Agenda and minutes

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.

Councillor O’Hara declared a personal interest concerning Blackpool Teaching Hospitals NHS Foundation Trust, which was referred to in Item 4 ‘Blackpool Clinical Commissioning Group End of Year Performance Report’, as his daughter was a Governor of the Trust.

To agree the minutes of the last meeting held on 9 May 2018 as an accurate record.

The Committee agreed that the minutes of the Adult Social Care and Health Scrutiny Committee meeting held on 9 May 2018 be signed by the Chairman as a correct record.

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

The Committee noted that there were no applications to speak by members of the public on this occasion.

To consider the performance of the Blackpool Clinical Commissioning Group for April 2017 to March 2018.

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group presented the Clinical Commissioning Group’s end-year performance for 2017-2018 (April 2017 - March 2018). Mr Roy Fisher, Chair, Blackpool Clinical Commissioning Group and Ms Kate Newton, Performance and Quality Manager, Midlands and Lancashire Commissioning Support Unit were also in attendance.

The Chairman referred to 266 incidents of patients having to wait over four hours on a trolley (target now retitled to ‘decision to admit’) whilst in Accident and Emergency. The high number was much worse than the previous year. This was particularly concerning given that the target was actually zero and Members had raised the issue on previous occasions and been given assurance that matters would improve.

Mr Bonson explained that the issue was mirrored nationally and was not specifically due to Accident and Emergency patient numbers but wider system pressures concerning patient flows throughout the hospital. In particular, availability of beds was an issue. Optimum bed occupancy would be between 85-90% allowing some spare capacity for ad-hoc demand. However, winter pressures had resulted in full bed occupancy and it had become an all-year challenge to reduce the bed pressures.

He clarified that the ‘decision to admit’ [to Accident and Emergency] target had been breached numerous times on a few days leading to the high number, i.e. a slightly skewed figure. Analysis had been undertaken to better understand the issues. A key element was the lack of available beds meaning that patients were being queued up with the knock-on effect impacting upon other areas, e.g. the 18 week target for GP referral to treatment. He added that the beds issue was not solely due to the Hospital, e.g. patients had been seen in Accident and Emergency and were awaiting mental health assessments but at times the Lancashire Care Foundation Trust had no available beds at its Harbour facility.

Mr Bonson re-iterated that the issues were due to ‘whole system’ pressures and that these had been escalated for consideration. NHS Improvement was involved with looking at what support was needed to tackle the beds issue.

Members queried whether effective use had been made of recent Council loans to the Hospitals Trust to help tackle pressures such as bed shortages. Mr Bonson advised that the loans had been made directly to the Trust who would be best placed to explain how the monies had been spent.

Members queried why waiting times for first cancer treatment following urgent GP referral and NHS health screening were so high. They expressed concern that some patients were cancelling cancer treatment appointments so they could maintain planned holidays.

Ms Newton explained that there were various reasons for delays including patient choice. The aim was to confirm a prompt appointment with patients as soon as possible but flexibility was required. Cases could involve various treatment options and complex pathways of care. However, delays due to patient choice were also referred back to their GPs for further influence highlighting the health issues and potential implications of unnecessary delay.  ...  view the full minutes text for item 4.

To present performance against Priority 2 of the Council Plan 2015-2020 for the period 1 April 2017 – 31 March 2018.

Members were presented with progress on the Council Plan performance indicators for the period 1 April 2017 to 31 March 2018. There were sixteen comprehensive indicators for Adult Social Care and fourteen for Public Health. Senior officers were present to answer any detailed service questions.

Members focused on the ‘exceptions’ commentary reports where indicators were significantly off target. The Chairman referred to the number of drug users successfully completing treatment for sustained recovery. Opiate drug user performance was significantly off target and substantially so for non-opiate drug users.

Mr Paolo Pertica, Head of Community Safety Strategy explained that there were different methodologies for measuring drug treatment outcomes. The National Drug Treatment Monitoring System (NDTMS) in the North West was monitored by John Moores University which received data from all drug service providers within the region. In addition to that, performance monitoring also took place by those commissioning the service locally.

He clarified that some of the targets referred to in the exceptions commentary such as ‘Number of drug users successfully completing treatment - Opiates and Non-opiates’ -  were set using inaccurate baseline data provided by the previous contracted provider. However, even if the baseline data had been correct, such percentages of successful completions would have been extremely ambitious and rarely seen anywhere in the country. Similarly, such ambitious outcomes were not known in most countries in Europe and elsewhere in the world.

Mr Pertica explained that the previous contracted service had been decommissioned and a new provider appointed to deliver the service, which had a more holistic approach to sustained recovery. In-depth analysis was currently taking place between the commissioners of the service, Public Health and the new provider to ensure that any inaccuracies with data recording were rectified, accurate baselines set and new realistic, achievable targets agreed.

Members noted that the numbers of people successfully completing alcohol treatment was less than half of the target of 500 people and had been based on the inaccurate data. They also noted that successful outcomes through the new service provider had increased but were still no more than national average levels. Members felt that the target needed to be more ambitious and also record numbers of people who sufficiently recovered to lead normal lives.

Mr Pertica agreed that targets needed to be ambitious but also realistic. He clarified that high numbers of people with drug and alcohol problems was often associated with a number of contributory factors such as deprivation, unemployment and poor housing. He added that whilst the effectiveness of drug and alcohol treatment had improved considerably in recent decades, there was still no simple solution to help those with drug and alcohol problems to achieve abstinence, and that was the case not just in the UK but throughout Europe and most countries worldwide. 

