Agenda and minutes

To receive Declarations of Interest (if any)

There were no declarations of interest.

To confirm the non-exempt minutes of the meeting of the Improvement and Scrutiny Committee - Health held on 21 November 2022.

RESOLVED – to confirm the minutes of the meeting of the Improvement & Scrutiny Committee – Health held on 21 November 2022.

30 minutes maximum for this item.  Questions may be submitted to be answered by the Scrutiny Committee or Council officers who are attending the meeting as witnesses, on any item that is within the scope of the Committee. Please see the procedure (below) for the submission of questions.

Question from Mr David Ingham:

“Following my Aunt’s hospital discharge into domiciliary care last year on 04-01-22 and her hospital readmission on 02-02-22, catching covid and passing away 2 weeks later I’m drawn to government promises over the weekend concerning patient discharge.

I note the ICB “Preparing for Winter” report presented to Scrutiny on 21-11-22.  Minutes indicate that members asked for further information and to be kept informed.

Since that meeting, nurses and ambulance services have striked. More are planned. Junior doctors could become involved. Winter admissions appear higher than expected due to flu/covid. Chesterfield Royal has featured on national news.

Whilst unsure of the NHS/PVI sector situation, within the Councils Adult Social Care and Health department despite 15.1 million being spent on agency cover from 2020 to 31-08-22 and 18.4 million on staff overtime (FOI 2245) its departmental sickness levels have continued to rise to unprecedented levels.  

Given the incredible pressure on the NHS, ASCH and PVI providers how can the Committee work to ensure that against this highly complex back drop, any hospital discharges reliant on in-house or PVI Domiciliary/Care Home provision is undertaken appropriately and critically, individuals are supported thereafter in accordance with post discharge expectancies/review periods.  

Reply from the Chairman of the Improvement and Scrutiny Committee - Health

The Improvement and Scrutiny Committee – Health is responsible for the scrutiny of any major health service transformations proposed by the local Integrated Care Board that will affect local patients and service users.

The Committee has, over many years, offered challenge to the way services are provided and this has extended to the joint provision of services with the Council’s Adult Care Services.

Very recently, the Committee undertook a review of Section 75 Agreements (a mechanism for joint funding and provision of services between the NHS and Adult Care) and the Committee is particularly committed to maintaining a level of scrutiny on services where patients receive care from multiple organisations – including the discharge process.

The Committee considers this to be especially pertinent at this current time now that the local Integrated Care Board – and its facilitation of joint working between partners - has been formalised.”

A supplementary question was asked by Mr Ingham:

“I understand the need to prevent bed blocking due to the medical needs of others and on ethical grounds.

I note the additional £200 million for the NHS to secure  care home beds to support discharge. I haven’t seen any reference to domiciliary support.

Discharged individuals will have various conditions. In 2018 my own mother was discharged from hospital for temporary care  into a Care Home. She had complex needs which the family understood. It was mothers wish to return home and was already in receipt of domiciliary support.

It still took a meeting involving my mother, DSO, Social Worker and myself at the Care Home to facilitate her return home. The Care Home genuinely believed if she returned home under domiciliary support it wouldn’t work and she would end up returning. They  ...  view the full minutes text for item 3/23

Chris Weiner, Tracy Burton and Claire Johnson, Derby and Derbyshire ICB introduced the report, which had been circulated in advance of the meeting.  It provided an overview of maternity services in Derbyshire, together with information on the governance, assurance and safety of maternity services locally, and how the Local Maternity and Neonatal System (LMNS) worked with the Integrated Care Board (ICB) in Derbyshire to meet the needs of pregnant people, babies and families.

Workforce pressure was impacting on safe staffing levels with sickness and maternity leave levels.  Recruitment of staff was challenging with hospital Trusts trying different ways of increasing the workforce including a rolling recruitment campaign which extends outside the UK.

Following the publication of the Ockenden report, Committee sought further information on those areas given an amber rating.  It was noted that the level of still-births was rising nationally.  Two reviews were on-going at University Hospitals, Derby and Burton (UHDB); the results would be brought to Committee at the next meeting.

Committee members expressed a number of concerns with the report, particularly around the lack of detail contained in it, action to be taken and comparative data.  Members questioned the difference in the level of death rates between Chesterfield and UHDB and it was noted that UHDB had a foetal medical unit which took in babies from around the county and the Sheffield area.  This therefore increased the level of deaths as there were more sick babies at the unit.

The ICB was committed to reducing the number of women who smoked during pregnancy.  All NHS hospital units had tobacco usage reduction pathways, including maternity units and a post-natal pathway was being developed.  Incentive schemes to encourage cessation of smoking were available but these required funding.

RESOLVED to:

1)   Note the report and actions taken to provide governance and assurance against the national maternity service recommendations and reports ensuring that Derbyshire maternity services are safe;

2)   Acknowledge the progress made; and

3)   A more detailed report be brought to Committee once all results had been collated following the re-assessment in May 2023.

Clive Newman, Clinical Director, Derby and Derbyshire ICB gave a presentation to the Committee to update on General Practice provision across Derbyshire, with emphasis on access, recruitment and demand following national and local challenges within primary care, and the recovery from the COVID-19 pandemic.

The presentation highlighted the demand on practices as a major concern for many patients and practices in Derbyshire.  Using GP Appointment Data and the annual national patient satisfaction survey, some practices achieved outstanding levels of patient satisfaction whilst others fell below the national average, with most concern around contacting practices or waiting times to see a GP; this was despite appointments offered for the same day increasing by 11% since November 2019 and the majority of appointments being face-to-face.

Demand was extremely high and was expected to increase.  Practices were reporting high levels of staff stress, burnout and abuse and were experiencing challenges in the recruitment of GPs.

Members asked a number of questions and Mr Newman undertook to provide additional information on:

·        The increase in face-to-face appointments.  This may not be available practice by practice but it would be provided to the Committee if possible; and

·        The areas of the county where it was more difficult to recruit GPs and other staff.

RESOLVED to:

1)   Note the contents of the presentation; and

2)   Invite Mr Newman to a future meeting for an update.

Jackie Wardle, Scrutiny Officer informed the Committee that work was being done with ICB colleagues to ascertain what items should come to Committee and when.  Potential items for March meeting were:

·        ICB/Adult Care joint report/presentation on joint financial responsibilities under ICB/ICP: particular issues that Members were keen to know more about were encouraged to advise Ms Wardle before 31 January when she and Councillor Wharmby were meeting with Helen Jones, Executive Director – Adult Care;

·        Delivery of the Winter Plan – performance

Healthwatch had proposed to report on the outcomes of their recent work as discussed at the November meeting:

·        GP Access;

·        Maternal Mental Health; and

·        Day Centre Closures.

The Committee’s review of Section 75 Agreements was submitted to Cabinet on 12 January and the recommendations were accepted.  The Cabinet Members for Health and Communities, Adult Care and Children’s Services and Safeguarding all expressed their appreciation of the review and thanked the Health Scrutiny Committee and the review working group Members, along with the officers who had contributed to the review.  The Cabinet Members believe that the review outcomes would help focus on joint funding arrangements for the ICB/ICP.

There were two actions stemming from the review recommendations:

·        The JUCD Children’s Board would prioritise Early Years Interventions; and

·        The review outcomes be shared with the ICB/ICP.

Both actions were being progressed by the Improvement and Scrutiny Officer with the appropriate officers.