Agenda and draft minutes

Adults and Health Select Committee - Thursday, 15 October 2020 10.30 am

Venue: REMOTE MEETING

Contact: Ben Cullimore, Scrutiny Officer 

Media

Items
No. Item

1.

APOLOGIES FOR ABSENCE AND SUBSTITUTIONS

    To receive apologies for absence.

    Additional documents:

    Minutes:

    Apologies were received from Bob Gardner and Neil Houston.

     

2.

MINUTES OF THE PREVIOUS MEETINGS: 14 JULY 2020 AND 7 AUGUST 2020 pdf icon PDF 252 KB

3.

DECLARATIONS OF INTEREST

    All Members present are required to declare, at this point in the meeting or as soon as possible thereafter:

          I.        Any disclosable pecuniary interests and/or

        II.        Other interests arising under the Code of Conduct in respect of any item(s) of business being considered at this meeting.

     

    NOTES:

    ·         Members are reminded that they must not participate in any item where they have a disclosable pecuniary interest

    ·         As well as an interest of the Member, this includes any interest, of which the Member is aware, that relates to the Member’s spouse or civil partner (or any person with whom the Member is living as a spouse or civil partner)

    ·         Members with a significant personal interest may participate in the discussion and vote on that matter unless that interest could be reasonably regarded as prejudicial

    Additional documents:

    Minutes:

    Clare Curran declared a personal interest as a non-executive director and the Chairman of the Board of Directors of Surrey Choices.

     

    Jeff Harris declared a personal interest as Director and Chairman of the board of Hendeca, which was associated with the Surrey Care Association.

4.

QUESTIONS AND PETITIONS

    Due to the Covid-19 pandemic, all questions and petitions received will be responded to in writing and will be contained within the minutes of the meeting.

    NOTES:

    1.    The deadline for Members’ questions is 12pm four working days before the meeting (9 October 2020).

    2.    The deadline for public questions is seven days before the meeting(8 October 2020)

    3.    The deadline for petitions was 14 days before the meeting, and no petitions have been received.

    Additional documents:

    Minutes:

    None received.

5.

REPORT OF THE MENTAL HEALTH TASK GROUP pdf icon PDF 320 KB

    Purpose of the report: The Select Committee will be provided with a detailed report on the findings and recommendations of the Mental Health Task Group.

    Additional documents:

    Minutes:

    Witnesses:

    Olive Aherne, Area Manager, Richmond Fellowship

    Karl Atreides, Chair, Independent Mental Health Network

    Janice Clark, Governor, Surrey and Borders Partnership

    Nick Darby, Chairman of the Mental Health Task Group

    Nick Markwick, Co-Chair, Surrey Coalition of Disabled People

    Sinead Mooney, Cabinet Member for Adults and Health

    Professor Helen Rostill, Director of Mental Health, Surrey Heartlands

    Kate Scribbins, Chief Executive, Healthwatch Surrey

     

    Key points raised during the discussion:

     

    Ernest Mallett joined the meeting at 10:36am.

     

    1.    The Chairman of the Mental Health Task Group introduced the report, highlighting issues in the mental health patient journey that were raised multiple times over the course of the Task Group’s work, namely:

    a.    There were often problems involved in the transition from children’s to adults’ mental health services;

    b.    ‘Falling between two stools’ – the phenomenon of patient not meeting criteria for a particular treatment and therefore being bounced back and forth between services;

    c.    The development of the GP Integrated Mental Health Service (GPIMHS) was deemed very encouraging;

    d.    Contracts with charity sector organisations tended to be only about three years long – the Task Group recommended that this be extended;

    e.    The Task Group recommended that longer opening hours of Safe Havens be considered;

    f.     Data protection rules meant that sharing patient information was difficult;

    g.    Incompatibility of IT systems meant that patients had to repeat their stories multiple times;

    h.    Training was important to foster greater understanding of mental health issues;

    i.      There had been delays in making improvements to the Abraham Cowley Unit of St Peter’s Hospital.

    2.    A Member emphasised that mental health problems could start as early as pre-school age, so it was important that the transition from children’s to adults’ services took this into account.

    3.    A Member asked whether ligature points had now been eradicated in the Abraham Cowley Unit. The Surrey and Borders Partnership (SABP) Director of Mental Health responded that the ward where ligature points had been identified had now been closed and patients were being cared for in other facilities. The ligature risk had been assessed on all wards and work was underway to fit Primera safe hinges, which had a sensor function to prevent ligature from occurring.

    4.    A Member enquired whether steps were being taken to provide out of hours service at Safe Havens. The Director of Mental Health stated that SABP was in the process of looking at providing 24/7 Safe Haven provision in partnership with NHS England. Moreover, the mental health liaison services and home treatment teams already provided 24/7 service.

    5.    A Member requested that the Select Committee be sent a diagram showing pathways for patients through the mental health system in Surrey.

    6.    A Member emphasised that all transitions should be considered, not only the transition from children’s to adults’ mental health services, as there were often weaknesses involved in transition from one service to another.

    7.    The Task Group assured the Select Committee that this report would be shared with a wide audience: it  ...  view the full minutes text for item 5.

