North Yorkshire Council
Scrutiny of Health Committee
Minutes of the meeting held on Friday, 14th June, 2024 commencing at 10.00 am.
Councillor Andrew Lee in the Chair, plus Councillors Liz Colling, Caroline Dickinson, Richard Foster, Sam Gibbs, Peter Lacey, Rich Maw, Heather Moorhouse, David Noland, Andy Paraskos, Clive Pearson, Andy Solloway and Andrew Timothy.
In attendance: Councillors .
Officers present: Vicki Ackerley (Strategic Integration Development Manager), Dr Gill Kelly (Public Health Consultant), Louise Wallace (Director of Public Health); Edward Maxwell (Senior Democratic Services Officer), and Diane Parsons (Principal Democratic Services Officer
Other Attendees: Lisa Pope (North Yorkshire CCG - Deputy Director of Primary Care and Integration) and Martin Ramsdale (NHS England (Northeast and Yorkshire)); Helen Edwards (YAS – Head of Comms and Community Engagement), Jeevan Hill (YAS – Director of Partnerships and Operations (Humber and North Yorkshire)), and Paul Mudd (YAS – Head of Operations (Northeast and Yorkshire).
Apologies: Councillors Nick Brown and John Mann.
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Copies of all documents considered are in the Minute Book
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Minutes of the Meeting held on 8th March 2024
Resolved:
That the Minutes of the meeting held on 8 March 2024, having been printed and circulated, be taken as read and be confirmed and signed by the Chairman as a correct record.
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Apologies for Absence
Apologies were received from:
· Councillor Nick Brown, with Councillor David Jeffels as substitute. · Councillor John Mann.
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Declarations of Interest
There were none.
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Public Questions or Statements
There were none.
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Yorkshire Ambulance Service
Members considered a report from Yorkshire Ambulance Service (YAS), which updated the committee on current performance and provided information on challenges currently facing the service. YAS saw high levels of operational demand continue, but also performed more strongly in some areas. Patient handovers continued to be well above the national 15-minute target.
Members sought further information on the report:
a) Had
alternative arrangements for servicing and maintaining ambulances
been considered, to obviate the need for lengthy round trips to
Harrogate to carry out maintenance?
b) How
effective was the stroke service being provided at York? When
the service was discontinued at Scarborough it was intended that
patients could be taken to York and transferred to Hull for CT
scans and further treatment. Was this process functioning
effectively, without undue delays from transfers and
handovers?
c) Were there
ever times when, due to transfers and maintenance, there were no
available ambulances?
d) What
information was available for transfers across into areas covered
by North East Ambulance Service? In areas such as Great Ayton
and Richmond, patients were often transferred to James Cook or
Darlington Memorial Hospital. Concern was expressed around
the perceived reliance on the Yorkshire Air Ambulance to facilitate
patient transfer.
e) How did
YAS performance on Hear and Treat compare with national guidelines,
and were there currently any delays with community See and
Treat?
f) How
many crewed ambulances are there on the road, compared to last
year?
g) Could YAS
account for the significant gap between the initial estimated cost
of the new Scarborough ambulance station of £7 million, and
its current projected cost of £21 million? Had
opportunities for additional funding been sought to meet this
shortfall?
h) Members
had heard anecdotal evidence that there were sufficient crews to
cover the Craven and Skipton areas, but insufficient vehicles for
them to operate.
i)
Was there a policy which prohibited paramedics from administering
fentanyl as a painkiller in critical trauma cases? This was
in response to reporting in the case of the death of Harry Dunn in
Northamptonshire in 2019.
Members thanked YAS for their attendance and the report, but identified some gaps in data. While there was sufficient detail on issues in Scarborough, members felt that other areas were not adequately covered in the report, and there was a lack of information on the impact on residents rather than the performance of specific hospitals. As well as requesting follow up communication, members asked that for this to be included in future reports.
Resolved:
That the report be noted.
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Director of Public Health Annual Report 2022/23
The Director of Public Health presented the 2022-23 Annual Report “In Our Words: A Child’s Life in North Yorkshire”, which focussed on the 151,000 children and young people under 25 living in North Yorkshire, which had been prepared in conjunction with the Youth Council. The report highlighted the rapid impact of digitisation, and mental health and wellbeing and made a number of recommendations, as well as providing an update on the 2021-22 Annual Report, “Learning From COVID-19”.
