NORTH YORKSHIRE COUNTY COUNCIL

17 November 2021

STATEMENT OF CHAIRMAN OF THE SCRUTINY OF HEALTH COMMITTEE

The Scrutiny of Health Committee has a responsibility to review any matter relating to the planning, provision and operation of health services in the County.  A key part of that responsibility is requiring NHS bodies to consult health scrutiny on proposals for substantial developments or variations to local health service provision.

Committee meeting on 10 September 2021

The committee last met on 10 September 2021, using Microsoft Teams for a live broadcast meeting.  At that meeting, committee members received detailed presentations on: the development of the services provided by the Harrogate and Rural Alliance; the Yorkshire Ambulance Service response to and recovery from the pandemic; the NHS response to and recovery from the pandemic locally; and data on the vaccination programme, infection rates and the number of people hospitalised with Covid-19.

There were six public questions/statements at the committee meeting relating to Scarborough Hospital and the move of services to York and other sites.  The majority related to the changes to the provision of hyper acute stroke services that had been enacted on a temporary basis in May 2020.

Outlined below are some of the areas that the committee has been looking at in-depth.

Scarborough Hospital

The proposed changes to hyper acute stroke services at Scarborough Hospital were not on the agenda at the September meeting.  In view of the public questions/statements received, however, there was a discussion during which it was restated that the committee had carefully scrutinised the changes to the provision of hyper acute stroke services over the past 18 months and at the June meeting endorsed the adoption of the direct admissions model as the only viable option.  This model of service delivery had been in place on a temporary basis since May 2020.

The NHS locally is undertaking a series of structured engagement sessions in Scarborough over November about changes to services at Scarborough Hospital, the outcome of which will be brought to the committee meeting on 17 December 2021.

Integration of health and social care services

The Scrutiny of Health committee, in common with the Care and Independence Overview and Scrutiny committee, has a long standing interest in reviewing how the NHS and social care locally can work more closely together and provide more integrated services.  One such model of integrated services in the county is the Harrogate and Rural Alliance (HARA).  This was setup in September 2019 and delivers an integrated operating model that brings together community health and social care services for adults.

The committee was interested to understand how that model of integrated working had developed and whether there were lessons that could be learned and applied to service delivery elsewhere in the county.  HARA has been at the forefront of the Council’s response to the pandemic and so it is too early to be able to review the performance data and information that would allow a full review of the effectiveness of this integrated way of working.  This is something, however, that the committee will follow up.

In the discussions about HARA, it became apparent that the structural changes that are underway across the NHS in terms of commissioning and provision are creating new points of focus within the system.  At a locality based, provider level the Primary Care Networks are becoming increasingly important.  At a strategic commissioning level, the Integrated Care Systems are embedding and taking on greater responsibility.  Over the next 12 to 18 months the committee will work to better understand how these changes will impact upon the provision of local services, how decisions about service provision are made and what the role of local government is in the decision making process.

Mental health services

The committee has continued to scrutinise the development and performance of mental health services in the county.  The Tees Esk and Wear Valleys NHS Foundation Trust (TEWV) has maintained a positive dialogue with the committee and been open about the challenges faced.  The committee has welcomed the investment that has been made by TEWV over the past 3 years in enhanced community services, the new in-patient hospital in York and the modern, purpose built community hub at Northallerton.  All of this has been done during the pandemic, when services have been stretched and had to evolve to meet the changing situation.  There remain some concerns, however, regarding the recent CQC inspections that have highlighted areas for improvement.  Also, the temporary closure of the Esk ward at Cross Lane Hospital, Scarborough due to staffing pressures.  The action plan that TEWV is implementing in response to the CQC inspections and the ongoing management of workforce pressures will be followed up by the committee.   

Yorkshire Ambulance Service

The Yorkshire Ambulance Service (YAS), like many other ambulance services in the country, has experienced very high levels of demand throughout the pandemic.  This is due, in part, to the challenges in the system around access to primary care.  The increasing levels of demand have then been exacerbated by the need to maintain covid-safe services, which has impacted upon the ability of YAS to work efficiently.  For example, the Patient Transport Service has reduced capacity from 3 people per ambulance to 1 person.  The number of journey’s made, therefore, increased even though demand had fallen.

Additional NHS funding of £5million has been secured for emergency response.  This will be invested in more staff for the ambulances and the control room.  YAS are also putting in measures to support the health and wellbeing of existing staff and to develop career pathways through the service to promote retention of experienced staff.

Once again, the committee has been hearing about the impact of the pandemic upon service delivery and the pressures caused by workforce shortages.  Whilst, the latter is well known and work is underway to address it, shortages of key personnel across the health system in North Yorkshire and particularly the coast are persistent and disruptive.

Mid Cycle Briefing on 5 November 2021

The Mid Cycle Briefing will be held on 5 November 2021.  At that meeting, there will be discussions regarding the consultation on changes to sexual health services commissioned by the Council and the temporary closure of the Esk mental health in-patient ward at Cross Lane Hospital, Scarborough.  These discussions will then help inform how the committee responds to the issues, what lines of enquiry to develop and when matters are to be brought to a public meeting of the committee.

Committee meeting on 17 December 2021

The next meeting of the committee will be at 10am on 17 December 2021.  At this time, the items for consideration at that meeting are as follows: hyper acute stroke services for the Scarborough population, with a focus upon the outcome of NHS led structured engagement that is taking place in November; the development of mental health services in the county and the Tees Esk and Wear Valleys response to recent CQC inspections; reflections upon some of the issues associated with unavoidably small hospitals; the outcome of the consultation on changes to sexual health services in North Yorkshire; the NHS response to and recovery from the pandemic, including an update on NHS funding; and an update on cvoid-19 prevalence.

COUNTY COUNCILLOR JOHN ENNIS

Chairman of the Scrutiny of Health Committee

1 November 2021