Agenda and minutes
PDF 203 KBVenue: Ashcombe Suite, County Hall, Kingston upon Thames, Surrey KT1 2DN
Contact: Ross Pike or Andrew Baird Email: ross.pike@surreycc.gov.uk
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APOLOGIES FOR ABSENCE AND SUBSTITUTIONS
Minutes: Apologies were received from Bob Gardner. No substitute attended.
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MINUTES OF THE PREVIOUS MEETING:
To agree the minutes as a true record of the meeting. Minutes: The Committee noted that the minutes of the last meeting have been amended to record Borough Councillor Lucy Botting’s attendance.
Borough Councillor Karen Randolph raised concerns with the responses provided by North West Surrey Clinical Commissioning Group (CCG) to questions that she posed at the Health Scrutiny meeting of 8 January 2015. It was requested that the CCG elaborate on their initial response to each of the questions. The Chief Executive of North West Surrey CCG (CENWS) acknowledged the concern that the responses were not felt to have offered enough detail. Assurances were given that steps had been taken to mitigate the loss of beds resulting from the refurbishment of two wards at Walton Community Hospital but the Chief Executive reiterated that although the closure was not ideal the environment at Walton prior to the refurbishment work taking place was not acceptable. Steps taken included opening additional beds at other locations as well as purchasing extra provision in nursing homes to cover any additional demand. It was further advised that the unprecedented level of demand experienced across the system during winter 2014/15 could not have been anticipated and so did not impact the decision made by the CCG to refurbish the two wards at the hospital.
Subject to this discussion, the minutes were agreed as a true record of the meeting.
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DECLARATIONS OF INTEREST
To receive any declarations of disclosable pecuniary interests from Members in respect of any item to be considered at the meeting.
Notes: · In line with the Relevant Authorities (Disclosable Pecuniary Interests) Regulations 2012, declarations may relate to the interest of the member, or the member’s spouse or civil partner, or a person with whom the member is living as husband or wife, or a person with whom the member is living as if they were civil partners and the member is aware they have the interest. · Members need only disclose interests not currently listed on the Register of Disclosable Pecuniary Interests. · Members must notify the Monitoring Officer of any interests disclosed at the meeting so they may be added to the Register. · Members are reminded that they must not participate in any item where they have a disclosable pecuniary interest. Minutes: None received. |
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QUESTIONS AND PETITIONS
To receive any questions or petitions.
Notes: 1. The deadline for Member’s questions is 12.00pm four working days before the meeting (Thursday 12 March 2015). 2. The deadline for public questions is seven days before the meeting (Tuesday 10 March 2015). 3. The deadline for petitions was 14 days before the meeting, and no petitions have been received. Minutes: None received. |
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CHAIRMAN'S ORAL REPORT
The Chairman will provide the Committee with an update on recent meetings he has attended and other matters affecting the Committee. Minutes: Interfacing to the Better Care Fund Work
The Department of Health ‘Guidance to support Local Authorities and their partners to deliver effective health scrutiny’ states that:
‘The primary aim of health scrutiny is to strengthen the voice of local people, ensuring that their needs and experiences are considered as an integral part of the commissioning and delivery of health services and that those health services are effective and safe.’
Substantial changes to health services are currently being commissioned and implemented through the Better Care Fund initiatives. In response to this we are in the process of re-organising the Member Reference Groups (MRGs) of our Committee. I’m pleased to say that most of the proposed MRGs are already in close liaison with the Clinical Commissioning Groups. We will be returning to this in some detail at Item 9 today. Increased Load on the Acute Hospitals All of our Surrey Acute Hospitals were required to accept much heavier Emergency Department workloads this winter and indeed in some of the summer months too. This is a pattern reflected across the Country.
We will be hearing about the particular case of Ashford and St Peter’s Trust this morning. The presentation will be made on behalf of the partner organisations which have worked together to alleviate the difficulties as they arose and which are trying to prevent recurrence in the future. Staffing Issues in the Health Service
The difficulty of recruiting and retaining suitable Health practitioners appears to be a growing problem across most of Surrey. Examples include:
- Central Surrey Health and Surrey Downs CCG cite the problem as a major factor leading to the closure of part of Leatherhead Community Hospital - The Care Quality Commission found that it contributed to some of the improvements required following its inspection of St Peter’s Hospital - The Surrey Heath CCG report difficulty in recruiting suitable staff for their 3 Locality Hubs - Public Health’s Report at Item 7 on today’s Agenda addresses the problem with relevance to Health Visitors and School Nurses. As greater integration between Health and Social Services is achieved there will be an increased requirement for practitioners to be able to work across what are currently distinct disciplines. There have to be pathways established for practitioners to gain the necessary skills.
Staff released from the Acute Hospital setting may require some re-training to enable them to move to other parts of the Health Service.
