Tees Valley Health Scrutiny Joint Committee Minutes

Tees Valley Health Scrutiny Joint Committee Minutes

Friday 21 October 2016
10:00 a.m.
Mandela Room, Town Hall, Middlesbrough

Attendance Details

Councillor J A Walker - Middlesbrough Council, J Taylor - Darlington Council, I Jeffrey - Redcar and Cleveland Council, E Cunningham - Stockton Council, L Hall - Stockton Council.
E Pout
Apologies for absence:
Councillor S Biswas, Councillor E Dryden, W Newall, L Tostevin, Harrison, R Martin-Wells, Harding, Reed, Cunningham
Declarations of interest:

None Declared

Item Number Item/Resolution

The minutes of the meeting of the Tees Valley Health Scrutiny Joint Committee held on 28 July were submitted and approved as a correct record.


The Committee had received a report in January 2016 regarding the Child and Adolescent Mental Health Transformation Plan and the Committee had agreed that it should be updated on its progress.


Members had also expressed a wish to look at the topic of Young People’s Mental Health and gather information on the following: pathways; resources; gaps in services; access routes; and how services were informed by the Joint Strategic Needs Assessment (JSNA).


Mark Burdon, Commissioning Manager - Mental Health, North of England Commissioning Support Services attended the meeting to provide information primarily about the services available for young people.


In describing the pathways and access routes, Members were told that there was an open referral to CAMHS (Child and Adolescent Mental Health Services). For example schools, family members and GPs referred and a quarter of referrals came from that route and the numbers were rising. Some areas had co-located Primary Mental Health Workers with Early Help teams in Early Help hubs and there was a multi-agency diagnostic pathway for ASD (Autism Spectrum Disorder).


The structure for the services provided by TEWV (Tees Esk and Wear Valley Trust) was presented and it provided information on the range of services which included community and out-patients, early intervention, crisis and liaison and inpatient services. The early intervention in psychosis team went across the age range from age 14 to adulthood mainly because it was important that young people with mental health issues were picked up early and had the opportunity of an early intervention. The team also saw people at their first episode of psychosis or where a person was in an 'at risk mental state’. The service offered appointments from 9am to 5pm Monday to Friday and offered some flexibility. There was a three year intervention period and family-based working was offered. There was a 2 week target to see people.


A new 24/7 crisis and liaison service had been established in June 2015 and was funded by money from the Transformation Plans. Early indications showed that it had cut admissions for Mental Health conditions for under 18 year olds.


Tees CAMHS which involved Hartlepool, Stockton on Tees, Middlesbrough and Redcar and Cleveland held an average caseload of 3,674 at any given time and each month 365 external referrals were made. The main source of referrals was primary health care and the main outcome of the assessment was referral to CAMHS.


A number of gaps in service were outlined and included the significant waiting lists to diagnose and support ASD. It was explained that this was due to it being a multi-agency pathway which was very complex, however the Trust were looking at what could be done to bring down the waiting time. There was also a high expected prevalence of conduct disorder in this area however there was little data on actual diagnoses or information on how well supported it was.


In terms of how services were informed by the JSNA it was explained that the JSNA was modular so some pages including mental health and learning disabilities were out of date. The main source of data used was from Public Health England and strategic direction was received from NHS England with local context input from partners.

In the discussion that followed, Members had concerns about waiting times based on anecdotal evidence they had heard. The committee was informed that recent figures that had been received showed an improvement in waiting times. In the first quarter of 2016/17 the average waiting time from referral to second appointment was 38 days however in the period up to September it had reduced to 15 days. However it was acknowledged that there were longer waiting times for ASD.


Members questioned how services were informed by the JSNA if it was out of date and asked what cognisance was given to other sources of information such as Directors of Public Health, information from Health and Wellbeing Boards, Healthwatch, young people etc. It was explained that the CCG would be responding to a recent paper on mental health by Healthwatch.


It was acknowledged that there was more to be done to improve the awareness of services. A discussion took place about how schools were key to that awareness raising and some examples of work in Redcar and Cleveland and Middlesbrough were given.


It was explained that there was a parity of esteem in mental health spending, for example if CCGs receive a 1% increase in their budget a 1% increase in spending on mental health must be made. Child and Adolescent mental health received 11% of spending from the mental health budget.

The Committee agreed that further information should be brought on this issue in 6 months’ time including specific information on

a) Suicide figures across the Tees Valley including age ranges and comparison with national figures.
b) Waiting times and how they are being addressed.
c) Update on the implementation of the Child and Adolescent Mental Health Transformation Plan.


