Contact: Sally Baker, Scrutiny Officer Email: SallyRose.Baker@surreycc.gov.uk
APOLOGIES FOR ABSENCE AND SUBSTITUTIONS
Purpose of the item: To report any apologies for absence and substitutions.
Apologies received from Nick Darby, Neil Houston, Frank Kelly. Michaela Martin, Helyn Clack, and David Lewis all attended remotely. There were no substitutions.
Purpose of the item: To agree the minutes of the previous meeting of the Adults and Health Select Committee as a true and accurate record of proceedings.
Attention was drawn to page 18 of the agenda which outlined a number of recommendations for the previous Adults and Lifelong Learning Select Committee. The Vice-Chairman informed the Committee that he intended to follow up on the relevant actions.
The minutes were agreed as a true record of the meeting.
DECLARATIONS OF INTEREST
Purpose of the item: All Members present are
required to declare, at this point in the meeting or as soon as
Any disclosable pecuniary interests and /
II. Other interests arising under the Code of Conduct in respect of any item(s) of business being considered at this meeting.
Members are reminded that they must not participate
in any item where they have a disclosable pecuniary
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.
Trefor Hogg declared a personal interest as a community representative for NHS Frimley CCG and Carla Morson also declared a personal interest with a close family member who works in the Emergency Department at Frimley Park Hospital.
QUESTIONS AND PETITIONS
Purpose of the item: To receive any questions
1. The deadline for Members’ questions is 12:00pm four working days before the meeting (28 September 2023).
2. The deadline for public questions is seven days before the meeting(27 September 2023).
3. The deadline for petitions was 14 days before the meeting, and no petitions have been received.
There were none.
Purpose of the item: to inform the Committee of the impact of Urgent and Emergency Care surge on the Surrey Heartlands system during 2023/24, including reference to the previous winter pressures; and to describe the whole system measures being put in place to promote resilience throughout the upcoming winter period.
Mark Nuti – Cabinet Member for Adults and Health (In person)
Ben Hill, Director – ICS Urgent Care and System Resilience will lead (In person)
Katy Neal, Associate Director – Ambulance Commissioning Surrey Heartlands ICS (attended remotely)
Radcliffe Lisk, Clinical Director UEC (attended remotely)
Jo Hunter, Director – ICS Planned Care (attended remotely)
Lorna Hart, Director of ICS Development. Email (In person)
Andrew Erskine, Deputy Chief Operating Officer SaBP (attended remotely)
Jackie Raven, Associate Director - ICS Urgent Care (attended remotely)
Key points raised in the discussion:
1. The Chair asked about the Surrey Heartlands Integrated Care Board’s [ICB] 5 objectives and wanted to know about the investment in I.T. in terms of putting standardised systems in place to improve the delivery of the objectives by joining up processes and performance. In particular, the changes of how things are managed concerning the year-to-year measurement of performance, changes, and improvements. The Director of ICS Urgent Care and System Resilience provided an update on the roll-out of the new electronic patient records in two of the acute hospitals and an upgrade on their third hospital which was rolled-out last year. This will support Surrey Heartlands in its ability to record patient records electronically as opposed to using paper with clinical audits and closer performance monitoring. The Surrey Care Record would also allow for the sharing of records with providers at point of access. The Director of Non Acute and Primary Care Contracts explained that cloud-based telephony is a significant tool offering a voice-redirection option, allowing for multiple lines to be open to better manage demand. Data sharing agreements between both Federations and practices provide confidence with not having the associated risks with distance prescribing or consulting. A Member asked if cloud-based telephony had now been rolled-out across the county. The Director of Non Acute and Primary Care Contracts confirmed it had been rolled-out across the Surrey Heartlands portion of the county.
2. A Member referred to the high level of complaints received from residents on the length of time for a call-back response. The Member questioned that as General Practitioners (GPs) are under strain, was securing more appointments realistic given recruitment issues to various roles as well as the recovery of dental activity, and how did Surrey Heartlands foresee managing more appointments for residents and patients. The Director of Non Acute and Primary Care Contracts explained that the aim is to be channel-agnostic, making services available however access to care is required. The additional roles reimbursement scheme introduced seventeen new roles with sixty-four thousand appointments from October to March managed. Surrey Heartlands was an early adopter of the Pharmacy, Optometry and Dentistry [POD] commissions, having taken it on from July 2022 and they continue to learn about the challenges faced with their dental contracts as there is an access issues for dental services.
3. A Member recognised there is some great technology but there are many people that ... view the full minutes text for item 35/21
Purpose of the report: to update the Committee on South East Coast Ambulance Service NHS Foundation Trust’s planning, timelines and preparation for the anticipated Winter 2023-24 pressures.
