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 25 March 2024.

RESOLVED – to confirm the non-exempt minutes of the meeting of the Improvement and Scrutiny Committee – Health held on 25 March 2024.

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 D Ingham:

“Whilst not wishing to come across as a pedant, from the perspective of a member of the public I can’t help but notice the number of verbal reports being presented at this Committee on Monday without papers being published on the Council website. 

For example, there is a verbal report associated with Hospital Discharge that I would be acutely interested in given questions I have recently submitted at other Council Committees but I have no idea what the contents of this verbal report will be.  There could have been something I would have liked to have specifically submitted as a question, but given I have no idea what is to be verbally relayed to the Committee that opportunity is now lost to me as a member of the public. The same applies for the other verbal reports.  Elected Members will obviously have the opportunity to ask questions on the day - but the opportunity will have passed for the public.

Going forwards, could the Chair kindly try to ensure in the interests of public questions that viewable reports are published wherever possible rather than verbal reports being presented on the day for the reasons as outlined?”

Response from the Improvement and Scrutiny Committee - Health Chairman, Councillor Jean Wharmby:

“The Committee plans its work and the items for consideration at its meetings in accordance with governance requirements. In doing so, it works with partners to establish the best way to provide information at meetings and to generate meaningful discussions.

Wherever possible, information is provided in written reports, but on occasions the Committee will consider an agenda item which is intended as an informative mechanism for the ICB, as service commissioner, or a service provider, to advise the Committee on how they contribute to a particular service area and the challenges and opportunities they face.  This is to give the Committee Members background information to enable them to better understand the service and how it is provided by different partner agencies.   Any areas where Members feel they have concerns, or need additional information, will be brought to a future meeting when detailed information will be provided in written reports.

The agenda item today, on the hospital discharge process and how DCHS contributes to this, is a general information item and therefore a verbal report is appropriate at this stage.”

Tracy Burton, Deputy Chief Nurse and Claire Johnson, Lead Midwife introduced the report, which had been circulated in advance of the meeting, which provided an overview of the maternity services in Derbyshire for 2023/24 and information on governance, assurance and safety of maternity services locally; this was accompanied by a presentation that highlighted the salient facts of the report regarding the maternity units at Chesterfield Royal Hospital (CRH) and University Hospitals of Derby and Burton (UHDB).

The neonatal death rate was below the England average however there was a slight rise in stillbirths and these were being monitored and reviewed to identify themes or learning.  A 100% compliance with clinical negligence requirements was required otherwise Trusts had to declare non-compliance.  Local rates of compliance currently stand at 79% for CRH and 69% for UHDB.

The Trusts had a 3-year Delivery Plan for Maternity and Neonatal Services to improve these rates and which incorporated the Ockenden Recommendations.  Many safety actions were around staffing and funds had been provided to help with staffing and training.  The senior leadership team had been significantly increased and specialist nurses and other staff had also increased considerably over the last 3 months.

The development of a new-build site was underway at Burton which would greatly help improve facilities.

Committee members were given the opportunity to ask questions, with particular concern shown around data and compliance.  Information gathering was complex however it was confirmed that improvements had been made and changes were being embedded alongside improved training.  Compliance rates were expected to be at 100% for the following year.

RESOLVED to –

1)   Review the contents of the report and note the actions taken to provide governance and assurance against the national maternity service recommendations and reports; and

2)   Provide an update to Committee in 6-12 months time.

Rose Lynch, Senior Communications Manager, Rami Khatib, Local Dental Network Chair and Clive Newman, Director of Patient Care introduced the report, which had been circulated in advance of the meeting, which provided an overview of NHS dental services across the county.

The commissioning of all NHS dental services was fully delegated from NHS England to Derby and Derbyshire ICB/JUCD in April 2023.  The importance of understanding the need of the local population had been recognised with an Oral Health Needs Assessment for Derby and Derbyshire being developed and the challenges with access to NHS dental services being fully recognised.

Dental service provision was still impacted by the response to the COVID pandemic.  During this time some practices closed and emergency units were set up across the country.  Derby and Derbyshire had a level of 59.8% NHS dental provision which was slightly less than national levels.  This was now 90%, which is higher than the national average.  Another major factor to be dealt with was attracting and retaining staff.

The ICB had a Dental Recovery Plan in place which included schemes to encourage access top NHS dental services.  Initiatives included:

·        A new patient premium – a financial incentive to encourage dentists to take on new NHS patients.

·        Financial incentives to attract dentists to work in less popular locations.

·        The Smile for Life programme for children to establish early habits of dental hygiene and care.

·        Assistance for dentists who have trained abroad to work in the UK and to UK standards via a pre-registration system for non-UK dentists.

·        A programme to increase the use of dental therapists to relieve the pressure on dental practitioners.

·        Patients at lower risk of dental ill-health to be seen less regularly (eg 12 -18 months instead of 6 months).

·        Working with Healthwatch Derbyshire on the patient experience across the county.

·        Use of a Provider Selection Regime (PSR) to help speed up the commissioning process.

Cllr Moss referred to the lack of NHS dental services in the Ripley/Heage area which impacted on his constituents.  The ICB representatives assured Cllr Moss that the initiatives already discussed should alleviate the situation and that, when a local contract terminates and a surgery closes, the contract was offered to other local practices to lessen the need for patients to travel out of area.

When questioned on future capacity, given the expansion of new-build homes across the county, the ICB representatives referred to incentives to attract new dentists to working in Derbyshire.  This should be done on a local basis and included incentives to attract re-turners to the profession.

RESOLVED – Committee noted the report.

Dean Wallace, Chief Operations Officer at Derbyshire Community Health Service (DCHS) gave an update on hospital discharges and 0-19 services.  The update was supported by briefing notes which were circulated to the Committee prior to the meeting.

Hospital Discharges

DCHS provided Pathway 2 beds to assist the hospital discharge process and allowed patients to continue their recovery away from Acute Care hospitals.  DCC also provided beds, under Pathway 8.  Combined together, there were 181 beds in the county.

The two organisations worked together as well as contract capacity from the private sector, to provide longer term nursing care.  Pathway 0 was where people go to their own home and receive support from family and the voluntary sector.

It was noted that Derby and Derbyshire performed in the top 10% nationally for efficient hospital discharges although there was still work to do due to the complexity of patients’ needs and an aging population.

0-19 Services

The service was currently being redesigned by Public Health and DCHS and was offered to all schools across the county - DCC controlled and academies.  DCHS found the use of Section 75 Agreements was useful in streamlining the contracting process and making it more flexible which helped with issues that were outside public control eg increasing populations in some areas due to new houses and families moving onto an area.

In respect of working in the Integrated Care System, investing in preventative services was key to improving the long-term health of local people from a young age and a lot of work was being done in this respect.  Other areas of DCHS work included Urgent Treatment Centres at community hospital sites and partnership working to support vulnerable people.

RESOLVED – Committee noted the reports.

Jackie Wardle, Improvement and Scrutiny Officer advised Committee of expected items to be discussed at future meetings:

·        Living Well Derbyshire programme – to inform the Committee of a new initiative;

·         Post COVID – to report on NHS post-COVID pandemic;

·        Pharmacy Services – including Pharmacy First and to discuss the capacity of pharmacies to provide services and level of prescriptions provided (include prescribing antibiotics and the blister pack issue); and

·        EMAS – to discuss CAT2 response times and hospitals accepting patients from ambulances.

It was agreed that supply issues for medicines, particularly diabetic injections, to be brought to a future meeting and would include the availability of medicines in general, supply issues and what was being done to address the problem.

RESOLVED – to accept the work programme for future meetings.