Meeting: Overview and Scrutiny Committee (County Hall, Durham - Committee Room 2 - 16/07/2007 10:00:00 AM)
Item: A1 Minutes
DURHAM COUNTY COUNCIL
OVERVIEW AND SCRUTINY COMMITTEE
At a Meeting of the
Overview and Scrutiny Committee held at the County Hall, Durham on
Monday 16 July 2007 at
10.00 a.m. Present: Councillor P Stradling in the Chair
Members:
Councillors Burlison, C Carr, R Carr, Chaplow, Chapman, Davies, Douthwaite, E Foster, N C Foster, Gray, Henderson, Holroyd, Iveson, Manton, Mason, Meir, O’Donnell, Ord, Porter, Pye, Shuttleworth, Simmons, Stelling, Stradling, Walker, Williams and Young
Other Members:
Councillors Nicholls and Pendlebury
Co-opted Members: Rev A Letby, Mrs L Bailey, Mrs O Brown and Mr M Iveson
District Council Members on Health Scrutiny Sub-Committee:
Councillors Agnew, Gray, Harrison, Lavin, Maitland and Pitts
Apologies for absence were received from Councillors Armstrong, Bell, Campbell (District Council Member), Ebbatson, Marshall and Southwell.
A1
Minutes The Minutes of the meetings held on 14 May and 21 May 2007 were confirmed as a correct record and signed by the Chairman. In relation to Minute A7 of the meeting held on 14 May, 2007 the presentation by Mark Lloyd, Chief Executive outlining the direction of travel, Members of the Committee were informed that agenda item 6 relating to the Overview and Scrutiny Work Programme links into the issues highlighted during the presentation. With reference to Minute A2 of the meeting held on 21 May, 2007, the final reports of the Overview and Scrutiny Working Groups, the reports are now in the process of going to the Cabinet Committee for consideration.
A2
Declarations of Interest There were no declarations of interest.
A3
North East Ambulance Service NHS Pathways System The Committee considered a presentation by Simon Featherstone, Chief Executive, North East Ambulance Service and Jackie Shears, NHS Pathways Co-ordinator concerning the NHS North East Ambulance Service (NEAS) Pathways System (for copy of slides of presentation see file of Minutes).
During the presentation the following issues were highlighted:-
· Undifferentiated urgent care need.
· NHS Pathways - where it has come from.
· Individual care providers that use Pathways.
· National pilots
· How is it doing so far?
· Gradual improvement in appropriateness over life of pilot -
· % of 8 mins per week
· % of 1 hour per week
· ED/PCP calls transferred - weekly
· Looking Forward
It was explained that the Pathways System had originated as a result of statistics showing that in relation to the GP out of hours service, 95% of those referred to this service do not get an ambulance whereas 96% of 999 calls do get an ambulance (ambulance provision picking up urgent care more and more rather than emergency care). In addition it was highlighted that in relation to the GP out of hours provision, the level of service received varies considerably and is determined by where you live. As a result it was established that there is a need for a common ‘front end’ to urgent care, a need to create an integrated urgent care service with the ambulance service at the heart of it. It was emphasised that the system was devised to ensure that the patient receives the most appropriate care by the most efficient/best use of resources available.
With reference to the Pathways System, Members were informed that there are a huge number of players who feed into the system, individual care providers all use NHS Pathways to assess or to receive referrals from other assessing providers. The system sits within each organisation in existing systems which are already in operation.
Pathways acts as a filter and is based on the clinical need/assessment of the individual. The system has been live since 2006 in the North East with the North East Ambulance Service selected as only a trial site, if it fails here, it fails permanently and the NEAs will move to use AMPDS like everywhere else. It was emphasised that the Pathways system has proven to be stable with no adverse incidents to patients. With reference as to 'how is it doing so far?' in comparison with other services performance members were informed as follows:-
· 8m rate - 28%; nationally 37% average with AMPDS (current alternative system used by other services) (want this rate down to 20%).
