Agenda and minutes

Apologies for absence were submitted on behalf of Councillors J Tayor (Darlington Borough Council); R Bell and J Chaplow (Durham County Council); G Hall(Hartlepool Borough Council); and L Hall (Stockton Borough Council) 

There were no substitute members.

There were no declarations of interest.

To receive and approve the minutes of the meeting of the Better Health Programme Joint Health Scrutiny Committee held on 13 September 2017

The minutes of the meeting held on 13 September 2017 were confirmed by the Committee as a correct record and signed by the Chairman.

The Chairman of the Committee has received a request from Tony Parkinson, Chief Executive, Middlesbrough Borough Council, to address the Committee regarding a number of issues raised at a recent meeting of the Middlesbrough Borough Council’s Health Scrutiny Panel in respect of concerns around the extent of local authority involvement and engagement in the development of the Durham, Darlington and Teesside, Hambleton, Richmondshire and Whitby STP.

The issues raised at the aforementioned meeting include:-

·                The Chief Executive Lead on the STP had written to the NHS STP Lead stating that from a local authority perspective there were issues with the way the STP was operating;

·                There was a risk that the STP process could jeopardise the integration work currently taking place in South Tees and propose a completely different model;

·                The Council and South Tees CCG were relatively small organisations trying to have an influence but the agenda felt very much dominated by the acute sector;

·                NHS England had outlined ambitions for STP’s to evolve into ‘accountable care systems’ (ACS) - the DDTHRW STP could be incorporated in a North East and Cumbria ACS and the influence of individual Councils and CCG would decrease further as the footprint widened;

·                The STP Lead’s perspective on the role of the local authority in the DDTHRW Sustainable Transformation Partnership (STP) would be beneficial;

In agreeing to the request, the Chairman has invited the Chief Executive, or their appointed representative, from each of the local authorities within the STP footprint to attend the meeting also.

The Chairman introduced Tony Parkinson, Chief Executive, Middlesbrough Borough Council, to address the Committee regarding a number of issues in respect of concerns raised around the extent of local authority involvement and engagement in the development of the Durham, Darlington and Teesside, Hambleton, Richmondshire and Whitby STP. Tony Parkinson stated that prior to discussing some of the real challenges with the STP it was important to make the point that all of the constituent local authorities appreciated the scale of the challenge facing both health and social care and the need for change. At a South Tees level there was some really good innovation work taking place. For example on admission avoidance, however, there was a real concern about how that work at a locality level fitted with the much larger STP and the impact potential reconfigurations of services could have on local delivery.

It was emphasised that there was a real need for the STP to reflect the whole health and social care system, as well as take into account public health, the local prevention agenda, challenges around cuts in grant funding and issues faced by the adult social care provider market, as well as specifics around the pace of change. At present there had been limited political and community involvement in the STP and there was a general lack of understanding around where the STP sat in the governance architecture. It was felt that insufficient consideration had been given to local authority involvement in the STP despite a reliance on the social care system for successful delivery. At present local authorities had no detailed understanding of possible acute service reconfigurations even though they could be real advocates for the STP.         

Miriam Davison, Director of Public Health, Darlington Borough Council stated that she echoed the comments regarding the lack of public involvement in the STP, although welcomed the NHS’s increased involvement in the prevention agenda. The point was made that further clarity was needed with regard to care closer to home and where opportunities for local integrated services existed these needed to be developed.

Jane Robinson, Corporate Director for Adults and Health Services, Durham County Council welcomed the care closer to home aspect of the STP proposals but stressed that locality work in respect of Health and Social Care Integration would be at different stages across the STP footprint.

Paul Edmundson-Jones, Director of Public Health, Hartlepool Borough Council advised that he shared the views expressed by others and recognised that a lot of integration work was taking place across the North East. From Hartlepool’s point of view the question was around whether this work would be undertaken at scale and systematically. Tony Parkinson reiterated that the concern for local authorities was how all of the integration work was taken forward as part of the STP process and how each local authority could be true to its local populations, while still working collectively with partners.

