Agenda and minutes

Councillor Martin Mitchell declared a personal interest as the Council’s representative on the Board of Governors for Blackpool Teaching Hospitals NHS Foundation Trust in relation to the item on Winter Health Planning and the Trust’s Strategy, Ambitions and Work Programmes.

To agree the minutes of the meetings held on 28 September 2016, 12 October 2016 and 29 November 2016 as a true and correct record.

The Committee agreed that the minutes of the Scrutiny Committee meetings held on 28 September 2016, 12 October 2016 and 29 November 2016 be signed by the Chairman as a correct record.

The Chairman explained that the BBC had commissioned local TV media to film a series of council committee meetings as part of a national project promoting local democracy. He welcomed back Paul Faulkner from That’s Lancashire Television who had attended the Committee’s meeting on 29 November 2016. The Committee noted that there were no applications to speak by members of the public on this occasion.

To note that there have been no Executive or Cabinet Member decisions, within the remit of the Health Scrutiny Committee, made since the Committee’s last meeting on 28 September 2016.

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

To note that there are no (key decision) items within the Council’s Forward Plan, December 2016 - March 2017, relating to Health Scrutiny Committee (HSC) functions but work on the outline Pan-Lancashire Health and Wellbeing Governance Arrangements and the contract for the new integrated clinical recovery, drug and alcohol treatment service are of interest to Members

The Committee noted that there were no items on the Forward Plan, December 2016 - March 2017 on this occasion within the portfolio of the Cabinet Secretary, Councillor Graham Cain relating to health scrutiny functions.

The Chairman referred to two other items of interest that were progressing which had been previously considered by the Committee. These were the new Health and Wellbeing Strategy in relation to Pan-Lancashire proposals and tendering of a new Integrated Clinical Recovery, Drug and Alcohol Treatment Service.

Councillor Amy Cross, Cabinet Member for Health Inequalities and Adult Safeguarding explained that a combined Health and Wellbeing Board was being proposed for Lancashire. The governance arrangements were due to be considered by the Council’s Executive on 15 December 2016 and by the other two upper tier authorities in Lancashire (Blackburn with Darwen Borough Council and Lancashire County Council). The target for the combined Board formally starting was May 2017.

She provided assurance that there would still be local delivery arrangements taking into account local needs which would support the strategic aims of the Pan-Lancashire Board. For Blackpool, local work would be through the Blackpool, Wyre and Fylde Coast Partnership.  

Councillor Amy Cross referred to the Drug and Alcohol Treatment Service and noted that the Committee had previously received a detailed profile of the Service aims from Dr Arif Rajpura, Director of Public Health. The contract was shortly due to be awarded with the new Service targeted to start in April 2017.

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

The Chairman referred to the Health Scrutiny Workplan for 2016-2017 and progress with the implementation of recommendations. The Chairman informed the Committee that some agreed actions from previous meetings required from the Blackpool Clinical Commissioning Group were still outstanding without any explanation and that It was important to complete actions and also ensure reports for meetings were submitted in good time. A request would be sent on his behalf to the Clinical Commissioning Group. 

The Committee were provided with a summary of key topics added to the Work Programme.

Following an inspection in the middle of 2016, the Care Quality Commission had required significant improvement from the Grange Park Health Centre which was the only health centre in Blackpool served by a single GP. The Committee had previously noted the concerns and that there had been no direct threat to patient safety or quality of care. Therefore a watching brief had been maintained. A re-inspection had taken place with another report due to be published in December 2016. It was understood that steady progress was being made with support from NHS England and Blackpool Clinical Commissioning Group. However, improvement needed to be sustained after the various support had ceased. Following the re-inspection report being published, the Committee could receive a detailed update at its March 2017 meeting from the Clinical Commissioning Group.

