Tees Valley Health Scrutiny Joint Committee Minutes

Tees Valley Health Scrutiny Joint Committee Minutes

Date:
Wednesday 26 April 2017
Time:
10:00 a.m.
Place:
Mandela Room, Town Hall, Middlesbrough
 

Attendance Details

Present:
Councillor E Dryden (Chair) - Middlesbrough Council, J Taylor - Darlington Council, I Jeffrey - Redcar and Cleveland Council, B Harrison - Hartlepool, E Cunningham, L Grainge, and L Hall - Stockton Council.
Officers:
C Breheny
Apologies for absence:
Councillor Taylor, Belcher, Martin-Wells, Biswas, Harding, Reed, Cunningham, Newall and Tostevin.
Declarations of interest:

There were no declarations made at this point in the meeting.

Item Number Item/Resolution
PUBLIC
16/15 MINUTES - TEES VALLEY HEALTH SCRUTINY COMMITTEE - 26 JANUARY 2017

The minutes of Tees Valley Health Scrutiny Joint Committee held on 26 January 2017 were agreed subject to minor amendments being made.

16/16 MENTAL HEALTH SERVICES FOR CHILDREN AND YOUNG PEOPLE

The Democratic Services Officer explained that the NHS representatives scheduled to be in attendance at today’s meeting had submitted their apologies. On 24 April 2017 advice was issued by NHS England (NHSE) Communications to all NHS Trusts advising staff against engagement in respect of political issues during the Purdah period.


The Chair expressed the view that this item had been on the agenda since January 2017 and was part of an evidence gathering session on this topic. It would not be used by Members of the Committee for political purposes. It was advised that despite efforts to offer reassurances that scrutiny was not a decision making body, and the Chair of the panel did not envisage any press issues arising, the invited representatives wished to withdraw from the meeting.


The Chair’s view had been relayed to the invitees in advance of the meeting, however, the North of England Commissioning Support Service (NECS), Hartlepool and Stockton on Tees/Darlington CCG and Tees, Esk and Wear Valleys (TEWV) NHS Foundation Trust retained the view that on this occasion and in respect of this particular topic they were unable to attend.

 

AGREED as follows:-


1. That the item be rescheduled and included as an item on the next agenda of the TVHSJC.

16/17 STAKEHOLDER ENGAGEMENT UPDATE - TRANSFORMING CARE: RESPITE SERVICES REVIEW

The Democratic Services Officer explained that the NHS representatives scheduled to be in attendance at today’s meeting had submitted their apologies. On 24 April 2017 advice was issued by NHS England (NHSE) Communications to all Trusts advising staff against engagement in respect of political issues during the Purdah period.

The Chair expressed the view that this item had been on the agenda since January 2017 and was part of an evidence gathering session on this topic. It would not be used by Members of the Committee for political purposes. The Chair’s view had been relayed to the invitees in advance of the meeting. However, NHS Hartlepool / Stockton on Tees Clinical Commissioning Group (CCG) and NHS South Tees CCG had advised that on this occasion they were unable to attend.
 

AGREED as follows:-


1. That the item be rescheduled and included as an item on the next agenda of the TVHSJC

16/18 NEAS CQC RATING AND RECRUITMENT

The Assistant Director of Communications and Engagement at NEAS was in attendance to provide an update on the work of the trust. The Committee was advised that an inspection by the CQC had been undertaken in November 2016 and NEAS had received a ‘Good’ rating. The Lead Inspector had stated that the NEAS had a lot of to be proud of and there were clearly many areas of good practice. There was a general culture of passion and enthusiasm at the trust and it was clear that everyone’s first priority was the patient. Information was provided on what NEAS did well and a number of areas of outstanding practice were highlighted as follows:-

  • Culture of compassion and commitment
  • Clear Vision and Strategy
  • Shift in patient engagement and staff wellbeing
  • Improved relationships between Executives and Unions
  • Front line clinical leadership improved
  • Good IPC management practices
  • High patient satisfaction
  • Introduced Advanced Practitioners
  • Active in Research
  • Strong relationships with Sports Ground Safety Authority
  • The "flight deck" system which monitors hospital capacity and demand in real-time to manage pressures in the system and divert patients to alternative care when necessary
  • Enrolled in the Mind Blue Light Project

It was explained to the Committee that a new Chief Executive had been appointed and this had resulted in a culture change in the organisation.


