Agenda and minutes

Councillor Sansome declared a non-pecuniary interest (relative works for the NHS at a local hospital)

There were no members of the public and press present at the meeting.

Improving Places Select Commission

The Chairman reported that a number of Select Commission Members had attended a recent meeting of the Improving Places Select Commission.  An item for discussion was the Housing Strategy which related to those residents who had learning disabilities, disabilities or any other specialist needs.  The Cabinet Member and respective officers had been challenged with a number of issues around the impact assessment, the number of houses which were being built for those with specialist needs against the ratio being built for those without needs etc.

CQC

There were to be follow-up inspections looking at the progress made on areas identified in previous inspections – the Yorkshire Ambulance Service inspection had started last week with the 111 Service in October.  The Rotherham Foundation Trust inspection would commence on 27^th September with the RDaSH inspection due to commence on 10^th October, 2016.

Commissioners Working Together Programme

Last week six Select Commission Members had discussed the consultation materials for the proposed Service changes with feedback submitted to NHS England as requested by 15^th September.  Helen Stevens (NHS England) would like to thank Members for their considered and helpful feedback.

The comments fed back had included slight rewording, more precise information/greater clarity on some of the details particularly regarding impact for Rotherham patients, including twitter/facebook links on posters/postcards and suggestions for a couple of additional questions.

The minutes of the previous meeting of the Health Select Commission held on 17^th March, 2016, were noted.

Arising from Minute No. 18 (Transforming Rotherham Adult (18+) Mental Health Services), it was noted that proposals for the Adult and Older Persons Mental Health model would be submitted to the RDaSH Board at the end of October.

Arising from Minute No. 20 (Adult Social Care – Performance Clinics), Councillor Roche reported that he had enquired about this issue and had been informed that the new system was different from that operated previously.  It was not a decision and, therefore, officers decided who was invited to a performance clinic.  The Democratic Services Manager sent out performance data on a quarterly basis, Cabinet Members received a briefing and it was then discussed by the Senior Leadership Team/Cabinet Members at their monthly meeting.  If a Member from this Commission was invited it would have to be opened to all the Commissions.

Councillor Ellis expressed concern that it was a new regime which involved all officer meetings with no Members; you could not have a performance tool without Members having no knowledge of it.  Previously a member of the respective Scrutiny Panel was always invited with the Cabinet Member chairing the clinic so it had changed considerably.  How could Members have governance over poor performance if they did not know what the tool was?

Additional information provided after the meeting:

The new system above was specifically with regard to meetings to discuss performance on the Corporate Plan, which had a varying number of Indicators for each Directorate. Officers have offered to brief Health Select Commission once a quarter Health Select on this data.

In the past there had been a system whereby a particular topic was examined in detail in a deep dive, with Members involved, but these were not currently in place.

Arising from Minute No. 21 (Caring Together Supporting Carers in Rotherham), it was noted that the Carers Strategy was to be submitted to the Health and Welfare Board in November for information and discussion in relation to the key themes aligned to the Health and Wellbeing Strategy.

Presentation by Ian Atkinson and Lydia George, Rotherham Clinical Commissioning Group

Keely Firth and Lydia George, Rotherham Clinical Commissioning Group, and Nathan Atkinson, RMBC, gave the following powerpoint presentation:-

National Strategic Context

-          Five Year Forward View

-          Delivering the Forward view: NHS Planning Guidance 2016/17-2020/21

-          General Practice Forward View

-          The Five Year Forward View for Mental Health

Rotherham CCG Plan takes account of 5 year Forward View

-          Unscheduled Care

-          Ambulance and Patient Transport Services

-          Community Services

-          Clinical Referrals

-          Medicines Management

-          Mental Health

-          Learning Disabilities

-          Maternity and Children’s Services

-          CHC and Funded Nursing Care

-          End of Life Care

-          Specialised Services

-          Joint Working (including Better Care fund)

-          Primary Care

-          Child Sexual Exploitation

-          Cancer Commissioning

Rotherham Integrated Health and Social Care Place Plan

-          Rotherham’s health and social partners have joined together to look at how we can make the most of our services with the public at the very centre of everything we do

-          By changing the way we approach health and social care in Rotherham we can improve our lives

-          Our vision is “supporting people and families to live independently in the community with prevention and self-management at the heart of our delivery”

Rotherham Context

-          Health and Wellbeing

Life Expectancy in Rotherham is less than the England average by more than one year

Life expectancy varies by eight years between different parts of Rotherham

Increasing numbers of older people with long term conditions

-          Care and Quality

Hospital attendances, admissions and waiting times continue to rise

There are opportunities to manage growth in emergency admissions to hospital

-          Finance and Efficiency

The NHS in Rotherham has a £75M efficiency challenge over the next five years

RMBC has in the region of a £40M financial gap to close over the next three years

Our Five joint priorities within the Place Plan

-          1.  Prevention, Self-Management, Education and Early Intervention

-          2.  Rolling out our integrated locality model – “the village” pilot

-          3.  Opening an integrated Urgent and Emergency Care Centre

-          4.  Further development of a 24/7 Care Co-ordination Centre

-          5.  Building a Specialist Re-ablement Centre

1.  Prevention, Self-Management, Education and Early Intervention

-          We will better meet the needs of local people by targeting individuals that can gain most benefit through:

·           Expanding our award winning Social Prescribing Service both for those at risk of hospitalisation and for mental health clients

·           Expanding systematic use of Healthy Conversations and advice by ensuring every statutory organisation signs up to Making Every Contact Count (MECC) and by training front line staff to talk about sensitive issues such as alcohol use, healthy eating habits, increasing physical activity and quitting smoking.  We will also ensure quick and easy referral to evidence based lifestyle services (e.g. smoking cessation) to support those that are ready to change and in a way that is right for them

2.  Roll out our integrated locality model “The Village” pilot

-          Our pilot “the village” is in Rotherham’s town  ...  view the full minutes text for item 31.