The Committee had recently considered progress being made at The Harbour (Lancashire Care Foundation Trust’s in-patient adult mental health facility in Blackpool). The Care Quality Commission had undertaken an inspection of the Trust in autumn 2016 and inspection report would be published in December 2016. The Trust had indicated to the Committee that no serious concerns had been raised by the Commission during the inspection. The Committee noted the option for a brief update at its March 2017 meeting.

The draft Public Mental Health Strategy would be considered at the March 2017 meeting and would complement a dedicated meeting focusing on young people’s health needs. The draft Sexual Health Strategy would be considered at the provisional July 2017 meeting.

The Committee had previously considered progress with integrated health and social care, principally through the development of the Sustainability and Transformation Plan 2016-2020. Progress with transforming care for people through the Plan as well as financial efficiencies were to be added to the provisional July 2017 or September 2017 meetings.

Councillor David Owen referred to the significance of the Sustainability and Transformation Plan and concerns that the Plan showed little prospect of delivering on effective transformation of services to improve patient care, manage demand or to achieve the level of financial savings required (£572m across Cumbria and South Lancashire equating to 25% of budgets) over the five years. Plans were being driven by national savings requirements of NHS England. He highlighted that the Plan lacked specific local detail of proposed actions, would impact negatively upon patient care and should be rejected.  He highlighted the importance of keeping track of progress.

Mr Roy Fisher, Chairman, Blackpool Clinical Commissioning Group acknowledged  ...  view the full minutes text for item 6.

To review performance against the Council Plan 2015-2020 for the period 1 July 2016 - 30 September 2016.

Mrs Ruth Henshaw, Corporate Development Officer had reported on key performance indicators July-September 2016 in relation to three groups - opiate drugs users, non-opiate drug users and alcohol users - and the percentages (%) of these substance users successfully completing treatment.  For drug users, recovery meant not re-presenting within six months. Opiate drugs users had been highlighted as an ‘exception’ with a shortfall in performance requiring more detailed reporting.

The Chairman noted that the sustained recovery rate of 5% for opiate drug users was well below the 8% target. Councillor Cross referred to the detailed explanation previous given by Arif Rajpura. She re-iterated that the remaining opiate users had the most complex and deep-rooted problems. She added the new integrated alcohol and drug treatment service would aim to support recovery through a more comprehensive approach involving aspects such as meeting accommodation needs and developing skills for jobs. In response to comments, she advised that there were no easy solutions, for example people could only gradually come off methadone, which was better than being on heroin and allowed people to manage their lives but the process could take years. 

The Chairman referred to the annual measures to reduce excess weight in children aged four - five years old (target of less than 25% being overweight) and children aged ten - eleven years old (target of less than 38%). He queried why the target in later years was higher instead of focusing on preventing problems in early years.

Councillor Cross explained that the targets were for key stages of children’s development and reflected how high existing numbers of overweight children were in each group and nationally. She acknowledged that excess weight rates were still high in Blackpool hence the Council had signed up to the Local Authority Declaration on Healthy Weight. She referred to proactive work for reducing excess weight in both age groups, for example free school breakfasts to support children in need of financial assistance and stated that those provided important nutritional value and studies showed that a healthy start supported concentration and activity during the school day.

In response to comments, Councillor Cross added that the content of breakfasts was carefully considered and monitored to ensure there was no high sugar content or other poor dietary element. Reducing sugar content helped towards tackling local children’s poor dental health including campaigns such as Give Up Loving Pop (GULP) which had been highly successful and would potentially be run again. She added that promoting children to clean their teeth would benefit them from the fluoride content of toothpaste.

The Committee referred to the annual measures to reduce the numbers of adults and pregnant women smoking. GPs currently received a cash incentive to refer patients for assistance to stop smoking. However, the £50k funding budget for GP referrals was being stopped and there was some concern that GP referrals would be lost. It was noted that GPs should be making referrals even without an incentive.

Councillor Cross clarified that the Council was  ...  view the full minutes text for item 7.

To inform the Health Scrutiny Committee of the specific activities undertaken around winter health planning across the Blackpool Health Economy and Fylde Coast area (involving local health service commissioners and providers of services).

