Agenda and minutes

Councillor J Clowes, Portfolio Holder for Health and Wellbeing

Councillor S Gardiner, Cabinet Support Member

B Towse, Cheshire East Local Involvement Network

L Scally, Head of Integrated Strategic Commissioning and Safeguarding

G Kilminster, Head of Health Improvement

D J French, Scrutiny Officer

To provide an opportunity for Members and Officers to declare any personal and/or prejudicial interests and for members to declare the existence of a party whip in relation to any item on the agenda.

Councillor A Moran declared a personal interest in item 5 – Draft Quality Account – Mid Cheshire Hospitals NHS Foundation Trust – on the grounds that he was a Member of the Trust.

To approve the minutes of the meeting held on 8 March 2012.  

RESOLVED: That the minutes of the meeting of the Committee held on 8 March 2012 be confirmed as a correct record subject to the following amendments:

      The inclusion of Mrs Barrie Towse, Cheshire East Local Involvement Network (LINk) in the list of those “Also Present”;

      Under Minute 74 “Update on progress with developing the Cheshire East Shadow Health and Wellbeing Board” , the third sentence of the 5^th paragraph be amended to read “J Greenwood, Cheshire East Council had given a presentation to the Health and Wellbeing Board…” rather than the LINk;

      The 4^th sentence of the 3^rd bullet point be amended to read “It was not yet know how Advocacy Services (PALS) would be provided…”

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.

Charlotte Peters Rock addressed the Committee.  She informed Members that the recent inaugural meeting had taken place of Cheshire Area for Cheshire Action and Knutsford Area for Knutsford Action and that links had been made with a number of groups across Cheshire. 

She also referred to changes to local services and their impact.  

To consider the draft Quality Account 2011/12 of Mid Cheshire Hospitals NHS Foundation Trust.

Jayne Hartley and Julie Smith presented the draft Quality Account from Mid Cheshire Hospitals NHS Foundation Trust. 

The Quality Account covered the period April 2011 – March 2012.  The Trust was now in the third year of its 10 out of Ten programme which set out 10 priorities under four headings:

Safety –

·        Mortality – reduce mortality rates by 10 percentage points in patients groups where death is not expected;

·        Patient Safety – monitor and reduce the number of unnecessary patient moves during a patient’s stay in hospital

·        Harm caused – monitor and reduce the number of patients who experience avoidable harm by 10% annually

Effectiveness –

·        Readmissions – reduce the number of patients who are readmitted to hospital within 7 days of discharge;

·        Finance – reduce the percentage of the Trust’s budget that is spent on management costs

Experience –

·        Patients and staff – ensure that the ratio of doctors and nurses to each inpatient bed is appropriate for delivering safe high quality patient care;

·        Environment – monitor and eliminate mixed sex accommodation for all patients admitted to the Trust (unless based on clinical need)

Outcomes –

·        Cardiovascular – reduce the 30 day mortality rate in patients following an Acute Myocardial Infarction (AMI)

·        Cancer – reduce acute admissions and length of stay in hospital following early complications of diagnosis and/or treatment of cancer

·        Infections – reduce the rates of Healthcare Associated Infections (HCAI).

Jayne explained that the Trust had achieved 5 of the 10 priorities – mortality, patient safety, finance, Cardiovascular and infections.  In relation to the targets that had not been achieved:

Priority 3: Harm caused – the Trust had made considerable improvements in this area especially in reducing harm in the severe, major and moderate harm categories with levels being below all other small acute Trusts according to the most recent data available. 

Priority 4: Readmissions – the Quality Account listed a number of actions the Trust had taken to reduce the number of patients who were readmitted to hospital within 7 days, with a plan to reduce readmissions to 2% by 2014.  This had resulted in a reduction in readmission rates during 2011/12 and better performance than peer Trusts; however the target of 3% had not been achieved for this year.

Priority 6: patients and staff – the Quality Account listed various actions taken to ensure nurse staffing levels were based on evidence, for example in July 2010 the maternity unit had begun using the Birth Rate Acuity.  This system provided “real time” information on the numbers of midwives needed to match the needs of the women in the labour ward.  It measured the intensity of need arising from the number and clinical status of women and infants during labour, delivery and other women being cared for in the delivery suite against the number of midwives available to provide care.  During this year, eleven out of the fifteen wards reviewed were within range of their required establishment which equated to 73% against the target of 75%.  ...  view the full minutes text for item 84.

To consider the draft Quality Account of East Cheshire NHS Trust (to follow).

Kath Senior and Julie Green attended from East Cheshire Hospital Trust, to present the Quality Account. 

The Trust’s mission was “to provide high quality integrated services, as specified locally by Commissioners and delivered by highly motivated staff” with their vision being to deliver the best care in the right place. 

A new Quality Strategy was being devised for 2012 – 15 with quality being at the forefront.  The overarching priorities for improvement in community and acute settings for the next 4 years were as below:

      Safe – to deliver a year on year reduction in patient harm – this would cover areas such as pressure ulcers, surgical site infections, MRSA and C diff infections, medication errors/prescribing;

      Personal – to improve patient experience – this would include areas such as end of life care, oncology services and patient/public engagement;

      Effective – to improve patient outcomes – this would cover acute stroke care, nutrition, mortality review and dementia screening.

