Health Scrutiny Panel Minutes

Health Scrutiny Panel Minutes

Tuesday 5 March 2019
10:30 a.m.
Mandela Room, Town Hall, Middlesbrough

Attendance Details

Councillors E Dryden (Chair), S Biswas, A Hellaoui, J McGee, L McGloin and M Walters.
Caroline Breheny - Democratic Services Officer
Apologies for absence:
Councillor C Hobson
Item Number Item/Resolution

The minutes of the Health Scrutiny Panel meeting held on 5 February 2019 were approved as a correct record.


The Chair advised that he had attended the North East Health Scrutiny Joint Committee (NEHSJC) on 22 February 2019 where a presentation had been given by NHS England on preparations for a No Deal Brexit. Following receipt of the presentation the Chair had requested that further information on the current preparations be obtained and an invitation was extended to NHS England and the Chair of the Local Professional Network (LPN) for Pharmacy to discuss this issue further with Members. The NHS England representative had advised that unfortunately she was unable to attend today’s meeting. However, she had provided reassurance that from NHS England’s perspective there were no particular issues with regard the supply of medications in Middlesbrough.


The panel was made aware that as part of the 'no deal' EU Exit preparations a significant amount of work had been carried out by NHS England, the Department of Health and Social Care (DHSC) and partners. A letter from Keith Ridge, Chief Pharmaceutical Officer, NHS England issued to GPs, community pharmacists and hospital pharmacists on 18 January 2019 was included with the papers. In addition Professor Keith Willett, Director of Acute Care and Strategic Commander for EU Exit, NHS England had written to Clinical Commissioning Groups (CCG’s) and Trust Chief Executives on 4 February 2019 to outline the operational response that NHS England and NHS Improvement were undertaking at a national and regional level in preparation for a No Deal Brexit.


In respect of the comments raised at the NEJHSC that there was already a greater shortage of medications than there had been in many years it was advised that this had happened irrespective of Brexit. Community pharmacists were currently spending a considerable amount of time contacting wholesalers to secure medicines. However, reassurances were offered that as much planning that could be undertaken had been undertaken by NHS England, 6 weeks of additional supplies were being stored and alternative transport arrangements put in place. Furthermore once medications were in the UK the supply chain was very effective and there were a number of wholesalers located in the region.


During discussion the following points were raised:-


  • In respect of medications that did not have a shelf life the question was focussed on whether the raw materials were available to manufacture the product. It was advised that this was an issue that was happening regardless of Brexit.
  • Legislation had been passed to allow Community Pharmacists to issue general rather than branded medication, tablets rather than capsules without the need for GP sign off.
  • The pressure points would be where medications for a patient could not be obtained and the Community Pharmacist had to go back to the GP’s to request an alternative.
  • The system for purchasing medication was particularly complex and different companies had numerous ways of distributing their medication. A significant amount of medication was imported from France and Germany.
  • The possibility of a no deal Brexit impacted on both over the counter drugs and prescription drugs.
  • As a percentage of the overall drugs market the number of drugs experiencing shortages were small. However, in cases where these were lifesaving drugs it could still be a significant issue.
  • The value of the pound could make a difference on the export / importing of medication, as well as the stockpiling issue.
  • Confident that the 6 week supply would be sufficient.
  • Patients and pharmacy teams had been advised not to stockpile medication, as this would generate further shortages.
  • The cost of drugs would increase and this had already happened in respect of some medications. The Government had put steps in place to realign tariffs, however the reimbursement figures often took time to be established.

The point was made there were effective contingency plans in place and Members could be confident that the relationships between GP’s, Community Pharmacies and hospital Procurement Team locally were really strong, which would help to ensure patients had access to the drugs they needed.


Reference was made by the Chair to a recent newspaper article entitled "Britain sleep walking into an opioid crisis" and the high levels of opioid deaths / overprescribing in the Tees Valley. In response to this issue the view was expressed that this was an area of concern that could be considered by the Health Scrutiny Panel and would need to involve the LPC, LMC and the pain clinic at JCUH.


AGREED that a roundtable discussion on opioids: an emerging issue be arranged.


