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; 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.

There were no declarations of interest on this occasion.

To agree the minutes of the previous meetings held on 5 November 2015 and 12 November 2015 as a true and correct record.

The minutes of the previous meetings held on 5 November 2015 and 12 November 2015 were signed by the Chairman as a true and correct record.

The Committee to consider the appointment of Ms Frances McErlane as a parent governor co-opted member to the Committee.

The Committee agreed to appoint Mrs Frances McErlane as a parent governor co-opted member to the Committee.

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

The Committee noted that there were no applications for public speaking on this occasion.

The Committee to consider the content of the Council’s Forward Plan, December 2015 – March 2016, relating to the portfolios of the Cabinet Secretary.

The Committee considered the items contained within the Forward Plan, December 2015 – March 2016 and noted that they were the same items as considered at the previous meeting of the Committee.

To inform the Scrutiny Committee of local Mental Health Services and activity undertaken within the area to allow a thematic discussion to take place on the topic.

Ms Lisa Moorhouse, Network Director, Lancashire Care Foundation Trust (LCFT), Mr Steve Winterson, Engagement Director, LCFT, Mrs Pat Oliver, Director of Operations, Blackpool Teaching Hospitals Trust, Ms Helen Lammond-Smith, Blackpool Clinical Commissioning Group (CCG) and Mrs Claire Powell, Healthwatch were in attendance for the thematic discussion on mental health in Blackpool. The report was presented as read and contained information regarding key challenges, priorities and the service user’s perspective of mental health services.

Members noted the complexity of mental health services in Blackpool and the number of different services and providers in operation and queried how a joined up approach was provided to patients. Ms Lammond-Smith advised the Committee that an Alliance Board had been established of senior representatives from the providers and the CCG to discuss key issues on a regular basis. Ms Moorhouse added that alternative approaches had also been trialled to ensure joined up provision including employing the same manager across two different organisations to create a better pathway for patients.

The Committee discussed the waiting times for patients to access Psychological Therapies, provided by the Hospitals Trust and commissioned by Blackpool CCG. Ms Lammond-Smith advised that waiting times had been up to 10 months and that an initiative had been put in place to reduce waiting times, which had had a significant impact. She added that the Hospitals Trust was on target to achieve the national targets for waiting times for Psychological Therapies by the end of March 2016. The Committee requested an update on waiting times in approximately six months.

Members raised concerns regarding the recent national news story of the failure to investigate deaths by Southern Health and also discussed concerns relating to some of the comments made in response to the survey undertaken by Healthwatch Blackpool. The Committee in particular was concerned with service provision around patients recently discharged from mental health services and cited comments in the Healthwatch report pertaining to feelings of isolation.

Mrs Powell advised that there did appear to be a gap in service provision for patients who had been discharged and that service users had set up their own support group to fill the gap. She added that there was concern that no funding had been provided for the support group and that it may not be sustainable.

In response to further questions, Mr Winterson advised that LCFT would be undertaking an additional piece of work with Healthwatch Blackpool in order to interpret the survey presented to Members further and to obtain additional narrative from patients. It was requested that that additional piece of work be submitted to the Committee for consideration in due course.

The Committee noted that Blackpool had the fifth highest rate for all mental health conditions in the country and queried what preventative measures were being put in place to impact upon the challenge that caused. It was noted that a full response to the question would be requested from Public Health following the meeting. Additionally, Ms Lammond-Smith advised  ...  view the full minutes text for item 6.

To consider the presentation on current savings plans aimed at improving Quality, Innovation, Productivity and Prevention (QIPP) and current performance data.

Mr Mark Johnston, Deputy Chief Operating Officer, Blackpool Clinical Commissioning Group gave a presentation to the Committee on Quality, Innovation, Productivity and Prevention (QIPP), performance and patient choice. He advised that a number of initiatives had been put in place to achieve savings of £3.2 million, however, the current forecast was that savings of £1.8 million would be achieved. He added that work was ongoing to close the gap but that Blackpool CCG was forecasting a deficit for the financial year.

