Agenda and minutes

To confirm the non-exempt minutes of the meeting of the Improvement and Scrutiny – Health held on 13 September 2021.

(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 for the submission of questions at the end of this agenda.)

Question posed by Mary Dwyer:

We all know the efforts that our NHS staff have put in during the pandemic that we are still in. This has lasted for 19 months now. The toll this must have already taken on their personal life, mental health and family life is not imaginable let alone fully known. 

What plans have you made to alleviate the pressures on this body of people with winter pressures looming, as Covid numbers grow again and winter flu pressures rise? If plans are not already in place, please develop a plan now to show how we appreciate these marvellous people, many of whom are on a low wage, yet give their all for the good of others. 

As this was a question for the CCG to answer, it was agreed that it would reply in writing direct to Mrs Dwyer.

Response of the CCG:

To give assurance, across Derbyshire we work as a collaboration in health and social care, supporting all colleagues, with their mental/ emotional and physical health needs. As part of this collaboration, we have established a peer network of critical friends, with the aim of developing clear shared priorities and ambitions in order to meet the needs of the workforce we support. To do this, we have shared best practice, e.g. around the roll out of wellbeing champions, extending the network of peer to peer support across all partner organisations. We have also introduced wellbeing conversations, structured conversations, where individuals develop their own wellbeing plan and discuss its contents with their line manager as part of a structured conversation, to improve an individual’s health and wellbeing at work, this programme will over time be rolled out across all partners in health and social care. As well as this, the development of a Wellbeing Guardian model, a pivotal enabler in helping to create an organisational culture where empowering the health and wellbeing of our people is routine and a priority consideration across all organisational activities and decisions, these posts is typically held by a non-executive director.

We have received £600k in Mental Health and Wellbeing funding from NHSE/I to allow us to set up a mental health and wellbeing hub for colleagues. This includes rapid access support to mental health support delivered by IAPT services. This includes a range of therapeutic interventions including; CBT, Trauma Therapy’s and EMDR for example, with limited waits, allowing us to fast track health and social workers into treatment and support as early as possible taking a proactive stance to supporting workplace wellbeing.

We have invested in the recruitment of 5 Health Improvement Advisors to support the roll out of best practice across Derbyshire and to ensure equity across all organisations in terms of the offer with a view that all staff regardless their role or organisation should have access to the same level of support.

The Integrated Care System have also have supported the roll out of CiC an Employee Assistance Programme providing employee and family assistance 24/7/365 to  ...  view the full minutes text for item 26/21

An update on the national review of Urgent Treatment Centres (UTC’s) in Derbyshire was given by Sarah Mackmin and Dr Paul Wood, representing the NHS.  The review would address patient and public confusion around the core set of standards for the Centres as well as identify the confusing mix of walk-in-centres, minor injuries units and urgent care centres along with numerous GP health centres and surgeries that offered varied levels of core and extended urgent care services.

Derbyshire had five UTC’s, located in Ilkeston, Ripley, Buxton, Whitworth and Derby City.  The COVID pandemic and associated necessary changes to health service provision had led to the provision of 2 further UTC’s located at acute hospital front doors at Chesterfield and Royal Derby hospitals.  In assessing and considering the need to formally commission and continue provision of these centres, a strategic level decision was made to review all UTC provision across Derbyshire, taking into consideration the investments in enhancing Primary Care provision and the development of local Primary Care Networks including the three GP walk in centres at New Mills, Swadlincote and Ashbourne.

The review was in its early stages of development.  An on-line survey for patients and the public was being designed with the CCG and JUCD to form part of pre-engagement work and decisions regarding the future provision of UTC’s would impact on a number of stakeholders, patients and the public.

A Strategic Working Group had been established, led by Dr P Wood, and was working through the logistics needed to undertake such a review.  The Group would report to the Urgent, Emergency and Critical Care Delivery Board and subsequently to the Joined Up Care Derbyshire (future ICS) Board. Work was continuing on an Engagement Plan, UTC review timeline and project plan.

