Agenda and minutes

To consider and approve the minutes of the previous meeting held on 29 September 2022 as a true and correct record of the proceedings.

Resolved:-

1.    That the minutes of the meeting held on 29 September 2022 be approved as a true and correct record of the proceedings.

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

There were no declarations of interest.

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

The Chair confirmed that there were no questions submitted by members of the press or public.

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

The Chair confirmed there was no reason to exclude members of the press or public from observing any items of business on the agenda.

To receive nominations for representative to Health, Welfare and Safety Panel.

Resolved:-

1.    Cllr Baum-Dixon was appointed as representative to the Health Welfare and Safety Panel.

To consider a presentation from Rotherham Healthwatch in respect of recent activities and trends.

Consideration was given to a presentation by the Community Engagement Officer of Healthwatch Rotherham which outlined recent inquiries and activities as well as future directions of engagement work in the community.

In discussion, a variation from the prior format of updates from Healthwatch Rotherham was proposed which would allow Healthwatch to give updates on a periodic basis to provide insights into specific agenda items for scrutiny.

Resolved:-

1.    That the report be noted.

2.    That the next update be received at the 09 March meeting.

To consider an annual update comprising a full overview of Rotherham’s Child and Adolescent Mental Health Services and two case studies.

Consideration was given to a fifth annual update report and presentation in respect of Child and Adolescent Mental Health Services. The presentation was delivered by Place Partners including the RDaSH Care Group Director as well as by CYPS officers including the Joint Assistant Director of Commissioning, Performance and Improvement; the Interim Service Manager for Neurodiversity; and the Service Manager for CAMHS and With Me in Mind. The presentation was introduced by the Cabinet Member for Children and Young People.

The presentation noted the progress made to implement strategies to support children and young people to have good mental health and emotional wellbeing. The presentation addressed:

•       Local Area SEND inspection in association with children and young people’s mental health,

•       Kooth digital mental health support

•       CAMHs pathways including progress in relation to implementing the re-designed neuro-developmental pathway

•       SEND sufficiency strategy

In discussion, Members requested clarification of the average wait time for CAMHS services. The response noted that the Service saw 70% of young people get help within 18 weeks. The longest wait times were 31 weeks.

Members noted a scenario that was representative of the difficulty encountered by families waiting on the neurodevelopmental pathway for diagnostic assessment. Members observed that two years’ wait can have a detrimental impact on a child’s long-term educational development and mental help. Members requested assurances that dispersed attention across multiple pathways, schemes and systems was not drawing resources away from working down the backlogs and reducing waiting lists for assessments that were needed most. The response from the Assistant Director for Commissioning, Performance, and Improvement, CYPS, noted that, in presenting the information around the number of children who were moving through the diagnostic pathway, this was not to suggest that the Service were not aware of the difficulty families were experiencing nor that the Service were not working very hard and doing all that they can to help reduce the waiting lists and ensure that children are able to access the services they need. The service acknowledged this and intended to present a rounded view of the services as a whole. The challenges associated with delivering a high volume of diagnostic assessments without reducing the quality of the assessments were described, and the Service were committed to ensuring that assessments delivered were of high quality. It was affirmed that access to resources and services should not be assessment dependent. New provision at Dinnington and further capacity being added to provide additional school places for children who would be on the waiting list for diagnostic assessment were also described. It was advised that if Members became aware of families that were not getting the support they needed because of not having a diagnostic assessment, please let the Service know. It was emphasised that support should not be diagnosis dependent.

The Cabinet Member for Children and Young People noted that budget pressures had been acknowledged nationally and emphasised the need to understand why children were experiencing mental health issues and poor mental wellbeing. Potential contributing  ...  view the full minutes text for item 41.

To consider an annual update report from The Rotherham NHS Foundation Trust (TRFT) in respect of actions, challenges, and achievements of the Trust for the financial year ending 31 March 2022.

