Agenda and minutes

Apologies for absence were received from:-

Councillor S Akers-Belcher (Hartlepool BC)

Councillor J Blakey (Durham County Council)

L Tostevin for H Scott, Darlington BC and O Temple for W Stelling

There were no interests declared

To receive and approve the minutes of the Better Health Programme Joint Health Scrutiny Committee held on 8 September 2016.

The minutes of the meeting held on 8th September 2016 were confirmed by the Committee as a correct record and signed by the Chairman.

At the Joint Committee’s meeting held on 8 September 2016, members received a presentation setting out performance within those Acute Hospitals within the Better Health Programme Footprint. During consideration of this information, members requested further information regarding the current national clinical standards which applied to A&E services in respect of waiting times and how these are applied within Acute Hospitals’ A&E services.

Representatives of the Better Health Programme Board will be in attendance to give the Joint Committee a presentation on this issue.

The Committee considered a presentation that gave further explanation to the presentation received at the meeting on 8th September 2016 regarding A&E performance standards. Members were informed that emergency department across the UK were categorised into three types and the performance indicators varied depending on the type of department it was.

Type 1 were consultant led units open 24 hours with full resuscitation facilities.  Type 3 were units such as Minor Injury Units which may be doctor or nurse led.

North Tees and Hartlepool NHS Foundation Trust had a type 1 and type 3 units.

Type 2 Units were consultant led single speciality units, for example the unit at Sunderland Eye Infirmary.

Resolved that the information be noted

To consider the attached cover report of the Principal Overview and Scrutiny Officer, Durham County Council and an associated presentation by Alan Foster, Chief Executive of North Tees and Hartlepool NHS Foundation Trust and STP lead for Durham, Darlington and Tees ;Hambleton, Richmondshire and Whitby STP.

Members were provided with a report that gave background information in respect of the development of health and care system Sustainability and Transformation Plans.

The Committee then received a presentation that updated Members on the progress made to date in respect of their development and submission to NHS England. The main information provided could be summarised as follows:-

-           Better Health Programme had become a key part of the local Sustainability and Transformation Plan covering the sub-region.  The STP Footprints had been determined nationally.

-           Organisations agreed that North Durham CCG would move into the Northumberland Tyne and Wear STP, and so no longer be part of the Better Health programme.

-           STPs were designed to address the health and wellbeing gap, quality of care, and finance and efficiency.  Local challenges included the need to reduce variation, ensuring success in relation to cancer mortality was repeated for other diseases, and standardising the approach to care across the area, including the care that was already available seven days a week.  This could for example mean increased access to specialists, and often involved the frail elderly.

-           STP needed to add value and stop variation.  Existing plans would be used and built upon wherever possible.

-           Details of the BHP model of care and the possible scenarios that were

being considered.

-    The Better Health Programme proposals included provision for a reconfiguration of acute care, but it was not planned that any hospital would close.  All sites would stay open but would deliver care differently.

-           Specialist hospitals would allow for patients to see a consultant who was a specialist in their condition or in that service. Currently this did not happen; patients may see an experienced doctor who would not always be a specialist in the condition the patient was at hospital for.

-           A timetable for the STP was provided with consultation on service change beginning in June 2017.  Also provided were October’s public engagement event dates.  Consultation had been moved back to 2017 in line with other STP timetables and no decisions had been made.

-           Some capital funding would be needed to change services, and each STP would be making bids to the national Investment Committee.  The local STP needed to be realistic about what it could secure.  National approvals would therefore not be given until March 2017.

Members were given opportunity to ask questions/make comments that could be summarised as follows:-

-           Representatives from North Yorkshire highlighted that during previous service reviews, residents had been reassured that although some services may be moved from the Friarage Hospital, Northallerton, they would still be accessible at Darlington Memorial Hospital.  It was noted that under the options being put forward, this may not be the case in future.  It was noted by the Programme Team that the CCGs in North Yorkshire were being engaged through the process.

-           Members queried the process of securing capital funding through the STP process.  It was noted that a bid would need to  ...  view the full minutes text for item 6.

Presentation – Representatives of the Better Health Programme will give a presentation to the Joint Committee updating members in respect of the Phase 4 Engagement process including further information regarding the revised long list scenarios/options and evaluation criteria to be used during options appraisal.

A timetable for the STP was provided with consultation on service change beginning in June 2017. Also provided were October’s public engagement event dates and the engagement themes.

Presentation – Dr Neil O’Brien, Better Health Programme lead for the “Not in Hospital” workstream will update members of the Joint Committee on the development of a Not in Hospital strategy, its key elements and the links to and input of Local Authority Adult and Children’s Social Care services within the Not in Hospital workstream.

A copy of the Not in Hospital strategy is attached for members’ information.

The Committee considered a presentation updating on the development of a Not in Hospital Strategy. The main information provided included:-

-           Better Health: Principles of care ensuring people were only in hospital when they needed to be.

-           The 4 principles were Prevention, Responsive & Accessible, Co-ordination and Proactive and the Standards and outcomes.

-           The out of hospital model of care.

-           The enablers, person centred outcomes, system outcomes and priorities for this year.

It was noted that 90% of health contacts took place out of hospital, and therefore it was only right to make this a major focus of service improvements.

A community hub approach would be developed, with hubs of services based on populations sized thirty to fifty thousand people.  These would have a physical base or be co-ordinated virtually, depending on the geographical location.  Teams would be sized appropriately for the local population.

Members raised concerns regarding having the right services in the community hubs, and ensuring good practice was repeated across the region, for example stroke care. 

Members queried the lack of involvement of mental health series in the Programme.  It was noted that the original focus was on acute services, but the out of hospital workstream was increasingly involving mental health services.  These services were however mainly based in the community already.

It was noted that increased use of technology (eg. remote monitoring of patients) had not been covered in detail in the presentation and the Programme Team would bring further details to a future meeting.

It was noted that there was a need to align the plans for acute and community care, and ensure that there was a transfer of resources to match any transfer of activity.

A member of the public noted the important role of nurses and this was agreed by all.  They also highlighted issues with community dental care in Hartlepool, and the representative of the CCG was surprised at this as access should be available via NHS111.  This was to be followed up outside of the meeting.

Resolved that the report be received and a further report on the use of technology be brought to a future meeting of the BHP Joint OSC.

The Chairman had no urgent items.

There had been no items identified.

-       Thursday 1 December 2016 at 1.30 p.m. – Council Chamber, Hambleton District Council, Northallerton

The date of the next meeting was Thursday 1st December 2016 at 1.30pm in the Council Chamber, Hambleton District Council, Northallerton.