Agenda and minutes

To consider the Executive and Cabinet Member decisions within the remit of the Health Scrutiny Committee. Note - there have been no such decisions made in the period since the Resilient Communities Scrutiny Committee’s last meeting in April 2016 when it was responsible for health scrutiny.

The Committee noted that there were no Executive or Cabinet Member decisions on this occasion.

To consider the content of the Council’s Forward Plan, July 2016 - October 2016, relating to Health Scrutiny Committee functions.

The Committee considered the items contained within the Forward Plan, July - October 2016 within the portfolio of the Cabinet Secretary, Councillor Graham Cain relating to health scrutiny functions. The Committee requested an update on the ‘Health and Wellbeing Strategy’ and was advised by Councillor Cain that public consultation on the draft Strategy had concluded and the final draft would be considered for approval by the Health and Wellbeing Board on 20 July 2016.

To consider the Public Health Scrutiny Review final report.

Mrs Sharon Davis, Scrutiny Manager presented the Public Health Scrutiny report. She explained that the Resilient Communities Scrutiny Committee, who had been previously responsible for health scrutiny, had undertaken a review following issues identified in the Public Health Annual Report 2014. The Annual Report had been a response to the Due North report in 2014 which had looked at regional health equity issues. She added that the scope of the review had been extended to include consideration of the Joint Strategic Needs Assessment which formed the main evidence base for the Health and Wellbeing Strategy. Review meetings had been held and Cabinet Members with relevant health responsibilities had been consulted.

Mrs Davis referred to the six recommendations contained in the report which would be considered by the Executive following the Health Scrutiny Committee meeting. She added that the Cabinet Secretary, Councillor Graham Cain would take into account any scrutiny comments.

The Committee agreed to approve the final report for consideration by the Executive.

To review performance against the Council Plan 2015-20 for the period 1st April 2015 – 31st March 2016.

Mrs Ruth Henshaw, Corporate Development Officer advised that Council Plan key performance indicators (KPIs) had been set by the Corporate Leadership Team. The report covered performance for 2015-2016 in relation to health KPIs. These had previously been reported to the Resilient Communities Scrutiny Committee who had been responsible for health scrutiny functions.

Overall performance was good but there were three exceptions where performance was not on target. These were non-opiate drug users completing treatment successfully and sustaining progress; numbers of overweight children aged 10-11 years old and the percentage take-up of NHS Health Checks (adults aged 40-74 years old).

The Chair queried why there was a significant difference in non-opiate and opiate drug users completing treatment successfully and sustaining progress. Councillor Cain explained that a drugs strategy was being developed and suggested that detailed information could be provided for the Committee’s next meeting.

Members referred to tackling the problem of overweight children and raised concerns that vending machines selling unhealthy snacks were located in some health centres, and that with the high levels of tourism a large number of unhealthy snacks were readily available.  The Committee also commented on the importance of parental responsibility and queried what work was being done with parents.

Councillor Cain noted the issue of overweight children and unhealthy snacks being sold in health centres and undertook to take the issue forward through the Health and Wellbeing Board. He added that there were various initiatives underway to support young people such as the Better Start Programme and the Head Start Programme supporting teenagers.

Mrs Lynn Donkin, Public Health Specialist explained that developing better health for people was a complex area with a range of work required. She gave the example of a successful campaign ‘Give up Loving Pop’ (GULP) which had encouraged young people to give up fizzy drinks for at least a month. There was no direct work with parents although there were initiatives such as Better Start, an Outreach Strategy and healthy choices were promoted through an awards scheme for healthier catering.  She added that the Council and partners had signed up to a ‘Healthy Weight Initiative’ and joint work had been developed through the Healthy Weight Steering Group.

Members queried why the percentage take-up of NHS Health Checks (adults aged 40-74 years old) had decreased. In response, Mrs Liz Petch, Public Health Specialist explained that this was mainly due to more accurate data recording at GP practices rather than a real drop in health checks. Some GPs had been recording health information in the wrong data fields but data quality had improved. She added that Blackpool was one of the top ten areas in the country for levels of health checks.

Members noted that one of the key projects in the 2015-2020 Council Plan period was the ‘New Business District’ which aimed to attract more professionals to work in Blackpool town centre.  Members recognised that previously there had been an increase of professionals with a higher than average disposable income working locally and  ...  view the full minutes text for item 6.

To consider the 2015-2016 performance of the Blackpool Clinical Commissioning Group (CCG).