However, Mr Pertica reported that a number of people did complete treatment successfully each quarter and some of them were able to secure full time employment and pursue constructive and productive drug-free lives. He re-iterated that total  ...  view the full minutes text for item 5.

This report provides an update on the current status and developments in Adult Social Care.

MsKaren Smith, Directorof AdultServices presentedan updateon thecurrent statusand developments inthe caresector forBlackpool.The updateincluded residentialand nursing provision,regulated placements,care athome servicesand otherongoing work and plans.

The Chairman referred to the current provision table on volume, demand and capacity across the in-house Homecare Service. The table outlined different types of social care provision, numbers of new referrals for each provision type and total hours allocated for new referrals as well as the total number of care hours delivered across the provision types.  He queried what quality outcomes had been achieved in terms of performance.

Ms Smith explained that the table aimed to give a current picture of social care demand and levels of investment and provision. She added that social care provision came through a mix of council commissioned services and from the private sector. She suggested that these social care issues could form part of a scrutiny exercise.

Ms Smith gave the example of the ‘Homes Best’ service which was developed to provide a speedy hands-on response to help people get home from hospital or prevent them going in the first place. The service was available for a short period to anyone, regardless of Care Act eligibility, and free at the point of use.  The more holistic approach helped keep people out of hospital through immediate support prior to consideration of longer-term needs and options, and for some people, the short term support was all that was needed to get them back on track.

In response to questions, Ms Smith explained that the ‘Vanguard’ pilot approach to develop support in neighbourhoods and new ways of working had finished.  The Blackpool Clinical Commissioning Group was now leading on neighbourhood ‘hubs’ and ‘new models of care’, using the learning from the pilot.

The Chairman referred to ratings given by the CareQuality Commission,the nationalregulator responsiblefor inspecting healthand socialservice providersincluding carehomes andcare athome. The Commissionhad ratedBlackpoolwell againstregional andnational peersfor residential andnursing provisionand careat home provision up to May 2018. He noted that most provision had been rated well but queried what was being done to secure the improvements recommended by the Commission for where provision was less satisfactory.

Ms Smith explained that the in-house quality monitoring team was responsible for holding providers to account and supporting them to ensure quality and safety of care improved. Quality monitoring officers would visit providers, develop improvement plans with them and identify any additional help needed to deliver improvements. Officers looked for evidence of improvement and provided advice and guidance to help providers to improve. Formal action under the contract terms could be taken in exceptional cases where the provider was unable to sustain the level of improvement required.

To present an update on the stop smoking service provision in Blackpool.

Members were presented with an update on the stop smoking support provision and proposed new service model. The target implementation date was 1 October 2018.

The Chairman noted that there was a wide range of support options listed with detailed analysis of costs, benefits and effectiveness. He queried why there was no mention or analysis of the electronic (e) cigarettes given that Public Health England advocated their use and cited evidence of three million people quitting successfully.

He added that leading cancer researchers from the University of Stirling had cited low levels of young people reducing cigarette smoking and also that e-cigarettes were not being taken up significantly by young people. The Chairman referred to the significant smoking issue within Blackpool which, in his opinion, was worse than people using e-cigarettes and that all avenues needed to be explored.

Ms Petch, Consultant in Public Health explained that there was still uncertainty over the merits and risks of e-cigarettes and debates were ongoing. The regional network of Public Health directors had noted the Public Health England viewpoint that e-cigarettes represented a low level of risk and could be an effective tool to help people quit smoking. It had been agreed regionally that where e-cigarettes were being used as a ‘quit’ aid then that would be ok as that was better than the harm from cigarettes.

However, she added that Public Health had concerns where people had from a zero base starting using e-cigarettes including young people. Therefore e-cigarettes had not been mentioned explicitly. Reputable brands of e-cigarettes needed to be used but there were concerns over quality control which council officers were attempting to tackle.  Nicotine replacement therapy (NRT) such as patches represented viable and effective alternatives.

Mrs Rachel Swindells, Public Health Practitioner explained that Blackpool had a high proportion of young people using e-cigarettes and that there were issues with them exhaling ‘clouds’ of vapour through e-cigarettes and that some evidence suggested levels of harm from the secondhand vapour produced. She added that young people were using e-cigarettes because they were seen as being fashionable whereas adults used them as a quit aid. Councillor Cross added that currently e-cigarettes could not be recommended given that they were not currently available through prescription.

Some Members referred to the costs of smoking (ordinary cigarettes and e-cigarettes) especially for people on low incomes and that people often went without more important basic goods. Members had concerns that some young people would never be persuaded to quit so it was important to promote anti-smoking messages and risks, e.g. to pregnant women and babies.

Councillor Cross explained that the proposed stop smoking support service worked on the premise that people needed to want to quit in the first place. They would then be offered support options. These ranged from ‘self-support’ (simple sign-posting to options available), targeted support through GPs and pharmacists and dedicated support for specific groups such as pregnant women.

Ms Petch explained that smoking was an addiction and needed to be treated as  ...  view the full minutes text for item 7.

To consider the Adult Social Care and Health Scrutiny Committee Workplan 2018-2019, together with any suggestions that Members may wish to make for scrutiny review topics.

The Committee considered its Workplan for 2018-2019.

The Committee agreed:

1.       To approve the Scrutiny Workplan, subject to discussions with lead officers to undertake short reviews (single meetings) on 1) delayed transfers of care and bed shortages, and 2) Accident and Emergency waiting times and ambulance handovers.

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

To note the date and time of the next meeting as Wednesday, 10 October 2018 commencing at 6pm in Committee Room A, Blackpool Town Hall.

The Committee noted the date and time of the next meeting as Wednesday 10 October 2018 commencing at 6pm in Committee Room A, Blackpool Town Hall.