Overview and Scrutiny Board Minutes

Overview and Scrutiny Board Minutes

Tuesday 7 November 2017
4:00 p.m.
Mandela Room, Town Hall, Middlesbrough

Attendance Details

Councillor J Sharrocks (Chair), Councillor J Blyth, Councillor E Dryden, Councillor T Higgins, Councillor L Lewis, Councillor D Rooney, Councillor M Storey, Councillor M Walters, Councillor J Young
D Johnson
B Carr and E Kunonga
Apologies for absence:
Councillor T Mawston, Councillor J McGee, Councillor L McGloin, Councillor P Purvis
Declarations of interest:

None declared.

Item Number Item/Resolution

The minutes of the Overview and Scrutiny Board held on 10 October 2017 were submitted and approved as a correct record.


The Chair of Overview and Scrutiny Board advised members that a document responding to the queries raised at the meeting of the Board held on 10 October 2017, in relation to the Balanced Scorecards had been circulated prior to the meeting.




The Tees-wide Safeguarding Adults Board (TSAB) was required to produce an Annual Report in line with the requirements of the Care Act 2014. The report set out what the Board and its member agencies had done to carry out and deliver the objectives of the Strategic Plan. The report also outlined how the Board was monitoring policies and how it intended to deliver its plans for the future. A key feature of the report was the focus on community engagement and consultation.


The Independent Chair of the TSAB - Ann Baxter, was in attendance at the meeting to present the TSAB Annual Report 2016/17, as part of the Board's local accountability arrangements.


The Chair of TSAB advised that this was the second time that she had attended the Board since she had been Chair of the organisation. The TSAB covered the footprint of the four local authorities (Hartlepool, Middlesbrough, Redcar and Cleveland and Stockton), together with Health, the Fire authority, the voluntary sector and the Police to provide a safeguarding network to promote consistency in relation to adult safeguarding. The nature of collating information meant that the report was historical and it looked back on the period for 1 April 2016 to 31 March 2017.


The Annual Report provided feedback on the Board’s 5 Strategic Aims, which were initially set for three years: 2015-18, and the 10 Objectives set within that framework for 2016-17. An overview of the work of the Sub-Groups over the last year was also outlined, as well as looking at future priorities and ambitions for continued improvement. It set out the structure and membership of the Board and included within it was a summary from each of the Board members with regard to their role and how the partner organisations had contributed to the Board throughout 2016/17.


The Board’s statutory partners had completed the Quality Assurance Framework over the last 12 months (included at pages 24 & 28 of the report), which was a significant milestone as adult safeguarding services had never been tested in this way across the Tees area before. Training provision had been expanded, and the analysis of Tees-wide operational and Safeguarding Adults Review data was starting to help inform the approach in relation to preventative practice.


It was highlighted that inclusion, was one of the key issues in relation to Middlesbrough. More work needed to be done to improve engagement with minority and marginalised groups and better analysis was required in relation to how these groups interacted with safeguarding services.


Page 13 and 14 contained a summary of annual communication and engagement. It was highlighted that the website page had received 41,000 views and there were 9,000 individual users.


The Board was advised that safeguarding did not only affect the vulnerable elderly that could have issues in later life, the Care Act raised awareness of issues such as modern slavery, domestic and financial abuse and neglect. It had been estimated that more people were in slavery today, then there had ever been in history. One of the reasons for this was that people did not recognise the situation that they were in as "slavery". This could be people that had been trafficked to this country, working in low paid jobs and they either were afraid, or didn't know how to ask for help, or the situation that they had found themselves in was better than the situation that they had escaped from.


It was highlighted that hoarding was also an issue but most people did not recognise this as a safeguarding issue. All of the above situations highlighted the difficulties and challenges associated with Adult Safeguarding. Most adults had a choice and capacity to make that choice and if a person did choose to hoard things, the difficulty was, when would this be recognised as a safeguarding issue?


Reference was made to Page 20 of the report which highlighted that there had been an increase in Section 42 care home referrals in relation to Middlesbrough care homes. Such referrals could include medication errors and these were usually referred by the care home managers and they would be processed through the safeguarding procedures. It was highlighted that Middlesbrough had more care homes than the other Tees authorities.