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group (BCCG) and Mr Roy Fisher, Chairman, BCCG presented the BCCG’s performance report for March 2016 and for the full year, 2015-2016. Mr Bonson explained that the BCCG had to follow national reporting requirements and key target measures. The BCCG commissioned a range of services provided by other organisations and so shared performance responsibility. The key measures covered a range of access to service areas. 

He highlighted areas where performance was below target and needed improving. The target for accident and emergency waiting times from arrival to being discharged after treatment was for 95% of patient visits to be achieved within four hours. The end of year outcome was under 93% and for March 2016 only around 86%. Mr Bonson explained that accident and emergency waiting times were nationally challenging and that winter months had a knock-on impact for the rest of the year with ongoing efforts to regain performance.  Members enquired about the two measures for types of accident and emergency attendance and requested more detailed information on the ‘all types’ of attendance measure. Mr Bonson explained that the walk-in health centre in Whitegate Drive, Blackpool offered a Tier 3 GP-led primary care service and this level of accident and emergency service had to be recorded separately and agreed to provide more detailed information following the meeting. Mr Fisher explained that the Tier 3 service at the walk-in centre on Whitegate Drive provided an important part of the care pathway including pointing patients in the right direction of care.

He added that urgent care systems were generally under pressure, e.g. ambulance emergency call-outs had increased. This had resulted in ambulance response times falling short on all targets for March 2016 and the full year 2015-2016 across Lancashire. Pressures were also seasonal with the greatest number of call-outs during the winter period. However, more recently figures were back on track for the Lancashire area.

Mr Bonson explained that although the performance report measures were for Blackpool, the BCCG was responsible for regional commissioning of the North West Ambulance Service (NWAS) and therefore the figures presented were for the wider area. It was noted that more localised performance figures demonstrated that the NWAS met targets within Blackpool and it was agreed that a more detailed discussion on  the ambulance response rates in Blackpool would be brought to a future meeting.

Members sought clarification on the difference between two of the Category A red indicators which both required 75% of response times to be within eight minutes but were below target. Mr Bonson explained that the first red indicator was for life-threatening emergencies and the second red indicator for other extremely serious call-outs such as road traffic accidents. Members added that the public wanted reassurance that a good ambulance service was being provided and good work should be publicised.

Members enquired how Accident and Emergency services and ambulance services would cope with increased pressures particularly during the winter period and what planning was  ...  view the full minutes text for item 7.

This report details the work Healthwatch Blackpool has conducted throughout the 2015/16 financial year, its key findings for each service review, and what changes have been made as a result of the involvement of the organisation.

Mr Steven Garner, Service Manager, Healthwatch Blackpool presented Healthwatch’s Impact Report 2015-2016 and draft priorities for 2016-2017.

He highlighted that Healthwatch had undertaken a wide range of review and survey work throughout the last year identifying the effectiveness of health and social care provisions mainly based on the views and concerns of local people using services. Subsequent reports had followed with a number of recommendations mainly directed at service providers. Responses had been sought from the providers concerning the recommendations with progress on actions was also sought.

The Chairman noted that some providers had not yet responded to recommendations and queried the reasons for the lack of response. Mr Garner considered that there were no serious issues as providers had generally welcomed review findings. He added that there was no legal duty requiring providers to respond but just to note recommendations.

Mr Garner explained that the annual report outlined the impact of Healthwatch’s work and recommendations.  He advised that notable recommendations taken on board by providers related to people’s wellbeing including increased food rotas and choice and better activities co-ordination at care homes. Other key work had included reviewing urgent care provision and why people were not making the best use of accident and emergency services. The urgent care review had also led to the service provider apologising for a lack of information being provided to patients whilst waiting for services and without refreshments. The provider aimed to ensure improved patient awareness in future.

Mr Garner added that a particularly important finding was that the ‘voice’ of service users was not currently being taken into account for the strategic development and commissioning of services. This was an important issue that needed addressing given that development and commissioning of services ultimately impacted upon the services available and delivery of services.

Mr Garner explained that consultation had taken place seeking the public’s views on health and social care priorities for 2016-2017. The consultation had identified five broad priority areas which would be refined. The priorities were GPs, hospital services, emergency services, adult mental health and care homes.

