Issue - meetings

Information Pack

Two queries were raised regarding the Health and Wellbeing Board minutes which were checked during a break in the meeting:

Minute No. S59 (Health and Wellbeing Strategy Refresh Workshop) – it was clarified that the point made about delivery mechanisms for the  Health and Wellbeing Strategy was in reference to the Casey Report and that the Strategy was currently being refreshed, together with the board structure and governance arrangements.

Minute No. S60 (Health and Wellbeing Performance Update) – it was confirmed that the transition of the Stop Smoking Service to Midwifery referred to specialist support for pregnant women only not the generic Stop Smoking Service.

No comments were received on the Commissioners Working Together update and it was agreed to receive further updates as the programme progressed.

Work Programme

An ongoing scrutiny work programme had been agreed with the Commissioners.  For this Select Commission there would be a focus on Health and Social Care integration and, in particular, the Better Care Fund.  At the present time it was not envisaged that there would be big changes to the Commission’s plans and standard work.  A more detailed report on the work programme would be considered by the Overview and Scrutiny Management Board at its meeting on 24^th April.

Yorkshire Ambulance Service - Performance Information

Due to the number of items on the agenda, the Service’s draft Quality Accounts had been circulated for comments by 22^nd April in order that they may be collated and submitted in accordance with the 27^th April deadline.

Chantry Bridge GP Practice

Some information had been received with further detail requested to inform any response the Select Commission wished to make.

Quarterly meeting with Rotherham Clinical Commissioning Group

A meeting had taken place the previous week.  The notes would be circulated when available.

Rotherham Mental Health Hospital Liaison Service

A 2 year pilot had been launched on 1st April to provide assessment, treatment and management of mental health problems to adults aged over 18, who were admitted to Rotherham Hospital. This was a positive example of partnership working between RDaSH and the Foundation Trust and an approach that recognised the links between physical and mental health and how ill health in one often impacted upon the other.

Rotherham Foundation Trust

The Monitor enforcement for governance had been lifted.

NHSE Property Services

A response had been received to the letter sent by the Select Commission regarding the issues being experienced at the Treeton GP practice.  It seemed likely that all interested parties would be invited to the June Select Commission meeting as planned.

The Chair thanked the previous Chairman, Councillor Wyatt, for his work on the Health Select Commission.

Yorkshire Ambulance Service

The Chairman reported receipt of correspondence, both written and verbal, from Unite and Yorkshire Ambulance Serviceregarding the performance of the service and industrial relations.

The Care Quality Commission was to inspect the Service in March and the Select Commission needed to decide how it would respond to the issues raised.

Leeds City Council Scrutiny Committee was to consider Yorkshire Ambulance Service at a meeting shortly and had invited Rotherham but unfortunately it clashed with the Council meeting.  Apologies for not attending would be conveyed to their Chairman and minutes of the meeting requested to help this Authority decide how to consider the Service.

Councillor Doyle, Cabinet Member for Adult Social Care and Health, reported that a performance update had been given to the Health and Wellbeing Board held the previous day.  The report was available on the intranet.  He had also had letters from Unite and had agreed to meet a representative of the union.  It had been emphasised that he could not become involved in any trade union disputes but performance issues had been raised.  Those issues had been conveyed to the Chief Executive of the Rotherham Clinical Commissioning Group asking that they be passed to the System Resilience Group.  When a response was received it would be passed to the Chairman of this Select Commission.

Joint Health and Overview Scrutiny Commission

Resolved:-  That the Chairman, Councillor Watson, (Vice-Chairman as substitute) represent the Health Select Commission on the above body.

Care Quality Commission

The Commission was to inspect Rotherham  Hospital shortly.  There was an event on 17^th February at the Holiday Inn commencing at 6:30pm for the public to share their experiences of the Hospital.

Incontinence Review

The Cabinet had accepted all 6 Review recommendations and the response would be further discussed at the Overview and Scrutiny Management Board on the 23^rd January with regard to monitoring arrangements.  A copy of the response would be circulated to Select Commission members.

