This being the first meeting of the Panel in 2015/2016 and because there were several Members who were new to the Council, the Scrutiny Support Officer presented a report which outlined presentations to be made at todays meeting.
By way of background the following documents had been circulated:-
Health Scrutiny in Middlesbrough
Middlesbrough Health Profile 2015 - Public Health England
A Councillors Guide to the Health System in England - Local Government Association
NHS Five Year Plan - Executive Summary
Local Authority Health Scrutiny Guidance - Department of Health
Glossary of Terms
A number of presentations were then made.
Health Scrutiny in Middlesbrough - Elise Pout, Scrutiny Support Officer
This presentation outlined the underlying principles for Health Scrutiny; legislation and guidance; and the respective powers and duties of Local Authorities and relevant Health Service Providers.
The presentation also outlined how the NHS is funded; how the various elements link together and how people can influence their health and social care services.
Good working relationships existed with colleagues in health and protocols were in place to ensure partners were aware of their respective responsibilities.
With regard to the Panels power to refer issues to the Secretary of State, the Chair said that this power had been used on occasions. Examples included the proposed transfer of staff and services from South Tees to North Tees and the relocation of the Ambulance Service from Middlesbrough to Tyneside. Both of these issues had been referred to the Secretary of State.
The Chair thanked the Scrutiny Support Officer for her informative presentation.
Middlesbroughs Health Profile - Edward Kunonga, Director of Public Health
The Director of Public Health advised that the Health and Social Care Act 2013 had distributed functions previously undertaken by Primary Care Trusts between NHS England; Clinical Commissioning Groups (CCGs) and Local Authorities. Local Authorities were now responsible for public health, with support from Public Health England
There was consensus around there being three broad factors that impact on peoples health and well being, namely:
Social factors - where people were born; their employment prospects; education; access to quality housing, etc.
Lifestyle risk factors - including the level of exercise; type of diet; alcohol consumption and any substance misuse.
Access to effective health care
Not only was there a stark difference in the life expectancy of people in Middlesbrough, compared to the national figure - there were also marked variations between different wards.
The Services Annual Report would be published shortly and would include a focus on mental health, as this tended not to receive the same attention as physical disabilities.
Public Health England had recently reduced budgets by a total of £200 million. This would be challenging for Middlesbrough and other Local Authorities - particularly as contracts had already been signed with providers.
The Chair commented that in some parts of the country the worried well would, effectively, self-admit, whereas in Middlesbrough many people would struggle on.
In response to comments by Members, the Director said that:-
greater emphasis would be given to public health in schools. The difficulty was that schools did not consider it their core business. His argument would be that if pupils were healthy, this would be reflected in their performance academically.
he was mindful of the effect of boundary changes, which could make it appear that health in some wards was improving, when it was not. The aim would be to ensure that public health levels in the more affluent wards were replicated across the town. Only by achieving this would the gap with other parts of the country be closed.
A Councillor, who was also on the Councils Licensing Committee, referred to the fact that "health" was not part of the licensing objectives. He hoped that the Panel would support the Committee on this. The Chair indicated this would be so.
The Clinical Commissioning Groups perspective - Craig Blair, Associate Director of Commissioning, Delivery and Operations, South Tees CCG and Julie Stevens, Commissioning and Delivery Manager, South Tees CCG
The priority of the CCG is to buy services that meet the health needs of the local population.
It commissioned routine health care from hospitals locally. More specialist services were commissioned by NHS England.
There were a number of ways that people could influence health and social care services. For example, 46 GP Practices had Patient Participation Groups and the CCG had a similar Group, which included 6 members of the public. A Member commented that the Group that she was on was not aware of the existence of the CCGs Patient Panel. Mr. Blair undertook to arrange for the Patient Panels to be notified of meetings of the CCG Patient Panel and to receive Minutes of those meetings.
There were diverse needs in our area. Sometimes people in areas of deprivation did not access services in a planned or timely way, thereby impacting on the likelihood of a good outcome.
It was crucial that the CCG targeted resources more effectively - concentrating on making services more accessible. The Improvement Programme had highlighted that some care for people who had suffered strokes was not appropriate.
There needed to be a shift towards rehabilitating people in their own home, where possible, rather than them staying in a community hospital. This would lead to better outcomes.
The system needed to be simplified, particularly around the structuring of urgent care services.
The CCG was working closely with partners to move resources by introducing more planned care. If people could be moved from complex pathways (which often culminated in them being in residential care) this would free up resources for the CCG and the Local Authority.
The Better Care Fund (designed to lead to closer integration between health and social care) was being used to raise peoples awareness and to introduce a SPOC - single point of contact.
Other initiatives included "The Deep End", which was targeting resources to GP Practices in the most deprived parts of the town and "Care Start - mental health services for young people.
A Member commented that, whilst it is good that services were becoming closer to the people, some would be reluctant to access them. Mr. Blair said evidence showed that young people were more willing to access the services available.
Members also felt that professionals should link in with Family Fun Days held throughout the town.