6.

UPDATE ON ADULT SOCIAL CARE MENTAL HEALTH TRANSFORMATION PROGRAMME pdf icon PDF 567 KB

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    Purpose of the report: The Select Committee will review and scrutinise the ongoing Adult Social Care (ASC) Mental Health Transformation Programme, making recommendations accordingly.

    Additional documents:

    Minutes:

    Witnesses:

    Olive Aherne, Area Director, Richmond Fellowship

    Karl Atreides, Chair, Independent Mental Health Network

    Janice Clark, Governor, Surrey and Borders Partnership

    Kirsty Gannon-Holmes, Senior Commissioning Manager (Mental Health)

    Nick Markwick, Co-Chair, Surrey Coalition of Disabled People

    Sinead Mooney, Cabinet Member for Adults and Health

    Kate Scribbins, Chief Executive, Healthwatch Surrey

    Liz Uliasz, Assistant Director (Mental Health) and Deputy Director of Adult Social Care

    Simon White, Executive Director of Adult Social Care

     

    Key points raised during the discussion:

    1.    The Cabinet Member for Adults and Health introduced the report, reminding the Select Committee that this was an update paper on mental health services now they had moved back into Surrey County Council Adult Social Care (ASC) following the decision to terminate the Section 75 agreement (of the National Health Services Act 2006). During the challenging journey to move these services into the Council, the focus had been on transition, training and supporting staff. Good progress had been made and the process continued.

    2.    The Assistant Director of Mental Health emphasised the use of strengths-based practice in the service and outlined the changes that had been made since the Section 75 agreement was terminated. Firstly, the structure of the team had been changed, as the team inherited had had no team managers. Two new teams had been developed: the mental health duty team, which acted as the service’s ‘front door’ during normal working hours; and the hospital discharge team. Work had also been done to ensure the service was linked into GPIMHS and Surrey Heartlands. There was more work to do around direct payments, creating robust structures and working with partners.

    3.    Regarding the service’s response to Covid-19, the Assistant Director continued to explain that since lockdown the team had been very busy – referrals and caseload had increased by 200 in the last six months and there had been an impact on mental health assessments both in and out of hours. There had been an increase in the number of Section 136 referrals, particularly amongst young people, and the service was working with the police on this. Overall, there had been an increase in the number and complexity of conditions. The service had been given guidance around virtual assessments in cases where there was a high Covid-19 risk, but, where appropriate, it had continued to conduct visits with PPE in the locality and check on people’s wellbeing.

    4.    A Member enquired what the timelines were for the service to achieve its goals, such as reinstating the Mental Health Programme Board Reference Group, working with the Surrey County Council Learning Disabilities and Autism (LD&A) team, and working together across area hubs. The Assistant Director of Mental Health replied that some of this work had been paused in the summer. However, in terms of the LD&A service, the ASC mental health team was working with Steve Hook, Assistant Director of Disabilities and lead for that service, and a report was being produced; joined up work between mental health and Autism  ...  view the full minutes text for item 6.

7.

WINTER PRESSURES IN SURREY HEARTLANDS pdf icon PDF 574 KB

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    Purpose of the report: The Select Committee is to review a follow-up report that outlines performance against the key themes included in the original Winter Pressures report, presented to the Select Committee in October 2019. The Select Committee will also ensure that appropriate measures are in place for Winter 2020-21, and it will scrutinise the ongoing work being done to improve the take up of appropriate vaccinations in Surrey for residents, NHS staff, partners and those who interact with the system.

    Additional documents:

    Minutes:

    Witnesses:

    Olive Aherne, Area Director, Richmond Fellowship

    Karl Atreides, Chair, Independent Mental Health Network

    Jane Chalmers, Director of Delivery (Financial Recovery), Surrey Heartlands

    Helen Coe, Recovery Director, Surrey Heartlands

    Nick Markwick, Co-Chair, Surrey Coalition of Disabled People

    Jackie Raven, Associate Director of Urgent and Integrated Care, Surrey Heartlands

    Professor Helen Rostill, Director of Mental Health, Surrey Heartlands

    Kate Scribbins, Chief Executive, Healthwatch Surrey

    Karen Thorburn, Director of Performance, Surrey Heartlands

     

    Key points raised during the discussion:

    1.    The Director of Performance introduced the report, highlighting key issues including:

    a.    The significant impact caused by the second wave of Covid-19 that had begun in autumn 2020;

    b.    There had been over 182,000 attendances to A&E in winter 2019/20, which was an increase of 9.4% compared to 2018/19;

    c.    The number of attendances to A&E had dropped significantly when the lockdown began in March 2020;

    d.    Performance over winter 2019/20 had deteriorated compared to Surrey Heartlands’ results in previous years, but was favourable against the England average;

    e.    Ambulance handover had improved and was performing well;

    f.     In order to ensure in-person work could continue where appropriate, Covid-secure measures had been put in place, including PPE;

    g.    A campaign to encourage the public to take up the flu vaccination had commenced;

    h.    In winter 2020/21, it would be important to balance business as usual, the Covid-19 second wave and recovering backlogs.

