Agenda and draft minutes

That the Minutes of the meeting held on 18 June 2021 be taken as read and be confirmed and signed by the Chairman as a correct record.

There were none.

Any correspondence, communication or other business brought forward by the direction of the Chairman of the Committee.

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 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 July meeting.

County Councillor John Ennis summarised discussions that had taken place at the Mid Cycle Briefing on 23 April 2021:

·         Changes to the provision of hyper acute stroke services at Scarborough Hospital and the sequencing of updates being brought to the Scrutiny of Health Committee and the Scarborough and Whitby ACC

·         The response of the Tees Esk and Wear Valleys NHS FT to the CQC inspection that looked at 5 in-patient wards and which raised concerns about the complexity of the risk management process and how it was being implemented

·         The response of York and Scarborough Teaching Hospitals NHS FT to the CQC inspection of Scarborough Hospital which raised concerns about patient safety

·         Whether there are opportunities through the Local Plans and s.106 funding to support the development of health services in a housing growth area

·         A review of the committee work programme and the timings of matters coming to the committee.

Members of the public may ask questions or make statements at this meeting if they have given notice to Daniel Harry, Democratic Services and Scrutiny Manager (contact details below) no later than midday on Tuesday 15 June 2021. Each speaker should limit himself/herself to 3 minutes on any item. Members of the public who have given notice will be invited to speak:-

at this point in the meeting if their questions/statements relate to matters which are not otherwise on the Agenda (subject to an overall time limit of 30 minutes);

when the relevant Agenda item is being considered if they wish to speak on a matter which is on the Agenda for this meeting.

A member of the public who has submitted a question of statement will be offered the opportunity to read out their question/statement at the remote meeting, via video conferencing, or have it read out by the Chair or Democratic Services Officer. We are not able to offer telephone conferencing due to limitations with the technology and concerns about confidentiality.

There were no public questions or statements.

This item is ‘To Follow’.

Considered – a presentation by Simon Cox of the North Yorkshire Clinical Commissioning Group (CCG) and Neil Wilson of the York Teaching Hospital NHS Foundation Trust on the reconfiguration of stroke services provided by York Teaching Hospital NHS Foundation Trust at Scarborough.

The key points from the presentation are as summarised below:

·         There is documented evidence of the improved patient outcomes associated with the centralisation of specialist hyper acute stroke services

·         National clinical guidance suggests that hyper acute stroke units should see a minimum 600 patients per year to provide the appropriate level of workforce expertise and critical mass of resources

·         There have been persistent shortages in staff at Scarborough hospital, which has impacted on the ability to provided specialist stroke services there

·         The ‘drip and ship’ model was introduced at Scarborough hospital in 2015.  This meant that people with a suspected stroke were first assessed at Scarborough hospital, stabilised and then transferred to York hospital

·         In 2020 a direct admission model was put in place, replacing the ‘drip and ship’ model

·         The direct admission model results in quicker access to specialist treatment at the Hyper Acute Stroke Unit (HASU) at York hospital (known as ‘door to needle’ time and so better long term patient outcomes

·         The Humber, Coast and Vale Integrated Care System (ICS) conducted a formal review of hyper acute stroke services in the area in 2020/21.  The review found that the direct admission model was safe, efficient and able to deliver better outcomes than the previous ‘drip and ship’ model. These findings were verified by regional and national stroke leads in the NHS

·         The community-based rehabilitation services for people who have suffered a stroke are being reviewed to improve patient outcomes and enable earlier, planned and supported discharge from hospital

·         There is a renewed focus upon prevention and there is a key role for primary care in the identification and management of risk.

Simon Cox asked the committee to formally endorse the direct admission model.

There followed a discussion, the key points of which are as summarised below:

·         Stroke is a preventable disease and there needs to be a greater focus in primary care upon identification and early intervention

·         There will need to be more joint work between health and social care in managing the rehabilitation of people who have suffered a stroke and been discharged from hospital.  In particular, around speech and language therapy

·         Paramedics are key in making the first assessment when someone presents with a suspected stroke.  They need to be trained appropriately and supported.

County Councillor Liz Colling asked whether the change from the ‘drip and ship’ model to the direct admission model, which the committee were being asked to endorse, was going to be a permanent change.

In response, Simon Cox said that this would be a permanent change as there was no other viable alternative.  In line with NHS guidance, no formal public consultation is required as there is no viable alternative to what has been in place since 2020.  The  ...  view the full minutes text for item 164.

6.1 - An Update on the TEWV Care Quality Commission (CQC) Action Plan

6.2 – TEWV CQC Improvement Actions – presentation

6.3 – Enhanced Community Services Model

6.4 – Community mental health hub in Northallerton

6.5 – A community mental health hub for Selby

6.6 – Rectification work at Roseberry Park – verbal update.

