Agenda and minutes

To receive declarations of interest from Members in respect of items listed on the agenda.

Cllr Bird declared an interest pertaining to the item on the Trailblazer Mental Health Pilot as Chair of Governors at Rawmarsh Children’s Centre and the Arnold Centre.

To consider whether the press and public should be excluded from the meeting during consideration of any part of the agenda.

There was no reason to exclude members of the public or the press from any item on the agenda.

To receive questions relating to items of business on the agenda from members of the public or press who are present at the meeting.

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

World Mental Health Day

The Chair reminded everyone that this was celebrated on 10th October and wished everyone a good and happy day.

Be The One Campaign

The Director of Public Health provided an update on the campaign which had achieved 160,847 web hits since its launch in September 2019, including 27,720 to date in October.  68 pledges had been made, excluding those via social media.  Very importantly, 373 toolkits had been downloaded.  The video had been shown at two Rotherham United games, reaching around 34,000 people with another 743 viewings on the website.  Three quarters of a million “shares” had been on social media and the aim was to reach one million.  More badges were available if required.

Healthwatch Rotherham

The Chief Executive informed the Select Commission about recent work that Healthwatch had undertaken:-

·       In support of World Mental Health Day a new men’s mental health group had been formed which met on Tuesdays at Rotherham Titans and was having significant impact.

·       The recent cluster of maternity issues at Rotherham Hospital had all been resolved satisfactorily bar one that would be discussed at a meeting between the service user, the Trust and Healthwatch the following week.

·       Healthwatch had been working with Child and Adolescent Mental Health Services (CAMHS) and RCCG on the neuro-developmental pathway to try and reduce waiting times for assessment.

·       Work on intermediate care and reablement would be commencing on behalf of RCCG through interviews with residents of Lord Hardy and Davis Court.

·       Annual PLACE assessments had been carried out at Rotherham Hospital and the Hospice.

·       Healthwatch Rotherham had won an award, along with their South Yorkshire and Bassetlaw partners, from Healthwatch England for outstanding achievement on engagement work on the NHS Long-term Plan.  Rotherham in particular had high levels of interaction and input.

·       The contract for the Healthwatch service in Rotherham had gone out to tender without the NHS complaints advocacy.

Information Pack

Contained within the information pack circulated to Members were the slides from the Respiratory Care Pack, further information from Rotherham Clinical Commissioning Group (RCCG) on engagement and a presentation about the proposed Target Operating Model in Adult Social Care.

To consider and approve the minutes of the previous meeting held on 5^th September 2019 as a true and correct record of the proceedings.

Consideration was given to the minutes of the previous meeting of the Health Select Commission held on 5^th September, 2019.

Resolved:-  That the minutes of the previous meeting held on 5^th September, 2019 be approved as a correct record.

Jenny Lingrell, Assistant Director Commissioning, Performance and Inclusion to present.

Jenny Lingrell, Joint Assistant Director Commissioning, Performance & Inclusion (RMBC and Rotherham Clinical Commissioning Group), delivered a short presentation to provide the Health Select Commission with an overview of the latest draft of the new Social, Emotional and Mental Health Strategy.

Initial actions had commenced in October 2018 with the development of robust data on Special Educational Needs and Disability (SEND) Sufficiency and would culminate in new provision being introduced in a phased approach by September 2021.  An action plan covering the six priorities was incorporated within the draft strategy and set out timescales to implement the Mental Health Trailblazer (see next item), which would pilot a new approach to delivering mental health support in schools and act as an enabler.  The action plan would also be refreshed annually.

Social, Emotional and Mental Health Strategy

Context

•        Provides a strategic framework to underpin activity

•        Builds on the foundation of existing work and policy drivers but tries not to over-complicate

•        Does not identify every activity or action in detail

•        Has been co-produced with headteachers; and reflects the views of children and young people

Principles of Collective Responsibility for Children and Young People with Social Emotional and Mental Health (SEMH) difficulties

•        Be based on the equitable use of resources which is affordable, with realistic expectations and clearly defined outcomes

•        Be a whole Borough response which is informed by transparent information and data and knowledge of local and national good practice;

•        Recognise the importance of early intervention and be family and person centred;

•        Recognise the importance of collective responsibility, which includes education, health and care partners and is based on a shared understanding of what is expected of all parties;

•        Provide a graduated response with thresholds to prevent escalation into expensive out of borough provision;

•        Provide local and flexible solutions which are developed and managed by schools;

Vision

Rotherham meets the social, emotional and mental health needs of all children and young people through seamless access to the right services at the right time and a confident and resilient workforce

Priorities

1.     Sufficiency: develop local education provision that responds to need – this will include flexible and specialist provision (special schools and specialist provision in mainstream)