The areas for improvement were presented and it was confirmed that NEAS, as was the case with all ambulance trusts throughout the country, was below the national standard for the dispatch of ambulances in response to 75% of Red1 and Red2 999 calls within 8 minutes. Following the inspection the CQC had advised that a second dispatch desk was needed at Russell House, which would require additional investment from the Commissioners.

 

The point was made that the Committee had previously expressed concerns in relation to the relocation of the 999 call centre at Ladgate Lane, which resulted in two sites in Newcastle. The Assistant Director of Communications and Engagements advised that the concerns expressed by the CQC related to the dispatch of ambulances and not to the answering of calls. If one centre went down the remaining centre was in a position to answer calls for the whole North East region.
 

The concerns raised were specific to the resilience element in that if one of the dispatch centres was out of action there was still a need to have another full time dispatch centre in operation. Under Regulation 17 i.e. Good Governance there was a need to build in that resilience. In response to a query, however, it was acknowledged that the two dispatch centres were in relatively close proximity.
 

The areas where NEAS needed to improve i.e. Must do, Regulation 17 were highlighted as follows:-

  • Improve resilience of dispatch (Requires a dispatch desk at Russell House)
  • Line management and clinical oversight of CFR’s
  • Safe storage of paper records
  • Management of Clinical risk in EOC when dispatch stack increasing
  • Business continuity plans for EOC require improvement
  • Learning from incidents and complaints is shared
  • Continue to reduce complaint and incident backlog

It was queried as to whether all ambulances were in-house ambulances or whether any supplementary services were used. It was acknowledged that due to fact NEAS did not have a full establishment of paramedic staff additional support was purchased from the British Red Cross and St John’s Ambulance. The technicians working for both organisations were trained to a lower skill than a paramedic. This in-built inefficiency resulted in the need for back up to be dispatched to administer pain relief. It also resulted in a higher number of patients being conveyed to hospital.
 

It was advised that in 2013/14 NEAS received a red incident every 3 minutes, which meant it needed 27 ambulances available to respond, based on average job cycle times. In contrast in 2016/17 NEAS received a red incident every 2 and a half minutes, which meant it now needed 37 ambulances available to respond, based on current job cycle times. The Committee was shown a screen shot from NEAS’ clinical escalation system, which showed an example of a stack of red calls waiting due to a lack of ambulance resources to send to Red1 and Red2 calls.
 

It was explained that an additional 393 paramedics would be needed for NEAS to match West Midlands Ambulance Service’s proportion of paramedics per square mile. An additional 178 paramedics would be needed for NEAS to match the proportion of paramedics per 10,000 population to West Midlands Ambulance Service. In terms of the number of life threatening red incidents these had increased during 2015/16 by over 6% since 2014/15.

 

It was explained that the number of incidents that have been met within the 8 minute target for Red1 and Red2 remained relatively static for the last 3 years, with around 370 incidents per day being reached within 8 minutes. With the exception of the winter of 2014, up until August 2015 responding to this number of incidents had meant NEAS had achieved its 75% target. From August 2015 onwards, NEAS had experienced an increased number of red incidents, which meant that although it continued to respond to a similar number of incidents in 8 minutes, the figure converted to a lower percentage of total incidents.
 

With regard to completion times the time taken for crews to complete a job had increased by 19% between August 2013 and August 2016. The yearly average was likely to be higher once the winter months had been included. NEAS crews spent on average 11 minutes longer on each job. Based on 380,000 incidents per year this equated to 2902 days, or an extra 16 shifts a day for a year.