The Board delivered a bespoke TSAB Awareness Day in July 2016, which coincided with the North East Smooth Radio campaign that was delivered for 10 weeks between 20 July and 28 September 2016. The awareness day in July was focussed on using on-line activities to improve the profile of adult safeguarding work across Tees, and in doing so encouraged organisations to further prioritise this work. Over 20 agencies were involved, which helped to increase the numbers of people accessing the Board’s website in the remainder of the 2016-17 period. Radio Campaign Evaluation Adverts aired 306 times reaching an estimated 735,000 people. This equated to 32% of the North East.


Reference was made to the work of the Performance, Audit and Quality Sub-Group. The Board was advised that the Quality Assurance Framework had been completed by the Boards 6 statutory partners in 2016-17. The findings included the following areas of good practice assurance across the Tees area:


  • Some agencies’ Strategic Plans set out safeguarding adults as a key priority;
  • Elected members induction programme and annual briefing sessions on safeguarding adults;
  • Good examples of robust induction training programmes for staff ;
  • Post qualifying training in place;
  • Provider review meetings in various forms, and good examples of information sharing at an early stage to prevent issues escalating;
  • Prevent training was being provided across all agencies.

The following were some of the areas highlighted for development:

  • Engagement with minority and marginalised groups to be improved, and better analysis was required in relation to how these groups interacted with safeguarding services
  • Some agencies needed to improve and / or update their adult safeguarding information for members of the public
  • Organisational structures should clearly indicate the senior leader for adult safeguarding, providing clarity for the whole workforce.

The Independent Chair of the TSAB advised that, on the whole, it had been a positive year from the Board's perspective and all of the individual partners were working well together. It had been a challenging year and Adult Safeguarding was a continuing challenge, in particular as a result of austerity and the ageing population. Good use of resources had been made and the Board was working effectively.


Page 34 of the report outlined what the Board planned to do in the year ahead:

  • The views of key stakeholders would further influenced the work of the Board.
  • The Board would use the experience of adults to help improve the approach to personalisation.
  • The Board would help more people to access preventative interventions.
  • The Board would use a targeted approach to reducing barriers to reporting abuse and neglect.
  • People Tees-wide would receive a more integrated response to safeguarding adult concerns.
  • There would be fewer repeat occurrences of abuse and neglect.
  • The Board would better co-ordinate safeguarding adults work.
  • The Board would be more effective in ensuring their safeguarding arrangements helped to protect adults.
  • The Board would provide effective assurances about services being delivered to adults.
  • Peoples’ experience of safeguarding would be the same no matter where they lived across the Tees area.

The Chair of the Overview and Scrutiny Board queried with regard to what was different in 2016/17 compared to the previous year. Members were advised that there had been more Adult Safeguarding activity in terms of more inquiries and referrals because more people were coming forward. The Board used a range of ways to find out if people felt safe. It was highlighted that in the year 2016/17, although there had been an increase in safeguarding activity there had not been a corresponding increase in resources.


A member queried whether there was any comparable data in respect of what the TSAB was doing and what other areas of the country were doing. Members were advised that there was very few other areas in the country that had cross authority Boards. There was one in Liverpool/Wirral and one in London. There was also more deprivation, health issues and more safeguarding activity in the Tees area compared to those other areas.


Reference was made to page 28 of the report, in respect of the priorities for the year ahead. The Sub-Group would improve the way feedback was captured from adults who had used safeguarding services, and performance benchmarks would be created in 2017-18 to help guide operational delivery. A multi-agency audit programme would also be established this coming year. Each of the partners would be asked to undertake audits.


The priorities ahead would be to continue to develop the policies and procedures outlined above, improve the focus on domestic abuse, sexual exploitation, modern slavery and financial abuse, and review national and regional multi-agency safeguarding arrangements for possible use in the Tees area. The group would also continue to focus on developing and sharing good practice. It was highlighted in the report that a range of e-learning could be accessed from the TSAB website.


A member queried whether there had been a rise in the reporting of domestic abuse incidents. The Board was advised that the Tees area was at the top of the league tables in respect of domestic abuse which was an issue for the Police, the Children's Safeguarding Board and the Adult Safeguarding Board. 


A member raised an issue regarding the length of time taken by the Care Quality Commission (CQC) to notify the authority with regard to issues in care homes. The Chair of the TSAB advised that the CQC had only attended one of the TSAB meetings however the issue had been raised with Senior Managers of the CQC to facilitate better working relationships.


