Agenda and minutes

Councillor J Clowes, Portfolio Holder for Health and Adult Social Care

Councillor S Gardiner, Cabinet Support Member

Councillor D Flude

Barrie Towse, Local Involvement Network

V Aherne, East Cheshire Hospital Trust

A Bacon, Project Director, Central and Eastern Cheshire Primary Care Trust

T Butcher, North West Ambulance Service

M Cunningham, East Cheshire Clinical Commissioning Group

Councillor D Beckett, Cheshire West and Chester Council

Councillor D Hammond, Cheshire West and Chester Council

Councillor P Dolan, Cheshire West and Chester Council

David Jones, Scrutiny Team, Cheshire West and Chester Council

D J French, Scrutiny Officer

G Kilminster, Head of Health Improvement

L Scally, Head of Integrated Strategic Commissioning and Safeguarding

D Taylor, Partnerships and Planning Manager, Children, Families and Adults Service

To approve the minutes of the meeting held on 3 April 2012.

RESOLVED: that the minutes of the meeting of the Committee held on 3 April be confirmed as a correct record.

To provide an opportunity for Members and Officers to declare any personal and/or prejudicial interests in relation to any item on the agenda.

Councillor G Baxendale declared a personal interest as a patient at Leighton Hospital.

To provide an opportunity for Members to declare the existence of a party whip in relation to any item on the agenda.

There were no declarations of the existence of a Party Whip.

A total period of 15 minutes is allocated for members of the public to make a statement(s) on any matter that falls within the remit of the Committee.

Individual members of the public may speak for up to 5 minutes, but the Chairman will decide how the period of time allocated for public speaking will be apportioned, where there are a number of speakers.

Note: in order for officers to undertake any background research, it would be helpful if members of the public notified the Scrutiny officer listed at the foot of the agenda at least one working day before the meeting with brief details of the matter to be covered.

Judie Collins addressed the Committee in relation to future healthcare provision in Knutsford.  She referred to engagement methods concerning the new proposals; the closure of Bexton Court and the availability of alternative respite facilities.  She mentioned transport issues and availability of services in Knutsford.  She queried out of hours provision and asked when the East Cheshire Hospital Trust would begin a process of public engagement on Foundation Trust status.

Charlotte Peters Rock addressed the Committee in relation to the proposals for Knutsford.  She referred to an amended version of the report by Andy Bacon, Programme Director for the Knutsford Integrated Health and Wellbeing Centre, which she had produced and circulated to all members of the Committee.    She commended her version of the document.  She queried the membership of the Committee.  She also commented that it appeared that only Cheshire East Council was being consulted on the proposals for Knutsford whereas she believed that many residents of Cheshire West and Chester Council also looked to Knutsford for health and social care services. 

Mabel Taylor addressed the Committee also in relation to the proposals for Knutsford.  She referred to the consultation process in relation to earlier changes to provision of services in Knutsford – specifically Stanley Centre and Stanley House and also Bexton Court.  She felt that local people had already made their views clear in the Autumn 2011 Knutsford Town Council survey and the Knutsford Town Plan.  She referred to imminent changes in the NHS and queried the timing of the changes proposed.  She referred to the application for Foundation Trust status currently underway at the East Cheshire Hospital Trust and the implications if Foundation Trust status was not achieved.  She commented that the consultation on the Knutsford project must be wide ranging and comprehensive.

To consider a report of the Programme Director Knutsford Project. (to follow)

The Committee considered a report of Andy Bacon, Programme Director, on the Knutsford Integrated Health and Wellbeing Centre project.  

The project was based on an aspiration to achieve greater integration between health and social care.  The project aimed to create a Health and Wellbeing Centre that was a purpose designed and built facility housing GPs and other professions and services in one building.  This would involve the co-location of 2 – 3 GP practices on a single site which would enable extended primary care supported by hospital specialists, access to therapy services (ie physiotherapy, speech and language, occupational therapy etc), community and social care services and diagnostic facilities, such as imaging and pathology and potentially other services such as pharmacy. 

There were other planned changes in Knutsford, namely an application by East Cheshire NHS Trust to become a Foundation Trust, which was a statutory requirement of the process as set out by Monitor; and the proposed permanent closure of the Tatton Ward, an intermediate care ward consisting of 18 beds at the Bexton Hospital site. 