A number of areas were highlighted where NEAS needed to improve - should do - as follows:-

  • Improve major incident training
  • Staff are further encouraged and supported to report incidents
  • Improve the system for monitoring cleanliness of PTS vehicles
  • Improve training for dementia and mental health

It was explained that conveyance rates have reduced since April 2016 as more patients receive telephone and at scene treatment. Time lost to handovers over 15 minutes had reduced between March 2016 and March 2017 by 66%. The hospitals with the greatest amount of time lost to handover for December were NSEC (337 hours), Sunderland Royal (234 hours) and UHND (117 hours).


Reference was made the National Audit Office report published in January 2017, which compared the 2015-16 figures for urgent and emergency income per head of population by NHS ambulance trust. It was noted by the Committee that the sums varied by almost £10 per head of population across the various ambulance trusts as follows:- 

  • South East Coast - £36.60
  • Yorkshire received - £34.90
  • East of England - £30.30
  • East Midlands - £29.80
  • North East £26.70.

The Committee was informed that commissioners had provided additional funding of £3.9m which would allow NEAS to employ an additional 42 paramedics in time, however NEAS believed this was not enough to achieve its performance targets.
 

NEAS also believed that one of the issues behind the challenging performance was the cumulative impact of individual NHS service reconfigurations across the region. This would need to be considered carefully in future, particularly in light of any changes emanating from STPs. NEAS was involved in discussions with the Durham Dales, Darlington Tees, Hambleton and Richmondshire STP.
 

It was advised that the largest clinical risk was as a result of delayed ambulance response for those patients predominately categorised as requiring a G2 30 minute response. These patients were experiencing long delays due to the increasing red incidents and the lack of both resources and clinical skill availability. It was acknowledged that moderate and serious harm/death reported incidents were a direct correlation to ambulance delay.
 

AGREED as follows:-

  1. That the Commissioners and NEAS be invited to attend a future meeting of the TVHSJC to outline progress made in respect of the Action Plan following the CQC inspection.
  2. That information on the Mind Blue Light Project be forwarded to all Members.
  3. That local MPs be advised of the disparities in funding received by ambulance trusts per head of population throughout the county. The North East Ambulance Service (NEAS) received significantly less funding in 2016/17 compared with other ambulance trusts and the performance targets set were unobtainable without addition funding / support.
  4. That a copy of the National Audit Office reports from 2011 and 2017 along with a copy of the NEAS presentation be circulated to Members.
16/19 TEES, ESK AND WEAR VALLEYS NHS FOUNDATION TRUST (TEWV) - QUALITY ACCOUNT 2016/17

The Committee was advised that the Tees, Esk and Wear Valley’s NHS Trust (TEWV) had produced a Quality Account, which covered Mental Health and Learning Disability services for County Durham, York and most of North Yorkshire, as well as the 5 Tees Valley Boroughs. Locally specific data had been drawn from the full report for the benefit of the Committee.


Within the 2015/16 Quality Account the Trust had agreed the following four Quality Priorities for 2016/17:-


1. Continue to develop and implement Recovery focused services;
2. Implement and embed the revised harm minimisation and risk management approach;
3. Further implementation of the nicotine replacements programme and smoking cessation project;
4. Improve the clinical effectiveness and patient experience at times of Transition Monitoring Progress.
 

The Committee was advised that 33 of the 35 actions within these 4 priorities were Green and 2 actions were Red - priority 3 and 4 (Transitions and Nicotine). The first Red action related to the training element of implement and embed the revised harm minimisation and risk management approach. The target had been to train 3137 TEWV clinicians by the end of March 2017 (65 per cent of the total clinical workforce of 4827). It was advised that 2044 (42 per cent) of staff had been trained. The period during which face to face training was to be provided had been extended and e-learning introduced from May 2017, in an effort to increase the proportion of staff trained.


The second Red action related to the training element of further implementation of the nicotine replacement programme and smoking cessation project. The target had been to train 75 per cent of community clinicians by the end the end of March 2017. During 2016/17 10 per cent of community staff had received the relevant training. The training period had now been extended to May 2017, in an effort to increase the proportion of staff trained.
In terms of the Quality Metrics 6 of the 9 were reported as Green and 3 Red at the end of March 2017 (full year).

