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 last meeting held on 5 July 2017 as an accurate record.

The Committee agreed that the minutes of the Adult Social Care and Health Scrutiny Committee meeting held on 5 July 2017 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 Executive and Cabinet Member decisions within the remit of the Adult Social Care and Health Scrutiny Committee.

The Committee noted that the Adult Social Care Contract Rates for 2017-2018 had been approved by the Cabinet Member for Adult Services and Health on 14 July 2017 and that the Learning Disabilities Step Down Service had been approved at the Executive meeting on 17 July 2017.

To consider the Annual Report of Healthwatch Blackpool for 2016-2017 including key findings from service reviews and changes made as a result of the involvement of the organisation; and to consider the operational Work Plan for 2017-2018.

Ms Sheralee Turner-Birchall, Chief Executive, Healthwatch Blackpool and Healthwatch Lancashire and Ms Katie Taylor, Senior Project Officer, Healthwatch Blackpool presented Healthwatch Blackpool’s Annual Report for 2016-2017 and Work Plan for 2017-2018.

Ms Taylor explained that Healthwatch acted as the independent ‘voice of the service user’ for people using health and social care services. Healthwatch undertook surveys and other activities including directly speaking to people to obtain the views and experiences of service users, friends and family and staff. Healthwatch made recommendations, including trends identified, to commissioners and providers of services.  Healthwatch Blackpool was commissioned by Blackpool Council but was independent.

Ms Taylor reported that the Healthwatch contract for Blackpool had over the last two years been provided by Groundwork (until April 2016) and then Empowerment until the end of 2016. Healthwatch Lancashire took over contract provision for Blackpool from Jan 2017 and formed Healthwatch Blackpool. The two organisations were separate legal entities but retained the ability to combine and share resources as necessary. Healthwatch Blackpool comprised of 1.5 full time equivalent staff (one full time Senior Project Officer and one part time Project Officer). The Chief Executive also committed some direct time.  Wider ad-hoc support from Healthwatch Lancashire covered communications, specific projects and other areas of work. The flexible access to pooled resources had been working well.

Ms Taylor added there had been a transitional period from the start of the contract, January 2017, through until the start of April 2017 when the first full year started.

Transitional work had included retaining and carrying forward Empowerment work, publishing Empowerment service reviews, setting up organisational systems and refreshing the website amongst other activities.

Ms Taylor referred to Empowerment work which had included five service reviews one of which had concerned the quality of community mental health services for adults. The other reviews had covered care homes, carers’ support, outpatient services at Blackpool Teaching Hospitals and services provided at the Harbour (Lancashire Care Foundation Trust’s in-patient mental health facility within Blackpool).

Ms Taylor explained that Healthwatch Blackpool developed its Work Plan following feedback from the services users and the public. Work undertaken during 2017 had included reviews of community pharmacies, access to mental health services, access to cervical screening and a winter pressures review of Accident and Emergency services at Blackpool Teaching Hospitals.

Ms Taylor added that several projects were planned for 2017-2018. These included regular ‘Enter and View’ inspections (nine GP practices had been visited and nearly 350 patients consulted) and reviewing Learning Disability and Autism services (a broad group including carers had been consulted with GP and dental services satisfactory but hospitals particularly for communications were not). Progress with John’s Campaign at Blackpool Teaching Hospitals (more flexible visiting hours especially for family and friends of dementia patients) had been considered. Resilience support for young people using services had also been considered including what support they wanted, e.g. for reducing self-harm and mental health issues. Another key piece of work was helping ensure that the public and voluntary sector were well-informed  ...  view the full minutes text for item 5.

To present progress on health and social care integration for new models of care.

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group, Mr Roy Fisher, Chairman, Blackpool Clinical Commissioning Group and Ms Jeannie Harrop, Senior Commissioning Manager, Blackpool Clinical Commissioning Group presented an update regarding the development of health and social care integration in Blackpool (as part of the wider Fylde Coast local delivery partnership).

Members had considered integration first in November 2016 in the early stages of development. They had felt that there was not sufficient detail of local work within the Sustainability and Transformation Plan (STP) for Lancashire and South Cumbria nor financial costings. Members had recognised that NHS England had given little time for draft plans so a comprehensive progress report had been requested for summer 2017 included detailed cost savings proposals. 

Mr Bonson explained that integration required strategic direction and practical changes to service delivery which were being jointly developed by councils and the health sector. He explained that Sustainability and Transformation Plans had been developed nationally as five-year plans (2016-2017 to 2020-2021) as part of NHS England’s Five-Year Plan. There were 44 ‘vanguard’ pilot geographic areas which were leading on transformation and integration of NHS and Social Care services. Lancashire and South Cumbria was one pilot area.