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group; Graham Curry, Sector Manager, North West Ambulance Service; and Neil Upson, Deputy Director of Operations, Blackpool Teaching Hospitals presented an update on specific activities undertaken around winter health planning across the Blackpool Health Economy and Fylde Coast area (involving local health service commissioners and providers of services).

David Bonson explained that a wide range of planning work had been undertaken recognising that demand pressures on acute and emergency services increased significantly during the winter period. Some regular services closed during the holiday period but demand needed to be managed and had increased in 2016.

He explained that planning followed national guidance which created standard local systems, structures and processes.  An Accident and Emergency Delivery Board, had been created for the Fylde Coast area incorporating Blackpool with a full range of executive decision-makers from health and social care commissioners and service providers. The Board was supported by an Emergency System Resilience Group which met weekly to review the previous and plan ahead. The Board would take more of a lead role as pressures increased.

David Bonson highlighted one of the key new elements being a structured approach to operational levels. There were four operation pressures escalation levels: a basic level one for day-to-day operations at an ordinary level of demand and management; level two for a slight increase in pressures requiring additional action; level three reflecting major pressures and level four where there were severe risks of unmanageable pressures. Each level was underpinned by the need for ensuring patient safety and sufficient resources to manage demand. 

He added that operations were currently at level two and outlined some new areas of planning. Primary care services (GPs) were more involved with enhanced opening times over the Christmas period and ability to take on non-routine appointments. The walk-in Whitegate Health Centre was offering standard and emergency slots. Pharmacists were ensuring their opening times allowed access to at least one pharmacist at any given time. Dentists were providing greater access through a ‘single point of contact’ dental helpline.  

Graham Curry profiled the pressures that the North West Ambulance Service was under. Call rates were up 10% totalling around 3,900 calls daily of which around 12% were managed through the NHS 111 advice line. To help manage the increased demand and support emergency responses more, resources were being pooled from different areas of the Ambulance Service. These included Urgent Care, NHS 111 and the Patient Transport Services.

He explained that one particular recent change had been simplifying the wide range of incident codes for telephone calls received from over 221 ‘red one’ codes (fastest response times required) to 16 codes. The streamlining made it easier and quicker for operators to process calls and allocate resources for these life threatening incidents.  He added that an Integrated Virtual Hub had been developed for managing a wide range of advice calls for the public and staff in the Urgent Care Service. Paramedics also reviewed incidents so that 48%  ...  view the full minutes text for item 8.

To consider a progress report on Blackpool Teaching Hospitals NHS Foundation Trust’s strategy, including progress against strategic ambitions and the financial position.

Mr Tim Bennett, Deputy Chief Executive and Director of Finance, Blackpool Teaching Hospitals NHS Foundation Trust presented a progress report on the Trust’s strategic ambitions, targets and financial position. He explained that the Trust was a large complex entity with a wide range of specialist and community services. Progress reports had been delivered to the Resilient Communities Scrutiny Committee in November 2015 and February 2016 when that Committee had been responsible for health scrutiny.

The strategy ran from 2015-2020 and aimed to deliver improved long-term clinical and financial sustainability.

Tim Bennett explained that the strategic ambitions had measurable targets to: improve quality of care (reduce mortality rates and improve patient experience); reduce the length of stay for operations; to develop the workforce (improve staff satisfaction and reduce staff turnover); and improve financial robustness.

He highlighted patient care as being the Trust’s primary goal. Mortality rates were based on average numbers of ‘expected’ deaths under normal conditions. The Trust’s rates had been as high as 120 expected deaths in previous years and were now down to 114 with a target of 100 in three years. He added that reducing deaths by even small numbers required significant resource effort to improve patient care.

Tim Bennett referred to the aspiration to improve patient experience (‘Friends and Family Test’) from the current 95.8% satisfaction rate to 98% in three years. He added that good progress had been made.

