, Care Group Director, Tees,Esk and Wear Valley NHS
Foundation Trust. Sue Peckitt, Director of Nursing, Humber and North Yorkshire Integrated
Care Board. Simon Morritt, Chief Executive York and Scarborough Teaching Hospitals
NHS Foundation Trust. Heather McNair, Chief Nurse 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 the meeting held on 17 June 2022
That the minutes of the meeting held on 17 June 2022 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 Councillor Rich Maw, with Councillor Steve Shaw-Wright attending as substitute. Apologies were received from District and Borough Councillors Sue Graham, Kevin Hardisty, Pat Middlemass, Jennifer Shaw-Wright and Sue Tucker.
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Declarations of Interest
Councillor Liz Colling declared an interest in item 8 as an appointed Governor to York and Scarborough Teaching Hospitals NHS Foundation Trust.
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Chair's Announcements
The Chairman made the following announcement:
“The Scrutiny of Health Committee has been made aware of recent concerns raised regarding the performance and safety of in-patient services within the Tees, Esk and Wear Valley NHS Foundation Trust, specifically relating to a number of deaths over the last 3 years.
Members will be aware that the Committee has scrutinised the Trust over the last five years, focussing on changes to in-patient services, the establishment of community hubs, the roll out of enhanced community services and more recently the response to Care Quality Commission inspections and the improvement plans that have been put in place. Indeed, there is an item on today’s agenda in relation to the findings of the most recently produced CQC reports.
With this in mind, it is concerning that an independent report has been produced which raises further concerns around the quality of patient care and safety. The Committee will therefore look into this in more detail and report back to Members at the earliest opportunity and also to the Committee meeting on 16th December 2022.”
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Public Questions and Statements
None were received.
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NHS Update on North Yorkshire Place since Integrated Care Systems were established on 1 July 2022 - updates from Wendy Balmain - North Yorkshire Place Director, Humber and North Yorks Integrated Care Board and Louise Wallace - Director of Public Health NYCC
Considered – Wendy Balmain, North Yorkshire Place Director, Humber and North Yorkshire Integrated Care Board gave a presentation to Members on the North Yorkshire Place following the establishment the of Integrated Care Systems (ICS) on 1 July 2022.
Key points to note were: · The 6 local places across Humber and North Yorkshire and 5 sector collaboratives · North Yorkshire County occupies one third of that footprint · Key roles and responsibilities of Integrated Care Partnerships, Integrated Care Boards, Health and Wellbeing Boards and Place Committees · The Humber and North Yorkshire Integrated Care Board Members · North Yorkshire Place Board Membership · Four Local Care Partnerships are being developed to reflect the diverse health and care needs of local communities · The New ICS strategy is being developed with clear alignment to the North Yorkshire Health and Wellbeing Board · Members of North Yorkshire County Council and the NHS Place Director will be represented at the Integrated Care Partnership · North Yorkshire Place priorities have been agreed at the Place Board Priority 1: A comprehensive and integrated health and social care model Priority 2: A high quality care sector, with sufficient capacity to meet demand Priority 3: A strong workforce Priority 4: Prevention and public health · Further detail in support the 4 Strategic Priorities of the North Yorkshire Place plan and the key actions required to achieve these.
Councillor Andrew Murday asked what measures were in place to monitor the changes. Wendy confirmed that there was sufficient funding and a number of metrics in place to monitor this and she would be happy to return to the Committee and report on progress in 12 months’ time.
Councillor Heather Moorhouse commented that some areas in North Yorkshire need extra support where there are less opportunities. Councillor Clive Pearson referenced our natural assets and that we need to connect and work together. Wendy confirmed that the re organisation would allow a more joined up approach from colleagues resulting in a reduction in waiting lists.
Councillor Paul Haslam referred to the carbon footprint of hospitals and how climate change is being accounted for and the benefits of good nutrition. Wendy referred to the Integrated Care Partnership and its aim to start well, live well and age well and add life to years and years to life.
Councillor Peter Lacey asked how this will be beneficial to North Yorkshire at a local level and how the winter fuel crisis may impact the County. Wendy reiterated this was about a sensible approach to local needs and through the local care partnerships deprivation can be recognised and colleagues brought together to rectify. Louise Wallace talked about the differences in population and the intelligence led data in use, which included the Craven area and the importance of people having up to date flu and Covid vaccinations. Community teams were working hard to promote this through communications and websites. The Director of Public Health Annual Report (DPHAR), also contains relevant local information and key priorities as well as case studies identifying lived in experiences. (2022 report to be published).
Councillor John Mann asked about the length of waiting lists and how we are looking to reduce this in North Yorkshire, the number of doctors that would need to be recruited and how to increase the flow of trainees and doctors generally.
There followed a discussion with the key points summarised below: · An international recruitment programme was currently underway with a focus on understanding where the gaps are and in which sectors in order to ensure the correct people would then be in the correct place · The workforce challenges being faced in the social care sector · Although the NHS is recruiting more doctors and nurses, training is long term, and the solution would not happen overnight · Recruitment is happening internationally · The carbon footprint of hospitals is largely due to the quality of estates although bids are in place to reduce these.
Councillor Liz Colling welcomed the approach and asked if there would be more joined up work in terms of co commissioning. Louise Wallace responded that while there were no plans to activate section 75 partnership agreements as there were no contractual reasons to do so, we would look to build trust and increase communications and learn from the current section 75 agreements in place. There would also be a requirement to look at opportunities to move or change investments or budgets.
Councillor Richard Foster asked about rural equalities in relation to Craven and how it fits into the place structure and how politically we move forward and interact with West Yorkshire. Louise reiterated that this was an important part of the way forward and it may be of benefit to invite Ali Jan Haider, the Place Director of West Yorkshire Integrated Care Board to a future Scrutiny of Health Meeting and/or Craven Area Constituency Committee.