The scheme would be funded through a procurement process to appoint a developer who would receive income from guaranteed rent for GP and integrated services; and income from rent from other tenants (non NHS) who may occupy the building.  The procurement process would be a joint public sector procurement that would be led by the NHS Commissioning Board and NHS Eastern Cheshire Clinical Commissioning Group and involving other public sector interested parties.  The engagement and consultation process would need to be coordinated with the procurement process so that public views could be taken into account before irrevocable procurement decisions were made.  Mr Bacon emphasised the need to make progress while financial decisions were in the hands of the PCT cluster; in the future such decisions may be made at a national level meaning it could be difficult to progress local priorities in a competitive environment.

Mr Bacon explained that at this stage of the process he was seeking views on how to engage and consult rather than on the proposals themselves.  There had been a number of consultation and engagement exercises around health and wellbeing in the Knutsford area over recent months including the Council’s consultation on Building Based services, meetings organised by Knutsford Town Council, meetings with the local MP and on-going discussions with the Town Council and the local group Knutsford Area for Knutsford Action.  He outlined various options for consultation and engagement with his preferred option being Option 5, which incorporated proposals for the closure of Tatton Ward with the clinical model, with the consultation on Foundation Trust status being separate.  

In discussing the report, Members of the Committee made the following comments:

      That the consultation process should be wide ranging and open minded to encourage views to be expressed;

      Clarification was sought about what services had been provided on the Tatton Ward?  In response, Val Aherne explained that Tatton Ward had 18 beds and provided intermediate care through nursing staff and  ...  view the full minutes text for item 7.

To consider a report of the Head of Integrated Strategic Commissioning and Safeguarding.(to follow)

The Committee considered proposed Terms of Reference for the shadow Health and Wellbeing Board.  A report had previously been submitted to full Council on 15 December 2011 where various concerns had been raised resulting in further consideration being given to the Terms of Reference and the report now submitted.  This report had been considered by Cabinet who had requested that the section on accountability be further clarified which was now set out in the report.  

The draft Terms of Reference covered various matters including the purpose, objectives, roles and responsibilities, membership, quorum, procedure and conflicts of interest. 

Councillor Clowes, Portfolio Holder for Health and Adult Social Care, explained that the membership was based on the statutory membership with the addition of an Opposition Party Member.  There was now an option to nominate Associate Members and this status was appropriate for individuals who wanted to be involved with the work of the Shadow Board but were not designated core members; they would be able to submit agenda items and would have a standing invitation to attend meetings.   There was also a new requirement to have an Associate Member on the Board from the National Commissioning Board. 

The Terms of Reference had been reviewed against those from other Authorities.  In relation to voting rights secondary legislation was awaited but it was hoped that agreement could be reached by consensus without the need for a formal vote.

In discussing the issue, the following points were raised:

      What was the role of the Local Involvement Network/Healthwatch representative?  It was explained that this was a statutory member on the Board and their role was to represent the patient and public voice;

      That the Opposition Member should be a matter for the Opposition Group to decide who that member should be;  Councillor Clowes agreed to discuss this with the Leader;

      That in relation to point 14 of the Terms of Reference it be clarified that the seven principles refer to the Nolan principles;

      Whether there was a role on the Board for provider representatives?  Councillor Clowes explained that this matter was being considered and it could be that provider representatives were Associate Members or part of Sub Groups that sat below the Board;

      Whether Public Speaking Time was included on the agenda for meetings?  In response, Members were advised that public speaking was allowed at the invitation of the Chairman.

Councillor Clowes explained that the Health and Wellbeing Board was currently focusing on 3 areas of work:

      Working towards the establishment of Healthwatch;

      The Health and Wellbeing Strategy which would be undergoing a consultation process over the summer;

      The Authorisation process for the Clinical Commissioning Groups.

Members asked whether there would be any training or briefing sessions on the Board for Members and were advised that officers were working on short written Briefing Notes.

RESOLVED:  that

(a) the draft Terms of Reference be supported subject to the comments made at the meeting as set out above; and

(b) that the Terms of Reference be  ...  view the full minutes text for item 8.

To consider the Quality Account and an update on current issues

Tim Butcher, Assistant Director for Performance Improvement, North West Ambulance Service (NWAS), presented the draft Quality Account.  He explained that the Quality Account provided an opportunity for NWAS to talk about the wide ranging role of NWAS rather than just focusing on response times. 

He outlined the main highlights of the year including:

      Exceeding the national quality target for responding to the most serious life threatening emergencies within 8 minutes following a 999 call;

      They were the first ambulance trust in England to achieve Level 2 compliance against NHS Litigation Authority’s Risk Management Standards;

      They were awarded the Health Service Journal Clinical Redesign Award for the Paramedic Pathfinder project, a toolkit to ensure that patients were treated and cared for safely and in the most appropriate place following an emergency call.