2.     Seamless Pathways: ensure that pathways to support are connected and aligned and develop a clear behaviour pathway that includes responses to attachment and trauma

3.     Partnerships: develop and sustain robust inclusion partnerships that enable schools to meet need through a collective approach to responding to the needs of individual children

4.     Evidence-Based Approaches: ensure that the local authority offer (from Early Help and Inclusion services) responds to need and is underpinned by evidence-based approaches and aligned with clear pathways

5.     Workforce: develop a robust training and support offer, enabling professionals to feel confident in responding to the needs of children and young people with SEMH needs

6.     Outcomes Focused and Value for Money: ensure that all activity can demonstrate a clear outcomes and value for money

The draft  ...  view the full minutes text for item 41.

Jenny Lingrell, Assistant Director Commissioning, Performance and Inclusion to present.

Following on from the SEMH Strategy, Jenny Lingrell continued with a second presentation in relation to the Mental Health Trailblazer.

Mental Health Support Team (MHST) Service Model

The mental health trailblazer pilot will see mental health support teams established in 22 schools and education settings across Rotherham.  Up to 8,000 children and young people will receive face-to-face support to help address and prevent mild to moderate mental health problems

Wave 1 – Whole School Approach including the senior designated mental health lead

Wave 2 – Delivered by the Education Mental Health Professionals

Wave 3 – MHST senior practitioners linked to CAMHS Locality and Advice Teams

Wave 4 – MHST clinical lead and liaison/case management function linked to CAMHS pathways

This project was not a replacement for the CAMHS service.  It provided a graduated response with a range of activities within each wave and needed to dovetail with and enhance what was in place.  Under wave 2 liaison with services to access the right support would help with triage.  Workers had been recruited and were at university but also working one or two days each week in schools already part of the time.

MHST Roles

•        Deliver evidence-based interventions 1:1 and to groups of children and young people, building on the support already in place, not replacing it

•        Support the senior mental health lead to introduce or develop a whole school approach

•        Give timely advice to school staff, and liaise with external  services, to help children and young people get the right support and stay in education.

Education Mental Health Professional Role

•        Delivering evidence-based intervention for children and young people, with mild to moderate mental health problems, in schools.

•        Helping children and young people who present with more severe problems to rapidly access more specialist service.

•        Supporting and facilitating staff in education settings to identify, and where appropriate, manage issues related to mental health and wellbeing.

Role of the MHST Strategic Lead

•        Strategic lead from the voluntary and community sector will  integrate the social model/trusted relationship approach to complement CAMHS clinical approach

•        Ensure effective dissemination of learning from the Trailblazer – viewed as key

•        Produce a MHST service model and referral pathway

•        Oversee the allocation of referrals across the schools

•        Establish how the views of young people and families are collated - done

•        Establish what schools need and how they will work together and share good practice -  a lot of time had been spent on this aspect

•        Following a competitive procurement process Barnardo’s will lead this work

•        Barnardo’s have significant experience of working in Rotherham schools.  They currently deliver services focused on  Child Sexual Exploitation, Child Criminal Exploitation, Harmful Sexual behaviour and young carers

Other slides

·       Diagram showing how MHST complement CAMHS Locality Model

·       Recruitment of MHST – 2 in Rotherham, fully recruited

·       Map of participating schools and colleges – some at different stages on the journey so the learning could be compared

·       Implementation milestones

Detailed discussion  ...  view the full minutes text for item 42.

Angela Wood, Chief Nurse to present.

Angela Wood, Chief Nurse, provided an update regarding the findings and the ongoing actions to improve the Care Quality Commission (CQC) rating for the Trust, in particular for the Urgent and Emergency Care Centre (UECC). 

Four requirement notices were given to the Trust following CQC inspections in 2018, plus 74 actions, (a combination of 47 Must Do and 27 Should Do actions), some of which were organisation-wide such as governance, training and medicines management.  A comprehensive action plan was developed and monitored in the Trust with significant progress made to address the concerns raised by the CQC.  Examples of activity and improvements were outlined across all five domains – Safe, Effective, Responsive, Caring and Well-led.  Two actions had slipped and the Trust was in dialogue about these with the CQC – training around mental health capacity and medical audits around care in the UECC.  The remainder of the actions would be completed by 31 October 2019, followed by monitoring/audit for a period of sustained improvement.

The CQC had subsequently returned in an unannounced inspection in August 2019 to the UECC and the Trust was awaiting the draft report for commen on factual accuracy.  A re-rating of the core service would ensue and the Trust hoped to achieve improved ratings in the domains previously rated as inadequate.