Consideration was given to a report presented by representatives of TRFT providing an update on the financial year 2021/22. The discussion of this report was followed by a presentation of court findings relating to a CQC children’s safeguarding investigation. Representing the Trust were the Deputy CEO, Deputy Chief Nurse, and Director of Performance. In respect of the Annual Report, it was noted that the Trust is organised into several divisions: medicine, surgery, urgent and emergency care, community, family health, and clinical support. The presentation noted key decisions and changes that had been implemented throughout the year, including setting up community as its own division, and responding to significant challenges presented by COVID-19. Successes were highlighted, including the award of funding which had been utilised for evolution and development of IT and command centre functions, and the return of the Trust to a financially balanced position following a cost improvement of £5 million. Areas for improvement were also noted, including the outcome of CQC inspections which rated two areas as requiring improvement: urgent and emergency care and medicine. It was noted that the outcomes are not a focus; the focus of the Trust is safe and effective care. Good CQC outcomes will be a positive by-product of the work being done to deliver safe and effective care. The response to the staff survey had been the highest ever for the Trust, and one of the better response rates nationally, with 60%. The new strategy Our Journey Together was launched during the year, with focus on patients and partners. Improvements in results went from bottom quartile to the median within a two-year period. Developments in the capital plan and strategic investments were noted, including a web-based platform to improve accessibility, a refurbished stroke unit, energy efficiency, and staff wellbeing developments. In terms of performance, Referral to Treatment Times (RTT) had consistently remained in the top fifteen to twenty Trusts nationally. The emergency department was not working within standard on the pilot. This was an area where other Trusts had also experienced similar challenges. The possibility of returning to the 4-hour target had not been confirmed in writing. Challenges regarding cancer waiting times were noted, as well as successes in elective care with reducing the waiting lists. Staff sickness had fluctuated between 7 and 11 percent, with requirements to use agency staff during the most challenging parts of the pandemic.

Consideration was then given to a presentation of court findings regarding a CQC investigation into historical cases, of October-December 2019 leading into January-February 2020, of four children involved in nonaccidental injuries which were appropriately highlighted to the Trust. Serious incident reports were completed as a result, with investigations internally. The CQC was not satisfied that the actions to take were fully embedded at the time. Going through to court proceedings, the Trust reflected on these historical cases that this was not an adequate level of care that the Trust would expect to deliver to children within Rotherham. The court were clear that no  ...  view the full minutes text for item 42.

To consider a presentation in respect of preparation across Rotherham Place in anticipation of seasonal pressures.

Consideration was given to a presentation by the Deputy Place Director of Rotherham Place in respect of the Winter plan response to seasonal pressures encountered by Place Partners in delivery of health and social care services. The Plan had been developed in collaboration with all Place Partners based on learning from previous years, and including learning from the Thinking Differently for Winter workshop. The Plan had been agreed through the Urgent Emergency Care Board. The presentation highlighted what will be different this year and noted anticipated challenges. Specific innovations and challenges around Winter Planning were noted in respect of acute services, community services, primary care, children and young people, mental health, and system wide approaches.

In discussion, Members expressed interest in hearing more about urgent care and the wider system efforts to promote self-help, acknowledging that children and particularly babies can become very unwell very quickly. Members wished to know more about how this self-help advice is handled and if risks had been considered in forming this guidance. The response from the Deputy Place Director noted that a thorough description of what is being done to provide guidance and give clarity to parents and carers on where to seek advice was available from a staff member who would be in touch with the detailed answer following the meeting.

In regard to workforce challenges, Members sought assurances that these were being addressed and that everything that could be done locally to provide enhancements was being pursued. Members noted that the workforce have gone through the pandemic and received quite an insulting pay rise. Details were requested around intentions of the ICB to progress incentives of other kinds. The Deputy CEO of TRFT noted that the Trust was working to implement health and wellbeing measures to support staff. This had included considering making hot meals available during the night, which has not been previously available but was being considered. Ringfenced capital was available for the purpose of supporting staff. It had been noted that staff sickness levels were up, and fatigue was evident. The Trust had observed it was a very challenged workforce at the moment.