Councillor Clark advised that North Yorkshire was made up of 7 district councils, 5 CCGs  ...  view the full minutes text for item 5.

To receive a presentation from Alex Glover, Local Director, Health Education England in respect of the development of a workforce strategy related to the STP.

The Committee received a presentation from Alex Glover, the Local Director of Health Education Excellence detailing the work that was being undertaken in respect of the workforce modelling workstream. It was advised that the new combined Cumbria and North East STP leadership forum supported the establishment of a single Workforce Strategic Group.

The role of the group would be to look at all the workforce challenges across health and social care. With a view to then making recommendations on priorities for investment in workforce development. It was acknowledged that as of yet the group had not been established and the framework presented to the Committee represented very early thoughts on the membership of the group.

A number of the key workforce challenges were outlined including:-

•           Recruitment and retention of hospital doctors

•           Recruitment and retention of the primary care workforce including GPs and practice nurses.

•           Local and national shortages of key workforce groups including midwives, surgeons, radiographers and interventional radiologists.

The General Practice Forward View, published in April 2016 recognised the pressure on general practice and in response Health Education England had taken a number of actions as follows:-

•           Increased GP training recruitment

•           Major recruitment campaign including international recruitment

•           Targeted £20k bursaries in hard to recruit places

•           Post CCT fellowships

•           Simplifying return to practice

•           Invest in training 1,000 physician associates

A strategy entitled ‘Developing and supporting the primary care workforce in the North East of England’ had also been developed, with two main areas of focus:-

•           Ensuring an appropriate level of workforce

•           Developing the current workforce

In response to a query it was advised that although the figures for GP recruitment nationally were close to the target, the GP recruitment figures for Cumbria and the North East had not been achieved. It was questioned as to how many had taken up the offer of a bursary. Although the exact figures for Cumbria and the North East was not known it was advised that the bursary had definitely resulted in an increase in GP recruitment over the last 2 years. 

Resolved that the information discussed and the comments made, be noted.

To receive the attached stakeholder briefing in respect of South Tees Hospitals NHS Foundation Trust’s engagement programme. Janet Probert, Hambleton Richmondshire and Whitby CCG will be in attendance to report on the programme and how this sits within the wider STP process.

Janet Probert was in attendance to report on a programme of engagement events for South Tees Hospitals NHS Foundation Trust entitled ‘Building a sustainable future for the Friarage’, which would run until the 20 December 2017. The Committee had been provided with a list of drop in sessions that were scheduled to take place in the coming weeks and the purpose of these events was to:

•           Share current challenges and start a conversation about how these might be addressed and to help shape any proposals going forward.

•           Gather feedback and thoughts on how safe and sustainable services can be delivered in the long-term from the Friarage site, given the challenges faced.

A short video highlighting the challenges faced at the Friarage was also presented to the Committee. The aim was to work with staff, partner organisations and the community to develop a vision, strategy and sustainable future for the Friarage. It was advised that following the engagement events a report would be submitted to North Yorkshire County Council’s Overview and Scrutiny Board prior to going out to formal consultation. It was emphasised that the consultation was not about closing the Friarage and South Tees NHS Foundation Trust had no concerns about the viability of the site.

Resolved that the information discussed and the comments made, be noted.

There were no urgent item arising.

Reference was made to an issue in respect of mental health beds at the Friarage and it was advised that whereas at Roseberry Park and West Park, patients had access to single rooms and ensuite facilities at the Friarage there were still mixed wards, which was not acceptable. Despite efforts to resolve this issue over the recent years a solution had not been found.

-       Wednesday 17 January 2017 at 2.00 p.m. – Venue TBC

The next meeting would be held as follows:-

Wednesday 17 January 2017 at 2.00 p.m. – Northallerton, North Yorkshire County Council