Agenda and draft minutes

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

Apologies were received from County Councillor John Mann, Hambleton District Councillor Kevin Hardisty, and Richmondshire District Councillor Pat Middlemiss.

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 thanked all present for being able to attend the meeting at the revised start time of 9am.  The change was necessary due to an unavoidable clash with another committee meeting and the constraints on the live broadcast technology which means that two meetings cannot be held at the same time.  He said that the meeting would need to finish promptly at 10.55am.

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 of 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 November 2021 meeting.

County Councillor John Ennis noted the sad and untimely death of former County Council John Clark.  He was a member of the committee up to 2017 as a County Councillor and then more recently in his capacity as a Ryedale District Councillor.  He was an active member of the committee and a strong advocate for high quality, accessible health services for the people of North Yorkshire.

County Councillor John Ennis said that the order of the printed agenda had been changed to accommodate the availability of key speakers.  The substantive items would now be taken as follows: 8; 9; 10; 7; and 6.

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 7 September 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.

Daniel Harry, Democratic Services and Scrutiny Manager, said that there were six public questions for the committee.  The Council Constitution states that public questions are taken in the order in which they are received and the maximum time allocated in total to public questions is 30 minutes.

Daniel Harry read out the first five questions at the request of those people who had submitted them.  Scarborough Borough Councillor Richard Maw was present to read out his question.

The answers to the six questions were provided by Lucy Brown of York and Scarborough Teaching Hospitals NHS Foundation Trust and Simon Cox of the North Yorkshire CCG.  Neither were able to attend the meeting due to other commitments and so Daniel Harry read out the responses on their behalf.

The responses to the public questions were batched together where there were common themes.

PQ1 - Dr Gordon Hayes – centralisation of specialist services and associated travel times

Scarborough Hospital has seen a huge reduction in local healthcare service provision for the 200,000 residents in its catchment area since York Trust took over in 2012.

One of the services that has been lost is out-of-hours ophthalmology, which I experienced first hand at the end of 2020.

I have previously suffered a torn retina in my eye which required laser repair. Early one Friday evening at the end of last year I experienced sudden onset recurrent symptoms which I had been advised required a fairly rapid ophthalmological assessment.

I telephoned 111 - who advised me to attend my nearest Emergency department within two hours.

On attending the Emergency department at Scarborough Hospital I was advised there was no longer an out-of-hours ophthalmology service located there and was signposted to York Hospital where our 'local' service was now based.

I phoned the Emergency department at York Hospital prior to travelling over to specifically check there was a duty ophthalmologist available who could see me if I arrived there. This was confirmed.

I was driven to York from Scarborough by a family member (I could not drive myself in the circumstances) where I eventually arrived over an hour later. I checked in at the Emergency department, was subsequently assessed by a nurse, and then waited for over two hours - only to be told in the early hours of Saturday morning that the duty ophthalmologist could not see me then as previously stated, but that they required me to return early the next morning.

I was driven back to Scarborough, arriving home at 2am on Saturday morning - and wearily driven back to York at 8am to get to York Hospital in time for my appointment.

The medical assessment I received when I saw the ophthalmologist was absolutely fine. But the access system and travelling involved (a total of 5 hours and 160 miles) were appalling. I was very lucky to have someone who could drive me to York, and at times when public transport would be difficult if not impossible to find. Many others would  ...  view the full minutes text for item 176.

Update on the development and performance of the services provided by the Harrogate and Rural Alliance

Considered - a presentation by Richard Webb (Director of Health and Social Care, NYCC) and Wendy Balmain (Director of Strategy and Integration, North Yorkshire CCG).