The CQC would probably return again in early 2020 as some core services had not been inspected for a while.  A request for a Provider Information Return would flag up that the CQC were expected imminently, usually within six weeks.  Regular meetings were taking place with the CQC, including inviting them to visit core services and to a quality assurance meeting.  The CQC had also visited a Serious Incident Panel and complimented the Trust on the rigour with which that was conducted.  Preparation for the next inspection was under way through assessments and peer reviews and after 12 months in post the Chief Nurse was able to see the progress made in terms of engagement and quality of care.

Members raised the following issues.

·         Was a system in place to reward positive role models and staff behaviours?  - This had been touched upon at the last meeting and discussed subsequently.  Star cards are sent as thanks for staff going over and above what they should be doing or demonstrating really good values.  The Proud awards on 15th November, 2019 would be voted for by staff and there was also a patients’ category.  One area to look at capturing would  be if a person received multiple star cards.

·         The positive report was welcomed as good news with the hope of it being formally confirmed in due course and clarification was sought on several acronyms within the briefing.

·         With the reorganisation within the Trust to what extent did the CQC pick up on the teething problems? – Some recognition was given to this such as the vastness of the areas, bringing things together and cultural issues to work on.  Team building and organisational development were  ...  view the full minutes text for item 43.

Angela Wood, Chief Nurse to present.

Angela Wood, Chief Nurse delivered a short presentation on the recently created role of Nursing Associate and how this would help to address the national shortage of Registered Nurses, estimated to be around 40,000, by bridging the gap between staff in unregulated support roles and Registered Nurses.  The need for defined principles of practice, a competency framework, and a defined career pathway had been recognised for the role.

The presentation covered the role of the Nursing Associate and the training involved, which was a two-year programme of study and clinical practice leading to a level 5 Foundation Degree.  The trainees would work in clinical practice as a member of the nursing team with a number of placements each year and achieve agreed competencies.  After the generic training they would then choose their preferred route.

Recruitment to the courses had been positive with over 5,000 people recruited nationally as trainee nursing associates in 2018, with the ambition to attract a further 7,500 in 2019.  Sheffield University and other local affiliated universities were offering the courses and the first five nursing associates qualified in April 2019 and were still at the Trust.  During June 2019, a further 22 commenced their training and the Trust would continue to support future cohorts as part of wider workforce planning. 

The June cohort was smaller than expected but the requirements regarding Maths and English could be a barrier for some people and the hospital was offering training to support people to achieve the required level so they could apply in the future.  The courses and opportunities were promoted both internally within the Trust and externally and school leavers would be considered.

Members inquired whether a patient’s treatment might differ between a Registered Nurse and a Nursing Associate.  It was clarified that not in terms of hands on care delivery once people were confident and competent. The difference would be more in the organisation, management and accountability of planning care for groups of patients.  The Nursing Associate would be responsible for the delivery of care planned by the Registered Nurse.  Nursing Associates were a Band 4 role working in health and social care, Registered Nurses were Band 5 and Support Workers would be a Band 2 or 3 so there would be differences in salary.

HSC welcomed the opportunities provided by the new role and drew parallels with the former State Enrolled Nurses but wondered if there were any threats to success.  There was a potential risk that people might all want to move straight to becoming Registered Nurses and hospitals needed some to stay in the Nursing Associate Role.  The Chief Nurse highlighted the importance of people utilising their skills fully and for the role and contribution to care to be recognised and valued appropriately. 

The Chief Nurse was thanked for her informative presentation.

Resolved:-

1)    That the information presented be noted.

The Governance Advisor confirmed that the committee was scheduled to meet on 7^th November, 2019.  Although the agenda had not yet been finalised it was likely to include:-

-   Hospital Services Review

-   Gluten Free Prescribing Proposals

-   Hyper Acute Stroke Services – implementation of the new model

-   Integrated Care System (ICS) Work Programme – what was coming up in the short-medium term that the JHOSC would wish to consider

There was a possibility that Yorkshire Ambulance Service would be scrutinised at some point but this would not be in November.  This might depend on the response from the service to the queries that had been submitted by HSC which colleagues were working on and which should be back in time for the next meeting.

Once the papers had been published they would be shared with the Health Select Commission to enable Members to feed in any questions or issues they would like the Chair to raise at the meeting.

An update was provided by Healthwatch under Communications. 

To consider any item(s) which the Chair is of the opinion should be considered as a matter of urgency.

There was no urgent business to report.

The next meeting of the Health Select Commission will be held on 28th November, 2019 commencing at 14:00p.m. in Rotherham Town Hall. 

Resolved:-  That the next meeting of the Health Select Commission take place on Thursday, 28^th November, 2019, commencing at 2.00 p.m.