The Committee discussed a number of the initiatives highlighted in the presentation including New Models of Care, which had previously been discussed by the Committee in detail, the pathway review, referral management and prescribing.

In response to a question regarding the Falls Pathway Review, Mr Johnston advised that there were dedicated falls nurses based in the six Blackpool neighbourhoods and patients continued to be assessed at home. Following further questioning, Mr Johnston advised that the CCG had commenced work to educate care home staff around fall management as part of a wider training programme.

Members noted that performance against the Paediatric Pathway Review was ‘red’ and Mr Johnston advised that that was related to the level of financial saving made to date, which was much lower than forecasted.

The Committee was informed that a number of the initiatives relating to Prescribing related to reducing spend by replacing high cost products with low cost products which were as effective. Members commented that it was important to communicate and explain changes to medication to patients.

Mr Johnston advised that a Care Homes Pharmacist had recently been appointed with a view to reviewing medication prescribed to older people in receipt of repeat prescriptions to identify if the medication continued to be necessary.

The Committee discussed the previous work of the Health Scrutiny Committee and noted that concern had been raised regarding patients receiving prescriptions from the Urgent Care Centre being unable to obtain medication from the pharmacist on site at Blackpool Victoria Hospital. Mr Johnston agreed to investigate the issue and report back to the Committee through the Chairman.

Members were informed of the additional initiatives designed to save money including the closure of the Windsor Unit respite care. The Committee queried if service users had been consulted regarding the changes and was advised that that had been the case. In response to further questioning, Mr Johnston advised that not all service users had been happy following the closure of the unit or their ability to access respite provision since it had closed. He explained that many service users accessing the Windsor Unit had been receiving unequal access to services, which in many cases was more than they were entitled to. He advised that the majority of service users had acknowledged that they had been receiving an unfair level of respite in comparison to carers not in receipt of support from the Windsor Unit.

Mr Johnston provided the Committee with an overview of performance in Blackpool against the NHS Constitution Measures and  ...  view the full minutes text for item 7.

To inform Scrutiny Committee of the work undertaken by Adult Services on a day to day basis to allow effective scrutiny of the service.

Mrs Del Curtis, Director of People presented the Adult Services Overview Report and the Chairman invited questions from the Committee.

Members queried the take up of Personal Health Budgets and were informed that although a responsibility of the Clinical Commissioning Group, Personal Health Budgets were managed through the Direct Payments Team at the Council. Mrs Curtis advised that the take up of Personal Health Budgets had been slow and that funding would generally be used by people to purchase care.

Members discussed the Share Lives Short Break Project and raised concerns that without adaptions, accommodation would not be suitable for those with complex needs. In response to questions, Mrs Curtis advised that the Coopers Way accommodation had been specifically adapted to suit a range of complex needs and that she was not aware of any specific funding for carers to make adaptions to accommodation as part of the Shared Lives Service. The Committee requested to be provided with a detailed overview of all respite care available in Blackpool with the aim of ensuring adequate provision was available.

In response to further questions, Ms Gornall, Principal Social Worker and Head of Social Care advised the Committee that the Care Act 2014 had altered the way the level of respite care was determined and had amended how an individual’s needs would be measured in order to determine the level of respite to be provided.

The Committee noted the additional safeguarding information relating to those cared for in their own home, as requested at the previous meeting of the Committee, and queried if Councillor Collett, Cabinet Member for Health Inequalities and Adult Safeguarding was satisfied that the measures put in place in order to make improvements to the safety of those cared for at home were sufficient. Councillor Collett advised that he was satisfied that the Safeguarding Adults Board had recently appointed a suitable independent Chairman who would ensure that progress was made and that he was pleased with the progress made to date.

Members further queried the progress made in specific relation to concerns raised regarding the provision of medication by carers and was advised that Care at Home providers had also identified the provision of medication as a concern and, through a forum, had met with the Medication Management Pharmacist employed by the Council to address the concerns.