Members requested clarification around the first primary care and health access in terms of clinicians that are available and whether this varies among Primary Care Networks (PCNs). The response from the Deputy Place Director noted that this did vary, but all PCNs were increasing their access in the way they saw fit. Additional appointment times and extended access service added capacity over the weekends and into the night.

As regards public health measures and prevention of admissions, Members requested more information around what is being done to encourage self-management of illnesses at home. The response from the Director of Public Health indicated that there was education through schools on the prevention side as well as an examination of unnecessary attendances at A&E. The findings showed that most attendances are very much necessary. There was not observed to be a proliferation of attendances associated with self-limited  ...  view the full minutes text for item 43.

To receive a summary of findings and recommendations from the spotlight review on safety of care home residents and workers during COVID-19.

Agenda Item 11. –  Scrutiny Review Recommendations: COVID-19 Care Home Safety

Consideration was given to a summary of findings and recommendations from the spotlight review of Care Home Safety during COVID-19. These findings remained relevant as Rotherham Place headed into what was expected to be a challenging winter season. The spotlight review obtained assurances that key learning was being captured and robust procedures were in place to protect care home residents and workers. However, the review also found that workforce challenges presented real risk to optimising safety for residents and workers in care homes.

Resolved:-

1.    That the following recommendations be submitted to Overview and Scrutiny Management Board for consideration:

a)    That the learning from the pandemic and ongoing needs in respect of care home safety be noted.

b)    That the service consider how the Council may help support recruitment and retention within the care sector.

c)    That consideration be given to how best to retain where possible the benefits of supportive models such as regular engagement, access to training/guidance and the IMT approach which were adopted during the pandemic.

d)    That outcomes of forthcoming reviews by the Health and Wellbeing Board on learning from the Pandemic be considered for scrutiny.

To consider and endorse an updated outline schedule of scrutiny work for the 2022/23 municipal year.

The Chair noted changes to the work programme:

·       The item on Drug and Alcohol Recovery Services had been deferred to 2023 to allow the new service contract to be tendered and commissioned.

·       A Scoping exercise for the Oral Health Review had been conducted and the outcome included on the schedule of work. Members were encouraged to make representations prior to 1 December if any further addition to this scope is desired.

·       Outcomes from the spotlight on Access to Primary Care would be received at the next meeting.

·       Upcoming updates from Healthwatch were reflected against the meetings where they would speak to specific items on the agenda. Healthwatch would also speak to the workshop on health inequalities, where Members will review the findings of the Health and Wellbeing Board review in respect of alleviating disparities in access to health and care services and information and in healthy life expectancy in Rotherham.

In discussion, Members emphasised the need for scrutiny to examine the local risks and findings associated with damp or mouldy conditions in housing accommodation. The response from officers noted that these concerns would be raised as part of the relevant scrutiny reviews of private sector housing and cost of living currently on the work programmes of Improving Places Select Commission and Overview and Scrutiny Management Board.

Resolved:-

1.    That the updated work programme be noted.

2.    That the governance advisor be authorised to make changes to the work programme in consultation with the Chair/Vice Chair and reporting any such changes back at the next meeting for endorsement.

3.    That risks and findings associated with damp and mouldy conditions in housing accommodation be raised with the relevant scrutiny Chairs for consideration as part of reviews on the scrutiny work programme.

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

The Chair announced that there were no urgent items requiring a decision at the meeting.

The next meeting of the Health Select Commission will be held on 26 January 2023, commencing at 5pm in Rotherham Town Hall. 

Resolved:-

1.    The next scheduled meeting of Health Select Commission will be held on 26 January 2023, commencing at 5pm in Rotherham Town Hall.