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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.

2.

MINUTES OF THE LAST MEETING HELD ON 3 JULY 2019 pdf icon PDF 229 KB

To agree the minutes of the last meeting held on 3 July 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.

FORWARD PLAN pdf icon PDF 218 KB

To consider the content of the Council’s Forward Plan, November 2019 – February 2020, relating to the remit of the Committee.

Additional documents:

Minutes:

The Committee considered the Forward Plan October 2019 – February 2020 and noted that there would be a special meeting held to input into the development of both the Drug Strategy and the Alcohol Strategy. Councillor Lynn Williams, Cabinet Member for Adult Social Care and Health was invited to outline the decision to be taken on the ‘Learning Disability and Autism Short Breaks Service’. She advised that the decision would provide a much needed facility, subject to planning permission, in an area where demand was expected to increase. The ability to provide the facility was due to a successful application for funding to the NHS and the running costs of the facility had been built into the budget.

5.

ADULT SOCIAL CARE FINANCIAL SUSTAINABILITY pdf icon PDF 233 KB

To provide a detailed overview of funding to Adult Social Care, and any demand pressures, together with how these are predicted and addressed, in order to understand more about position in relation to the financial sustainability of Adult Social Care.

Additional documents:

Minutes:

Ms Karen Smith, Director of Adult Services highlighted that the £82 million budget of Adult Services was one third of the total budget of the Council. The Service had achieved a balanced outturn budget in previous years, despite many challenges and increases in demand. It was explained that demand was projected to continue to increase and that pressure was being experienced across the whole health and social care system.

 

The positive impact of investment had been demonstrated through reductions in delayed transfers of care, no long wait times for assessments and good quality provision, as rated by the Care Quality Commission. There was also a high level of satisfaction amongst services users and staff.

 

Ms Smith noted that a large proportion of the budget was spent on residential care services and care at home services. Should demand continue to outstrip resource in these areas, there would be a significant impact on the rest of the healthcare system. As an example, if an appropriate residential place was not available for a person in a hospital bed, the patient could not be discharged, therefore freeing up the bed for a new patient. It was therefore imperative that discussions were held consisting of all partners to plan for the future.

 

Members noted that the financial sustainability of the Service had been raised as a concern during the Committee’s workplanning process, to which Ms Smith commented that there was currently financial stability, but that stability could not be guaranteed for future years. In response to questioning, Mr David Bonson, Chief Executive Officer, Blackpool, Fylde and Wyre Clinical Commissioning Groups advised that discussions had commenced between Adult Services and partners in the healthcare system in order to understand the demand and explore the options together to make informed decisions. He assured the Committee that difficult decisions would be taken together, as a system.

6.

MENTAL HEALTH SERVICE PROVISION pdf icon PDF 231 KB

To provide an update on Lancashire Care Foundation Trust’s (LCFT) and partners’ progress in making improvement on the actions identified within the Care Quality Commission inspection report, the outcomes of the external review undertaken and the discussions and recommendations made at the special meeting of the Committee on 24 January 2019.

Additional documents:

Minutes:

Mr Andrew Bennett, Executive Director for Commissioning, Integrated Care Partnership introduced the item and advised that the Partnership had a clear sense of concern of the issues within the mental health care system and the impact of those issues on patients and their families. He introduced the new Chief Executive Officer of Lancashire Care NHS Foundation Trust (LCFT), Caroline Donovan who presented the report to the Committee.

 

Ms Donovan advised that a new leadership team had been put into place and that there had been many improvements made since May 2019 when the results of the external review had been published and the latest Care Quality Commission (CQC) inspection was undertaken of the Trust. The CQC inspection outcomes, which had been published in August 2019, had rated 10 of 14 of the Trust’s core services as ‘good’, two as ‘requires improvement’ and two as ‘inadequate’. It was noted that the most concerning judgements related to the adult acute mental health care pathway.

 

In relation to the CQC inspection findings, Ms Donovan cited the lack of specialist mental health beds across the region as a key determinant of the previous poor performance and highlighted that new beds were being created in Preston to be opened in February 2020, and a business case was being prepared for a further mental health facility with additional beds on the Fylde Coast for later in 2020.

 

A further key determinant was the community provision and it was noted that LCFT was working closely with the local clinical commissioning groups, the Integrated Care Partnership and the local authority to invest in expanding staffing and to introduce a 24/7 crisis team and a community crisis house in Blackpool. Ms Donovan also highlighted the importance of changing the leadership culture, managing performance and engaging with partners and the voluntary and community sector and reported that strong improvements had already been demonstrated. However, the level of improvement that could be achieved was limited until the opening of the additional beds and additional staff being in place and fully trained.

 

Members raised concerns that the latest CQC inspection results had not shown improvement in the key mental health pathways and further commented that assurance had been provided by LCFT representatives on a number of occasions previously that improvements would be made. In response, Mr David Eva, Chair, LCFT advised that he had been in post for approximately three years and had also been given the same assurances previously. He advised of his commitment to ensuring the promised improvements happened. Ms Donovan added that, previously, there had been no additional investment to carry out the required improvements, however, a partnership approach had been taken and additional funding had been allocated in the last few months to increase spend on beds and additional staffing, the two issues which were fundamental to achieve improvement. The decisions taken within the last two months addressed the causes of the problems, which had not been previously addressed by any provider or commissioner.

 

In response to questions,  ...  view the full minutes text for item 6.

7.

DIRECTOR OF PUBLIC HEALTH'S ANNUAL REPORT pdf icon PDF 221 KB

To receive the Annual Report of the Director for Public Health.

Additional documents:

Minutes:

Dr Arif Rajpura, Director of Public Health presented his independent report for 2018 and advised that it focussed on the health and wellbeing of children and young people. He cited the changes to the health visitor service, the life expectancy of children born in Blackpool in comparison to other areas and the level of smoking in pregnancy as key factors in the report.

