Agenda item

The Committee received a presentation on the North East and North Cumbria ICB Joint Forward Plan 2023/24 to 2028/29 Update (for copy of presentation, see file of minutes).

The Director of Local Delivery/Head of Integrated Commissioning was in attendance to deliver the presentation that provided the difference between an ICS, ICB and an ICP; areas covered; ICB Budget Overview; Strategic aims of ICBs set by Government; Developing the Integrated Care Strategy; Significant Change experience by the NENC ICB in its first year of operation; the NENC way, Key Achievements and the Impact in County Durham.

Councillor Jopling complemented the 111 service saying that in her experience it had improved. She then referred to the waiting lists for knee and hip replacements that were still not carried out in a timely manner and stated that the current waiting time was a year.

Councillor Robson referred to dentistry and indicated that his local dentist was now private and asked if there was anything being done to improve this service.

The Director of Local Delivery/Head of Integrated Commissioning responded that Dentistry had been considered by the Committee earlier in the year where they talked about the national policy actions that had been put into place to attract dentists to areas that had under provision and the introduction of mobile services. She continued that reform was needed for dental services and the dental contract was a challenge for the dentists who work across the region. When she attended the Committee previously dentists from the local dental committee had come along and gave their perspective on this. There were a range of things that they were doing to bring more dentists to the region to help commission services for under serviced areas, but it was recognised that it was an ongoing challenge and a pressure. With regard to the waiting lists for the replacement of hips and knees they were reducing the waiting lists, but they had not eradicated them resulting in some long waits in County Durham. However, the service was doing comparatively well with other parts of the region and country. She congratulated County Durham and Darlington NHS Foundation Trust who had been proactive in the work done to begin the elimination of waiting lists.

Councillor Hovvels expressed concerns that mental health was the poor relation in terms of funding when compared with other health services and asked if there were any plans to do more in terms of mental health.

The Director of Local Delivery/Head of Integrated Commissioning responded that mental health services were coming higher up the agenda of health related issues. She continued that mental health was an increasingly high priority issue being the single biggest long-term condition in County Durham and issue that the population was facing. She also referenced the Mental Health Investment Standard that ensured that increased investment in mental health services that was monitored robust. She stated that during the pandemic, mental health issues and mental illness had increased. This had resulted in mental health not being talked about in isolation anymore but discussed within the context of all health pathways.

Councillor Haney indicated that he was not sure that this was the reality of the patients experience on the ground. He then referred to the presentation at an earlier meeting of the Committee where he raised concerns about University Hospital North Durham where there were 5 beds in a 4-bed bay that was put down to winter pressures, but he indicated that this was still occurring.

The Director of Local Delivery/Head of Integrated Commissioning responded that in terms of urgent and emergency care, the challenges were huge, and demand was at its highest with more people presenting to the emergency department than ever including ambulance conveyances. There was equally a huge focus on how they can improve and regionally they had an Urgent and Emergency Care Improvement Board and members of the Board were experts from across the field looking at what could be done to make improvements. Locally the Accident and Emergency Board always had a strong focus on improvements and experience and stated that a report would be considered by the committee on winter planning and the work of the local Accident & Emergency Board which may be an opportunity to explore some of these issues in more detail.

Councillor Savoury referred to ambulance hand over times that was a concern and heard that patients were waiting 2 to 3 hours on trolleys before been seen. She stated that the need to go to hospital was greater and the clinicians were having to work extra hard to ensure that patients received timely and appropriate treatment. She stated that if ambulances were backed up at hospital, they were unable to attend other calls that was putting people’s lives at risk.

The Director of Local Delivery/Head of Integrated Commissioning confirmed that the work on this was underway and the delay in handovers had reduced significantly. She stated that work should be done to support people in the community and reduce the need to go to hospital by enhancing support at home where appropriate.

Councillor Jopling stated that triage in Accident & Emergency had improved but this still needed further streamlining and commented that a number of people in Accident & Emergency were under the influence of alcohol or requiring methadone. She continued that this should be a sperate area as it was an unsettling environment to be in.

The Director of Local Delivery/Head of Integrated Commissioning responded that patients were screened in Accident and Emergency department based on the appropriate service that was needed. She stated that space within the emergency department at the UHND was at a premium and the Trust had been developing a business case for a new build, but the site was landlocked and there was little space for reconfiguration although noting that a new Accident & Emergency department would address these issues.

In response to a question from Mrs Gott on the availability of medication for mental health patients the Director of Local Delivery/Head of Integrated Commissioning responded that she would follow this up outside of the meeting but stated at times there was a shortage of some medication.

Councillor Higgins referred to waiting times in Accident & Emergency Departments and the capacity and stated that Peterlee was reduced from a 24-hour service resulting in more pressure on hospitals. He stated that they should look at opening the walk-in centres back up to 24 hours. He then referred to COPD rescue packs that some GPs would not prescribe that resulted in a hospital admission and stated that these packs should be prescribed.

The Director of Local Delivery/Head of Integrated Commissioning responded that she would pick the COPD rescue packs up with GP practices and clinical leads. With regard to the Peterlee Centre, she advised Members that the overnight service they go out to people’s homes rather than patients visiting the centre. When this change was implemented, they monitored this and had not seen an increase in people going to Accident & Emergency departments in the areas where the changes were made. She indicated that the ICB was constantly looking at the effectiveness of services and this was something that they were currently looking at to ensure the urgent model was the right one based on people’s change in needs and preferences.

Councillor Higgins asked if a report could be brought back to the next meeting on the COPD Rescue packs.

Resolved: That the information contained in the presentation be noted.