South Tees Health Scrutiny Joint Committee Minutes

South Tees Health Scrutiny Joint Committee Minutes

Date:
Wednesday 25 April 2018
Time:
3:00 p.m.
Place:
Mandela Room, Town Hall, Middlesbrough
 

Attendance Details

Present:
Councillor Dryden (Chair), Councillors Cooney, Jefferies (substitute for Cllr O’Brien), Holyoake, Goddard, McGee, Rooney, Watts and Walters.
Officers:
C Breheny, A Pearson and S Wall.
Apologies for absence:
Councillor O’Brien.
Declarations of interest:

There were no declarations of interest.

Item Number Item/Resolution
PUBLIC
17/9 MINUTES - SOUTH TEES HEALTH SCRUTINY JOINT COMMITTEE - 4 DECEMBER 2017

RESOLVED that the minutes of the meeting held on 4 December 2017 be confirmed and signed by the Chair as a correct record.

17/10 LD RESPITE REVIEW

The Chair advised that the purpose of the meeting was to seek reassurance from the CCG’s in respect of the future provision of LD respite services at Bankfields and Aysgarth. Clarification on whether an agreement has been reached with TEWV in respect of future funding arrangements was also sought. Representatives from ST CCG, HAST and TEWV were in attendance at the meeting to respond to the concerns raised by Scrutiny in respect of the LD respite review.

 

The CCG’s advised the correspondence received from local authorities in advance of the meeting had highlighted the following themes of concern:-

 

1. Consultation - robustness
2. Assessment and allocation and reducing offer
3. Safety of any new service

 

In response to the these concerns the CCG’s and TEWV stated that they were able to provide the following assurance statements to the committee:-

 

Assurance Statement 1

  • The CCGs gave their assurance that the commissioned service would be based on the individual’s needs, and would, in addition take into consideration the needs of the carer.
  • The assessment of need would define the level of relative resource.
  • All of this resource could be chosen to be utilised solely within the commissioned bed based respite.

Assurance Statement 2

 

The CCGs would continue to commission a service based on individual needs
The CCGs had protected the level of respite funding across Tees
The bed based service was commissioned by CCGs from the Tees Esk and Wear Valley NHS Foundation Trust (TEWV), there were no plans change that
Contracts had been agreed and signed in March 2018 supporting this continuation

 

Assurance Statement 3 - TEWV

 

  • The CCG had continued to commission and contract bed based respite provision for those with complex needs from TEWV
  • As a provider TEWV were committed to continuing to work with commissioners and stakeholders to ensure that services provided meet the needs of individuals in the most appropriate way, ensuring the necessary skills and competencies of those providing the services, which would include that for the bed based provision
  • TEWV were committed to proactive recruitment and retention of Learning Disabilities Nurses. Current initiatives included; retire and return, nurse training secondment opportunities and development of nursing associate roles. This allowed TEWV to ensure that it had have an appropriately skilled and experienced workforce across its learning disabilities services, who would continue to provide high quality care to meet the complex health needs of the people who accessed its respite services both now, and in the future.

In terms of the proposed phasing of the project it was advised that Phase 1 (2015 - Feb 2018) involved the Development and Consultation, Phase 2 (Feb - Sept 2018) the Specification Refinement & Assessment Criteria, Phase 3 (Sept 2018 - Mar 2019) the Providers Solution and Phase 4 (March 2019) Implementation.

 

As part of the ensuing discussion, the following points were raised: 

  • The CCG’s expressed the view that from their perspective the consultation process had been as robust as they could make it.
  • Bed based respite was commissioned from TEWV, a 2 year contract was in place and it was reviewed on an annual basis.
  • The assessment of need would define the resource allocation and would consider both the needs of the individual and the needs of the carer, which the CCG’s believed was a significant improvement.
  • TEWV was committed to working with commissioners and stakeholders on the implementation phase.
  • The process of refining the specification and assessment criteria was to be co-produced and TEWV would be involved, as partners in that process.
  • TEWV was fully committed to retaining appropriately skilled staff and a number of initiatives including retire and return, secondment opportunities and the development of new roles ensured all staff received specialist LD training.
  • In terms of the current respite arrangements and future booking requirements the CCG’s acknowledged that families needed additional certainty. The CCG’s advised that they were prepared to extend the implementation phase until December 2018 (in place of September 2018) to ensure sufficient time was taken to implement the proposed changes effectively.

The Chair invited the parent / carer representatives to express their views in respect of the assurances provided. The following points were raised:
 