Members raised concerns around the level of care provision following the review and the Committee was keen to contribute to the review as it progressed and to have an input in any final decisions.

Dr Chris Clayton and the Executive Director of Adult Care presented an update on the development of the Integrated Care System (ICS).  The purpose of the Derby and Derbyshire ICS was to improve outcomes and population health and healthcare, tackle inequalities in outcomes, experience and access, enhance productivity and value for money and help the NHS support broader social and economic development.

The presentation gave an overview of relationships within the ICS and the setting up of the Integrated Care Board (ICB) which would lead integration within the NHS and the Integrated Care Partnership (ICP) which would align ambitions, purpose and strategies of partners across each system.

Feedback from the ICB and ICP engagement exercise was summarised with the overarching themes coming from the exercise being:

·        a true feeling of JUCD partnership working;

·        clear structures in place to support the development of the ICS going forward thus ensuring clarity and understanding; and

·        having the same vision and objectives.

These themes were further broken down for the Board and the Panel respectively.

The ICP development would happen over two phases – January to September 2022 and then from September 2022 onwards.  Objectives for Phase 1 work included:

·         the sign off of the strategic intent for the H&SC system including the development of the Integrated Care Strategy;

·         development of a clear view on the contribution of the H&SC system into the determinants of health, including the collective “anchor” approach;

·         support the work of the Health and Well Being Boards and to respond to their strategies; and

·         to work with broader partners on the wider determinants of health and develop the framework for future approach on these.

The development of a Forward Plan and an inaugural meeting would take place during December 2021.

The presentation went on to show what considerations were contemplated around the establishing of the ICB which should enable and facilitate partnership working and deliver statutory duties through agile governance.  The Board’s functions and proposed membership were also detailed.

The next steps in the programme included:

·        the designation of a Chair & CEO;

·        the recruitment for Non-Executive Directors;

·        Board composition submission to NHSEI and feedback;

·        appointment to other ICB roles by January 2022 to enable Shadow ICB Board to be in place;

·        continue discussions on ICB development and;

·        Final submission of the new Constitution by mid-March 2022.

The slides of the full presentation can be seen by clicking ICS Development.pdf

RESOLVED - Members appreciated that the ICS was currently going through the establishing of governance and that additional issues surrounding representation were yet to be agreed however, they were very keen to support the inclusion of elected representatives from local authorities, as well as Healthwatch Derbyshire and the local voluntary sector, in the creation of a Forward Plan for the ICS and to have regular dialogue with a nominated officer from the ICS team.

The Scrutiny Officer gave an update on the Committee’s forthcoming work programme and what it might expect in the future.  The following issues had already been identified for the next two meetings:

·        Continued scrutiny of the Chesterfield Royal Hospital HASU Review and a progress report (January);

·        Primary Care report on virtual and face-to-face GP consultations (January); and

·        Update on the new Mental Health in-patient facilities in Derby (Kingsway) and Chesterfield (Royal Hospital) (March).

Following the meeting on 22 November, the Committee would also be working with the Integrated Care System (ICS) leads to contribute to the ICS Forward Plan.  The Cabinet Member for Health & Communities was scheduled to attend the March meeting.

The Committee Chairman had drafted a proposal to consider a review of Section 75 Agreements between the County Council and local NHS commissioners and service providers, particularly timely with the development of the ICS for Derbyshire.  It was hoped a scoping report would be submitted to the January meeting.

Cllr Jean Wharmby was the representative on the South Yorkshire region of the Joint Health Scrutiny Committee (JHSC) and Cllr Linda Grooby was the representative on the Greater Manchester JHSC. Issues considered by these Committees and which impacted on Derbyshire residents would be reported to this Committee.

RESOLVED – that (1) Committee to work with the Integrated Care System (ICS) leads to contribute to the ICS Forward Plan; and

          (2) comments and suggestions of future items to be submitted to the Chairman for consideration.