· 19m rate - 57%; nationally 46% average with AMPDS
· PCP/ED rate - 4% (could be 10%); nationally 0.5 - 1%
It was highlighted that the aim is to get the PCP/ED rate from 4% to 10%.
With reference to the percentage of 8 minutes response times/calls per week (28%) the Committee was informed that there has been a gradual improvement in appropriateness over the life of the pilot, it was highlighted that alternative systems send around 36% of calls to 8m (response times).
With reference to the percentage of calls where a 1 hour response time is given on a weekly basis there has been a gradual improvement/increase in the transfer to primary care of non-urgent ambulance work over the life of the pilot. The NEAS previously sent around 1% to primary care (now up to 4%).
It was highlighted that the Pathways System has reduced the number of ambulance journeys per week by 500 which in turn reduces the number of vehicles by 4 per shift.
In relation to the future it was emphasised that Pathways offers something to the entire NE Health economy, it enables the ambulance service to become the central hub around which patients can get fast access to urgent care, the system leaves ambulance provision for the really sick whilst pointing people to the best alternative care for them as an individual.
It was emphasised that the data/statistics produced can be used to determine care needs.
Councillor Walker requested clarification as to how long does the average call take and what training is given to the operators of the Pathways System.
Members were informed that in terms of Category A calls (emergency calls), they take between 3 to 35 seconds, for the rest of the calls from start to finish approximately 2 minutes 40 seconds. With reference to training the system requires non-medical staff to undertake clinical assessments therefore the training is 'heavy duty' lasting for ten days and involving written and practical assessments. In addition the staff are continually monitored and if a problem is identified with a particular operator then there is a system of referral where additional guidance is given on an individual basis.
Councillor R Carr requested clarification as to whether all the individual care providers illustrated in the presentation provided services that could be accessed on a 24 hour basis.
It was confirmed that the diagram illustrated those partners using the system to which callers can be referred however many do not provide 24 hour service provision.
Councillor R Carr then requested as to whether paramedics would still be located on ambulances.
It was confirmed that there is no intention to take out qualified staff from existing ambulance provision.
Councillor C Carr questioned that in relation to the reduced number of ambulance journeys and therefore the reduced number of vehicles required as a result of the Pathways System transferring calls to primary care or patients asked to make own way to ED, will this not result in reduced numbers of staff and vehicles.
Members were informed that there is still enough work to maintain current levels of staffing and vehicles.
Councillor C Carr continued by commenting that the Pathways System ranks calls, it is a system of screening.
The Committee was informed that currently there is a system of ranking in relation to ambulance response times depending on an assessment of the clinical condition of the patient i.e. 8 minute, 19 minute, 1 hour or 4 hours, currently there is a variety of different timescales.
Councillor C Carr questioned that if there is a cost saving as a result of the Pathways System where will the saving be directed.
Members were informed that the service budget is not being reduced as a result of the Pathways System, the system does not cut costs it uses existing resources more effectively.
Councillor Mason questioned as to whether First Responders are still in the system as waiting 8 minutes for an ambulance when the case is an emergency is a long time.
It was confirmed that First Responders are still in the system.
Councillor Mason continued by requesting as to whether response time data could be made available on a community basis (in relation to Seaham).
The Committee was informed that such information is available on a locality basis and would be forwarded to him following the meeting.
Councillor Shuttleworth requested clarification as to the cost of the consultants who will be evaluating the performance of the Pathways System.
It was confirmed that the evaluation is being undertaken by the Department of Health who have decided to employee Consultants therefore the cost is not known.
Councillor Pitts (District Councillor) questioned as to whether the operators of the Pathways System can gain access to patient's history.
Members were informed that the staff do not have general access to patients history, they do have access to information if the individual has special arrangements, a pre-determined management plan.
Resolved: That the presentation be noted.