The key points from the presentation are as summarised below:

·         The alliance was setup in September 2019

·         The alliance delivers an integrated operating model that brings together community health and social care services for adults in Harrogate

·         It involves North Yorkshire County Council, Harrogate and District NHS Foundation Trust, Tees Esk and Wear Valleys NHS Foundation Trust, North Yorkshire CCG, and the Yorkshire Health Network Local GP federation

·         The annual budget is £49m and there are 400 staff (approximately 50/50 HDFT and NYCC)

·         Benefits include reducing duplication, the continued development of the Home First Model and the development of care market

·         The co-location of the workforce leads to new ways of working

·         It is not the intention to roll out the HARA model to other parts of the county.  Each area needs to develop a partnership and model of health and social care delivery that works for them

·         Links with the Primary Care Networks are becoming increasingly important

·         Local Government Review presents new opportunities as key elements of prevention and early intervention are brought together in the new unitary.

County Councillor John Ennis asked how HARA would fit within the Integrated Care System for Humber Coast and Vale.

Wendy Balmain said that there are four care partnerships within the footprint of the Integrated Care System for Humber Coast and Vale, and one of these aligned to the area covered by HARA.

County Councillor John Ennis asked how HARA had performed and how patient outcomes were measured.

In response, Richard Webb said that the alliance was setup in September 2019, just six months before the first national lockdown.  As such, much of its work to date has been dominated by the response to the pandemic.  Whilst this has resulted in some new and innovative ways of working that will be continued post pandemic, it has meant that it has been difficult to measure performance overall.  Anecdotally, there has been improved working across the local system with better care planning and more timely decisions about care pathways and packages.  This will have had a positive impact upon patient outcomes.  He said that further work would be undertaken to evaluate HARA and its first 2 years of operation.

County Councillor John Ennis summed up, thanking Richard Webb and Wendy Balmain for attending and noting the positive impact that HARA had locally during a very difficult period of time.

Resolved:-

1)    That a watching brief be maintained and that an evaluation of the performance of HARA be brought back to a future meeting of the committee.

Considered - a verbal update by Rod Barnes, Chief Executive, Yorkshire Ambulance Service NHS Trust

Rod Barnes updated as summarised below:

·         The service was in a unprecedented position with very high levels of demand

·         The service is operating at the highest level of escalation since early July 2021

·         All ambulance services are currently struggling with high levels of demand and one has declared an emergency

·         There are 3,900 calls a day to the control room at present, with an increasing number of those calls relating to serious incidences

·         The activity levels are similar to what you would see in winter and there were 190,000 calls to the NHS 111 line in July alone, which is 20% higher than normal

·         The challenges in the system around access to primary care and dental care, amongst others, can lead of an increased ambulance call out

·         The need to maintain covid-safe services has meant that the Patient Transport Service has reduced capacity from 3 people per ambulance to 1 person.  The number of journey’s made, therefore, increased despite there being lower demand

·         The requirements upon the NHS for infection control are greater than for the public as a whole and this impacts upon the service provided by YAS

·         Additional NHS funding of £5million has been secured for emergency response and this will be invested in more staff for the ambulances and the control room

·         Looking ahead, the intention is to bring in an additional 300 staff prior to the busy Christmas period and to develop more defined career paths with the service to aid staff retention

·         Work is underway to support staff wellbeing and also to build surge capacity, which will in turn take the pressure off A&E.

County Councillor Heather Moorhouse asked whether YAS worked with the Air Ambulance.

In response, Rod Barnes said that that there was a strong working relationship between the two services.

County Councillor John Ennis asked whether the transport of patients from the catchment area of Scarborough Hospital with a suspected hyper acute stroke directly to York hospital, rather than going to Scarborough Hospital for assessment first, created any operational issues for YAS.

Rod Barnes said that the direct admission model made more sense as it removed delays caused by patient transfer between sites and improved access to specialist treatment.

County Councillor John Ennis thanked Rod Barnes for attending.

Resolved:-

1)    That a watching brief be maintained on YAS performance and that Rod Barnes keep the committee informed of any emergent issues of concern.

Considered – A presentation by Wendy Balmain, Director of Strategy and Integration, North Yorkshire Clinical Commissioning Group.

