Agenda and minutes

Councillor R Domleo – Portfolio Holder for Adult Services

Councillor A Knowles – Portfolio Holder for Health and Wellbeing

Councillor O Hunter – Cabinet Support Member for Adult and Health Services

Councillor D Cannon – visiting Member

Phil Lloyd, Head of Adult Services, People Directorate

Sandra Shorter, People Directorate

Jill Greenwood, People Directorate

Jon Wilkie, People Directorate

Fiona Field, Central and Eastern Cheshire Primary Care Trust

Simon Whitehouse, Central and Eastern Cheshire Primary Care Trust

Fran Willshaw, Central and Eastern Cheshire Primary Care Trust

Helen Kershaw, East Cheshire Hospital Trust

Mike Flynn, Legal and Democratic Services

Denise French, Legal and Democratic Services

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

RESOLVED:  That the following Declarations of Interest be noted:

      Councillor D Flude – Personal Interest on the grounds that she was a Member of the Alzheimers’ Society and Cheshire Independent Advocacy;

      Councillor C Tomlinson – Personal Interest on the grounds that she was a patient of the Hawthorn Lane surgery, Wilmslow.

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.

There were no Members of the Public present who wished to address the meeting.

To approve the minutes of the last meeting as a correct record

RESOLVED:  That the minutes of the meeting of the Committee held on 29 April 2010 be confirmed as a correct record subject to an amendment to the list of those present to identify Councillor R Domleo as Portfolio Holder – Adult Services and not as a member of the Committee.

To receive the minutes of meetings of the Cheshire and Wirral Councils Joint Scrutiny Committee held on 26 January and 12 April.

RESOLVED:  That the minutes of the following meetings of the Cheshire and Wirral Councils’ Joint Scrutiny Committee be received:

      26 January 2010 – subject to a correction to the Declaration of Interest by Councillor C Andrew to read “on the grounds that she attends meetings of Nether Alderley Parish Council as the Local Ward Councillor”;

      12 April 2010. 

To update the Committee of the work that has commenced following the Committee supporting the preferred option of dispersing the practice list.

Simon Whitehouse Director of Primary Care, Central and Eastern Cheshire Primary Care Trust (PCT), briefed the Committee on the current position with the closure of the Hawthorn Lane Surgery, Wilmslow.

The surgery was a single handed practice (the last single handed GP practice in the PCT area) and the GP, Dr Chung, had informed the PCT that he was to retire on 30 June 2010.  The mid point meeting had considered the issue and supported the PCT in its preferred option of dispersing the patient list.  The PCT had identified that there was sufficient capacity and choice within its patch to meet the needs of patients and liaison with other GP practices showed that local GPs were keen to work with the PCT and increase their patient lists. 

The PCT had recently written to all practices most likely to be affected by the dispersion of Dr Chung’s list.  The PCT had also sent letters to all patients, and included a personal letter from Dr Chung, with letters translated into Chinese where necessary.  The PCT were able to support practices with any language issues that may arise.  Most patients would be able to have a choice of practice to transfer to.   A number of patients lived in the Stockport area and the PCT had liaised with Stockport PCT for those patients. 

Dr Chung had identified a number of vulnerable patients on his practice list and the PCT was working closely with those patients to help achieve the most appropriate outcome. 

A freephone helpline had also been established.

RESOLVED:  That RESOLVED:  That

(a) the proposal to close the Hawthorn Lane Surgery Wilmslow be confirmed as a Substantial Development or Variation in Service, Level 3;

(b) the steps taken by the PCT to manage the closure of the Surgery and recognising the short timescales involved be endorsed;

            (c) the dispersal of the patient list to other practices be supported; and

            (d) the public consultations which had taken place, particularly

             involving the patients affected by the changes, be noted.

To receive a verbal update

Fiona Field, Director of Governance and Strategic Planning, Central and Eastern Cheshire PCT, briefed the Committee on Dr Foster.  This was a private national company that looked at the performance of acute care.  It produced annual public reports and sometimes league tables of acute care providers. 

