Health Scrutiny Panel Minutes

Health Scrutiny Panel Minutes

Date:
Tuesday 8 January 2019
Time:
10:30 a.m.
Place:
Mandela Room, Town Hall, Middlesbrough
 

Attendance Details

Present:
Councillor E Dryden (Chair), Councillor A Hellaoui, Councillor J McGee, Councillor L McGloin, Councillor M Walters and Councillor J Walker
Apologies for absence:
Councillor S Biswas and Councillor C Hobson
Declarations of interest:

None declared

Item Number Item/Resolution
PUBLIC
18/34 MINUTES - HEALTH SCRUTINY PANEL - 19 DECEMBER 2018

The minutes of the Health Scrutiny Panel held on 19 December 2018 were approved as a correct record subject to addition of the wording Director of Finance.

 

AGREED that following comments expressed at the last meeting clarification be sought from the Chief Executive of South Tees NHS Hospitals Foundation Trust that all hospital admissions were based on clinical need, not on costs.
 

18/35 UPDATE - REFERRAL TO THE SECRETARY OF STATE FOR HEALTH AND SOCIAL CARE - RESPITE OPPORTUNITIES AND SHORT BREAKS FOR PEOPLE WITH COMPLEX NEEDS AND LEARNING DISABILITIES AND/OR AUTISM

A number of parent / carers from Bankfields were in attendance at the meeting and the Chair invited a parent / carer representative to provide an update to the panel, as had been received from the Chief Operating Officer of the 5 CCG’s.

 

The parent / carer representative advised that they had met with the Chief Operating Officer and had received the following assurance:-


The ninety five families using the service would be able to continue with the support as it now stood. The service as it now stood meant 5 places in Bankfields, 6 places in Aysgarth, 95 families and 33 nights and NHS funding would continue to be spent on NHS Nurses.


The view was expressed that during the course of this review the nurses who had chosen Learning Disabilities as their speciality had been diminished and that it was the view of parent / carers of those with profound Learning Disabilities that CCG’s from all over the UK should come to Teesside to see what could be achieved through the provision of gold standard care. TEWV were the leaders in this field.


Middlesbrough and Redcar and Cleveland Councils had supported the parents / carers from the outset and it had been impressive to see what scrutiny did actually mean, if democracy meant that no one was left behind then it was evidenced in this very room and the people of Teesside were better for it. The parent / carers at Bankfields and Aysgarth were very grateful and only requested that the panel remain as vigilant partners.
 

The Chair thanked the parent / carer representative and expressed the view that the news had made his Christmas and New Year. It had felt as though everyone had been holding their breath for a long and there had been an exhalation, which had been joyful. The Chair offered his congratulations to the parent / carer representatives and the CCGs for making the right decision. The scrutiny process had helped ensure transparency and the parent/carer representatives’ dedication to their children had always been there; they had been fighting all of their lives.
 

Assurances were offered that the panel would remain vigilant and it was the panel’s understanding that TEWV had been given the responsibility to provide that service and there would always be pressure on that service. The panel would continue to be vigilant and liaise with TEWV in relation to what they were planning to deliver as part of the ring fenced budget to ensure that people were receiving the right type of support in line with their level of need. The Chair expressed the view that the panel was relieved that the parent/carers had received the outcome they deserved.
 

Reference was made to the formal referral to the Secretary of State for Health and Social Care and it was acknowledged that the outcome of that referral was still awaited. However, it would be viewed by the parents / carers as the ‘cherry on the cake’ should it fall in their favour. The parent / carers expressed their appreciation for the work undertaken by the Council’s Legal and Democratic Services in pulling together the evidence bundle for the formal referral to the Secretary of State for Health and Social Care, as well as support provided throughout this process.
 

The Chair expressed the view that although a local resolution had now been achieved, there remained issues of national importance contained within the panel’s formal referral. This related to how the consultation was conducted and the future funding of NHS health respite provision.
 

The Chair of the Adult Social Care Services Scrutiny Panel advised that the panel had agreed to consider the proposed new assessment process, as part of its work programme 2018/19 and at a meeting prior to Christmas in relation to the proposals it had been acknowledged by colleagues at the CCGs and TEWV that there was a need for communication with parent / carers to be improved. The panel would continue to consider the new assessment process for families first accessing adult services and it was anticipated that an update on the new assessment process would be provided at the panel’s forthcoming meeting on 11 February 2019.
 

AGREED that news of the local resolution be forwarded to the Local Government Association and Centre for Public Scrutiny to demonstrate the value that can be achieved locally through effective scrutiny.

18/36 BREAST SERVICES FOR PATIENTS IN MIDDLESBROUGH

The Democratic Services Officer introduced the item and advised that the Director of Programmes and Primary Care and Senior Commissioning Support Officer at South Tees CCG, as well as the General Manager, Elective Care at North Tees NHS Foundation Trust were in attendance to update Members of the provision of breast symptomatic services for patients in Middlesbrough.