  • The best news parent / carers could have received was to hear that TEWV had agreed to continue their contract and provide bed based respite services for the most vulnerable people at Bankfields and Aysgarth.
  • TEWV was the only service in which parent / carers had confidence that the complex needs of their sons and daughters could be met. Bankfields and Aysgarth represented gold standard respite provision on Teesside.
  • The parents / carers were relieved that in order to receive respite provision at Bankfields and Aysgarth parents / carers there would no longer be a requirement for them to choose a proportion of their respite allocation from the alternative menu e.g. a caravan, hotel or care home. All of the allocation could be taken at Banksfields or Aysgarth.
  • Despite the above reassurances it remained unknown as to how many nights respite each family would receive. From the examples presented to parents the minimum number of respite nights an individual family would receive was 15. The question was posed to the CCG’s as to whether there was a benchmark figure for how many nights, out of 365 nights, constituted respite?
  • The staff at TEWV were highly valued and their skills were way beyond that of parents. The nursing staff had the skills to see things that parents did not and were regarded as their health partners in the provision of care.
  • The point was emphasised that from the parents / carers perspective they was absolutely no desire to pursue equity in allocation. What parents / carers needed and wanted was proper support from people qualified to provide it.
  • In terms of the other reassurances offered by the CCG’s it was felt that these did not offer parents / carers any reassurance, as it was evident that some people would receive less respite than they did currently. Despite the fact all 4 Local Authorities had advised they could not condone any reduction in the current service.
  • The CCG’s had confirmed that some people would lose out, which was a worry and not a reassurance. The issue of a minimum respite provision had not been addressed.
  • The CCG’s had repeatedly emphasised that the level of funding for future respite provision had been protected. However, it was evident that the current funding allocation had to cover a wider cohort of people. The reassurance was not as strong as parents were seeking.
  • TEWV had a number of staff qualified in autism and it was queried how these skills would be replicated if community based respite provision was commissioned.

The Chair invited representatives from the CCG’s and TEWV to respond to the issues highlighted. The following responses were provided:

  • TEWV was committed to providing staff training in respect of supporting people with autism across all areas of the organisation. However, it was acknowledged by TEWV that it was very difficult for someone to go from having an awareness of autism to being an expert in autism.
  • The Chief Officer at HAST advised that the CCG had a statutory responsibility to provide choice and younger people had different views about the support they required in terms of respite provision. This did not take anything away from the respite services provided at Bankfields and Aysgarth.
  • In many places throughout the country a hospital bed based respite service was not available and people were accessing other types of respite provision.
  • In response to a query regarding the proportion of funding that would be diverted away from Bankfields and Aysgarth the CCG’s advised that this remained difficult to answer.
  • The CCG’s were still working through the development of the new assessment process and what was being proposed was a needs led assessment that would be undertaken in collaboration with families. It maybe the case that initially 100 per cent or 95 per cent of respite funding would remain with TEWV initially but would change over time based on the preferences of those in receipt of the service.

In response to the CCG’s response a parent currently in receipt of respite provision advised that Bankfields was not a hospital environment. The staff at Bankfields helped her son plant sunflower seeds in the gardens and took a real interest in him. The care provided at Bankfields was the appropriate care required for adults’, who had been brain damaged since birth and needed that protection. Bankfields was a homely environment and her son had been receiving respite care there for over 30 years. In addition her son had been assessed every year.

 

It was again requested that the CCG’s provide some certainty for parents around a minimum number of respite nights, with a suggested figure of 30 nights. The Chief Officer at STCCG advised that the CCG’s would not be able to offer a minimum number of nights. The previous allocations had been based on a historic process and the allocation needed to be based on the very specific needs of the individual and their carer. An indicative piece of work had been undertaken in respect of the assessment process and examples had been provided. However, in hindsight this had not been helpful and had in fact caused upset. It was emphasised that each case needed to be worked through on an individual basis.

 

A Member expressed the view that engagement with parents / carers needed to be improved in the future, as the process was both time consuming and stressful. Clarification was sought on the combined annual budget of STCCG and HAST CCG. The Chief Officer at HAST CCG confirmed that the annual budget was approximately £1billion. It was accepted that those in receipt of respite provision at Bankfields and Aysgarth were the most vulnerable of the vulnerable. The question was posed as to whether the CCG’s had undertaken any cost / benefit analysis on the significant costs that the NHS would incur if the parent / carers affected were no longer able to support their loved ones at home. The point was made by Members that the families in receipt of respite at Bankfields and Aysgarth should be at least able to retain the support they currently received.

 

The CCG’s advised that unfortunately any service had to be provided within a specific financial envelope. The current assessment process was not currently adhered to and both the proposed new model / old model had been shared with colleagues, the penultimate stage now was to involve clinicians. A relative resource had been identified by the CCG’s for future provision but the truth was that respite was not a statutory service. It was stated that despite there being no statutory requirement for the CCG’s to fund respite provision STCCG and HAST were committed to continuing funding the service at £1.5m per annum.

 

A Member of the Committee expressed the view that it was clear these families desperately sought reassurance around the minimum number of respite nights they would receive at Bankfields and Aysgarth. There was no demand from the parents/carers in receipt of the service to access any alternative provision. The overriding preference was for the current service to be maintained and for the CCGs’ to sustain the provision that had been in place for many years. It was also emphasised that the needs of the carers would more than likely increase with age, rather than decrease.

 

In addition the CCGs’ had acknowledged that demand for the service was increasing. The Chair stated that it was both cruel and wrong to change the current provision. The Committee expressed the view that Members remained dissatisfied with the assurances offered and the CCGs’ inability to demonstrate the impact of the new assessment process on the individual families affected at Bankfields and Aysgarth.

 

AGREED as follows:-

  1.  That it be recommended to the appropriate panel / committee, with the relevant delegated powers, at Middlesbrough and Redcar and Cleveland Borough Council that both local authorities proceed with a referral to the Secretary of State in respect of the CCGs’ LD Respite Review.
  2. That the CCGs’ be provided with the reasons for the Committee’s decision in advance of any formal submission of the referral to the Secretary of State. 
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