North Yorkshire County Council
Scarborough and Whitby Area Constituency Committee
Minutes of the remote meeting held on Wednesday, 20th January 2021 commencing at 10.30 am.
County Councillor Joe Plant in the Chair. plus County Councillors C Pearson, Andrew Backhouse, Derek Bastiman, David Chance, Liz Colling, David Jeffels, Janet Jefferson, Andrew Jenkinson, Tony Randerson and Roberta Swiers.
In attendance: County Councillors Carl Les, Gareth Dadd and Caroline Dickinson.
Officers present: Richard Marr and Gary Fielding.
Other Attendees: Simon Cox (NHS North Yorkshire CCG), and Heather McNair and Simon Morritt (York Teaching Hospital NHS Foundation Trust).
Apologies: County Councillors Eric Broadbent and Callum Walsh
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Copies of all documents considered are in the Minute Book
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Introductions & Apologies for Absence
The Chair welcomed everyone to the meeting and Members introduced themselves.
Apologies were given for County Councillors Callum Walsh and Eric Broadbent.
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Minutes of the meeting held on 6 November 2020
Resolved –
That the Minutes of the meeting held on 6 November 2020, having been printed and circulated, be taken as read and confirmed and signed by the Chair as a correct record.
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Declarations of Interest
There were no declarations of interest.
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Public Questions & Statements
There was one public statement from County Alderman Jayne Miller in relation to agenda item 6 – East Coast Review & Scarborough Hospital Performance Update. The Chair agreed that the statement would be read out by the clerk in the absence of the member of the public, and that it should be read out at the start of consideration of agenda item 6.
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Council Budget Proposals for 2021/22
Gary Fielding, Corporate Director for Strategic Resources gave a presentation on NYCC’s latest Budget & Mid Term Financial Strategy Forecasts, together with the associated risks and issues, which highlighted: · 2021/22 would be balanced mostly through one-off Government funding and Reserves – Gary Fielding provided a breakdown of where those reserves would come from, confirming that some reserves were ring-fenced e.g. insurance reserves. Members noted the use of Reserves would allow the time to produce the necessary plans. · No Spending Review was expected beyond 2021/22; · It was not a sustainable option to balance 2022/23 through the use of Reserves, so a strong and credible plan was needed; · Funding and Net Service Pressures; · The legacy of Covid – a breakdown of the post Covid pressures; · The latest forecast for the next 3 years was projecting a £82m cash shortfall at the end of the MTFS, with a recurring £30m shortfall thereafter; · Whilst there was a great deal of uncertainty at this stage, the Local Government Review may deliver part of the solution; · Council Tax consideration and Adult Social Care Precept Options – it was confirmed that the Council had the option of taking advantage of the 3% ASC precept now or retaining the flexibility of doing so in the future. Members noted that the ASC precept would be built in to the base budget; · The proposed locality budget per annum for 2021/22 and 2022/23£ was 10k per member, at a total cost of £1,440k; He went on to outline the Council’s budget plan, which included the option of an intermediate Budget later in 2021, and the next steps in the Budget process.
Finally, Gary Fielding highlighted some specific financial issues affecting the Scarborough & Whitby constituency area, which included: · Projections for maintained schools, including that 115 LA maintained schools (49%) were projecting an in-year deficit in 2020/21; · A breakdown for schools across the constituency e.g. the number of schools expected to be in deficit over the next 3 years and the value of that deficit, which was expected to rise to £18.3m by 2022/23. Members noted that the average deficit figures provided often masked some serious problems for some individual schools; · The Scarborough & Whitby constituency area covered one ASC budget area · The expected HAS Directorate overspend for 2020/21 of £10.3m, made up of COVID-19 related budget pressures of £13.9m and non-COVID net underspends of £2.7m, related to business-as-usual activity; · Detailed examples of reduced ‘business-as-usual’ activity, as a result of COVID e.g. a 30% reduction in Living Well referrals and a 25% reduction in reablement activity etc. Members raised concern about the likely impact of a growing backlog of need in those areas; · In Scarborough & Whitby 38% of existing residential and nursing care contracts were being paid above NYCC rates; · Overall, 94.7% of the new residential and nursing payments since April 2020 cost more than the Council’s official rate; Looking forward, it was confirmed that it might be possible for Area Constituency Committees to have more say on Highways maintenance budgets as part of the development of their role.