 

Members discussed the provision of breastfeeding support and noted the importance of providing support to new mothers not just on breastfeeding but on healthy and nutritious infant feeding. It was noted that despite different approaches taken to breastfeeding, the levels in Blackpool remained very low.

 

Concerns were also raised around the levels of vaping amongst young people in Blackpool. The long term effect of e-cigarettes was not yet known and some young people were starting to vape despite never having smoked previously.

 

The positive improvements to oral health were noted and it was suggested that success in areas should be celebrated more.

 

The Committee agreed to forward the report to the Children and Young People’s Scrutiny Committee due to the strong link to its remit.

8.

INTEGRATED CARE PARTNERSHIP DEVELOPMENT pdf icon PDF 962 KB

The purpose of this report is to update the Committee on ICP development activities specifically in relation to:

  • The development of the Fylde Coast ICP five year strategy;
  • Progress with delivering the improvement/transformation agenda;
  • Succession planning.

Additional documents:

Minutes:

Ms Vicky Ellarby, Interim Strategy Developer, Integrated Care Partnership highlighted the high level of participation in the development of the new five year Integrated Care Partnership (ICP) Strategy. She advised that there were statutory requirements that must be included in the strategy, but the remainder focussed on the needs of the Fylde Coast. She cited the strategic needs assessment and Citizen’s Enquiry approach as imperative to gaining insight into the needs of the population. It was reported that the strategy would focus on what, how and, most importantly, how the ICP would measure the success.

 

Mr Peter Murphy, Interim Director of Nursing, Blackpool Teaching Hospitals NHS Foundation Trust advised that the Quality Improvement Strategy was the first of its kind for the Trust. It had three key aims: to reduce preventable deaths, to reduce avoidable harm and to improve the last 1,000 days of life. He noted that on average patients spent too long in hospital in Blackpool and the Strategy aimed to reduce that number over the next three years.

 

Members noted the importance of the key aims of the Quality Improvement Strategy, but questioned where patient experience was reflected within the Strategy. Mr Murphy advised that patient experience was strongly linked with the three core aims of the Strategy, by reducing the length of unnecessary stay the experience of the patient would be improved.

 

It was noted that the healthcare system was increasingly complex with the introduction of the ICP and the Integrated Care System and Members questioned where responsibility lay. Mr Bonson advised that all providers and commissioners were equally responsible in different ways and that ultimately there was a responsibility to the patient. In order to avoid confusion, there had been little publicity of the changes to the NHS, it was important to ensure that a patient could make contact with the NHS through any means and be treated and guided appropriately from that contact

 

The Committee noted that the ICP was holding a workshop on 12 November 2019 on the development of the Strategy and agreed to send a representative to input if possible.

 

The Committee also agreed to receive an update on the ICP Strategy and the implementation of the Quality Improvement Strategy in approximately six months.

9.

SCRUTINY WORKPLAN pdf icon PDF 227 KB

To review the work of the Committee, the implementation of recommendations and receive an update on the briefing received on Renal Dialysis Service Reconfiguration.

 

Additional documents:

Minutes:

The Committee agreed its workplan for the remainder of the 2019/2020 Municipal Year and considered the implementation of previous recommendations as follows:

 

Recommendation

Update

That the CCG report back to the Committee in July 2019 with the main areas of concern in relation to succession planning and an approach to be taken.

 

The Committee agreed the action as completed.

That future data demonstrate the number of patients experiencing a 12 hour wait due to attending the emergency department with drug and/or alcohol intoxication.

 

The Committee was satisfied with the data presented and signed off the action as completed.

That LCFT be requested to identify all voluntary and community mental health support groups in Blackpool and arrange to meet with them quarterly to ensure the views of service users were truly reflected and understood.

 

Based on the discussions earlier in the meeting, the Committee agreed the recommendation as completed.

That LCFT consider setting all targets for completion of mandatory training, completion of appraisals etc at 90% with a view to incrementally increasing the target to 100%.

 

It was noted that the recommendation had not been discussed at the meeting and LCFT would be asked to address the recommendation at the special meeting to be held in early 2020.

That all representatives be requested to attend a further meeting of the Committee in approximately six months to further update on progress made and to:

·         Provide feedback on the implementation of the Committee’s recommendations.

·         To provide evidence of the work undertaken to reduce the number of four and 12 hour delays at Accident and Emergency and the impact of that work.

·         To report on the outcomes of the external review and action taken to implement the actions.

 

The recommendation was agreed as completed.

That attendees at the meeting give consideration to the process and the wording of the healthy weight letters sent and report back to the Committee at its next meeting with a new draft of the letter.

 

The Committee was satisfied with the response from Dr Arif Rajpura and agreed that the recommendation had been completed.

To add in consideration of the outcomes of the Psynergy pilot to the workplan.

 

The Committee had considered the Psynergy pilot within the Mental Health Service Provision item on the agenda and agreed the recommendation as completed.

 

To request that the data held on the number of unexpected deaths (those that the SHMI is based upon) within the hospital and outside of the hospital following discharge be circulated to Members.

 

The Committee agreed the recommendation as completed.

That the provision of facilities including the comfort of chairs provided to patients waiting in the emergency department be considered.

 

The Committee agreed the recommendation as completed based on the response provided by Ms Berenice Groves.

 

The Committee also noted the update from the presentation on Renal Dialysis Service Reconfiguration.

10.

DATE AND TIME OF NEXT MEETING

To note the date and time of the next meeting as Wednesday, 11 December 2019, commencing at 6.00pm.

Minutes:

To note the date and time of the next meeting as Wednesday, 11 December 2019, commencing at 6.00pm.