 

The 3 Red Quality Metrics were as follows:-

 

Patient falls per 1000 admissions
 

It was advised that TEWV’s position for the period April 2016 to the end of March 2017 was 64.32 i.e. 35.53 above the target of 28.79. This equated to 399 falls during this period; 120 related to people from the Tees Valley; 90 (23%) were classified low with minimal harm (patient required extra observation or minor treatment) and 27 (7%) were reported as moderate short term harm (patient required further treatment). It was explained that many of the older people in receipt of MH services were frail, displayed challenging behaviour and had complex health issues. Reporting of this issue had also improved in recent years and sustained efforts including additional training and the use of hip protectors were being made to prevent patient falls.

 

Average length of stay for patients


TEWV’s position for the period April 2016 to the end of March 2017 in MHSOP was 78.06 i.e. 26.06 above (worse than) target of <52 days. The median length of stay was 50 days. A number of factors impacted on achieving this target including Social Care provision, Care Home capacity and lack of Nursing Home placements, as well as the physical health difficulties experienced by older patients.


Percentage of complaints satisfactorily resolved


The end of year data indicated that 74.87 per cent (143/191) of complaint letters did not have requests from the complainant for further review/action by the Trust. A follow up request was received in 25.13 per cent (48/191) of cases against a 10 per cent target. It was emphasised that the complaints received could be very complex. The Committee queried the type of complaints TEWV received and it was advised that they ranged from complaints regarding clinical treatment to concerns around waiting times.


The Committee queried whether TEWV had a Whistleblowing Policy and it was confirmed that a policy had been in place for a number of years. Various reporting mechanisms were available and a designated independent person was in post to address any concerns raised. In addition staff also had the facility to report any concerns anonymously directly to the Chief Executive’s Office through the TEWV intranet page. The primary reason for establishing the system had been to enable patient safety concerns to be escalated. The system was very well used for a host of staff issues, although not always related to patient safety, as originally intended. The Director of Nursing was a further point of contact along with the CQC if patients had any serious issues of concern.


The Quality Priorities for 2017/18 were as follows:-

  • Ensure Safe Staffing in all services.
  • Implement phase 2 of the Recovery Strategy (a 3 year priority).
  • Reduce the number of preventable deaths.
  • Reduce the occurrences of serious harm resulting from inpatient falls.
  • Improve the clinical effectiveness and patient experience in times of transition from Child to Adult Services (second year).

It was explained that during 2016/17 a new TEWV Quality Strategy was approved, which included a set of metrics to monitor progress. The Quality Metrics within the Quality Account would be replaced to align with the Quality Strategy for 2017/18.


In terms of next steps the Draft Quality Account had been circulated to all interested parties on 13 April and comments were required by 13 May 2017. The Quality Account would be submitted to Secretary of State on 30 May and published on the 30 June 2017.
 

Reference was made to reducing the number of preventable deaths and the panel requested the figures for 2016/17. It was advised that there had been 107 deaths recorded in 2016/17 and following careful consideration of those cases had been viewed by TEWV Trust as preventable.


Reference was made to concerns raised locally and nationally in respect of Children and Young People’s Mental Health Services. Yet no Quality Priorities, other than the one that made reference to transitions, specifically related to Children and Young People. The Committee was advised that very few children were in receipt on inpatient MH services and South Tees CCG had commissioned a Children’s Crisis Team for all 4 Boroughs, with the exception of Darlington.

 

The Crisis Team ensured that children were kept out of hospital 24 hours a day, 7 days a week and waiting times in the Tees Valley were much lower than in other parts of the country. Once a child / young person was on caseload a significant amount of work was undertaken to support them.
 

Reference was made to the high percentage of prisoners with mental health conditions and the services in place for them. It was confirmed that TEWV does provide input and a joint presentation with the prison service could be arranged for the Committee.
 

AGREED as follows:- 

  1. That a TVHSJC response be provided to the TEWV NHS Trust Quality Accounts 2016-17 be prepared and submitted to in advance of 15 May 2017 following approval by the Chair.
  2. That further information on the joint work undertaken by TEWV with the prison service be presented to a future meeting of the Committee in 2017/18.
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