The Head of Planning and Business Development, Director of Quality Governance and Director of Operations at TEWV were in attendance to provide a presentation on the 2018/19 Quality Account, as well as respond to Members queries in respect of TEWV’s priorities for 2019/20.


TEWV’s priorities and plans for 2019/20 were highlighted as follows:-

  • Review urgent care services and identify a future model for delivery
  • Improve the clinical effectiveness and patient experience at times of transition
  • Improve personalisation of care planning
  • Develop a Trust-wide approach to dual diagnosis which ensures that people with substance misuse issues can access appropriate and effective mental health services
  • Reduce the number of preventable deaths

Performance against quality metrics for 2018/19 were discussed in detail and a number of concerns were raised in respect of the following issues:-

  • The percentage of patients who reported 'yes, always' to the question 'Do you feel safe on the ward?' was 60.44 per cent against a target of 88 per cent. Were comparative performance figures available for other NHS Mental Health Trusts and could a breakdown of these figures by children and young people, adults and older people be provided.
  • The number of incidents of physical intervention/restraint per 1000 occupied bed days was 31.75 against a target of 19.25. What actions were being taken to address this issue?
  • The average length of stay for patients in Mental Health Services for Older People Assessment and Treatment Wards was 68.34 against a target of less than 52.

During discussion the following points were raised:-

  •  Questions about feeling safe were non comparable with other mental health trust providers.
  • The reason given in the majority of cases where patients answered they did not feel safe related to other service users.
  • It was acknowledged that the targets set were ambitious, however, TEWV were keen to ensure service users did feel safe on the wards.
  • It had been a very challenging time for the families of the children and members of staff in respect of the issues raised at West Lane. It was emphasised that the dignity and safety of service users was paramount.
  • The work undertaken in respect of Roseberry Park had been impressive.

The Quality Account would be issued to stakeholders on 12 April 2019 and the deadline for the panel’s submission of comments was 12 May 2019.


The Head of Planning was in attendance to provide an update in respect of the planning policies contained in the Local Plan regarding Hot Food Takeaways.


During discussion the following points were raised:- 

  • Two policies had been included in the publication draft of the Local Plan, namely policies EG7, INFA4 following approval by Council.
  • A consultation exercise commenced in December 2018 and 2 objections had been received in respect of the proposals.
  • Objections had been raised by McDonalds and KFC. The principle concern raised seemed to be about the 400m exclusion zone around secondary schools. The view had also been expressed that the ban on Hot Food Takeaways outside of defined centres was unjustified.
  • Planning was but one tool in tackling obesity and a strategic approach needed to be adopted by the Council and Partners on this issue.

 AGREED that a further update be provided to the panel in 6 months’ time.


In December 2018 the Council’s Principal Solicitor had attended the panel to provide legal advice in respect of the temporary relocation of breast symptomatic services from JCUH to the University Hospital of North Tees. The panel had been advised that the CCG had a duty to inform the scrutiny panel as to when a decision was to be taken in respect of significant changes to service provision i.e. the relocation of breast symptomatic radiology services from JCUH to University Hospital of North Tees. The CCG also had a duty to advice as to whether a public consultation would be undertaken and when that consultation would take place.


Following the advice provided a formal request was submitted to the Accountable Officer and Chief Officer at STCCG that the following information be provided to the panel:-

  1. The CCG’s formal decision process for the provision of breast symptomatic services for patients in South Tees to be delivered at the University Hospital of North Tees.
  2. The proposed timescale for undertaking a statutory consultation in respect of this significant service change.
  3. A final copy of Regional Breast Service Review Report, as produced by Cancer Alliance in 2017, be provided to the panel.

 A response from STCCG had been received to advise that the request would be actioned and timely, accurate information provided to the panel. However, it had not been possible for a detailed response to be given in advance of today’s meeting.


AGREED that STCCG be advised that should the information requested not be received by the panel in a reasonable timescale the panel was minded to make a referral to the Secretary of State in respect of Breast Diagnostic Services in South Tees.


The Chair provided a verbal update in relation to matters considered by the Overview and Scrutiny Board on 5 and 19 February 2019.

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