    2.    A Member expressed concern about a statistic in the report that in March 2020, NHS 111 calls answered within 60 seconds had dropped to a low of 12%. How much longer than 60 seconds did it take to answer these calls? Was it significantly longer (for example, one hour), or only a matter of seconds? The Director of Performance said that every year, the service conducted modelling and learning to ensure there was more than 100% staffing to ensure that all 111 call volumes could be covered. The Associate Director of Urgent and Integrated Care stated that she would provide the information requested on the duration of waiting times for 111 calls to be answered. She added that the 111 service would focus on recruitment and increased home working to ensure there was resilience in future.

    3.    A Member requested data on the time between a service user calling 111 or 999 and the service user being seen or treated by a doctor or consultant. She had heard anecdotal evidence of people waiting many hours for an ambulance to arrive. The Director of Performance agreed to provide this information.

    4.    The Chair of the IMHN asked what provisions would be put in place over winter considering that bed capacity had been reduced in the Abraham Cowley Unit and Langley Green mental health hospital (in West Sussex, close to the Surrey border). The Director of Mental Health stated that there was a short-term arrangement in place at the Elysium site in Surrey for people who had been on the Abraham Cowley Unit wards. Surrey and Borders  ...  view the full minutes text for item 7.

8.

WINTER PRESSURES IN FRIMLEY HEALTH AND CARE pdf icon PDF 455 KB

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    Purpose of the report: The Select Committee is to review a follow-up report that outlines performance against the key themes included in the original Winter Pressures report, presented to the Select Committee in October 2019. The Select Committee will also ensure that appropriate measures are in place for Winter 2020-21, and it will scrutinise the ongoing work being done to improve the take up of appropriate vaccinations in Surrey for residents, NHS staff, partners and those who interact with the system.

     

    Additional documents:

    Minutes:

    Witnesses:

    Olive Aherne, Area Director, Richmond Fellowship

    Nicola Airey, Director of Planning and Delivery, Surrey Heath CCG

    Karl Atreides, Chair, Independent Mental Health Network

    Michelle Head, Area Director, Adult Social Care

    Nick Markwick, Co-Chair, Surrey Coalition of Disabled People

    Professor Helen Rostill, Director of Mental Health, Surrey Heartlands

    Kate Scribbins, Chief Executive, Healthwatch Surrey

     

    Key points raised during the discussion:

    1.    A Member requested more detail on the new standard to replace the four-hour standard for waiting times in A&E. The Director of Planning and Delivery stated that the new standard measured average time in A&E rather than percentage of people seen within four hours. The rationale behind this was to try to see the right people in the right time-frame. For instance, a very sick person would need to be seen much more quickly than four hours. The benchmark average time was 220 minutes, and this week Frimley Health and Care had averaged around this benchmark. As well as the 220-minute figure, there were sub-targets including particular pathways for the most vulnerable.

    2.    A Member enquired what the effect of the closure of the Camberley Safe Haven had been. Had it resulted in increased footfall at the Safe Haven in Aldershot, particularly amongst Surrey Heath residents? The Director of Mental Health agreed to provide footfall data for the Aldershot Safe Haven and said that there had not been a significant increase in people with mental health needs going to A&E.

    3.    The Chair of the IMHN questioned whether the possibility was being looked into of Safe Havens run by Frimley Health and Care offering 24/7 provision, as well as Surrey Heartlands. The Director of Mental Health stated that this had not been decided yet but the possibility of extending the 24/7 model was being explored.

    4.    A Member asked how Frimley Health and Care were viewing staffing and other challenges, given the rapidly changing situation brought about by the Covid-19 pandemic. The Director of Planning and Delivery acknowledged that the situation was changing rapidly day by day. Key to Frimley’s response were adjusting for risks, flexing resources and mutual aid. The service was aware that this period would be challenging and had experience of adapting to change. The Member questioned whether, during the approaching second wave of Covid-19, Frimley had the resilience to continue offering treatment for conditions other than Covid-19, such as cancer. The Director of Planning and Delivery replied that there were plans in place to treat patients with the greatest need, including elective operations in some cases. The Area Director added that the service was able to adapt quickly and respond to residents’ needs in a personalised manner. It was also anticipated that communities would support each other during the second wave, as they had during the initial wave of Covid-19. Moreover, councillors could support the work of the health service by sharing the message that the NHS was open for business.

     

    Recommendations:

    1. The Select Committee recommends that GPs ensure digital modes  ...  view the full minutes text for item 8.

9.

RECOMMENDATIONS TRACKER AND FORWARD WORK PROGRAMME pdf icon PDF 106 KB

10.

DATE OF THE NEXT MEETING

    The next public meeting of the committee will be held on 17 December 2020.

    Additional documents:

    Minutes:

    The next meeting of the Select Committee would be held on 17 December 2020.

11.

PRIVATE WORKSHOP

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    Budget Scrutiny: review of the Council’s current financial position and core planning assumptions.

    Additional documents:

    Minutes:

    The discussion was conducted in private after the conclusion of the meeting.