The Chairman referred to the previous agenda item, Public Health Scrutiny Report which included a recommendation that Healthwatch should look beyond its approach of surveys for identifying people’s concerns and adopt a greater focus on work promoting public health and tackling health inequalities.  Mr Garner responded that Healthwatch did work with Public Health partners and closer working would be developed further, in particular taking into account the ‘voice’ of service users. He gave examples of public health work including being on a steering group to tackle tobacco and alcohol issues. Healthwatch had also been involved in developing the Joint Strategic Needs Assessment for identifying and tackling local priorities to produce the Health and Wellbeing Strategy.

Members noted that adult mental health services had been identified as a priority. Members expressed concern that children’s mental health services had not been prioritised citing that issues such as young people’s stress and anxiety had been recently prominent in  ...  view the full minutes text for item 8.

To brief the Health Scrutiny Committee on Delayed Transfers of Care (DToC) from Blackpool Teaching Hospitals NHS Foundation Trust.

Ms Pat Oliver, Director of Operations, Blackpool Teaching Hospitals (BTH) and Mr Ian Ellwood, Discharge Manager, BTH presented the Delayed Transfers of Care report. Transfers of care issues concerned delays affecting patients who had finished one stage of their treatment but then had to wait some time before bed facilities became available at the next stage. Transfers of care could be internal or external and could be to another health or social care provider. The next stage of care could be at a facility such as a care home or the patient’s own home.

Ms Oliver outlined the wider background context of issues and pressures that could impact on patient discharge services. She referred to the earlier agenda item on the Blackpool Clinical Commissioning Group’s performance report and issues concerning accident and emergency waiting times and ambulance response rates. She explained that ‘front door’ issues impacted upon ‘back door’ performance and vice-versa, for example a patient unable to be transferred from  a hospital bed impacted upon an accident and emergency patient. She added that there were three wards dealing with a range of patients with complex issues.

Ms Oliver explained that there many patients arrived in winter with respiratory diseases, heart attacks, infections and were generally frail and vulnerable people.  There was a lot of pressure on local ambulance services due to much higher than average demand in Blackpool compared to regional neighbours.

Members requested if figures could be provided as to inappropriate use of ambulance services. Ms Oliver agreed to obtain inappropriate use figures from the North West Ambulance Service for a future meeting.  She added that a joint piece of work was taking place with GPs concerning out-of-hours services with a view that GPs could direct appropriate cases to hospital in good time rather than people unnecessarily using emergency services.

Mr Ellwood explained that there was a national performance dataset for measuring delayed transfers of care as presented in the report and appendices. Figures were for a five week period (one month) from 13 May 2016 to 13 June 2016. The recent five week period was compared against the parallel five week period in 2015.

Mr Ellwood reported that the number of delays for the five week period in 2015 averaged around 30 per week, which had risen to around 50 for the parallel period in 2016. He explained that the number of corresponding lost bed days, which had also risen, depended on the complexity of individual patients’ needs and reasons for delays. There could also be other factors such as seasonal variation due to bank holiday pressures.

Ms Oliver added that delayed transfers of care, with patients still resident in wards unnecessarily, could potentially have an annual financial cost of up to £1million for each ward of 20 beds. There were 25 wards and the delays equated to the loss of two wards amounting to an annual cost of up to £2million. The current pressures creating delays reflected a national trend and Ms Oliver advised that it  ...  view the full minutes text for item 9.

To review the Health Scrutiny Committee’s Workplan for 2016-2017.

The Chairman referred to the Health Scrutiny Workplan for 2015-2016 and progress with the Implementation of Recommendations. Members were informed that this was an initial outline Workplan which was evolving and aimed to focus on key strategic health issues and future health service plans. There were a range of actions to pursue following the earlier performance agenda item with Blackpool Clinical Commissioning Group (BCCG).

Members were informed that training seminars were being arranged with BCCG, Blackpool Teaching Hospitals and the Council’s Public Health Team to learn more about their roles and work. Members were reminded that an additional meeting had been arranged on Wednesday 12 October 2016 to receive a progress update on issues at the Harbour care facility and improvements made.

The Committee agreed:

1.        To approve the Scrutiny Workplan subject to the inclusion of the additional items identified for consideration with the Blackpool Clinical Commissioning Group.

2.        To note the ‘Implementation of Recommendations’ table.

To note the date and time of the next meeting as Wednesday, 28 September 2016

commencing at 6pm in Committee Room A.

The Committee noted the date and time of the next meeting as Wednesday 28 September 2016 commencing at 6pm in Committee Room A, Blackpool Town Hall.