A4
New Partnership Framework for County Durham (Local Area Agreements) The Committee considered a report of the Head of Corporate Policy detailing the progress made with the review of the County Durham Strategic Partnership, the development of the new Local Area Agreement and implications of the new arrangements for Durham County Council (for copy of slides of presentation see file of Minutes).
Members were informed that there are two stages in the approach, Stage 1 involves seeking partners views on where they see themselves in a future partnership framework and mapping the responses, Stage 2 involves exploring practicalities and any issues thrown up in Stage 1 and re-drafting the governance framework to meet the needs of wider partnership working.
It was highlighted that partners have agreed to use the four themes in the new LAA guidance as a starting point for discussion about what our partnership framework should look like in the future, although there is flexibility. The four themes are similar to the existing LAA Blocks however more clarity is needed in relation to Stronger, Safer: What is the desired structure linked to the CDRP debate, how far do we integrate Economy and Environment, how does Lifelong Learning fit in (across the four blocks), how many themes do we want and what should they be, challenge and clarity in terms of links and responsibilities. (Mechanisms to support cross cutting work and doing things differently).
Councillor Pitts (District Councillor) commented that issues such as social inclusion of older people is cross cutting, how does this fit in the new framework.
Members were informed that as a partnership they would decide best how to deal with cross cutting issues.
Councillor N Foster highlighted the need to develop Adult Learning in the County, from an educational and economic perspective. He continued by highlighting the role of SureStart in providing an opportunity for parents as well as children to learn.
Councillor Stradling commented on the need for member involvement in the process of shaping the new partnership framework.
The Committee was informed that the authority is currently responding to the first stage of consultation, issues concerning member involvement will be covered in the second stage of the consultation process.
Resolved:
That the presentation be noted.
A5
Review of Medium Term Improvement Priorities The Committee considered a presentation by the Head of Corporate Policy (for copy of slides of presentation see file of Minutes) providing details of the review of improvement priorities. During the presentation the following issues were highlighted.
· DCC context
· Current Improvement Priorities
· Peer Review Action Plan
· Things to take into account
· Issues
· Challenges in the County
· BVPI Satisfaction Survey
· Questions
With reference to questions Member were asked as to how Overview and Scrutiny would want to play into the process.
It was suggested that Overview and Scrutiny could contribute to this process via the Co-ordinating Panel.
Resolved:
· That the presentation be noted.
· That Overview and Scrutiny contribute to the setting of the Medium Term Improvement Priorities via the Co-ordinating Panel
A6
Overview and Scrutiny Work Programme The Committee considered a report of the Head of Overview and Scrutiny informing Members of the work programme and approach to delivering effective scrutiny for Durham County Council in 2007/08 (for copy of report see file of Minutes).
Members were informed that policy development and policy review will be delivered through either a specially convened working group or via the Scrutiny Sub-Committee, light touch reviews will be time limited and will involve a small group approximately 4+ of members, cross cutting reviews will be a combination of both working group and/or light touch.
It was highlighted that there are capacity issues in relation to supporting members to deliver on the work programme, this is being considered at present including opportunities to pursue a joint appointment with the NHS to support the JHOSC is being discussed, opportunities to engage with Council services to directly support delivery of the work programme is also an option under consideration.
With reference to the recommendations it was suggested that an additional recommendation be included that the Work Programme for Overview and Scrutiny be shared with Cabinet.
In relation to 'Stress Related Ill-Health' project, Councillor Coates commented that this is a joint project with Human Resources and that it may not be appropriate for it to be time limited.
It was confirmed that the members involved in the project would define the time period to be taken.
Resolved:
1. That the work programme be agreed together with the suggested approach in delivering effective Scrutiny for Durham County Council.
2. That Overview and Scrutiny Members agree to participate fully in delivery of the work programme thereby contributing to policy development and assisting the Executive (Cabinet) develop and implement a policy that makes a difference for our communities.
3. That the work programme be shared with the Executive (Cabinet).
Attachments
Minutes 16th July 2007.pdf