Refresh of the Health and Wellbeing Strategy

The Health and Wellbeing Board would commence scoping of the new Strategy at a workshop in mid-February and, following wider engagement with stakeholders, would be aiming to have the new Strategy in place by September, 2015.

Health, Public Health and Social Care Round Up

Mental Health

The NHS mandate for 2015-16 included the introduction of access and waiting time standards in Mental Health Services by March, 2016.  50% of people experiencing a first episode of psychosis were to receive a package of care within 2 weeks of referral and 75% of those referred to improving access to Psychological Therapies Services would be treated within 6 weeks of referral and 95% within 18 weeks.

New Models

A good summary contained within around the forward view for the NHS and new models of working and delivering health care.

Healthwatch

No issues were raised.

There was nothing to report.

Better Care Fund

Shona McFarlane, Director of Health and Wellbeing, reported that Rotherham had been required to submit a revised version of the Plan in accordance with a September deadline.  It had gone through a process of moderation and feedback was awaited.  Every Plan was checked by an independent assurance process commissioned by NHS England and a telephone conference call had taken place to check a few matters of fact and accuracy in the document. 

The revisions to the Plan had included an additional action (BCF15) regarding End of Life.  Each of the action plans were currently in the process of implementation and would update the Select Commission in due course.

Minor Oral Surgery

NHS England (NHSE) Area Team was consulting on proposals to commission dental procedures such as wisdom tooth extraction and removal of retained roots from specialists based in general dental practices rather than from the local hospital as at present.  The proposals affected Rotherham and Sheffield as Barnsley and Bassetlaw had had such services based in the community for a number of years and NHSE planned to recommission them.  There would be no overall reduction in the amount of activity commissioned.

The proposal was to have 1 contract for Rotherham to treat 600 patients per annum (which equated to 1 dentist seeing 14 patients per week).

The deadline for comments on the proposal was 6^th November.

Resolved:-  That a response on behalf of the Select Commission be submitted including comments with regard to location, access and disability access.

Joint Health and Overview Scrutiny Committee

2 meetings were to be held in November to develop consultation responses to the proposed standards for Congenital Heart Disease Services for both children and adults.

(2)  That Councillor Wyatt be nominated as the Select Commission’s representative on the Joint Health and Overview Scrutiny Committee.

(3)  That Councillor Sansome be nominated as Councillor Wyatt’s deputy on the Joint Health and Overview Scrutiny Committee.

MyNHS

The above were the new web pages on the NHS Choices website containing health data that facilitated comparison with other areas on a number of measures/indicators for hospitals, social care, Public Health, services and outcomes and mental health hospitals.

NHS England Road Map

The Chairman commented on the information released in the press regarding the major issues facing the NHS and the budgetary pressures that needed to be addressed.

It was noted that the DoH had issued guidance around Health Scrutiny following the 2013 Regulations.  A briefing would be circulated to the Health Select Commission.

There were no communications to report.

LGIU Policy Briefings/Minding the Gap

Details of how to sign up for the briefings had been circulated to Members.

A further useful resource was the recently published A Cllr’s Guide to the Health System in England which was available on the intranet under Member Learning and Development Resources.

Support for Carers Review

The Cabinet’s response to the review was to be considered by the Overview and Scrutiny Management Board on 20^th June.  All 11 recommendations had been accepted and progress monitoring reports to be submitted to the Select Commission in due course.

Access to GPs Review

NHS England were involved in discussions with regard to Clinical Commissioning Groups being more closely involved in commissioning primary care with a range of models including joint or co-commissioning.  There were mixed views on the issue such as the impact this may have on relationships between the CCGs and GPs as well as concerns regarding conflicts of interest.  The Rotherham CCG had expressed an interest in managing GP contracts in their 5 year plan believing it would facilitate the development of system-wide care pathways needed to achieve efficiencies.

It was felt that this required further discussion as there appeared to be a conflict of interest.

Resolved:-  That this issue be included on a future Select Commission agenda.