The Care Quality Commission had conducted an inspection in March 2012 and had given a very positive report on NWAS compliance with the CQC standards of quality and safety. 

This year NWAS was seeking authorisation as a Foundation Trust which would involve enhanced arrangements for public and staff involvement. 

In relation to the five priorities for improvement as identified in the previous year’s Quality Account, progress was as follows:

      End of Life Care – NWAS had developed a Rapid Discharge Procedure with ten organisations across the North West.  This had enabled an integrated discharge pathway to ensure patients could end their lives with dignity and in their own home.  This year 87% of transfers had been completed within 2 hours of the request being made;  NWAS had also produced a “how to” guide for ambulance services to improve services offered to people at the end of life; NWAS had introduced a system where patients at home had personalised care plans wherever possible and staff were alerted to this when attending the patient’s home address;

      111 and Frequent Callers – NWAS had stated they would begin the process of a single point of access for urgent and emergency care.  They also wanted to work with local commissioners to address the issue of people who made frequent 999 calls.  A pilot had been set up of the 111 number for urgent care needs.  Work had also taken place with each PCT regarding frequent callers who were often vulnerable people who were not aware of alternative help and support;

      Chain of Survival and Complementary Resources – NWAS had a two year plan to increase community access to life saving equipment and skilled volunteers – the “Complementary Resources” Strategy.  During 2011/12 NWAS had worked in partnership with the British Heart Foundation, and introduced 20 new Community First Responder Schemes, 50 new staff responders (volunteers) and 125 additional Automated External Defibrillators (AEDS) installed in public places.  There were a number of Community First Responder schemes in Cheshire East including Holmes Chapel, Knutsford, Poynton and Alsager, with new schemes introduced in Bollington and Middlewich.  The presence of Community First Responder schemes had helped with response time targets.  NWAS had achieved the target for  ...  view the full minutes text for item 9.

To review the current Work Programme (attached).

The Committee reviewed its current work programme:

      North West Ambulance Service – following the earlier presentation where the new 111 call system was referred to, the Committee discussed having further information on the new system and inviting the Programme Director to attend a future meeting;

      Diabetes/Obesity – update to the September meeting;

      Annual Public Health Report – presentation to the July meeting;

      Alcohol Services – update to the September meeting;

      Joint Health and Wellbeing Strategy – report to the July meeting;

      Local Involvement Network – presentation to the July meeting on the Annual Report and current Work Programme;

      Update on Mental Health and Learning Disability – a Workshop to be held on provision of mental health and learning disability services in Cheshire East;

      Lifestyle – to future meeting;

      Health and Wellbeing of carers and service users in Cheshire East – noted that Adult Services Scrutiny Committee would be receiving an update to the meeting on 5 July;

      Suicide prevention – to be covered as part of the workshop on mental health; noted that Child and Adolescent Mental Health services is being covered by Children and Families Scrutiny Committee.

The Committee also received a request from Councillor A Moran that some scrutiny work be undertaken on prostate cancer treatment and detection via screening.  He said around 35 thousand men were diagnosed with prostate cancer each year and a high number of these would die.  A simple test could help with detection and he referred to an event at Nantwich Football Club where 500 men took the test.  There was no national screening programme and no specialist clinician at Leighton Hospital.  The local support group had provided a lot of equipment.

The Committee also discussed undertaking some Scrutiny work on Immunisation Services.  The Chairman had a guide from the Centre for Public Scrutiny that outlined a lifetime’s programme of immunisations along with questions for scrutiny to ask when undertaking a review of the topic.  The Portfolio Holder explained that she had asked one of the Associate Directors of Public Health to provide some information on immunisation uptake in the Borough.

RESOLVED: that

(a) the Work Programme be updated in accordance with the views outlined at the meeting;

(b) a Scoping Report on Screening and Treatment for Prostate Cancer be prepared;

(c) a report on Immunisations be submitted to a future meeting.

To consider extracts of the Forward Plan that fall within the remit of the Committee.

The Committee noted two items on the Forward Plan – Shadow Health and Wellbeing Board revised Terms of Reference and Health and Wellbeing Strategy; both of which had been considered at meetings and were due for further consideration at future meetings.

RESOLVED: that the Forward Plan extracts be noted.

To note any consultations referred to the Committee from Cabinet and to determine whether any further action is appropriate.

There were no consultations from Cabinet.