The Chair expressed the view that the panel had kept this issue alive and STCCG acknowledged that it had been both useful and positive to have conversations with the Health Scrutiny Panel Members in respect of this issue. Data was provided on the prevalence of breast cancer in Middlesbrough and it was advised that breast cancer was the highest form of cancer for women in Middlesbrough. The female cancer mortality trend data showed that the highest was lung cancer, with the second highest being breast cancer.


Breast Screening Service vs Breast Symptomatic 

  • Breast screening meant using tests to find breast cancers as early as possible, before they caused symptoms such as a lump in the breast. The UK breast screening programme used mammograms to screen for breast cancer in women every 3 years between the ages of 50 and 70. A mammogram was a specialised x-ray of the breast.
  • Breast screening was currently commissioned by NHS England
  • North Tees NHS Foundation Trust was the Screening Hub for Middlesbrough patients
  • Screening services were delivered at a number of locations across Middlesbrough in mobile units for patient convenience.
  • Patients who were identified as having abnormalities were sent an appointment to attend North Tees Foundation Trust and if necessary will have treatment at North Tees Trust.

The question was posed as to whether the local authority’s Public Health was also involved in promoting increased uptake of breast screening services and the Senior Commissioning Support Officer confirmed that were working in partnership with Public Health on this issue. The point was made that there were a number of issues around population health and encouraging people to take up the opportunity for breast screening, bowel screening, particularly in the most deprived areas.

 

Breast Symptomatic Service

  • The Symptomatic Breast Service was for patients who had experienced some changes to the breast and had been referred by their GP.
  • Under NHS Standards, all breast patients should be offered an appointment within two weeks whether the GP suspects cancer or not.
  • South Tees CCG was responsible for the commissioning of the Breast Symptomatic Service for South Tees patients
  • The Symptomatic Service was currently being delivered by North Tees NHS Foundation Trust
  • Patients from Middlesbrough, who were diagnosed with cancer, were treated in South Tees Trust (except where clinically inappropriate). 

Breast screening in Middlesbrough

  • Identified the majority of ladies who did not attend their screening appointments were from the TS1 & TS3 postcodes
  • High level of deprivation
  • High levels of BME / hard to reach groups
  • Often dis-engage with NHS services

What was being done to improve Breast Screening uptake? 

  • Dedicated post, funded by Cancer Alliance, to work within the community to promote Early Diagnosis /screening and to recognise signs and symptoms
  • Targeting hard to reach groups and a number of examples were provided
  • Identify what the barriers were to screening and working to breakdown those barriers
  • Dedicated Cancer Champions in Primary Care to educate staff in general practice
  • Additional funding from the Cancer Alliance to produce a suite of patient leaflets targeted to TS1 & TS3 postcodes
  • Since July 18, 27 GP practices had signed up to become ‘No Fear’ practices
  • Social media campaigns via Twitter and Instagram

The panel acknowledged that people in the general community were not taking advantages of the screening opportunities available and the question around this was why we don’t attend screening appointments and what could be done to change this.

 

Breast Symptomatic Patient Satisfaction Survey

 

The panel was advised that patient experience questionnaires had been provided to patients who attended the symptomatic breast service by North Tees Trust in August 2017 and November 2017. 

  • In August 2017, 350 questionnaires were distributed to patients. 124 questionnaires were returned (35% response rate)
  • In November 2017, 150 questionnaires were distributed to patients. 50 questionnaires were returned (33% response rate)
  • STCCG had met with Councillor Cllr Julie McGee and Cllr Margaret Walters in November 2018 to present the patient satisfaction data
  • The November 2017 data focussed solely on South Tees patients
  • Was it the service rather than the people that were hard to reach? It was acknowledged 76% of people had responded to say they were happy to travel.  

Next steps re breast symptomatic services 

  • Data showed that a higher proportion of ladies from the TS1&3 postcodes cancelled and re-arranged their appointments.
  • Plans were in place to contact these ladies to understand why they re-arranged
  • Common themes would be analysed and potential solutions identified where possible
  • Increased promotion of ‘how to claim travel expenses’ on Trust websites and in GP waiting rooms had been explored

AGREED that a meeting be arranged between representatives of the panel and the General Manager, Elective Care, North Tees NHS Foundation Trust and the Senior Commissioning Support Officer to discuss a DNA survey for South Tees patients.

18/37 VULNERABLE AND FRAGILE HEALTH SERVICES IN MIDDLESBROUGH - PROPOSED AIM AND DRAFT TERMS OF REFERENCE

The Chair presented the draft terms of reference for the panel’s current scrutiny review topic as follows: -

  • To establish whether any health services currently provided in Middlesbrough are vulnerable to being relocated or decommissioned during the period 2018/19 to 2020/21.
  • To consider the potential impact of significant reductions in Public Health funding on local system provision and particularly preventative services up to 2021.
  • To examine the progress made to date and challenges still to overcome in respect of the integration of health and social care services locally.
  • To examine the approaches adopted by those health and social care systems recognised nationally for developing new care models in response to the future delivery of vulnerable and fragile health services.

Following discussion it was requested that in the first term of reference ‘Middlesbrough’ be replaced with ‘South Tees’.

 

AGREED that the proposed aim and draft terms of reference be approved subject to the above amendment.

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