Agenda and draft minutes

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.

Apologies were received from:

·         Councillor Nick Brown, with Councillor David Jeffels as substitute.

·         Councillor John Mann.

All Members are invited to declare at this point any interests they have in items appearing on this agenda, including the nature of those interests.

There were none.

Members of the public may ask questions or make statements at this meeting if they have given notice to Diane Parsons, Principal Scrutiny Officer, and supplied the text (contact details below) by midday on Tuesday 11^th June, three working days before the day of the meeting.  Each speaker should limit themselves 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.

If you are exercising your right to speak at this meeting, but do not wish to be recorded, please inform the Chairman who will instruct anyone who may be taking a recording to cease while you speak.

There were none.

Update report from YAS on service delivery, challenges and recent developments. 

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?

Alternative sites had been considered, and further investment in Bridlington is planned to expand it as a vehicle servicing point.  Currently the site was being assessed to determine its suitability for expansion and additional vehicle technicians being based on site.

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?

The closure of the stroke unit at Scarborough was necessary because the need was only sporadic, leaving specialist crews idle for long periods.  The closure allowed for ambulances to be dynamically moved to areas of anticipated demand.

c)    Were there ever times when, due to transfers and maintenance, there were no available ambulances?

A handover escalation policy was in place to quickly free up resources at times when ambulances were critically short.  A process to rapidly release patients in hospitals to release community resources had been implemented earlier this year and was now in use at such times.

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.

The information in the report only covered transfers within YAS’ area, but members would be provided with the requested information separately through the Democratic Services Officers.  The Yorkshire Air Ambulance formed a part of the critical care strategy for major trauma.

e)    How did YAS performance on Hear and Treat compare with national guidelines, and were there currently any delays with community See and Treat?

Currently YAS Hear and Treat rates stood at 14.6%, against 16% nationally.  The two control rooms, in York and Wakefield, administered the dispatch of resources and the remote clinical triage hubs.  The target for See Treat Refer was 51%, which YAS were moving towards.  North Yorkshire saw a higher proportion of See Treat Refer than anywhere else.

f)     How many crewed ambulances are there on the road, compared to last year?

Staffing ambulances was currently made difficult by significant recruitment challenges.  North Yorkshire was an attractive place to work and an international recruitment campaign had been undertaken to attract recruits from Australia and New Zealand.  Paramedics from Teeside University remained a key  ...  view the full minutes text for item 5.

For the committee to consider the report and its recommendations.  Presented by Louise Wallace, Director of Public Health.

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. 

Work on the oral health promotion service was ongoing, alongside NHS colleagues.  A range of measures was been undertaken to address the problems, including improving awareness and education in schools through measures like workshops in schools, supervised tooth brushing sessions, and information handout packages.  This was being expanded across the Humber and North Yorkshire.  It was recognised that this was a multifactorial issue with a range of causes, that required a similarly diverse approach to tackle the problem.

Ensuring a good start in life was key from a public health standpoint, and deprivation was linked to a range of poor health outcomes.  There were flexible commissioning arrangements in deprived areas to ensure help could be targeted quickly to address arising issues, and work was ongoing to prepare a range of recommendations to tackle the issues.  The forthcoming Growing Up in North Yorkshire survey would help provide an evidence base to track progress and show how wellbeing and resilience was being developed.

b)    The fact that 20% of children in Scarborough were classed as living in poverty was highlighted as concerning.

Scarborough was identified as a particular area of concern and the high levels of depravation in that area and along the coast was recognised.  A poverty proofing toolkit for schools was under development to address deficiencies, and approval had recently been obtained to reform the provision of free school meals by making them opt-out rather than opt-in, so children would be included in the scheme by default and removing the need for families to apply.  In each case this would provide £450 of support annually.  Mental Health Support Teams were also active in the area, and the role of local care partnership was also recognised.  ICB representatives undertook to find further information on mobile fluroide varnish services in the area and pass this information back to members.

c)    Members asked what steps were being taken to address the recommendations in the report, and how negative trends could be addressed.

The Joint Strategic Working Group brought together ICB place leads, North Yorkshire Public Health, and Children’s Services to identify areas where health services and the local authority could work more closely together.  The Healthy Children and Families Board worked to  ...  view the full minutes text for item 6.

Report from the Director of Public Health, updating on the Better Care Fund Submission for 2023/25 and quarterly returns for 2023/24.

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.

Financial strains were recognised and the need to carefully prioritise allocation of the BCF.  The ICB had several ways to integrate and deliver services and was not solely relying on the BCF to do so.  Care partnerships were in there infancy but were expected to deliver savings, as well as expected efficiencies from working with one council after local government reorganisation, which had removed the need to work concurrently with the seven former district and borough councils.

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.

The challenges in recruitment and retention due to lower pay in some roles were acknowledged, but there were a range of roles at varying levels of pay and the figure cited was for the lowest paid.  The Make Care Matter campaign had tried to address this issue.

Members thanked officers for the report.

Resolved:

That the report be noted.

Report from the Principal Scrutiny Officer regarding the current government consultation on expanding community water fluoridation in the north east of England. Briefing note provided by NHS England.

Members considered a report inviting comment on a government consultation, regarding the expansion of community water fluoridation schemes across north east 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 north east 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.

Report from Diane Parsons, Principal Scrutiny Officer, proposing a programme of work for the committee.

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.

Friday 13^th September 2024 – 10am – County Hall, Northallerton.

The date of the next meeting, on Friday 13 September at 10:00, was noted.