One of the streams of work in the Better Care Fund focuses on this issue and it will be addressed at the next meeting of the Adult Social Care Select Committee on 10 April. Vanguard Project
North East Hampshire and Farnham CCG is leading a consortium which has been chosen to carry out a Vanguard Project in the Primary and Acute Care Systems (PACS) category. Other members of the consortium include Frimley Health, Surrey and Borders Partnership, and Surrey County Council.
Over 5 years the project will involve developing local health and care services to keep people well ... view the full minutes text for item 5/14 |
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JOINT REPORT A&E WINTER PRESSURES
Following the high level of demand on NHS A&E units across the country and the effect on performance the Committee has requested that Ashford & St. Peter’s Hospitals Foundation Trust and its partners provide an analysis of the pressures in their area including detail on the immediate response to the increased demand and how the system is planning to cope going forward. The Trust has been approached as it has demonstrated resilience in this period and can provide evidence of the lessons learnt as it steps down from major incident status. Minutes: Declarations of interest:
None
Witnesses:
Suzanne Rankin, Chief Executive, Ashford and St Peter’s Hospitals Foundation Trust Julia Ross, Chief Executive, North West Surrey Clinical Commissioning Group Shelley Head, Area Director (North West Surrey), Adult Social Care Sarah Wardle, Head of Community Care and Rehabilitation, Virgin Care Nick Markwick, Director, Surrey Coalition of Disabled People
Key points raised during the discussion:
The Chief Executive of North West Surrey CCG (CENWS), who also is the head of the area’s system resilience group, highlighted that she was proud of the way in which all partners across the system had coped with the unprecedented level of demand that occurred over winter. Attention was drawn to statements made by the Care Quality Commission (CQC) which congratulated Ashford and St Peter’s Hospital Foundation Trust and its staff on their response to this demand. Confirmation was given, however, that procedures are currently being developed across the system in North West Surrey to improve resilience and responses to an unforeseeable escalation in demand on A&E services.
· The Committee asked for clarification on what a major incident is in practice and the reasons why it was declared at St Peter’s hospital. CENWS advised that declaring an internal major incident mobilises partners across the system such as the Ambulance Service and the Council as well as providing access to a range of measures and resources to help manage the sharp increase in demand experienced by the hospital. The Chief Executive of Ashford and St Peter’s Hospitals Foundation Trust (CESAP) highlighted that the sheer volume of patients attending A&E at St Peter’s hospital jeopardised patient safety as it was operating at its maximum capacity. The decision to declare a major incident was necessary so that enough staff, beds and other resources were available to ensure all patients continued to receive a high standard of care despite the pressures on the hospital.
· The Committee were further informed that declaring a major incident also establishes a control room from which directors can manage the hospital centrally and ensure all patients that attend A&E receive the required care. The CESAP did acknowledge that the declaration would garner media scrutiny and political interest but it was decided that declaring a major incident was the right thing for the Trust to do at the time and that it was correct for this status to be maintained until pressures on the hospital had reduced to the extent that it was felt that the hospital was able to function normally. |
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Minutes: Declarations of interest:
None
Witnesses:
Ruth Hutchinson, Deputy Director, Public Health Harriet Derrett-Smith, Public Health Principal, Public Health Karen Cridland, Lead for Universal Services, Virgin Care
Key points raised during the discussion:
· Members inquired about the transfer of responsibility for the commissioning of health visiting services for children under five to Public Health (PH) which comes into effect from 1 October 2015 and requested information on what work still needs to be done to complete this transfer as well as details on the challenges and risks to performance indicators. The Public Health Principal (PHP) advised that PH is working closely with the current providers of health visiting services. A Board which includes representatives from NHS England and the current providers meets regularly to discuss the transfer of responsibility for commissioning these services and has oversight of the ‘Call to Action’ programme to increase the number of Health Visitors and the delivery of their reviews. NHS England, as the current commissioners of the Health Visiting Service, currently collects data on the performance of service providers against current Key Performance Indicators (KPIs). These are made available to PH on a quarterly basis through the transition board.
· The Committee was advised that more work to understand the current and future workforce capacity of both Health Visiting and School Nursing Services in Surrey is being undertaken by PH. This builds on a previous review into the School Nursing service by PH.
· Health Visiting has been closely monitored by NHS England through a suite of KPIs and PH will continue to have oversight of these through the transition process. PH will also ensure that any monitoring processes remain after transition through use of contracting procedures. It was agreed that the current KPIs for Health Visiting will be circulated, with agreement from NHS England, to the Committee.