Health Conference on 16 July

There was one spare place from those booked by commission members; details available from Janet Spurling.

July Meeting

A ballot was currently underway for possible industrial action on 10^th July, the diaried date for a meeting of the Select Commission.  Depending upon the outcome, it may be that the date of the meeting would be changed.  Members would be notified of the revised date and time.

(1)           Response to Youth Cabinet

The response to the question from the Youth Cabinet (Minute No. 70 of 13^th March, 2014) was attached to the agenda.

(2)           Joint Health and Overview Scrutiny Committee

2 reports had been published following the Leeds Children’s Heart Surgery Services review – the Mortality Case Review and the Family Experience.  The third report, Governance Review, would be published later in the year:-

Mortality Case Review Overview Findings

-          Clinical management of the cases examined showed medical and surgical care to be in line with standard practice

-          Case mix of surgical conditions and patients operated on was in keeping with comparable Children’s Cardiac Surgical Units in the United Kingdom

-          The cases reviewed were predominantly of high or significant complexity often with additional contributory risk factors

Family Experience Finding

-          A number of themes around care planning and support for families emerged based on the views and experience of 16 children and their families

Both reports made recommendations that had formed the basis for an action plan that the LTHT and the Unit were implementing – Service development, audit programme development.

(3)           Suicide Prevention Conference

The conference, held in Rotherham, had been attended by Councillors Beaumont, Dalton and Steele representing the Select Commission.  It had been a well attended thought provoking event with some very good speakers.  CARE about Suicide, the Guide to help universal workers prevent suicide, had been launched.  The Chairman highlighted the work of the Youth Cabinet on self-harm which had been featured at the conference.

(4)     The Rotherham Foundation Trust Quality Accounts

The first draft would be circulated at the end of April/first week in May for Members to consider before the Trust attended the meeting in June.

(5)           Healthwatch

It was proposed that there be a new standard agenda item “Issues from Healthwatch”, either verbal update or written report, to enable Healthwatch to raise issues/concerns they wished to bring to the Select Commission’s attention.

(6)           Yorkshire Ambulance Service Quality Accounts

To be submitted shortly.

Resolved:-  That “Issues from Healthwatch” be included as a standing item on future agendas.

(1)          Childhood Obesity Cabinet Response

The Cabinet’s response had been submitted to the Overview and Management Board in January, 2014.  Of the 12 recommendations, 10 had been accepted and 2 deferred (revising the report template to show consideration of health implications and promotion of the Rothercard).  A monitoring report was due to be submitted to the Commission in July but, as work was currently taking place on the pre-tender questionnaire and current providers continuing until October, it may be more appropriate to delay until a more appropriate time.

(2)          Work Programme

The Mental Health Review was to roll over into 2014/15 as the Carers Review and Childhood Obesity mini-Review had been carried out which had not formed part of the original Programme.  Mental Health Services was potentially a very large Review so there needed to be a clear focus as to what it should centre upon.

The 2014/15 Work Programme would need to be agreed by June so any suggestions would be welcomed by the end of April.

(3)           Public Health Conference

The Chairman reported that he had recently attended the above conference.  A written report would be submitted in due course.

(4)           “Working Together for a Healthier Rotherham”

The Chairman reported that a conference, entitled as above, was to be held in Rotherham on 16^th July, 2014, at the New York Stadium.

(5)           Rotherham Heart Town

The initiative had done very well to be short listed for a national award.

(1)          With regard to the proposed Urgent Care Centre the Vice Chair had received a response from NHS Rotherham Clinical Commissioning Group in relation to the issues raised by the review group.  It was noted that design work has now commenced in respect of the proposed building  which is scheduled for completion during 2015.

(2) The Chairman clarified the issues which are included in the 2013/14 Work Programme of the Health Select Commission : priority has been given to the scrutiny reviews of (i) support for carers in Rotherham; (ii) services provided by GPs in Rotherham; and (iii) the provision of Incontinence Services. Members also noted that the scrutiny review of Mental Health Services was to take place during the 2014/2015 Municipal Year.