Resolved – The Chairman thanked Wendy for her presentation and asked that she return to a future Scrutiny of Health meeting with an update on the progress of the ICB. Louise Wallace would attend the December meeting to provide Members with data on sleep, nutrition, school meals and care homes.
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TEWV Care Quality Commission Inspection and Action Plan - update from Brian Cranna, Care Group Director (North Yorkshire, York and Selby)
Prior to presenting this item Brian Cranna, Care Group Director, Tees, Esk and Wear Valley NHS Foundation Trust (TEWV) responded to the Chair’s announcement under agenda item 4. Brian made an apology on behalf of TEWV for the failure of care and systems and agreed to return to Committee in December with further details.
Considered – Brain Cranna then gave a presentation to Members on the latest Care Quality Commission (CQC) reports and the action plans to rectify.
The main points covered:
· The results of the CQC reports from June 2021 to August 2022 · The issues identified in these inspections · The action plans put in place to address the issues · Observations on the improvements made.
Councillor Liz Colling asked about the timescales for the improvements. Brain Cranna reiterated that workforce issues were apparent with recruitment being a challenge, so a review and a different approach would be considered as well as working with partner providers. More detail on this would be brought to the December meeting.
Councillor Peter Lacey enquired about the system issues, how this was being alleviated and how the Committee could provide support. Councillor Paul Haslam questioned the timeline and the metrics available to help give more information, perhaps at the next meeting.
There then followed a discussion in response to this where the main points identified were: · Challenges are countrywide and information needs to be shared · A transparent service is fundamental to success · Significant work around Autism and Mental Health has taken place and continues to be the case · Attracting and retaining employees was a key factor · Impact needs to be focused locally, identifying areas to respond to.
Resolved – The Chairman thanked Brian for his presentation and confirmed that he would return to the December Scrutiny of Health meeting with further detailed information on the West Lane reports and the CQC improvement plans.
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Scarborough & York Hospitals Care Quality Commission Inspections and Action Plans
Considered – Presentation by Simon Morritt, Chief Executive, York and Scarborough Teaching Hospitals NHS Foundation Trust and Heather McNair, Chief Nurse, York and Scarborough Teaching Hospitals NHS Foundation Trust to update Members on the most recent CQC report and the actions arising from it.
The main points to note were: · March 2022 Inspection raised 4 asks · Vacancies were running at approx. 10% · A change from paper based patient records has recently been undertaken and an electronic system is now in use · Cost savings are being seen in both paper usage and time · Volunteer help has been greatly appreciated · A formal report is expected in November 2022.
There then followed a discussion around the following areas: · The need to not rely too heavily on voluntary staff, in addition to as opposed to instead of should be the priority · The time and cost element of staff to travel across the County, this would be alleviated through sufficient successful recruitment · There was a large piece of work to undertake keeping staff once recruited.
Resolved – The Chairman thanked Simon and Heather for their presentation and requested they return to a future Scrutiny of Health meeting with further updates.
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South Tees Care Quality Commission Inspection Report and Action Plan - update from Sue Peckitt, Director of Nursing, Humber and North Yorks Integrated Care Board
Considered – Presentation by Sue Peckitt, Director of Nursing, Humber and North Yorkshire Integrated Care Board to update Members on the South Tees recent CQC report.
The presentation identified that the CQC reports highlighted 4 Section 29 A’s . The subsequent action plan contained 93 actions, all of which were now completed. This has been embedded and is being monitored ongoing and a further CQC inspection is expected by the end of the month.
Resolved – The Chairman thanked Sue for her presentation and suggested she return to a future Scrutiny of Health meeting with a further update.
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Update on the deep dive into Autism
Considered – the interim update report from Natalie Smith – Health and Adult Services. (HAS) to update the Committee on the deep dive into Autism agreed at the last Scrutiny of Health meeting.
The Chair gave Members an update on the work undertaken so far on the deep dive into Autism by colleagues in HAS. The completed report will be presented at the December meeting.
The committee discussed and suggested the following: · Inclusion of CYPS in the Autism outcome · Networking people with lived in experience for inclusion on the Autism work.
Support was given for the work undertaken on the Autism strategy. A subsequent meeting has been agreed with the Chair & Vice Chair, support officers and Natalie for a further update and discussion and a separate committee style session may be arranged once the finalised report is shared.
Resolved – HAS colleagues present the final report at the December 16th meeting and the next steps identified.
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Scrutiny of Health work programme 09.09.22 - Christine Phillipson
Considered – The Committee’s work programme.
· The objective is to enable the Committee to review the work programme and make suggestions for areas of scrutiny for inclusion for the remainder of the year and prioritise accordingly.
There followed a discussion which highlighted the following areas as suggestions for inclusion in the workplan: · The current situation in relation to GP waiting lists · Dentistry · Yorkshire Ambulance Service (YAS) performance · Mental Health · Social prescribing preventative solutions · Craven services, in particular Airedale Hospital · More detailed information on the TEWV CQC reports.
Whilst dentistry and GP waiting lists are of a high priority this is a national problem and the Committee has undertaken scrutiny work on these areas in the past. Following the conclusion of the current deep dive around Autism the Committee suggested a similar deep dive process be carried out around mental health. An update re Airedale hospital is on the agenda for the December Committee meeting Brian Cranna is returning to the Committee in December with further detail on the TEWV CQC reports. Louise Wallace has agreed to update the Committee on preventative measures, i.e. sleep, nutrition, meals etc. at the next meeting. YAS performance to be added to the work programme.
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Other business which the Chair agrees should be considered as a matter of urgency because of special circumstances
There being no further items of business the meeting concluded at 11.59am.
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