The Committee discussed the training provided to domiciliary care providers and noted that all training provided by the Council was optional, however, there was some training that was mandatory for all providers to undertake. In response to a question, Ms Gornall advised that training was targeted at providers who had had several safeguarding alerts raised and that there had been a 20% reduction in the number of safeguarding alerts to date in the current year.

The Committee noted the positive results of the Care Quality Commission inspections of care homes and requested that the inspection results for all regulated services be included in future reports to the Committee.

Members queried why  ...  view the full minutes text for item 8.

To inform the Committee of the work undertaken by Children’s Services on a day to day basis and to update on the progress and implementation of developments within the area to allow effective scrutiny.

Mrs Del Curtis, Director of People presented the Children’s Services Improvement Report and the Chairman invited questions from the Committee.

Members queried why South Shore had been identified to undertake the Transition Project and was advised by Councillor Jones, Cabinet Member for School Improvement and Children’s Safeguarding that a number of children within the ‘feeder’ schools of South Shore had been identified as requiring additional support. He added that if the project was successful it would be rolled out across Blackpool. The Committee discussed the importance of the transition between primary and secondary school and noted that it had also been identified by Ofsted as a key determinant in attainment.

The Committee also discussed the transient nature of children both within Blackpool and from out of the area moving into Blackpool. Councillor Jones advised the Committee that the Blackpool Challenge Board was considering ways of reducing the movement across the town to try and promote stability for students and schools. However, Members were informed that it was beyond the control of the Council to impact upon the number of people moving to Blackpool. It was noted that transience was an increasing pressure for schools that was difficult to manage.

The Committee highlighted the excellent Early Years inspection results and commended the good work.

The Committee also discussed the Emergency Duty Team and noted that it was formally under review as part of the budget savings target. Members noted that due to the 100% increase in calls to the Team reported at the last meeting of the Committee, it had been requested that an update be included on each Children’s Services Improvement Report. The Committee requested that further information on the review of the Team be presented to a future meeting of the Committee.

Members had a frank discussion on the case studies provided and the complexities of clinical thresholds. Mrs Curtis advised that there were many challenges pertaining to thresholds for a mental health diagnosis and the clinical judgement that some individuals had a behavioural issue rather than a mental health condition. She added that she had escalated her concerns nationally regarding the gap in service provision for the individuals. In response to further questioning, Councillor Jones advised that although there was not a long waiting list to access Children and Adolescent Mental Health Services (CAMHS) it was the action taken after the referral which was the key concern. He added that additional concerns included access to CAMHS for children with a learning disability, the transition to adult mental health services and the aforementioned thresholds that determined if a condition was behavioural or mental health related and therefore requiring treatment. The Committee noted that these were concerns that should have been raised during the Mental Health Thematic Discussion and requested that a written response be sought from the appropriate health representatives following the meeting.

The Committee discussed the work of the Corporate Parent Panel and requested that further information be included within future reports to reflect the views of the  ...  view the full minutes text for item 9.

The Committee to consider the Workplan, together with any suggestions that Members may wish to make for scrutiny review.

Mrs Sharon Davis, Scrutiny Manager presented the report to the Committee and highlighted the outstanding recommendations, advising that she had received an update from Blackpool Teaching Hospitals Trust to confirm that information regarding complaints would be circulated monthly to the Committee commencing in January 2016.

Members queried the reasons why the ligature risk assessments had not been circulated to the Committee as requested at the special meeting held to discuss The Harbour. Ms Lisa Moorhouse, Network Director Mental Health, Lancashire Care Foundation Trust advised the Committee that the documents would be circulated once the Trust had removed any information within the risk assessments that it deemed confidential.

The Committee also discussed and noted the Public Health Scrutiny Review Panel scoping document.

The Committee agreed:

1.             To approve the workplan.

2.             To note the Monitoring the Implementation of Recommendations table.

3.             To approve the Public Health Scrutiny Review Panel Scoping Document.

To note the date and time of the next meeting as Thursday, 4 February 2016 commencing at 6pm in Committee Room A.

The Committee noted the date and time of the next meeting as Thursday, 4 February 2016, commencing at 6pm in Committee Room A.