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.

There were no declarations of interest on this occasion.

To agree the minutes of the last meeting held on 6 February 2020 as a true and correct record.

The minutes of the last meeting held on 6 February 2020, were signed by the Chairman as a true and correct record.

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

To consider the content of the Council’s Forward Plan, September 2020 to December 2020, relating to the remit of the Committee.

The Committee considered the Forward Plan, September 2020 to December 2020 and invited Councillor Jo Farrell, Cabinet Member for Adult Social Care and Health to provide an update on the development of the Alcohol and Drug Strategies. She advised that the Alcohol Strategy was awaiting consideration by the Health and Wellbeing Board prior to being submitted to the Executive. It was noted that the Health and Wellbeing Board had not been meeting due to the pandemic. In relation to the Drug Strategy, Councillor Farrell advised that as the new portfolio holder she had requested that some amendments be made to the draft strategy to ensure that it fully explained how the aims of the strategy would be achieved.

Members noted that they had previously considered and contributed to the draft Drug and Alcohol Strategies and considered it important to further review the Drug Strategy following completion of the explained changes to that draft strategy.

The Committee agreed to receive the Drug Strategy following its revision for further comment.

To provide an overview of the whole directorate including financial position and impact of the pandemic.

Ms Kate Aldridge, Head of Commissioning introduced the Adult Services Overview report to the Committee and highlighted the effort made by services in order to support people and the incredible partnership working across the health and social care sector during the pandemic.

The Committee expressed its thanks to whole of the Adult Social Care Team for their exceptional work during the most difficult of times.

The reopening of the Keats Day Service was queried, in response, Councillor Jo Farrell, Cabinet Member for Adult Social Care and Health advised that day services had not yet reopened, with services looking towards October 2020 for potential reopening. She added that there had been short term increases in other services to meet demand.

Members queried what lessons had been learned from the response to the pandemic which could be taken forward. Councillor Farrell advised that the strong partnership between the health and social care sector and providers had been a real asset. Ms Aldridge added that the relationship had ensured that discharges had been approached collaboratively and that there was a joint clarity across the system which had enabled provision of the best possible support to the community.

In relation to challenges and concerns moving forward, Ms Aldridge highlighted the national challenge in regards to testing. Councillor Farrell noted that the service was continuing to work in the best possible way to support the community and follow all guidelines issued by the Government.

In response to further questioning, Ms Aldridge agreed that the financial implications of the pandemic were a significant challenge and that Blackpool, along with all other local authorities, was continuing to make representations to the Government regarding the costs incurred during the pandemic. The Council was also working to ensure that providers continued to receive the support they needed and supporting individuals to maintain personal resilience for the winter months ahead.

ahead.

The report will update the Committee on:

1.      The progress made since the Care Quality Commission inspection

2.      Key actions taken throughout the pandemic

3.      The impact of the pandemic on improvement and restoration

4.      Positive learning from reduced attendances at the Emergency Department and Walk In Centre

Dr Jim Gardner, Medical Director, Blackpool Teaching Hospitals NHS Foundation Trust (BTH) re-emphasised the importance of the strong relationship between the health and social care system during the pandemic. He went on to highlight that the Trust was continuing to address the 249 actions identified by the Care Quality Commission (CQC) in their most recent inspection of the Trust. He referred to the hospital mortality indicator, SHMI, noting that progress had been made and over the previous five months the Trust had achieved a statistically normal figure which was a material improvement.

Dr Gardner also highlighted the additional funding received from Government during the pandemic which had allowed the Trust to put certain measures in place including the temporary move of the Urgent Treatment Centre to Whitegate Drive in order to increase space at the hospital. Furthermore he noted the new trial taking in place in Blackpool to pre-triage attendees to the Emergency Department, with all patients being requested to call 111 unless an ambulance was required.

In response to questions, Dr Gardner advised that testing had revealed that 18% of the approximately 6,000 employees of the Trust had been known to have had Covid-19 and a recent exercise that tested all staff over a one week period had resulted in seven positive tests. The results of the test had changed national policy as a return of seven positives was seen as a low return on the investment of testing so many staff in a short amount of time.

Members referred to the 249 actions identified in the CQC inspection and noted that the actions consisted of 32 ‘must dos’ and 86 ‘should dos’ and that it was not clear from the report how many actions within each of the categories were outstanding. Dr Gardner advised that 183 of the actions had been completed and progress was regularly reviewed by the CQC. All mission critical actions relating to patient safety had been signed off and actions had been addressed in priority order.

In reference to parking at the hospital, it was noted that as per national guidance parking was currently free of charge. Members expressed the opinion that free parking should continue and Dr Gardner advised that it would do so until Government guidance changed. He added that as the car parks at the hospital were getting busier, permit parking for staff was being restored. Members further commented that free parking for staff would be a boost for morale if it could continue, alongside all the other additional support mechanisms put in place since the start of the pandemic.

Dr Gardner reported that additional support had been provided during the pandemic such as the ‘wobble room’. However, there were barriers to continued provision of the additional support provided such as physical capacity on site and financial implications. It was a continual challenge to balance the Trust’s books. He added that the Trust would continue to review and determine the support that could be provided for staff.