Janet Spurling, Scrutiny Officer, reported on the above Programme. 

There were a number of workstreams in the programme with options for substantial changes to Hyper Acute Stroke Care and non-specialised Children’s Surgery and Anaesthesia being consulted on in the Autumn.

The report and appendices provided an overview of the work already undertaken and the development of operations appraisals for both Services which included:-

Stroke Care

-          Hyper Acute (first 72 hours) – would be in one of the proposed centres (Doncaster, Sheffield or Chesterfield)

-          Acute – would be in patient’s local hospital once well enough to transfer

-          Rehabilitation – local sites

Hyper Acute Stroke Care

-          Recognised minimum number of patients per annum – 600

-          Rotherham Hospital – 482

-          Barnsley – 554

-          Chesterfield 586

-          Doncaster – 677

-          Sheffield – 1,009

Children’s Surgery – 6 sub-specialities

-          Ear, Nose and Throat (ENT)

-          Trauma and Orthopaedics (T&O)

-          General Surgery

-          Opthalmology

-          Urology

-          Oral

Children’s Surgery – Patient Numbers for Rotherham Hospital 2014/15

Model for the 6 sub-specialities

Surgery Tiers

-          Tier 1 Day case

-          Tier 2 Elective in-patient/non-elective in-patient – where most of the changes were proposed

-          Tier 3 Tertiary

Discussion ensued with the following issues raised/highlighted:-

Hyper Acute Stroke Units

·           The first hour was the most important part of a stroke.  A paramedic had to try and assess whether it was a bleed or a blockage and that was very important in how to begin to treat a patient.  It would be more onerous for Rotherham patients if they had to travel further afield

·           45 minutes travel time did not give much time once arrived at hospital for assessment and treatment – this did not include the waiting time for the ambulance to arrive

·           Concern that the ambulance crews would have the skills to be able to make that diagnosis to carry out the appropriate treatment (bleed v blockage) and have the equipment in place

·           National shortage of skilled staff and the importance of maintaining those skills through the volume of patients seen each year in line with recognised minimum numbers. Both Rotherham and Barnsley Hospital had vacancies for senior staff with the requisite skills

·           The need for statistics or data for assessing the outcomes for people admitted to Rotherham and Barnsley versus admittance to Sheffield and Doncaster in terms of survival rate etc? 

·           Did Sheffield and Doncaster have the capacity to take additional patients in terms of bed availability?

·           Importance of assessment process for clots and the time.  Not everyone was suitable for the assessment but staff had to have had training to carry it out

·           The hour was based on how long it took an ambulance to arrive – the proposal should be looked at in conjunction with ambulance response  ...  view the full minutes text for item 32.

Janet Spurling, Scrutiny Advisor, presented the final draft of the 2016/17 work programme for the Select Commission.

The proposed work programme helped to achieve corporate policies by addressing key policy and performance agendas, aligned to the priorities in the Corporate Plan with a clear focus on adding value.

It was agreed that the planning and prioritisation meeting in  July 2016 that an underlying theme would be to ask questions regarding addressing health inequalities.  A further consideration was the importance of meaningful public consultation and involvement of Service users, customers, patients and families/carers in Service transformation.

Priorities would be the major transformational projects which were interlinked:-

-          Sustainability and Transformation Plan including the Rotherham Place Plan

-          Health and Social Care Integration (continuing from 2015/16)

-          Adult Social Care Development Programme

-          Mental Health transformation (all ages)

Within these major projects specific issues/Services were identified including:-

-          Learning Disability

-          Carers

-          Older people’s housing

It was the intention that the majority of the work would be conducted through the full membership during scheduled agendas.  Witnesses would be required to submit information two weeks prior to the meetings in order to allow time for full preparation in advance.

Resolved:-  (1)  That the draft work programme for the 2016/17 Municipal Year be approved.

(2)  That it be noted that should any urgent items emerge during the year this may necessitate a review and re-prioritisation of the work programme.

Minutes of meeting held on 13^th July, 2016

The minutes of the Health and Wellbeing Board held on 13^th July, 2016, be noted.

It was noted that with regard to Minute No. 17 (Rotherham Local Digital Roadmap), the Select Commission wished to be informed if the assessment had been completed and what were the associated finances.

Additional information provided after the meeting:-

None of the CCGs in Yorkshire and Humber have had formal feedback on their Local Digital Roadmap as yet or further information on applications for funding.  Requirements for interoperability had changed and it was expected that further work would be needed but no further detail had emerged.

The minutes of the meeting between the Select Commission and Health partners held on 12^th July, 2016, were noted.

Councillor Cusworth gave the following update from the meeting held on 21^st September on health related issues:-

-          Lifestyle Survey – the number of young people identifying themselves as having an illness or disability

-          Annual report of the Local Safeguarding Children’s Board – dental and health assessments of Looked After Children to be monitored by the Corporate Parenting Panel but uptake for both was improving

-          Audit of paediatric assessments May 2015 as delays had been experienced by Social Workers with regard to children experiencing physical abuse and neglect.  Re-audit had not yet been carried out

-          Domestic abuse – experienced in households with children and by children themselves

No issues had been raised.

Thursday, 22^nd September at 9.30 a.m.

Resolved:- That the next meeting of the Health Select Commission be held on Thursday, 27th October, 2016, commencing at 3.00 p.m.