The Strategy outlined how progress to achieve priorities identified would be monitored and what evidence of improvement would be sought.  The Trust provided services in both an acute setting and in the community, which gave rise to opportunities for partnership working.  The Trust had also met with GPs to enable joint working around providing appropriate support for patients with long term conditions.

The Quality Account also reviewed priorities from 2011/12 and assessed whether they were achieved, on track to achieve or behind schedule.  For priorities that were behind schedule, action taken or proposed was outlined.

In discussing the Quality Account, Members of the Committee made the following comments:

      The Trust is commended in achieving or being on track to achieve its targets in relation to :

    - reducing the number of injurious falls per thousand bed days;

    - protecting patients within the Trust’s care from hospital acquired

      infection;

    - maintaining or reducing the Hospital Standardised Mortality Ratio

      (HSMR);

    - reducing Hospital acquired venous thromboembolism (VTE);

    - improving the quality of care for stroke patients;

    - reducing the average length of stay for patients who are medically fit

      for discharge;

    - delivery of same sex accommodation through the provision of same

      sex designated bays and bathing facilities in all inpatient areas;

    - complaints are acknowledged and responded to in agreed timescales;

    - an increase in the number of clinical staff trained in basic dementia 

      care awareness.

In particular, the Committee notes and commends:

      the work done to deliver same sex accommodation in the day surgery and endoscopy unit through the introduction of all female and all male lists;

      the work carried out around falls reduction including the introduction of “comfort rounding” ie regular checks on in-patient’s needs; 

      the reduction in cases of hospital acquired infection including there being no cases of MRSA occurring in April – November 2011, and only one case in each of December, January and February – the Committee suggests that this success is highlighted and publicised to address any misconceptions around infection rates; 

The Committee suggests the following:

      in relation  ...  view the full minutes text for item 85.

To consider the report of the Head of Health Improvement

The Committee considered the draft Interim Health and Wellbeing Strategy.  The Health and Social Care Bill placed a duty on local Councils and Clinical Commissioning Groups (CCGs) to develop a Joint Health and Wellbeing Strategy to meet the needs identified in the Joint Strategic Needs Assessment (JSNA).  The Strategy should be developed through a robust process of prioritisation in order to achieve the greatest impact and the most effective use of collective resources.  The Department of Health had produced draft guidance setting out a number of values underpinning good strategies, including:

      Setting shared priorities based on evidence of greatest need;

      Concentrating on an achievable amount, recognising that prioritisation was difficult but it was important to maximise resources and focus on issues where the greatest outcomes could be achieved;

      Supporting increased choice and control by people who used services with independence, prevention and integration at the heart of such support.

The draft strategy as submitted had been produced by taking into account information from the JSNA, Sustainable Community Strategy and priorities identified by the Children’s Trust, Safer Cheshire Partnership, the CCGs, the Cheshire East Housing Strategy and the Ageing Well Programme.   A further draft strategy would then be approved by the Health and Wellbeing Board in early summer 2012 for wide consultation.  Following consultation, a further draft would be presented to the Health and Wellbeing Board with the strategy being finalised for 1 April 2013. 

The draft strategy adopted a “life course” approach under 3 Outcome headings –

      Starting and developing well;

      Working and living well;

      Ageing well.

In discussing the draft strategy, Members of the Committee made the following comments:

      A national and local policy context should be included at the beginning of the strategy to “set the scene”;

      The strategy should include local demographical information with a narrative explanation;

      Outcome 1 should include a reference to families and carers;

      The Strategy should include reference to the roles of relevant Cabinet members and Scrutiny Committees to reflect the wide ranging roles and responsibilities for health and wellbeing;

      Outcome 2 should include reference to learning difficulties and mental health as priorities.

RESOLVED:  that the draft Health and Wellbeing Strategy be supported and the comments made at the meeting, as outlined above, be taken into account when the Strategy is redrafted.

To receive a verbal update from the Portfolio Holder for Health and Wellbeing

Councillor Clowes, Portfolio Holder for Health and Wellbeing, updated the Committee on progress with developing the shadow Health and Wellbeing Board.

She explained that the transition arrangements for public health into the local authority were progressing smoothly, as was the transition from the Primary Care Trust to the Clinical Commissioning Groups (CCGs). 

The Board had received a briefing on the transition from the Local Involvement Network to Healthwatch, from Jill Greenwood, Commissioning Manager at the Council.  The Board had also received a briefing on the Welfare Reform Act from Juliet Blackburn, Performance and Partnerships Manager. 

A meeting had been held with the Chief Officer of the Cheshire East Council for Voluntary Services regarding how the Board could work with the voluntary sector; discussions were ongoing. 

Members discussed the membership of the Board, which in Cheshire East was currently based on the statutory membership.  It was queried whether this would be limiting and whether there should be wider membership to reflect the contribution made to wellbeing from a wide ranging number of organisations and postholders. There were various models from different areas.  The Portfolio Holder explained that there were likely to be a number of Working Groups set up by the Board to look at specific issues such as Ageing Well.  She was also attending a meeting in London shortly where learning would be shared and the membership of the Board was still under consideration.

RESOLVED: that the update be noted. 

To review the current Work Programme (attached).

The Committee considered the current Work Programme.

RESOLVED: That the current Work Programme be noted.

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

There were no items on the Forward Plan for consideration by the Committee.

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.