Mr Bonson referred to the Lancashire and South Cumbria Sustainability and Transformation Plan within which were five local ‘footprint’ geographic areas responsible for delivering services, one being the Fylde Coast area including Blackpool and eight themed workstream programmes.  The local areas were based on populations, locations of services and actual patient flow rather than traditional local authority boundaries.

Mr Bonson explained that the Sustainability and Transformation Plan aimed to develop major transformation to meet patient, population and financial demand. He added that NHS funding had increased but was being outpaced by patient and population demand. There was a drive towards more community and locality based services (including promoting self-help and better health for people avoiding illness) and reducing the need for hospital admissions.

Mr Bonson explained that the Fylde Coast delivery arm was now also one of eight pioneer Accountable Care Systems being developed nationally. These were leading on developing integrated working arrangements between council, health and other partners including the pooling of budgets. They were not legally binding but designed for partners to make the best use of resources and hold each other individually and collectively to account. Ms Harrop added that on a practical level the Accountable Care System would allow joint commissioning to integrate spending and provide more seamless care pathways for patients.

Ms Harrop referred to New Models of Care (NMC) work which had been developing over recent years. These aimed to develop alternative primary care options closer to people in local neighbour hubs with the co-location of professionals (GPs, mental health staff, social workers, nurses and other groups) and promote preventative action to reduce costs and hospital admissions. She gave examples of health and wellbeing workers going to people’s homes and helping devising individual care plans. She added that the team were growing and that  ...  view the full minutes text for item 6.

To consider a progress report on Blackpool Teaching Hospitals NHS Foundation Trust’s (the ‘Trust’) 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. Previous progress reports had been delivered to the Resilient Communities Scrutiny Committee in November 2015 and February 2016 and the Health Scrutiny Committee in December 2016.

Members had requested an assurance report after March 2017 on clinical care and financial performance achieved during the winter period. They had highlighted concerns on performance impact from winter pressures including acute and emergency services and availability of beds. Finance issues had included staffing concerns (costs of agency staff).

Mr Bennett explained that the Strategy ran from 2015-2020 and aimed to deliver improved long-term clinical and financial sustainability. He added that the Strategy did not operate in isolation citing that it needed to be delivered as part of the wider Accountable Care System which involved a range of partners working together.

Mr Bennett referred to the strategic ambitions which 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 emphasised that progress took time. The targets were either medium term with three years allowed to achieve targets or long-term requiring five years.

Mr Bennett noted that mortality rates were still too high at 114 deaths per year. However, steady progress was being made towards the target of no more than 100 deaths per year. When the Strategy started in 2015, mortality rates had been 120 deaths per year.

Mr Bennett referred to the length of stay for operations which was above the average for comparable neighbours. Work was developing through the Accountable Care System involving primary care and social care partners. It was important to eliminate the numbers of patients incurring delayed ‘transfers of care’ (moving from one form of care to another) and also having efficient hospital discharges. A range of options were being explored.

Mr Bennett confirmed that financial challenges remained and would continue. Although the NHS was getting funding increases these were outstripped by increasing patient and population demands. Financial targets had been achieved for 2016-2017 although there had been some additional one-off funding assistance.

Members noted the reported surplus of £3.3m for 2016-2017 and queried whether this had actually been a deficit as additional one-off funding may have created an apparent surplus. They referred to NHS Improvement who had provided nearly £10m for promoting innovation and efficiencies. They also queried whether a similar sum in the region of £10m from Blackpool Council’s Investment Fund had been included in the 2016-2017 figures. Mr Bennett explained that the £10m from NHS Improvement had been included in the figures. However, £9.2m loaned from the Council was a one-off cash payment not included within the balance sheet. He pointed out that the £3.2m was a reasonable outturn given that the Trust had a budget of nearly £400m  ...  view the full minutes text for item 7.

To consider the Adult Social Care and Health Scrutiny Committee Workplan 2017-2018, together with any suggestions that Members may wish to make for scrutiny review topics.

Members were referred to the Adult Social Care and Health Scrutiny Workplan for 2017-2018 and progress with the Implementation of Recommendations. Members noted that it was a strategic balanced programme with a good level of focus targeted towards quality outcomes and room for flexibility.

The Committee agreed:

1.             To approve the Scrutiny Workplan.

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

To note the date and time of the next meeting as Wednesday, 15 November 2017

commencing at 6pm in Committee Room A, Blackpool Town Hall.

The Committee noted the date and time of the next meeting as Wednesday 15 November 2017 commencing at 6pm in Committee Room A, Blackpool Town Hall.