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Agenda and draft minutes

Venue: Committee Room A, Town Hall, Blackpool

Contact: Sharon Davis  Scrutiny Manager

Items
No. Item

1.

DECLARATIONS OF INTEREST

Members are asked to declare any interests in the items under consideration and in doing so state:

 

(1) the type of interest concerned either a

 

(a)   personal interest

(b)   prejudicial interest

(c)    disclosable pecuniary interest (DPI)

 

and

 

(2) the nature of the interest concerned

 

If any member requires advice on declarations of interests, they are advised to contact the Head of Democratic Governance in advance of the meeting.

Minutes:

There were no declarations of interest on this occasion.

2.

MINUTES OF THE LAST MEETING HELD ON 13 FEBRUARY 2019 pdf icon PDF 223 KB

To agree the minutes of the last meeting held on 13 February 2019 as a true and correct record.

Minutes:

The Committee agreed that the minutes of the last meeting held on 13 February 2019 be signed by the Chairman as a true and correct record.

3.

PUBLIC SPEAKING

To consider any applications from members of the public to speak at the meeting.

Minutes:

There were no requests from members of the public to speak on this occasion.

4.

EXECUTIVE DECISIONS pdf icon PDF 218 KB

To consider the Cabinet Member decision taken within the remit of the Adult Social Care and Health Scrutiny Committee since the previous meeting.

Additional documents:

Minutes:

The Committee considered the Cabinet Member decision taken since the last meeting, PH15/2019 ‘Adult Services Fees and Charges 2019-20’ and invited Councillor Lynn Williams, Cabinet Member for Adult Social Care and Health to outline the key changes to fees and charges made as part of the decision. In response to questioning, it was reported that 50% of people would be unaffected by the increases as they received care free of charge, of those that did pay for services, 22% would be expected to contribute an increased amount.

5.

WHOLE SYSTEM TRANSFERS OF CARE SCRUTINY REVIEW pdf icon PDF 650 KB

To update the Committee on the implementation of the recommendations made by the Committee following the final report and recommendations of the Whole System Transfers of Care Scrutiny Review.  

Additional documents:

Minutes:

Ms Berenice Groves, Interim Director of Operations for Unscheduled Care, Blackpool Teaching Hospitals NHS Foundation Trust (BTH) and Mr Peter Murphy, Director of Quality Governance, BTH presented the Integrated Care Partnership’s response to the recommendations made in the Whole System Transfers of Care Scrutiny Review. Ms Groves highlighted that hospital performance had improved in the winter of 2018/2019 in comparison to previous years citing increases in meeting the four hour standard measure of wait time in the emergency department and a fall in non-admitted breaches.

 

The Committee considered the response to each recommendation of the review in detail, asking questions regarding implementation and determining whether further information was required or if the recommendation could be signed off as complete.

 

The Committee agreed:

 

Recommendation

Action/update

Next steps

One – To consider introducing a policy to limit the number of family and friends attending the emergency department.

 

A policy had been introduced as per similar policies on the wards. Clinicians were also allowed to use their discretion in implementing the policy dependent on the severity of the illness or injury of the patient.

 

Completed.

Two – To review extended access appointments to look at usage, the reasons why the service was not more widely used and how to improve the use of appointments.

A review had been undertaken and take-up had been improved, however, there remained unused capacity. Members of the Committee also provided additional anecdotal evidence to suggest that not all GP surgeries offered extended access appointments as a matter of course. Mr Roy Fisher, Chairman, Blackpool Clinical Commissioning Group highlighted the ongoing work to improve the offer of the appointments including undertaking a mystery shopper exercise. He advised that work was ongoing to ensure practice was embedded.

Completed.

Three – To explore the impact of delayed receipt of prescriptions from the pharmacy on discharges from hospital and identify a course of action to address the delays.

It was noted that further work was required to roll out identified improvements across all hospital wards. A number of wards had been trialling different approaches and the use of Ward Pharmacy Technicians had proved positive. Members highlighted a number of issues with dispensing of prescriptions which demonstrated that further improvements were required. It was also noted that the discharge lounge, where patients could wait for prescriptions, had recently started operating seven days per week.

Members were of the opinion that further work was required on the recommendation and requested a further response in approximately six months.

Four – To identify ways to offer facilitated parking for discharge staff.

It was reported that this recommendation had been the hardest to achieve and that it had been an ongoing issue for a number of years. However, it had now been resolved and Mr Les Marshall, Head of Adult Services reported that staff had been appreciative of the resolution and productivity and efficiency of discharges had improved as a result.

Completed.

Five – To review discharge processes to ensure they are efficient, effective and to identify  ...  view the full minutes text for item 5.

6.

BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST: PATIENT SAFETY pdf icon PDF 227 KB

To update the Committee on the actions taken to ensure patient safety within Blackpool Teaching Hospitals NHS Foundation Trust.

Minutes:

Mr Peter Murphy, Director of Quality Governance, Blackpool Teaching Hospitals NHS Foundation Trust (BTH) highlighted that there were national, ongoing reviews of clinical staffing and it had been recognised that there were not enough doctors and nurses for continuing demand. BTH currently had approximately 260 registered nurse vacancies.

 

With regards to the Standardised Hospital Mortality Index (SHMI), Mr Murphy reported that the current measure was 116, which was a small increase since the last reported quarter’s value of 115 in quarter 2 of 2018/2019. The Committee considered the SHMI in detail and was informed that the index was calculated using algorithms and being above the average of 100 did not necessarily mean that there was a specific issue, but that the hospital should investigate potential problems. Blackpool Teaching Hospitals NHS Foundation Trust sought to learn from all deaths and had commissioned two external reviews to gain assurance and develop appropriate action plans with a focus on pneumonia, Chronic Obstructive Pulmonary Disease (COPD) and sepsis. The intricacies of responding to subtle symptoms which did not necessarily indicate a serious condition and diagnosing patients correctly was also discussed in detail.