The Chair thanked Gary Fielding for his informative presentation and it was
Resolved – That the presentation and update be noted.
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East Coast Review & Scarborough Hospital Performance Update
The public statement submitted by County Alderman Jayne Miller was read out by the clerk as follows:
“I am grateful for the opportunity to contribute to the debate regarding the Healthcare of the residents and patients on the Coast.
As a former non-executive director of the former Healthcare Trust it gives me no pleasure to express deep concern about the deterioration in the state of Healthcare at Scarborough Hospital since it was taken over by the York Healthcare Trust. Many of the specialities such as breast cancer, strokes, surgical procedures previously done at Scarborough are now carried out in York and the overall deterioration in care on the wards at Scarborough Hospital is at a critical level.
We all know that the Health Service is facing unprecedented challenges due to Covid but whilst dedicated staff work hard to save lives on these wards, we cannot allow the care of patients on other wards to fall well below the acceptable standard they not only need but are entitled to expect.
A lack of personal care such as ensuring a patient receives basic human respect, being washed, kept clean, helped to drink and eat if required, given empathy, support and compassion cannot and should not be allowed to go unchallenged.
The March CQC report identifies many of these issues. Equally concerning it identifies a lack of clinical leadership and many can testify that the situation has deteriorated further since March. What procedures have the Trust put in place to hold Consultants to account for their performance, what procedures are in place to ensure Wards are being managed so patients feel valued and cared for and relatives kept informed and up to date, how are complaints being monitored so lessons are learnt and used as an essential part of identifying poor practice and care.
Owing to Covid restrictions relatives cannot go into see for themselves that their loved ones are being cared for as they would wish. They can only trust and hope they are being cared for and rely on telephone calls - only to be let down when they cannot get the information they seek.
It is clear that as more and more services are being transferred to York, Scarborough Hospital's ability to serve the Community is being diminished.
The issues I refer to are not a matter of resources - they are indicative of poor management and a culture which lacks robust challenge. I urge the Committee to hold the Trust Management to account to put in place transparent, tangible strategies to radically improve and monitor the quality of care, clinical leadership at Scarborough Hospital and give our patients the dignity, compassion and healthcare they deserve so we can all have confidence that the service can and will care for us when we need it most.”
The Chair noted his thanks to County Alderman Jayne Miller for her contribution and invited NHS representatives to give their presentation.
The Committee received an update on NHS North Yorkshire Clinical Commissioning Group’s East Coast Transformation Programme from Simon Cox – Programme Director, together with a performance update for Scarborough hospital from Simon Morritt (CEO) and Heather McNair (Chief Nurse) of York Teaching Hospital NHS Foundation Trust.
The transformation programme update provided a strategic overview of the recognised challenges for coastal communities, for isolated rural District General Hospitals e.g. dis-economy of scale, workforce recruitment and retention, infrastructure, limitations of effective networks, the impact of the wider economy and the financial challenges if providing care within the provided financial allocations. He went on to detail progress with the programme to date, and gave reassurance that the principal aim of the Scarborough Acute Review was to support the ongoing provision of an Emergency Department in Scarborough.
In regard to the ongoing performance of Scarborough Hospital, Simon Cox outlined the 2019 quality and performance summit which aimed to address the same quality concerns raised in the public statement. Finally, he drew members attention to the planned relaunch of the East Coast programme in 2021.