The Chair of Health Scrutiny Panel queried whether the TSAB would see part of their role as a consultee in relation to the Transforming Care: Respite Services Review and the Durham, Darlington and Teesside, Hambleton, Richmondshire and Whitby Sustainable Transformation Plan and the implications for Middlesbrough residents. The Chair of the TSAB advised that they should have been consulted as part of their role in protecting adults.


A member referred to the last page in the report in relation to "See it - Report it" and the list of emergency numbers included and she queried with regard to how widely the list of numbers was promoted. The Chair of TSAB advised that the list was included on the TSAB website and over 41,000 had viewed the website in the previous year and the leaflet which included the numbers was also distributed to GP surgeries, libraries and hubs. Stalls had also been set up at Stockton market where leaflets were available and South Tees A and E department. The Chair of Overview and Scrutiny Board advised that checks would be made to ensure that the numbers were available on the Middlesbrough Council Website.


A member queried with regard to which keywords were used when searching for help with safeguarding issues as generally, safeguarding was not a familiar term to most members of the public. The Chair of TSAB advised that she would seek clarification on this issue.


The Chair thanked the Independent Chair of TSAB for a very informative presentation.

AGREED that the information presented be noted.


The Director of Public Health and Public Protection was in attendance at the meeting, to provide the Overview and Scrutiny Board with a briefing in relation to the areas of concern identified within the Balanced Score Card, in respect Public Health and Public Protection.


The Director of Public Health and Public Protection referred to the indicator on the Balanced Scorecards in relation to satisfaction of business with local authority regulation services; the figure was currently 89.2% but this was subject to monthly fluctuations.


The workforce was currently under review but a new model of working was due to be put in place and it was anticipated that this would improve satisfaction. An update would be provided following the implementation of the new model of working. It was an important measure of the overall health and was a good indicator of inequality in length of life across all age groups.


In Middlesbrough, life expectancy at birth was 76.2 years for males and 79.8 for females. This was lower than the national average of 79.5 for males and 83.2 for females. Up until 2010/11 there had been a year on year improvement in the figures. There had been a plateau in the figure in 2011 and since then, the life expectancy figures had reduced. A report published on 18 July 2017 by Sir Michael Marmot highlighted this as an area of significant concern. A full analysis of the statistical data would be included in the Annual report.


In respect of the measure for early deaths from all causes (standardised mortality <75), of the 1400 deaths recorded, 500 of the people were below the age of 75 which was higher than the national average. This pattern was similar to other areas in the north east. Redcar, Stockton and Middlesbrough had the same trend.


Nationally, life expectancy was slowing down although in the South of the country, this was not the case. The causes of early deaths included cancer, heart disease, strokes, respiratory diseases (such as bronchitis) and circulatory disorders.


There were several vulnerable groups that had a lower length and quality of life. These included:


People with serious mental illness - evidence showed that they died 15 to 25 years earlier than the rest of the population;


Learning disabilities - these people died, on average, 14 years earlier than the rest of the population. The causes of these deaths were often preventable long term conditions such as diabetes, obesity, heart failure, chronic kidney disease or stoke or cancers;


Minority ethnic groups - generally had poorer health and increased premature deaths.


In terms of drug related deaths and suicides, the incidence was usually much higher in young men than women.  There had been 13 drug related deaths and 28 suicides. In terms of suicides, Middlesbrough was the highest in the country. A member queried whether the level of suicides was attributable to deprivation. The Board was advised that the pattern mirrored the pattern of deprivation and poverty.


In relation to drug related deaths, a member queried with regard to how Middlesbrough compared to the rest of the country. The Director of Public Health and Public Protection advised that if it was considered in relation to published data, Middlesbrough would fall within the top 10%.


A member queried how the data was recorded. Members were advised that rather than wait for the result of an inquest, as soon as it was suspected that the death was due to suicide, it would be included in the figures. The World Health Organisation had stated in 2004, that suicides were not inevitable, they were preventable. The Board was advised that two new posts had been established within public health; one to lead on work to prevent drug related deaths and one to lead on work to prevent suicide deaths.


The Board was advised that there was a requirement to work on emotional well-being and mental health from an early age. The Council needed to work with the voluntary and community sector on this issue.


The Director advised that he had heard of 2 anecdotal case studies of two people with learning disabilities that had committed suicide as a result of cuts to benefits. When conducting an inquest, the coroner could however take a different view as to the cause of death. A member commented that the fact that people with Learning Disabilities had committed suicide due to benefit cuts was a very serious public health issue.