Considered – reports and presentations by Naomi Lonergan, Martin Dale and Dr Tolu Olusoga of the Tees Esk and Wear Valleys NHS Foundation Trust (TEWV) regarding progress with improvement actions in response to recent Care Quality Commission (CQC) inspections, the progress with enhanced community services, the community mental health hubs for Northallerton and Selby and the rectification work being undertaken at Roseberry Park.

The committee Chairman asked Naomi Lonergan to first provide an overview of the response to the findings of the recent CQC inspection and then respond to questions relating to the other areas of work being undertaken by TEWV to improve mental health services.

Naomi Lonergan provided an overview as follows:

·         In January 2021 there was a CQC inspection of three acute wards for adults of working age and psychiatric intensive care units which raised concerns about risk management processes, which were found to be complex and difficult to follow

·         The CQC rated the wards as ‘inadequate’ for both safe and well-led.  The overall trust CQC rating remains ‘requires improvement’

·         An improvement programme has been developed and it is reviewed by an external quality assurance board

·         New, simpler, safety (risk management) summaries and safety plans for our patients in both inpatient and community settings have been introduced and risk management training and audits put in place

·         A practice development team has been established

·         Recruitment is underway to address some persistent work force shortages

·         A peer review was undertaken in May 2021

·         A CQC inspection is currently underway and will be completed at the end of July 2021.

County Councillor John Ennis asked for clarification of the scale of the workforce shortages across TEWV and what progress was being made with the work to recruit to vacancies.

In response, Naomi Lonergan said that the issues with staffing varied across the geography covered by and services provided by TEWV.  There were particular issues around the Scarborough, Harrogate and Selby areas.  In addition to a renewed recruitment drive, work is being done the develop nurse apprenticeships with education providers and social work placements.

Dr Tolu Olusoga said that there are also challenges in recruiting to medical and clinical positons as there was a great deal of competition and other areas may be more attractive to work in.  This is particularly the case in psychiatry.

There followed a discussion about the other areas of work being undertaken by TEWV to improve mental health services.

District Councillor Kevin Hardisty said that the community hub in Northallerton had progressed well and welcomed the fact that it would be a modern and purpose built facility.

County Councillor Heather Moorhouse said that the problems with recruitment were understood, known and common to many organisations working in North Yorkshire.  County Councillor Heather Moorhouse asked how the work was progressing with the rectification of the Roseberry Park site.

In response, Naomi Lonergan said that significant progress had been made and a further two blocks will be handed over to the service in September 2021.

County Councillor John  ...  view the full minutes text for item 165.

Considered – A report and presentations by Dr Stefan Serban, Public Health England (PHE), Simon Hearnshaw and Debbie Pattinson, NHS England (NHSE) and NHS Improvement (NHSI) Yorkshire and Humber regarding how NHS dental services are commissioned, some of the problems associated with that process and how services are recovering from the pandemic.

County Councillor John Ennis welcomed County Councillors Annabel Wilkinson and Tony Randerson to the meeting.  They had an interest in NHS dental service for Looked After Children and recent changes to provision in Scarborough, respectively.

Dr Stefan Serban, Public Health England (PHE), gave a presentation on children’s oral health in North Yorkshire compared to elsewhere in Yorkshire and Humber and nationally, as summarised below:

·         One fifth of under 5-year olds in the county have tooth decay

·         Of those, by the time they are 5 years old they will have had nearly 3 teeth decayed extracted or filled

·         Children living in the more deprived area of the county are most at risk of and affected by tooth decay and extractions

·         Tooth decay is almost entirely preventable

·         The situation in North Yorkshire is better than the averages for Yorkshire and Humber and England

·         Tooth decay is still the most common reason for hospital admissions in the 6-10 year-old age group

·         Hospital extractions for children’s teeth cost around £40 million/year to the NHS in England

·         Reducing sugar consumption, regular brushing with fluoride toothpaste, routine visits to dentists will help promote good oral health.

There followed a discussion and during the course of which the following points were made:

·         The levels of sugar consumed by young children and much higher than expected and shocking

·         More could be done to enable access to NHS dental services by Looked After Children

·         The high costs associated with a hospital admission to have an extraction of a decayed tooth of a child could be saved if a fraction of that money was invested in prevention in those areas most at risk

·         More targeted work could be done with schools

·         Local authority Public Health has a lead role to play in prevention and early intervention work.

There then followed a discussion about the commissioning of and access to NHS dental services, based upon the report that had been provided by Debbie Pattinson of NHS England.

County Councillor Tony Randerson raised his concerns about the closure, at short notice, of the NHS dental practice at Eastfields in Scarborough, which is one of the most deprived areas of the county.  County Councillor Tony Randerson said that all people deserved easy access to NHS dental healthcare near to where they live.  He said that this had been a problem with NHS dental provision in Eastfields for the past 17 years and that the Council needed to bring pressure to bear upon the government.  He then asked what more could be done to encourage greater NHS dental provision in the area.