 

The Chairman highlighted that Blackpool Victoria Hospital had been an outlier for the SHMI since 2011 and queried why the hospital had been performing poorly with regard to the indicator for such an extended period. Mr Murphy advised that work had been ongoing to review deaths and understand the ways in which they had been documented. Once a diagnosis had been made, the patient would be given a code that reflected the diagnosis. Work was ongoing to determine the accuracy of the coding and its reliability. If a patient was coded incorrectly, the recording of any future death could also be recorded incorrectly.

 

Ms Maxine Power, Director of Quality, Innovation and Improvement, North West Ambulance Service (NWAS) advised the Committee that the SHMI was a complex indicator based on unexpected patient death up to 30 days following original diagnosis, whether the patient had died within the hospital setting or elsewhere. Therefore, a wide range of partners and systems outside of the hospital also contributed to the SHMI performance. It was queried whether data was available to demonstrate the number of patients that died unexpectedly within the hospital in comparison to the number who died after leaving hospital. Mr Murphy agreed to investigate the level of data held and supply the information to the Committee as appropriate.

 

The Committee went on to consider the Care Quality Commission (CQC) Inspection of the Emergency Department carried out in January 2019 and queried whether all the actions identified by the CQC had been implemented. It was noted that the actions had been implemented and that the Trust had been subject to a fully comprehensive CQC inspection of all services, the outcome of which was expected later this year. Mr Murphy highlighted that the Executive Team of the Trust’s primary focus continued to be the quality of care for patients.

 

The Committee agreed:

1.      To receive the  ...  view the full minutes text for item 6.

7.

BLACKPOOL CLINICAL COMMISSIONING GROUP END OF YEAR PERFORMANCE pdf icon PDF 223 KB

To consider the end of year performance for Blackpool Clinical Commissioning Group (BCCG) (April 2018 – March 2019) and to review the outstanding performance related recommendations for the Fylde Coast system following the Adult Social Care and Health Scrutiny Committee meeting on 28 November 2018.

Additional documents:

Minutes:

Ms Kate Newton, Performance and Quality Manager, Blackpool Clinical Commissioning Group (BCCG) presented the BCCG report on end of year performance for 2018-2019.

 

The Committee drew attention to the continued poor performance for the percentage of patients being seen within two weeks of referral for breast cancer symptoms, noting that the target was being substantially underachieved, with a target of 93% and performance of 34%. Ms Newton advised that the deterioration in performance had been attributed to physical capacity constraints in terms of both imaging and clinic space. Members noted that the reason for poor performance had changed and that the last time the Committee had considered the performance for the target the reason for the poor performance then had been cited as a lack of consultant radiographers. Ms Newton advised that the previous issues had been resolved and that a plan was in place to ensure targets were met by the end of July 2019, highlighting that new equipment had been purchased. Further concern was raised regarding the length of time it had taken to resolve the issues and the number of women that had been put at risk as a result and Members were advised that the BCCG was reviewing the situation on a weekly basis and was involved in the process to recover the target as quickly as possible.

 

Concern was also raised regarding the number of 12 hour trolley waits in the emergency department, noting that there had been 300 in 2018-2019, of these 212 were mental health related. Ms Groves, Interim Director of Operations for Unscheduled Care, Blackpool Teaching Hospitals NHS Foundation Trust (BTH) highlighted that the indicator had been a focus of attention for BTH. The Psynergy pilot scheme had been introduced to alleviate the number of inappropriate mental health attendances at the emergency department and it was hoped the scheme would have a positive impact on the number of mental health patients waiting for more than 12 hours.

 

Mr Mark Lewis, Operations Manager, North West Ambulance Service (NWAS) advised that the Psynergy vehicle was currently in operation from 4pm until midnight, however, it was hoped the timeframe could be expanded if additional funding could be identified. The pilot commenced in November 2018 and had attended 950 patients. Of those patients, 11% had been transferred to the emergency department, a reduction from the 100% that an ambulance would have transported. The patients transferred to the hospital by the Psynergy vehicle had already received a mental health assessment before attendance at the emergency department, which therefore also speeded up their admission. It was considered that the Psynergy vehicle would have a positive long term impact and NWAS aimed to roll out the scheme to other areas in the North West.

 

Ms Groves also highlighted that the emergency department regularly coped with 200 attendances per day without any delay, however, on a number of days attendances could be between 230 and 260, which did cause significant delays in the speed in which patients could be seen.  ...  view the full minutes text for item 7.

8.

SCRUTINY COMMITTEE WORK PROGRAMME pdf icon PDF 225 KB

To review the work of the Committee, the implementation of recommendations and review scoping documents requiring approval as required.

Additional documents:

Minutes:

The Committee noted that the workplan would be updated based on the topics identified at the recent workplanning workshop.

 

The implementation of the previously identified recommendations was discussed and it was agreed that the action relating to the Healthwatch contract could be signed off as complete. It was agreed to defer consideration of the response regarding the ‘healthy weight’ letters until the next meeting.

 

The Committee also approved the Healthy Weight Scrutiny Review scoping document and agreed to carry out the review as a whole committee, subject to individual availability in November 2019.

9.

DATE AND TIME OF NEXT MEETING

To note the date and time of the next meeting as Wednesday, 16 October 2019, commencing at 6pm in Committee Room A.

Minutes:

The Committee noted the date and time of the next meeting as Wednesday 16 July 2019, commencing at 6.00pm.