It was commented that Universal Credit had to be applied for on-line but people with learning disabilities could have difficulties in accessing benefits. More pressure needed to be placed on the Government with regard to access to benefits. It was recommended that the Director of Public Health and Public Protection prepare a report on the impact of the Welfare Reforms on public health for submission to the Executive. It was recommended that the Chair of Overview and Scrutiny Board submit the completed report to Executive.    


A member stated that there was an issue with alcohol abuse in the area and this caused health problems. The Director advised that use of alcohol over a long period of time could lead to heart problems, circulatory problems or cancer. The authority was trying to raise awareness of issues with alcohol and encourage sensible drinking. The work that had been carried out by the licensing authority in promoting a responsible alcohol trade in Middlesbrough, placing licensing conditions on licences, reviewing licences when necessary and through the Best Bar None programme had been very positive. 


The Director of Public Health and Public Protection advised that in terms of cancer screening, the uptake of the service was below the national average but progress was being made in increasing the uptake. Members could encourage the uptake of screening within their own Wards.


In terms of high blood pressure, 20-25000 adults who had experienced high blood pressure were not going through the health system and it was important to encourage people to enter the health system via a planned route rather than an emergency route.


The Board was advised that the Live Well Centre was providing a good service and it was important to ensure that the community were making use of the initiatives in place such as the cancer screening service. A member commented that if people did take up the opportunities available, it could place more pressure on doctor's surgeries. The Board was advised that services had to be ready to deal with any increase in work and work was currently ongoing with the NHS to ensure that the services were available. It was positive that people were attending the Centre but the real test was what happened next after that appointment.


The Board was advised that in the past, a practitioner had been paid to go into offices so staff could make use of various services. The Director of Public Health and Public Protection advised that the University, the hospital and Middlesbrough college had signed up to hold awareness sessions and small and medium enterprises were also being encouraged to sign up to hold such sessions. The Town Hall was currently hosting flu vaccination sessions for members of staff. The Director of Public Health and Public Protection advised that lots of different opportunities were available including immunisations and screening programmes.


A member queried whether the Director could report back on how the Council were performing in relation to supporting staff and what opportunities were taken up by staff and how the authority could promote the initiatives available.


The Board was advised that in terms of child deaths, after the age of one, there were few deaths in children. For Middlesbrough, there were seventeen deaths in children aged 1 - 17 in six years (2010 to 2015), fewer than three per year, on average. The child mortality rate was lower than England. The Chair of the Teesside Child Death Overview Panel reviewed all child deaths and made recommendations to agencies with the aim of preventing future deaths but sometimes there was no preventable cause. The infant mortality rate was in line with the national average.  


The Public Health Team had looked at the number of people killed as a result of a road traffic accident. The team were looking to see if there were any patterns and to ascertain if there was anything more that the Council could be doing to prevent the accidents from occurring. The Annual Report was due to be presented to the Health and Wellbeing Board on 6 December 2017.


The data in respect of excess winter deaths showed that Middlesbrough had an additional 88 deaths in the winter months of 2014/15 when compared with the preceding and following months, Not being able to heat a home to adequate levels, could contribute to excess winter mortality. It was estimated that there were 9000 households in Middlesbrough in fuel poverty, spending a high proportion of their income on energy. This equated to more than one in seven households. The rates of fuel poverty in Middlesbrough were higher than both the North East and England rates. Mark Fishpool from Environment City had advised that over 400 homes in Middlesbrough did not have a central heating system.      


 It was suggested that the Director of Public Health and Public Protection be invited back to a future meeting of the Board. The Director advised that the previous year's Annual Report was positive, but this years had been difficult to write.


A member commented that in terms of poverty and the use of foodbanks, a whole generation of children were not eating healthily. The Director advised that a Healthy Child Programme was being operated in schools but there was more work to do particularly in relation to the provision of free school meals in the school holidays. The Board was advised that Public Health were currently working with the supermarkets to utilise food waste. It was commented that some supermarkets had a box of free fruit which children were able to access. The Council were also working with the Director of Education and Gregs regarding healthy breakfasts.


It was suggested that the private sector be approached with regard to assisting in the provision of free meals during the six week holidays. It was also suggested that the Council look at whether the six week holiday period was still fit for purpose.   


ORDERED as follows:


1. That the Director of Public Health and Public Protection prepare a report on the impact of the Welfare Reforms on public health for submission to the Executive. It was recommended that the Chair of Overview and Scrutiny Board submit the completed report to Executive.