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

·         NHSE returns include regular updates on outlining plans for activity, finance and workforce

·         There is a potential efficiency saving requirement of approximately 3%

·         Good progress being made with the vaccination programme.  As of 27 August 2021, a total of 524,572 second doses had been administered

·         Currently preparing for a covid booster programme to be carried out in the autumn alongside an influenza vaccination programme for all over 50s

·         Patients on waiting lists for treatment are to be supported through  the ‘Waiting Well’ programme that is being developed

·         Patients continue to be prioritised due to clinical need

·         Face to face appointments and digital interactions are now exceeding pre-covid levels (in total), albeit that there may be local variations across the county

·         Recognise that there is a need to better describe the health system so that people access the right care at the right time

·         A programme of support is in place for staff.  The staff absence rates for NHS trusts in the Humber Coast and Vale Integrated Care System were on 17 August 2021 an average of 6.2% ranging from 3.8% to 7.7%

·         GPs can make referrals to specialist long covid treatment, where there are severe symptoms that persist longer than four weeks after contracting covid 19.

County Councillor Philip Barrett asked what more could be done to enable a wholesale return to face to face appointments with GPs and primary care.

In response, Wendy Balmain said that there is a lot of anecdotal evidence that suggests that some people are having real problems accessing in person appointments and she recognised that this was very frustrating for many people.  Wendy Balmain said that she would raise this issue with colleagues in the CCG who work directly with primary care providers as the issue is likely to be exacerbated during the winter months when people tend to become ill or existing conditions worsen.

County Councillor John Ennis summed up, thanking Wendy Balmain for attending and responding to questions from the committee members.

Resolved:-

1)    That Wendy Balmain provides an update on the local NHS response to and recovery from the pandemic, with a focus the potential impact of national funding and policy changes at the committee meeting on 17 December 2021.

Considered – A verbal report by Victoria Turner, Public Health Consultant, North Yorkshire County Council.

Victoria Turner updated as summarised below:

·         At 7 September 2021, there had been 53,544 positive tests since 3rd March 2020.  The massive expansion of testing of school children may be a factor to consider here

·         The 7-day incidence rate (to 05/09/2021) in North Yorkshire was 361.8 cases per 100,000 population, higher than the England rate of 336.5

·         At 7 September 2021, there were 143 hospital beds occupied by people admitted from North Yorkshire.  123 people were in general and acute beds and 20 in intensive care beds

·         There have been an estimated 441 Covid-19 deaths in hospital of North Yorkshire residents since 1 September 2020 (wave 2).  There were 259 deaths in wave 1 (March-August 2020)

·         The pandemic has exacerbated existing health inequalities as people with generally poorer health have been disproportionately affected

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

County Councillor John Ennis asked what surveillance was in place to track the development and spread of new variants of covid-19.

In response, Victoria Turner said that Public Health England regularly send positive PCR tests for genetic sequencing to help identify and assess any new variants.  Where variants appear, then there is close working with the local Public Health team to understand the implications and response.

County Councillor Andy Solloway said that more large scale vaccination centres were needed as these were efficient to run and manage and could vaccinate large numbers of people in a short period of time.

County Councillor John Ennis summed up, noting the success of the vaccination programme and the work that Public Health in the county was doing to manage local outbreaks of covid.

Resolved:-

1)    That Victoria Turner or Louise Wallace provide a further update at the meeting on the committee on 17 December 2021.

Considered – the report of Daniel Harry, Democratic Services and Scrutiny Manager, regarding the committee work programme.

Daniel Harry introduced the report and asked Members to review the work programme and make suggestions for areas of scrutiny for inclusion.

Daniel Harry noted that there were only two more formal meetings of the committee prior to the May 2022 elections.  The March meeting may fall within the pre-election period and so the agenda for that meeting may be limited.

Resolved:-

1)    That the committee review the work programme

2)    That an item on unavoidably small hospitals is added into the work programme.

There was no other business.