In response to the issues raised within the public statement, Heather McNair provided information on the quality improvement achievements to date and the planned actions going forward which would deliver the improved standards on wards
Heather McNair provided an overview of the quality improvement achievements to date and confirmed the hospital’s access to newly trained nurses. She also provided information on IT improvements that supported the monitoring of the quality of care on wards. She went on to confirm that as a result of the improvement measures, the Trust now felt they were in a position to request that the CQC remove the Hospital’s regulatory actions.
Simon Cox noted the Hospital was part of a wider health and social care system, particularly with the elderly population in Scarborough, requiring closer working with primary and social care services outside the boundary of the hospital. He tied to this the benefits of working with Whitby Hospital. He also confirmed that significant additional capital (£47m) had been secured to deliver a new Emergency Department and Intensive care unit and the initial business case for that development was due to be approved in summer 2021, with a planned opening in late 2023. He noted this evidenced the commitment to the long-term sustainability of the Hospital
He went on to provide a brief update on staffing level improvements in general surgery and urology, and confirmed that the temporary acute service change was to be made permanent. In regards to the stroke service, he confirmed that the temporary stroke service pathway in operation since May 2020 i.e. the direct transfer of all patients requiring acute stroke care to York and Hull, was proving successful with improved clinical outcomes. Finally, he provided an overview of the new service model for Medical Oncology.
The Chair thanked CCG representatives for the presentation, but drew attention to a number of recent CQC reports which evidenced concerns about staffing and breaches in service standards. He also queried Scarborough Hospital’s response to the Ockenden review of maternity services, and highlighted the public perception of Scarborough Hospital moving towards becoming an accident and emergency centre with all other acute services being moved to York.
In response, Heather McNair confirmed the steps taken to both improve training and staffing levels in the respiratory and cardiology wards, and the ongoing response to the Ockendon review which would require some investment.
Simon Cox and Simon Morritt assured members that whilst there would always be an ongoing review of the services provided in both Scarborough and York, the CCG was committed to the provision of an acute hospital in Scarborough. Simon Morritt also acknowledged that the public perception needed addressing, and that action would be taken to do so, which included renaming the organisation York & Scarborough NHS Teaching Foundation Trust from April 2021.
Other members raised their concerns about: · The ongoing quality of basic care provision on the hospital wards; · The increased activity for York hospital in dealing with the number of transfers · Staffing levels, the use of bank nurses and the ability to attract consultants; · The possibility to use CCTV on wards to monitor · The future of Malton Hospital; · The absence of a continuing narrative around the changes to hospital services
In response, Heather McNair confirmed: · The current vacancy rate at Scarborough hospital was roughly double of that at York Hospital (13% & 6% respectively). · Bank nurses were never left to run wards and it was the same small cohort of bank staff that were used. · The use of CCTV on wards was not considered appropriate but it was used in public areas. · Patients and families were encouraged to talk to the hospital about any treatment and care concerns - the process for monitoring and reviewing complaints was outlined.
Simon Cox confirmed there would be a continued evolution of health care across the east coast, as happened in all other areas of the country, and agreed there needed to be better communication with partners about changes. Simon Morritt also accepted the need for an improved and ongoing discourse with partners, politicians and the public, and gave a commitment to do so.
Finally, the Committee agreed they wished to keep a watching brief and the Chairman requested a further update in June 2021. It was also agreed that the Chairman would write to the CQC about the community concerns for the future of Scarborough Hospital and the quality of care.
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Scarborough & Whitby Area Constituency Committee Work Programme 2020/21
Considered -
The report of the Assistant Chief Executive (Legal and Democratic Services) asking Members to review the Work Programme, taking into account the outcome of discussions on previous agenda items and any other developments taking place across the area.
Resolved - That the Democracy Officer update the work programme to reflect the following decisions made during the meeting:.
17 March 2021 Meeting - Road Markings Update - Stronger Communities Update on work in response to Covid throughout the year
16 June 2021 Meeting - Further Performance Update on East Coast Review - Update on Scarborough & Whitby Citizens Advice Bureau
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The meeting concluded at 1.00 pm.