2. That the Director of Public Health and Public Protection report back on how the Council were performing in relation to supporting staff and what opportunities were taken up by staff and how the authority could promote the initiatives available.


The conclusions and recommendations of the Social Care and Adult Services Scrutiny Panel were outlined following a scrutiny investigation of the topic of Aster Care Home (formerly Belle Vue Care Home).


The Social Care and Adult Services Scrutiny Panel recommended to the Executive:


a) That the Social Care and Adult Services Scrutiny Panel receives reports of any safeguarding concerns that have been raised by the CQC and or the Local Authority in respect of any care home within Middlesbrough, for information, in the following instances:

  • Where the Council has taken the decision to suspend placements in a care home; or
  • Where the Council is placing a care home into the formal safeguarding arena, where it is a serious concern and multi-agency protocols have been evoked.

A member commented on the excellent work that had been carried out by the service area in collaboration with the Scrutiny Panel. Particular reference was made to the improvements that had been made in respect of the new processes that had been put in place in relation to receipt of reports to the Social Care and Adult Services Scrutiny Panel whenever safeguarding concerns have been raised by the CQC and Local Authority in respect of care homes in Middlesbrough.


ORDERED that the findings and recommendations of the Social Care and Adult Services Scrutiny Panel be endorsed and referred to the Executive.


The Chair of Overview and Scrutiny Board invited the Scrutiny Panel Chairs to provide a progress report in relation to their respective Scrutiny Panels.


The Chair of Economic Development and Infrastructure Scrutiny Panel advised that representatives Mersey Travel and Transport for Quality for Life were due to attend the next Panel in relation to the Tees Valley Strategic Transport Plan Including Bus Franchising, Transport for Quality for Life were a keen lobbying group who were looking at a franchising system. Merseytravel also funded non-commercial bus services and were part of the LCR Bus Alliance leading on the development of a Buses Business Case for the Combined Authority.

The presentations would focus on the Liverpool City Region Bus Alliance, research regarding the impact of de-regulation and the opportunities and powers provided by the Bus Services Act 2017.


At the following meeting, the Panel was due to hear from transport officers about the implementation plan for submission to the TVCA. They were also due to receive an update from Jomast with regard to progress with the regeneration of Albert Road. The Panel's next topic would be support for businesses in Middlesbrough, looking at how the Council supports businesses.


The Chair of Health Scrutiny Panel advised that at the next panel meeting members were due to consider:

  • DDTHRW - Local Authority involvement, engagement and considerations
  • DDTHRW - Development of a Workforce Strategy
  • Building a sustainable future for the Friarage Hospital - Engagement Programme

The footprint of the STP had been expanded to include Cumbria. Alan Foster had been appointed to lead the revised STP footprint. 


The Respite Opportunities and Short Breaks Consultation Joint Health Scrutiny were looking at  the "Respite Opportunities and Short Breaks for People with Complex Needs and/or Autism Consultation" and the panel was informed that findings of the public consultation report were due to be received on 11 December 2017. A decision on the proposals by the CCG were scheduled for 30/31 January 2018. The Joint OSC would need to submit its formal response, including Middlesbrough’s contribution, to the consultation by 11 January 2018. The Committee was looking at the proposals to close Bankfields and Aysgarth respite centres for people with learning disabilities.


The Chair made reference to the closure of the Breast Radiology Service at JCUH and the proposals to bring the service back in July 2017. There had been no progress with this issue and patients now had to travel to North Tees Hospital for treatment. The CCG had flagged up that there were issues with non-attendance and they were looking into the reasons for the non-attendance.


The Chair of the Culture and Communities Scrutiny Panel advised that the Panel's current topic was Selective Licensing. Three landlords were due to attend the next meeting of the panel to give their opinions on the scheme. The Panel was also due to receive an update in respect of begging.


The Chair of the Environment Scrutiny Panel advised that the Panel was currently looking at the issue of fly tipping and enforcement. The Panel heard that there had been improvements and more enforcement officers had been employed. The Panel was currently looking at how other local authorities were performing in comparison to Middlesbrough.


The Chair of the Children and Learning Scrutiny Panel advised that the Panel's current topic was The Voice of the Child. The Panel were due to receive an update from officers from the Children’s Services Department on work that was currently being undertaken to listen to the Voice of the Child and the importance of seeing, observing and hearing the child. 

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