Recommendations:
1. The Committee is pleased with Public Health’s confidence in their preparation for the transfer of 0-5 responsibilities in October 2015. Actions/further information to be provided: 1. The Committee requests that Public Health share information collected by the present commissioner – NHS England – on the current performance of Health Visiting in Surrey; and
2. The Committee recommends that it receive a further report from Public Health on performance, benchmark data and Surrey specific targets in 2014/15 in this area and the commissioning plans for the complete 0-19 service at its November meeting.
Committee next steps: None
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PREVENTION AND SEXUAL HEALTH IN SURREY
Purpose of report: Scrutiny of Services
To provide an update on last year’s report to the Health Scrutiny Committee about sexual health prevention work currently taking place in Surrey. Minutes: Declarations of interest:
None
Witnesses:
Ruth Hutchinson, Deputy Director, Public Health Lisa Andrews, Senior Public Health Lead, Public Health Harriet Derrett-Smith, Public Health Principal, Public Health
Key points raised during the discussion:
The Senior Public Health Lead (SPHL) gave a brief update on the delivery of sexual health services for young people. The Committee were informed that PH has now taken on new responsibilities such as the commissioning of the condom distribution scheme and locality based teenage pregnancy advisors and is working to ensure that cohesive and comprehensive sexual health services are delivered by all providers across the county.
· There was agreement between the Committee and the SPHL that more needed to be done to make young people in Surrey aware of the sexual health services that are already available in the county and to ensure that they are comfortable accessing these services when required. Members were informed that PH is in the process of improving how it promotes the availability of sexual health services by using social media more effectively.
· Attention was drawn to the gap in the provision of 40 working time equivalent (WTE) school nurses. The PHP advised the Committee that the recruitment of school nurses is a national problem although Surrey’s problem is exacerbated further by proximity to London and a workforce that is retiring and not being replaced. PH is in the process of formalising a partnership with counterparts in Kent and Sussex in order to help address this shortage. It was also highlighted that work is being done in conjunction with Children’s Services and Youth Support Services to look at commissioning more broadly in this area and to explore creative opportunities for collaboration.
· The SPHL was asked what evidence there is to indicate that these services are improving the sexual health of young people in Surrey.It was highlighted that Surrey performs better than rest of England on most indicators such as having lower teenage pregnancies and recording fewer sexual health problems. There are patches in the county where performing more poorly than expected and PH is working to drive improvement in these areas.
· The Committee asked how well children were responding to sex education in Personal Social Health and Economic (PSHE) education classes at school. The SPHL indicated that feedback suggested that this can be an uncomfortable environment for many children to receive sex education and schools have been surveyed to provide information on how PH can best support them in creating tailored delivery for PHSE for children.
Recommendations:
1. The Committee suggests that the Woking Local Committee invites Public Health to a forthcoming meeting to understand the particular issues facing their residents.
Actions/further information to be provided: None Committee next steps: None
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REVIEW OF QUALITY ACCOUNT PRIORITIES
Purpose of the report: Scrutiny of Services and Budgets/Policy Development and Review.
The Committee will review its Quality Account Member Reference Groups and the draft priorities of NHS providers.
Minutes: Declarations of interest:
None
Witnesses:
Mr Bill Chapman, Mr Ben Carasco, Mr W.D. Barker OBE, Mr Tim Evans, Mr Tim Hall, Mr Peter Hickman, Rachael I. Lake, Mrs Tina Mountain, Mr Chris Pitt, Mrs Pauline Searle, Mrs Helena Windsor Ross Pike, Scrutiny Officer
Key points raised during the discussion:
A brief discussion took place with each of the Members providing feedback to the committee on their work with trusts on the quality accounts for 2014/15. The conversation included a number of points raised by Members beyond the scope of health provider quality accounts.
The meeting adjourned at 12.40 pm to discuss the membership and purpose of the groups in private. The meeting was reconvened at 12.55 pm.
Recommendations:
1. The Committee endorses the shift in purpose of the Member Reference Groups to act as liaison bodies with each of the six CCGs and the two countywide providers.
2. Members of the Committee to contribute to draft Terms of Reference for these groups at the next meeting of the Health Scrutiny Committee and sign-off. Actions/further information to be provided:
· Scrutiny Officer to seek the views and agreement of the six CCGs in the operation of these groups. Committee next steps: None
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RECOMMENDATION TRACKER AND FORWARD WORK PROGRAMME
Purpose of the report: Scrutiny of Services and Budgets/Policy Development and Review.
The Committee will review its Recommendation Tracker and draft Work Programme.
Additional documents: Minutes: Declarations of interest:
None
Witnesses:
None
Key points raised during the discussion:
None
Recommendations:
None
Actions/further information to be provided: None Committee next steps: None
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DATE OF NEXT MEETING
The next meeting of the Committee will be held at 10.00 am on 21 May 2015. Minutes: The Committee noted its next meeting will be held at 10.30 am on Thursday 21 May 2015.
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