Members noted that Blackpool  ...  view the full minutes text for item 6.

To consider the end of year performance of the Blackpool Clinical Commissioning Group (April 2019 – March 2020) and also a more in depth look at the impact of the pandemic on current performance and the financial position.

Mr David Bonson, Chief Executive, Fylde Coast Clinical Commissioning Groups (CCGs) echoed the importance of true partnership working during the pandemic and praised the joined up approach of organisations within Blackpool. He highlighted that there had been a huge impact on waiting lists including diagnostics due the pandemic and it would take time to clear the backlog.

Ms Kate Newton, Performance and Quality Manager, Fylde Coast CCGs presented the yearly performance report to the Committee noting the significant changes to treatment and diagnostics in the previous six months. She noted that where significant waiting lists existed, patients were being seen in priority order with priority given to clinically urgent cases. Despite many services resuming, there was a reluctance of some patients to attend appointments evident with up to 30% of patients still choosing to not attend an appointment at the hospital.

It was reported that the number of 12 hour breaches at the Emergency Department had reduced, despite the number of attendances at the department returning to pre-Covid levels and that mental health patients were being directed towards appropriate support and treatment at an earlier stage.

Members noted the percentage of patients being seen within the two week wait for breast cancer diagnosis and noted that at the end of the financial year 2019/2020, performance remained significantly below target and that this was an ongoing issue. In response, Ms Newton advised that the measures put in place to address performance in this area had started to have an impact and performance had improved to 98% in August 2020, and that good performance had continued into September 2020.

In relation to a question regarding whether there had been any policy changes during the pandemic which would result in changes to procedures and treatments offered in Blackpool, Mr Bonson confirmed that there had been no policy or threshold changes to date.

The Committee raised concerns regarding the potential for a second spike of infections over the winter period, during a time when services were already usually stretched and queried how confident representatives were that health services locally would be in a position to respond quickly and effectively to such a second outbreak. Mr Bonson noted that the challenges being faced were unknown, as was the potential impact. He advised that various scenarios had been modelled to aid planning and that a robust Winter Plan had been prepared. It would also be a challenge to reduce waiting lists over the winter period.

Mr Roy Fisher, Chairman, Blackpool CCG added that regional meetings had been held and plans put in place including the identification of hubs for any potential vaccine to be distributed. He highlighted the hard work and resilience of all staff during the pandemic.

The Committee expressed its thanks to all staff in the health service for the support and help provided to residents during this difficult time.

The purpose of this report is to update the Committee on the outstanding recommendations from the initial review which consisted of the following:

• Impact of delayed prescriptions as part of the discharge process
• Review and improve the discharge pathways
• Update on the exploration of subsidised parking.

The Committee received an update report on the outstanding recommendations of the Whole System Transfers of Care Scrutiny Review and a brief impact analysis of the recommendations of the review. With regards to the recommendation relating to discharge delays as a result of the pharmacy, Members raised concerns that the issues had not yet been resolved and cited examples of more recent delays. Dr Jim Gardner, Medical Director, Blackpool Teaching Hospitals NHS Foundation Trust advised that there was significant complexity around the discharge of patients from hospital, in particular, those who attended for unscheduled care. He highlighted the imminent move to electronic prescribing which it was hoped would have a positive impact.

Dr Gardner advised that the pandemic had not stopped progress around implementing improvements in relation to discharge processes. It was known that once medical issues had been resolved, hospital became a dangerous place and that the quicker a patient could be safely and appropriately discharged the better.  Ms Jo Bark, Deputy Director of Operations for Unscheduled Care, BTH added that there was an understanding of the causes for delays and trials were ongoing in two wards for unscheduled care currently in order to expedite discharges. She advised that the data from the initial findings of the trials could be shared when completed.

Members also noted the separate issue of avoidable readmissions and requested an additional report on the subject at a future meeting for review. Dr Gardner suggested that readmissions and avoidable readmissions could be considered as two separate complex issues. He added that the report would need to be provided by the whole health and social care system.

The Committee agreed to sign off the Scrutiny Review as completed, however, wished to revisit the issue of delayed discharges in approximately 12 months in order to ensure improvement had continued.

To consider the workplan and to monitor the implementation of Committee recommendations, together with any suggestions that Members may wish to make for scrutiny review topics.

The Committee considered its workplan for the remainder of the Municipal Year 2020/2021 and approved it subject to the inclusion of the items identified during the course of the meeting.

Members also approved the recommendations identified during the Children and Adolescent Mental Health Services review meeting which took place in conjunction with Members of the Children and Young People’s Scrutiny Committee and noted the updated implementation of recommendations table.

To note the date and time of the next meeting of the Committee as Thursday, 26 November 2020, commencing at 6pm.

The date and time of the next ordinary meeting of the Committee was noted as Thursday, 26 November 2020, commencing at 6.00pm. Members also noted the date and time of the Special meeting of the Committee on Monday, 19 October 2020, commencing at 6.00pm.