The following points were raised in the discussion by members, and answers given by officers:
a) Members
sought information on the factors driving the decline in poor oral
health in children under five, and what steps were being taken to
address this. Members also discussed the links between poor
oral health and financial deprivation.
b) The fact
that 20% of children in Scarborough were classed as living in
poverty was highlighted as concerning.
c) Members
asked what steps were being taken to address the recommendations in
the report, and how negative trends could be addressed.
Members thanked officers for their report, and highlighted that they were willing to offer assistance in acting as a link to their communities, highlighting initiatives to residents and providing feedback and local context.
Resolved:
That the report be noted.
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Better Care Fund 2023/25
The Director of Public Health presented a report updating members on the Better Care Fund (BCF) for 2023-25, which included the Quarterly Report for Quarters 2, 3, and 4 for 2023-24.
Members discussed the report and obtained further information during questions:
a) The use of
the BCF to strategically focus on prevention and stimulate joint
working, and concerns were expressed that increasingly the fund was
being spent reactively to “prop up” failing
systems.
b) Members
expressed some concerns that the starting salary for care staff of
£11.92/hr was not competitive, and only just above the
National Minimum Wage. Members thanked officers for the report.
Resolved:
That the report be noted.
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Consultation on Community Water Fluoridation Expansion in Northeast England
Members considered a report inviting comment on a government consultation, regarding the expansion of community water fluoridation schemes across northeast England, which would affect some northern areas of North Yorkshire. Comments were invited which would be passed to the Executive member, responding on the Council’s behalf as NYC was a statutory consultee.
Representatives from NHS England reiterated the benefits of the scheme, which could serve as part of a package to improve children’s oral health, as had been highlighted during Minute 6.
During the discussion, members disclosed that they had been contacted by groups opposing the measure, but said that on balance the claims that fluoridation posed health risks were not evidenced. The naturally occurring fluoride in drinking water was highlighted, along with the use of fluoridation in some other areas of England for many decades.
Members also raised concerns about the potential for artificial fluoridation to cause fluorosis, and asked about some reports that hip fractures could be increased. The Committee was advised that the National Monitoring Report monitored fluoridation for adverse health outcomes, and no evidence had yet arisen regarding hip fractures. Fluorosis and mouth ulcers had been reported in some cases, but the cosmetic effects of these conditions could be countered and were much less significant than the high levels of tooth decay which fluoridation could help prevent.
Members heard from expert representatives of NHS England and the Director of Public Health, who advised that on balance the scheme would have a very positive impact and that the evidence base to support fluoridation was clear.
Resolved:
That the Committee communicate the following response to the Executive member which would contribute to the consultation response:
The Scrutiny of Health Committee considered the government consultation on expansion of community water fluoridation schemes in the northeast of England at its meeting of 14th June 2024. The Committee had been provided with details of the proposals including an outline of the areas of North Yorkshire that would be affected, along with a briefing produced by NHS England on water fluoridation. They were also able to draw on input from the Director of Public Health and a Consultant in Dental Public Health.
Having considered the information put before it, the committee are supportive of fluoridation when viewed as part of a broader package of public health interventions and factors (such as encouraging supervised teeth brushing in children) that are needed to prevent and reduce tooth decay. The committee did acknowledge that there are contrary views to community water fluoridation but having considered the scientific basis around potential health impacts such as fluorosis, Members felt that on balance the outcomes are very favourable, particularly in looking to help prevent tooth decay in children.
Clearly if any further evidence is developed to indicate that this matter would need to be revisited by the committee then they would welcome the Director of Public Health keeping them apprised.
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Work Programme
Members considered the committee’s work programme, and the chair reminded members about training opportunities, including the Oliver McGowan Training on Learning Disability and Autism. While mandatory for health and social care staff, the chair strongly recommended that members undertake it.
The committee was advised that the agenda currently contained a large number of items, and that the Mid Cycle Briefing in July would likely decide to defer a number of less urgent items to December. The motion on glyphosates and neonicotinoids, proposed by Cllr Brown at Full Council, and referred to Scrutiny of Health on 21 February, would now be considered at the September meeting with a view to it returning to Full Council in November.
Resolved:
That the work programme and updates be noted.
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Date of Next Meeting
The date of the next meeting, on Friday 13 September at 10:00, was noted.
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The meeting concluded at 12.00 pm.