There had been a specific issue around mortality rates at both Mid Cheshire Hospital Foundation Trust and East Cheshire Hospital Trust.  The Committee had therefore asked for a report to a future meeting and attendance by clinicians to discuss the issues raised by Dr Foster.  Work at the PCT and two hospital trusts was almost complete and the issue could be fully considered at the next meeting.

RESOLVED:  That the Dr Foster report and mortality rates be considered at the next meeting of the Committee on 1 July 2010. 

Due to the tight schedule in putting this report together, it has not been possible to complete the report within the normal timescales and therefore the report will be circulated in due course.

Helen Kershaw, Associate Director of Nursing and Patient Care Standards, introduced the East Cheshire Hospital Trust’s Quality Account. 

She explained that the Trust had a number of quality and safety improvement initiatives underway including requirements from the PCT, standards from the Care Quality Commission and from the Trust’s own Quality Strategy that had been introduced in 2008.  The Quality Strategy had focused on 10 areas of patient safety and 5 on improving patient experience and improvement in 8 out of the 10 areas had been demonstrated.  Two of the areas had been included as priority areas for 2010/11 – reduction of falls and reducing serious medication errors.  In relation to reducing falls, various measures had already been introduced through a strategy and action plan but reducing falls had proved challenging.  Further work was to be carried out including the introduction of functional electrical stimulation as recommended by the National Institute for Health and Clinical Excellence.  In relation to reducing medication errors it was noted that most medication errors were minor and could be classed as prescribing, dispensing or administrative errors.  Progress in reducing errors had not been as expected and a study had been undertaken to improve understanding of the issues.  This had now resulted in some specific areas of work to try to reduce medication errors.

The Trust Board had agreed the following statements as underpinning principles for continuing to improve care given to patients:

      Do me no harm (safety)

      Make me better (clinical effectiveness)

      Be nice to me (patient experience)

            The following areas were identified as priorities for 2010/11:

            Do me no harm

      Reduce the number of falls sustained by patients;

      Protect patients from hospital acquired infection;

      Reduce the impact of medication errors on patients.

            Make me better

      Reduce avoidable death, disability and chronic ill health from venous thromboembolism;

      Deliver evidence based interventions to patients with a diagnosis of acute myocardial infarction, heart failure, pneumonia, stroke or undergoing hip or knee surgery;

      Support the timely and effective discharge of patients to the most appropriate setting and provide timely information to GPs.

            Be nice to me

      Ensure patients within the hospital’s care were treated in privacy with dignity and respect which would include the provision of same sex accommodation unless it was clinically justified.  All toilet areas and bays were same sex.  In the critical care unit curtains were available around individual beds to enable greater privacy and one-to-one nursing took place;

      Ensure patients concerns and complaints were listened to, investigated appropriately and acted upon and lessons were learnt.  The Committee was advised that all complainants were contacted within 48 hours;

      Develop all staff to ensure they acted as a role model, took personal responsibility, had courage to speak up and make voices heard;

      Improve incident reporting and be in the highest 25% of reporters.

            The report included a list of audits both national and local that had been conducted in relation to the hospital Trust or in which the Trust

            had participated.   An unannounced visit by the Care  ...  view the full minutes text for item 36.

To consider a report of the Borough Solicitor.

The Committee considered a report of the Borough Solicitor containing a draft protocol setting out the arrangements between the Committee and the Central and Eastern Cheshire Primary Care Trust (PCT) and outlining further consideration regarding co-option onto the Committee.

The Committee was advised that the view of the Scrutiny Chairmen’s Group was that co-option should not take place onto Scrutiny Committees (apart from where required by statute) but rather to allow co-option onto Task/Finish Groups or for specific scrutiny reviews.  Members of the Committee also raised concerns about making the Committee too large and also noted the wide remit of the Committee about which Members were still learning.

The Committee considered the draft protocol which would help govern the working arrangements between it and the PCT.  The protocol set out the respective roles and responsibilities and how the relationship between the Committee and the PCT would work in practice.  The Protocol reflected the current legal framework for the conduct of health scrutiny and would be updated when new guidance from the Department of Health became available.  

RESOLVED:  That

(a) no action be taken on co-option onto the Committee and the position be reviewed in twelve months time; and

(b) the draft Protocol be approved and adopted subject to one amendment to paragraph 8.7 under the heading Level Three to include “ Local Ward Councillors concerned would be informed of the proposals by the Secretary” and forwarded to the PCT for approval by the PCT Board.