Mark Nuti -Cabinet Member for Adults and Health (In person)
Matthew Webb, Associate Director, Strategic Partnerships and System Engagement (attended remotely)
Mark Eley, Associate Director, Operations (In person)
Helen Wilshaw-Roberts, Strategic Partnerships Manager, Surrey Heartlands and Frimley (In person)
Key points raised in the discussion:
1. The Vice Chair asked about the anticipated challenges in relation to the winter pressures across a regional space made up of several Integrated Care Boards and local authorities and secondly, whether governance structures sufficiently involve the Trust in the planning of the winter requirements and what the plan would be to implement it and when did they expect to see this capacity available. The Associate Director, Strategic Partnerships and System Engagement explained that current forecasts are being reworked by the data analytics team to be outlined in the winter Plan before going to their Trust Board. They have introduced an aligned governance model which is a comprehensive structure allowing their Chief Executives to meet monthly. Two additional forums are on clinical quality where they jointly manage clinical safety risk from a clinical quality angle. The gap identified within this governance model concerned not having a formalised forum for discussing workforce constraints, financial challenges, and concerns. As a result, a strategic commissioning group was introduced to better support working with the systems when considering those financial and economic constraints. The Resource Escalatory Action Plan framework [REAP] is a medium-longer term outlook, reviewed weekly to consider factors such as demand constraints and changes in demand profiles. Industrial action is a key influence on this monitoring.
2. A Member referred to long term issues with recruitment and wanted to know what specific changes have been put in place to identify and address those difficulties, and how effective those recruitment changes have been in resolving the issues. The Associate Director of Operations explained that they are not experiencing any ongoing problems concerning recruitment. The areas of challenge regarding recruitment are their call centres for both 999 and 111. 999 is impacted in their service area. There is a difficulty to recruit into the East of the region since the move. There are issues with recruitment in the Crawley area, but they expected to be able to improve recruitment in Kent.
3. A Member asked about £2.5 million of additional funding has been received from NHS England to support 999 capacity, and asked if they could quantify those increases and explain how that has been implemented. The Strategic Partnerships Manager, Surrey Heartlands and Frimley responded that in terms of the front-line staffing increases there has been an improvement of 5% as a result of that funding. The Associate Director, Strategic Partnerships and System Engagement explained 2.5 million pounds of funding that has been offered to them as well as other ambulance Trusts is not winter funding and will not continue beyond October. They have utilised the funding by being able to apply a 60% increase in an additional ambulance fleet which resulted in an increase to their hours. ... view the full minutes text for item 36/21
Purpose of the item: to inform the Committee of improvement delivered in the delivery of Emergency Department (ED aka A&E) at Frimley Park Hospital in Surrey.
Mark Nuti - Cabinet Member for Adults and Health (In person)
Philip Kelley, Director of Improvement & Workforce (Primary Care) Development / Acting Director of UEC access, NHS Frimley. Frimley Health and Care ICS (attended remotely)
Dr. Stephen Dunn, Director of System Flow & Delivery, NHS Frimley (attended remotely)
Key points raised in the discussion:
1. The Chair referred to how the pilot was terminated by NHSE and as a result, whether difficulties had been created for the Trust, and how much notice was provided. The Director of System Flow & Delivery, NHS Frimley explained that there had been discussions over several months concerning the likelihood to move away from the four-hour Accident and Emergency performance. Formal confirmation was provided to them at the beginning of January 2022 which meant there was effectively three or four months to work through the actions that were needed to return to the standard. It was considered a good notice period however, as changes and dynamics on how patients were processed needed to be embraced regarding new clinical reference standards. Staff embraced this challenge and sought to improve performance.
2. A Member asked about the Bracknell and the Brants Bridge site concerning the publicity surrounding them and how they are making effective use of that publicity. The Member also questioned how many people have arrived at emergency departments that could have been seen at the Bracknell site. The Director of System Flow & Delivery, NHS Frimley explained that they have recently seen eight hundred and eighty people attend both Frimley Park and Wexham hospitals, both sites had an excess of four-hundred attendees. There may be opportunities to divert people attending to Accident and Emergency to use the urgent treatment centre at Brants Bridge. They had identified opportunities to potentially treat patients at alternative locations, reflective of the discussions around primary care access. They had the highest numbers of virtual ward emissions per hundred thousand by an Integrated Care Board in the country, and the highest number of same day appointments within two-weeks in the region. The Director of Improvement & Workforce (Primary Care) Development / Acting Director of UEC access, NHS Frimley and Frimley Health and Care ICS explained there are several services operating from the Bracknell site such as cancer care and dialysis services and there was a good use of the capacity provided. NHS Frimley had around 5,000 people attending that site with 2,600 for the walk-in site and around 2,300 appointments. On average 96% of patients are seen within 4-hours at that facility.
3. A Member clarified that the question was regarding the publicity for the site. In particular what publicity is there and are they making effective use of that publicity considering not everybody is online or aware that there is somewhere they can walk into in Bracknell. The Director of System Flow & Delivery, NHS Frimley thanked the Member for clarifying this question and explained that they have a detailed communications plan around ensuring their services are being used wisely which is delivered by ... view the full minutes text for item 37/21
Purpose of the item: For the Select Committee to review the attached recommendations tracker and forward work programme, making suggestions for additions or amendments as appropriate.
Key points raised in the discussion:
1. The Chair mentioned that the forward plan requires further work past December. One of the areas that he wants to focus on concerns about frequent visitors to A&E as that accounts for a major depletion of resources.
DATE OF THE NEXT MEETING: 7 DECEMBER 2023