Members noted that the agenda item about Children’s Continuing Healthcare has been deferred from the next meeting of the Health Select Commission (23^rd January 2014) and will be considered at a later date.

Janet Spurling, Scrutiny Officer, reported on the following:-

1.     Cancer Care

The 2013 Cancer Patient Experience Survey and related league tables showed that the Rotherham Foundation Trust was the 4^th best performing Trust in the United Kingdom around patients’ experience of cancer care.  This had been determined by analysis carried out by Macmillan Cancer Support of the NHS England survey data.  The report as well as the local and national NHS England reports were available.

2.     Women’s Health Survey

The Women’s Health and Equality Consortium were conducting a confidential United Kingdom-wide survey about women’s experiences of using GP services, both positive and negative.  The results would be presented to the Department of Health early next year.  The Consortium worked to ensure that the experiences and needs of women and girls were reflected in Health and Social Care Policy and that public sector services were effective in meeting their needs, ensuring that they were safe from violence at home and in their wider community.

3.     Indicative CCG Funding Allocations

Further information regarding the indicative figures showed that under the proposed formula (under review by NHS England), the 68 CCGs in the north of England would have been allocated £46 per person less than they received in the actual 2013-14 allocation and CCGs in the Midlands and the east of England would have received £39 more per head.  The reduction for Rotherham would be 6.38%, just under £21M.

Janet Spurling, Scrutiny Adviser, reported on the following:-

1.      Previous Scrutiny Reviews

          The response from Cabinet had been received for the Continuing Health Care and Residential Care Homes scrutiny reviews and would be going to the Overview and Scrutiny Management Board next week.  All recommendations have been accepted and monitoring reports would be presented to the commission in due course.

2.      CQC Hospital Inspections

New style inspections of NHS acute hospitals were commencing. The inspection teams would spend longer inspecting hospitals and cover every site that delivered acute services and eight key services areas:-

·                Accident and Emergency.

·                Maternity.

·                Paediatrics.

·                Acute Medical.

·                Surgical Pathways.

·                Care for the Frail Elderly.

·                End of Life Care.

·                Outpatients

Engagement with the public and Health Scrutiny would feature strongly.  The initial list covered eighteen Trusts including some that were high risk, some low risk and some that were in between those two extremes. Rotherham was not one of the eighteen and Airedale was to be the first one in the North.

3.      Local Health Website

Public Health England had launched a new online tool to help Councillors, Local Authority officers and other partners. The website included health information presented clearly for users. The information was available at upper and lower tier Local Authority level, as well as by Ward, using interactive maps, summary charts and more detailed reports.  The website could be found at the following link, but an executive summary was to be provided for all Members of the Select Commission:-

http://www.localhealth.org.uk/#v=map9;l=en

4.      JHOSC Meeting - 13 September, 2013

A new review was being established at this meeting to consider the whole lifetime pathway of care for          people with congenital heart disease.  Councillor Steele would be in attendance.

5.      The Health Scrutiny and Care Quality Commission Event for Health Scrutiny Members in York which was due to take place on Thursday, 26^th September, 2013 had been postponed and a new date was to be confirmed. 

6.      L.G.Y. & H. Events

          A report had been circulated outlining forthcoming events, detailing co-ordinated activity to make best use of resources.

7.      Briefings – Sign Up

          The following briefings were available to sign up for:-

·                LGiU Monthly Health and Social Care Round Up.

·                Minding the Gap - the Local Government Regional capacity building project for health inequalities for Yorkshire and Humber.

8.      From Yorkshire and Humber Health Scrutiny Officer’s Network

          CCG allocations

          NHS England was currently reviewing the local allocation of resources across the full range of its responsibilities, covering both allocations to CCGs and the budgets available for direct commissioning functions in area teams. ‘Indicative’ future funding allocations for CCGs, suggest a reduction for the North of England overall by 3.84% (approx. £722 million) and all CCGs across Yorkshire and the Humber were likely to see a reduced allocation of funding to varying degrees.