A Bacon – Programme Director East and Mid Cheshire Intergrated care, has advised the Mid Point Meeting of a range of potential changes to the geography, service models and organisational structure of health services that may occur due to a number of factors.  The health and social care economy is looking at a range of options to integrated social and health care (GPs, Community, Hospital and mental health) to achieve more integrated services that enable treatment to be provided earlier and recovery delivered faster.  The overall programme is known as the "Caring Together Programme" and will also respond to external changes including:  the Transforming Community Services and Foundation Trust programmes and the pressure due to be placed upon public sector funding.

It was agreed that this programme would be a standing item on the midpoint meeting, so that engagement and involvement of all stakeholders is maintained and that formal consultation is used only where it is legally required or adds value.

Fiona Field, Director of Governance and Strategic Planning, Central and Eastern Cheshire Primary Care Trust (PCT), outlined the Caring Together programme.  This involved the integration of health and social care services and was aimed at achieving earlier delivery of treatment and faster recovery.  It would involve developing multi agency and multi disciplinary teams, development around buildings both existing and new build and integration of IT systems.

The mid point meeting had been fully briefed by Andy Bacon, Programme Director, and would continue to receive full briefings to enable in-depth consideration.  Any specific pieces of work could be dealt with through Task/Finish Groups.

RESOLVED:  That the update be noted.

To consider the following items in relation to dementia:

• Building Based Services – report of the Strategic Director People;
• National Dementia Strategy, response of Cheshire East to the Strategy – presentation;
• Assistive Technology – report of the Strategic Director People;
• Carers Issues;
• Admiral Nurses

The Committee considered various items relating to dealing with dementia:

      The Council’s response to the National Dementia Strategy – Jill Greenwood, Service Manager (Dementia) briefed on dementia - dementia caused a progressive decline in many areas of function including skills needed to carry out daily activities.   As well as emotional impact, the financial cost was estimated at over £50 billion a year in the next 30 years.  In 2009 in Cheshire East the total number of people aged 65 and over was 68,000 and of these 4810 were predicted to have dementia (of which 3153 were female).  This figure was expected to grow by 88 % by 2030.  The predominant users of Adult Social Care were people with mental health needs and home care was the largest component of community services provided for the over 65s.  The Care Service Efficiency Delivery (CSED) programme was aimed at providing a fully integrated pathway.  An audit of current services and how needs were met had been undertaken and current work was looking at future demographic need, any gaps in service delivery and joint working possibilities.  Workshops on the programme had been held and well attended.  Gaps in service included – crisis response/home treatment – 24 hour service, intermediate care (step up and step down service), lack of awareness/stigma, enhanced support for carers and clients.  A draft strategy with options and resource implications would be produced for consultation prior to adoption and implementation of the final strategy. 

      Alongside the development of the new strategy other work was             underway including - to develop staff to undertake new and different      roles, provision of a new dementia unit at Lincoln House, Crewe (to       include a first stop shop including advice and information and a carers            café), introduction of a dementia website for Cheshire East    (Demenshare) to be launched on 5 July 2010. The Demenshare project      was a partnership involving the Council, Age Concern Cheshire,           Alzheimers Society, the Primary Care Trust and Opportunity Links and           was an online resource that would enable people affected by dementia      across Cheshire East to share and exchange their experience and       knowledge.

      Sandra Shorter, Manager of Provision of Adult Social Care, briefed on the role of Community Support Centres in Transforming Adult Social Care - she explained the distribution and usage of the current beds at the Centres including vacancy rates.  The in-house provider service had been renamed Care4CE (Careforce) and had three strategic priorities – reablement, complex needs and market cover.  The existing service was to be transformed to meet these priorities.  This would require having buildings that were fit for purpose, flexible well trained staff and viable cost effective services.  The current position was tired and out of date buildings, lean staff structures, under-occupancy at the Centres and high unit costs.  A short term solution was to reduce spare capacity and increase cost effectiveness by rationalising a number of centres – by integrating the services of both Santune House and Lincoln House at Lincoln House (and thereby  ...  view the full minutes text for item 39.