He referred to the length of stay in hospital patients had for undertaking operations. It was important to consider people’s needs carefully from admission to discharge and aim to discharge people in good time. He re-iterated comments made by health colleagues that, other than for emergencies, being in hospital was not the best environment for promoting health and wellbeing; discharging people into community care was better.

Tim Bennett reported that the current length of stay was higher than average at 4.2 days with a target of three days in five years. He explained that the target appeared a modest goal over a long period but it was a significant challenge to reduce length of stays and was a gradual process. Members noted that there were many thousands of different pathways of care for patients and that significant changes would be required particularly at admission stages for emergencies. He added that progress had been slow for elective (planned in advance) care. Complex surgery was often necessary but it was important to aim to get more people coming in just for one day.

He referred to supporting the workforce through improving staff satisfaction and reducing staff turnover. At the start of 2016, the Trust had been using a relatively high proportion of agency staff at a high cost. Agency use had been reduced by focusing more on filling permanent vacancies. Although good progress had been made continuing financial pressures meant that it had been necessary to impose a recruitment freeze (non-clinical staff) and improve ‘back office’ efficiencies. Clinic vacancies needed to be filled at appropriate times as non-clinical  ...  view the full minutes text for item 9.

To consider the mid-year performance of the Blackpool Clinical Commissioning Group for 2016-2017 (April 2016 – September 2016).

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group presented the Clinical Commissioning Group’s mid-year performance for 2016-2017 (April 2016 - September 2016).

He explained that the Clinical Commissioning Group purchased various services provided by other organisations and so shared performance responsibility. National reporting requirements underpinned by key performance measures covered a range of access to service areas which included referrals from GPs to hospital cancer appointments, time taken to get treatment in accident and emergency wards, access to psychological therapies and ambulance response times to get to incidents.

David Bonson added that NHS England had introduced a new Improvement and Assessment Framework which allowed each clinical commissioning group to be benchmarked against national averages to identify potential good practice and areas needing improvement. 

He highlighted areas where performance was below target and needed improving and where good progress had been made.

David Bonson explained that 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 mid-year outcome had dropped to under 90%. Accident and emergency waiting times were nationally challenging and winter months had a knock-on impact for the rest of the year with ongoing efforts to regain performance.  He added that historically Blackpool rates had been above 95% but recent pressures had been severe.

He referred to performance being below target for securing first appointments for cancer treatment within 62 days of referral from a GP. There were various reasons for delays including patient choice.

The Chairman noted that excellent progress had been made in some areas. He referred to the headline targets of accident and emergency turnaround times for treatment, access to cancer treatment services (first treatment following referral) and the missed target for ambulances responding to all ‘red’ (serious) incidents within 19 minutes. Immediate life-threatening incidents required faster responses times but those targets were being met. He noted that the three headline targets had been missed the previous year and queried if they had been set too high.

David Bonson agreed that there was a risk of targets not being realistic in view of the same demand pressures and complexities of cases occurring nationally. Particular concerns were delays in accident and emergency having a ‘knock-on’ impact on other parts of the health system. Most pressures were at the acute services ‘front-door’ and were being managed but nationally acute services were under extreme pressure. He referred to the £10m funding being given by the NHS Improvement Agency to support the work, and efficiencies required, of Blackpool Teaching Hospitals. The improvement funding would help alleviate some of the accident and emergency pressures.

The Committee enquired about access to psychological therapies and recovery rates being below target. David Bonson clarified that access rates had improved but full recovery was more challenging in view of the complex conditions people had. Counselling ‘talking’ therapies were a common support mechanism.

The Committee enquired about the 62 day first cancer treatment (following GP referral)  ...  view the full minutes text for item 10.

To note the date and time of the next meeting as Wednesday, 22 March 2017

commencing at 6pm in Committee Room A.

The Committee noted the date and time of the next meeting as Wednesday 22 March 2017 commencing at 6pm in Committee Room A, Blackpool Town Hall.