9.      The Chairman and Vice-Chairman of the Health Select Commission held a positive meeting with the Chair and the Manager of Healthwatch to look at ways for joined up working.

10.    A report  ...  view the full minutes text for item 24

(1) Reference was made to the workshop about “Make Every Contact Count” which takes place at the Town Hall, Rotherham on Monday 16^th September 2013. It was agreed that the Chair and the Vice-Chair should attend this workshop.

(2) It was agreed that Members of the Health Select Commission shall continue to have an agenda briefing session immediately prior to each scheduled meeting.

(3) Members thanked Deborah Fellowes (Scrutiny Manager) for her work in support of the Health Select Commission; this role would now be performed by Scrutiny Officer Janet Spurling.

Caroline Webb, Senior Scrutiny Adviser reported the following:-

Children’s Cardiac Surgery Review

The Prime Minister had announced that the process in terms of the potential closure of Leeds and a number of other surgical centres had been halted although the future arrangements around Children’s Cardiac Surgery would be revisited at some point in the future.

Further details of the implications of this announcement are awaited from the regional Joint Health and Overview Scrutiny Committee. These would be circulated in due course.

Deborah Fellowes, Scrutiny Manager reported the following:-

Children’s Cardiac Surgery Review

On March 27th the High Court found that the consultation and decision-making process which underpinned the Joint Committee of Primary Care Trusts (JCPCT) reconfiguration of Children's Heart Surgery Services in England and Wales was flawed and that its assessment of Quality of Services was unfair and unlawful.  The case was brought by Save Our Surgery Ltd. (Leeds) a body affiliated to the charity linked to the Heart Unit at Leeds Children’s Hospital (part of Leeds Teaching Hospitals NHS Trust).

The National Commissioning Board (the new body replacing the JCPCT) had been asked to reconsider the elements identified by the Judge, including how they arrived at the quality scores, issues of travel and access, co-location of vital services, strength of cardiac care network and financial viability.  The Judge had asked that they then report back on their findings and decide upon which Centres were to be designated on those new grounds. 

On the same day as the judgement was made, services at Leeds were suspended because of concerns about mortality rates and patient outcomes. There has been considerable press and media attention in this issue. However, after rigorous examination of evidence surgery was reinstated last week, concluding that there was "no evidence of significant safety concerns in terms of governance, staffing or the management of the patient pathway for surgical care in the unit or referral to other units as required" and added that "A number of very positive aspects of practice are present in the service provided… the teamwork is strong, inter-professional working is effective, surgical staffing levels are comparable to other units."

The Joint HOSC met in Leeds on April 10th. Cllr Ali has been the scrutiny representative on this body since the process started in 2011.

The meeting was originally convened to discuss the Secretary of State's referral of the proposed closure of the surgical unit to the Independent Reconfiguration Panel and their response.  However, following recent developments regarding the provision of Children’s Cardiac Surgery and interventional cardiology at Leeds Children’s Hospital, the focus of the JHOSC meeting had changed from what was originally planned.

The JHOSC considered the outcome and implications of the High Court ruling that found in favour of Save Our Surgery Ltd.  It also considered issues associated with the implementation phase of the review, with representatives from NHS England in attendance. The meeting also focussed on issues/ concerns about the service provision at LTHT, which resulted in the suspension of services. 

Following the meeting, the JHOSC concluded "Our prime concern throughout has been the welfare of the children concerned and limiting the anxiety of their parents and families.  We hope that the restoration of services and the outcome of the joint review being made available through NHS England and Leeds Teaching Hospitals Trust will bring families peace of mind and the certainty that their children are in safe hands.  We must now focus our attention on the ongoing issue  ...  view the full minutes text for item 72

Councillor Hoddinott reported that the Secretary of State’s Judicial Review into the proposed closure of the Children’s Cardiac Surgical Hospital in Leeds had found that the consultation process was unfair and legally flawed.