Representatives from the North East Ambulance Service (NEAS) circulated a document on their review of the year which was a short summary of their annual report. (The full report could be found on the NEAS website).


Representatives welcomed the opportunity to maintain the dialogue with the committee and went on to present information on their ambulance emergency care report.


It was noted that NEAS had seen an increase in a number of conditions, notably the main 4 included breathing problems, chest pain, abdominal pain and falls. Representatives took Members though the presentation. It was noted that whilst the number of incidents remained relatively static there had been a significant increase in 111 calls and 999 calls. Whilst those calls had gone up the number of attendances had changed due to categorisation at triage. The national standard was that 75% of red calls should be answered within 8 minutes.


Green calls were sub categorised into level 1 or 2. However the proportion of calls assessed as red had increased by 15%. In order to show the impact of this it was explained that in April 2013 there were 350 incidents and performance stood at 79%, compared with April 2016 again 350 incidents but the proportion of red calls were greater, which meant NEAS were no longer meeting the 75% target as performance stood at 68%.


As an element of assurance it was explained to Members that 74.5% of red calls are answered in 9 minutes and 78% in 10 minutes, meaning NEAS were close to where they needed to be to achieve their target.


There was a decreasing trend of calls resulting in conveyance to A&E, the Trust had worked hard to ensure that. It had taken place through assessments of patients over the telephone and the introduction of paramedics with enhanced skills and practitioners who could deal with multiple and complex conditions who could treat people at the scene. Investment in more clinicians in the control room had improved hear and treat statistics.


Handover delays had peaked over winter, resulting in 1,200 hours of delays, numbers had dropped slightly but not to previous levels. The overall trend showed that hospital delays were increasing due to wider issues and cutbacks in social care. The impact of those delays had a ripple effect across the region as delayed ambulances could not be used. It equated to 150 days or 5 months or 300 double crew shift or £72,000 in staff costs.


With regard to the workforce issues there was still a national shortage in paramedics. Paramedics were being lost to the Department of Work and Pensions who were being employed to undertake assessments and received a higher salary and a more attractive 9-5 working week. Workforce levels were an ongoing challenge and the Trust had 80 vacancies however there were students coming through from Teesside University and a number of paramedics had been recruited from Poland. It was anticipated that the Trust would have a full complement of staff by April 2017. It was noted that the use of private ambulances had decreased as staffing levels at NEAS had increased.


Members were concerned about the demand coming from areas of high deprivation. It could be seen that the legacy of heavy industry was having an impact on elderly patients. However as deprivation was a factor it was not the driving force of the demand.


Concern was raised about delayed handovers at Darlington Memorial Hospital. It was explained to the committee that a task and finish group had been established to look at handover times, which was a significant piece of work with support from the wider NHS. NEAS were working with NHS colleagues to support patient flow and a discharge capability vehicle was being introduced from 1 November 2016.


Members also raised concerns about winter pressures and that it was now the new norm as pressures had not abated over summer. It was explained that A&E delivery boards were working on winter pressures with partners and the voluntary sector, however no significant additional resources were being put forward for winter this year.

It was noted that a winter scheme from last year which involved a special ambulance being available for end of live transportation was being shortlisted for an award.


NEAS representatives were thanked for their presentation and the information given to the Committee. Information regarding the findings from the CQC was due imminently and it was hoped that this would be available at the regional committee on 27 October.




That the information be noted


A report was brought to the Committee to inform Members about a review of health funded respite care for adults with a Learning Disability and complex needs in relation to the wider Transforming Care agenda.


The respite review project was still gathering and analysing information although initial findings indicated the following: demand was increasing, the complexity of need was increasing, there were potential gaps, duplication, the influence of local and national policies, improved choice needed and cost effective and appropriate transport options needed to be made available.


The review would focus on health respite services for people with Learning Disabilities and complex needs in the Hartlepool and Stockton-on-Tees CCG area and the South Tees CCG area and the CCGs are working in partnership with the four Local Authorities. A respite Task and Finish Group with members from CCGs, NECS and Local Authorities had been established.


Work will commence over the next several months to seek the views of people using the services, their carers, providers and commissioners with a view to determining future respite care arrangements.


Discussions took place about appropriate groups for consultation and Members suggested residents groups, Health Watch, Carers Together, the Travelling Community, Asylum seekers and Voluntary Groups.


It was explained how it was hoped that people with Learning Disabilities would be employed on the project as policy advisors.



That further information be brought to the Committee in January 2017

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