In response, Simon Hearnshaw said that work was underway to re-procure those NHS dental services in Eastfields that had been  ...  view the full minutes text for item 166.

Considered – A presentation by Wendy Balmain, Director of Strategy and Integration, North Yorkshire Clinical Commissioning Group on the Health White Paper and Integrated Care Systems.

The key points from the presentation are as summarised below:

·         The ICS will be responsible for developing a plan that addresses the wider health, public health and social care needs in the area

·         There will be a NHS ICS board.  It and local authorities will have regard to that plan when making decisions

·         The Humber Coast and Vale ICS (HCV) will operate through two strategic partnerships, ‘North Yorkshire’ and ‘York and The Humber’

·         It will take on the commissioning functions of CCGs and be directly accountable for NHS spend and performance within the system

·         There will be a strong focus upon place-based services and integration

·         Also upon collaboration between NHS services rather than competition

·         Structures are being developed and shadow arrangements put in place

·         There is a strong focus upon continuity to services during this period of organisational change

·         The necessary legislation is excepted to be enacted in January 2022, with the ICSs being established as legal entities in April 2022.

County Councillor John Ennis noted that there White Paper was largely an NHS document and very little mention of social care was made.

In response, Wendy Balmain said that collaboration is key to the success of the ICS model, with success being measured as to how well the local health needs of the population are met and how health inequalities are reduced.

County Councillor Heather Moorhouse asked how the existing funding, based upon specific geographies, currently managed by the CCGs would be allocated by the ICSs.

Wendy Balmain said that the money would be kept in the ICS area.  Work would then be undertaken to understand the health needs across the area and how resources could then be best allocated to respond to those needs.

County Councillor Jim Clark raised concerns about the speed with which the changes were being introduced, the large geographical area being covered by the ICS and the scale of the financial challenge.

County Councillor John Ennis thanked Wendy Balmain for attending and asked for an update on progress with the implementation of the ICSs at a future meeting.

Resolved:-

1)    Wendy Balmain to attend a future meeting of the committee and update on progress with the implementation of the ICSs, in the summer or autumn of 2022.

Considered – A presentation Wendy Balmain, Director of Strategy and Integration, North Yorkshire Clinical Commissioning Group regarding the NHS response to and recovery from the pandemic.

The key points from the presentation are as summarised below:

·         NHS recovery planning has six elements, including developing primary care, supporting and retaining staff, rolling out the vaccination programme and building upon lessons learned from the pandemic and new ways of working

·         Waiting lists for elective procedures have increased as a result of the response to and recovery from the pandemic

·         Work to reduce waiting lists and times is prioritised according to risk

·         Hospitals are planning to be able to deliver 85% of pre-covid activity levels by July 2021

·         There has been a strong focus upon restoring all cancer services and the aim is to reduce the number of patients waiting over 62 days for treatment to pre-pandemic levels

·         There is increased demand for primary care services and face to face appointments and digital interactions are now back to almost pre-covid levels, albeit that there may be local variations across the county.

County Councillor John Ennis asked when the 100% recovery target for elective procedures would be met.

Wendy Balmain said that the focus was upon 85% at present.  As of September, a new target would be set with accompanying guidance.

County Councillor John Ennis noted that NHS would need ongoing support as the pace of work in the NHS had not let up since February 2020 and there was still some way to go with responding to and recovering from the pandemic.

Resolved:-

1)    That Wendy Balmain provides an update on the local NHS response to and recovery from the pandemic, with a focus upon the work to support people with ‘long-covid’ at the committee meeting on 10 September 2021.

Considered – A verbal report by Louise Wallace, Director of Public Health, North Yorkshire County Council regarding Covid-19 in North Yorkshire

Louise Wallace updated on progress with the vaccination programme in the county, as follows:

·         By 31 July 2021, all 1st doses of cohorts 1-12 as well as the majority of 2nd doses will have been completed

·         Preparations are in hand for covid-booster vaccinations and the annual flu vaccinations for all over 50s

·         Making sure that everyone has had two doses of the vaccine is important as is adhering to the standing advice ‘hands, face, space’.

Louise Wallace said that Public Health was working with various organisations to support the response to local outbreaks.  Also, to support the continuation of large scale public events, where it can be done in a covid-safe way.

Resolved:-

1)    That Louise Wallace provide a further update at the meeting on the committee on 10 September 2021.

Considered – Daniel Harry, Democratic Services and Scrutiny Manager, North Yorkshire County Council, introduced this item and asked Members to review the work programme and make suggestions for areas of scrutiny for inclusion.

Resolved:-

1)    That the committee review the work programme.

There was no other business.