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City of York Council |
Committee Minutes |
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Meeting |
Health, Housing and Adult Social Care Scrutiny Committee |
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Date |
10 July 2024 |
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Present |
Councillors J Burton (Chair), Hook, D Myers, Rose, Runciman, Wilson, Knight (Substitute) and Cuthbertson (Substitute) |
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Apologies |
Councillors Smalley and Wann |
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In Attendance |
Councillor Steels-Walshaw (Executive Member for Health, Wellbeing and Adult Social Care) |
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Officers Present |
Peter Roderick, Director of Public Health Anna Lee-Hughes, Infant Feeding Lead |
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External Visitors |
Dawn Parkes, Chief Nurse, York and Scarborough Teaching Hospitals NHS Foundation Trust Simon Morritt, Chief Executive, York and Scarborough Teaching Hospitals NHS Foundation Trust |
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6. Declarations of Interest (5:33 pm)
Members were asked to declare at this point in the meeting any disclosable pecuniary interests or other registerable interests they might have in respect of the business on the agenda, if they had not already done so in advance on the Register of Interests.
None were declared, although in relation to agenda item 4 (York and Scarborough Teaching Hospitals NHS Foundation Trust CQC Update) Cllr Rose noted in the interests of transparency that he was an appointed City of York Council representative on the Trust’s Council of Governors.
7. Minutes (5:34 pm)
Resolved: That the minutes of the meeting held on 23 April 2024 be agreed as correct record and signed by the Chair.
8. Public Participation (5:35 pm)
It was reported that there had been two registrations to speak at the meeting under the Council’s Public Participation Scheme.
Flick Williams, speaking remotely in relation to agenda item 4 (York and Scarborough Teaching Hospitals NHS Foundation Trust CQC Update), drew attention to issues of patient safety around Covid-19 for those who were clinically vulnerable. Describing a recent hospital experience, she raised concerns about hospital-acquired infections and the sustainability of safe staffing, querying the place of patient protection in the Trust’s improvement plan.
Dr Ernestine Gheyoh Ndzi, speaking in relation to agenda item 5 (Breastfeeding and Infant Feeding), noted that while the benefits of breastfeeding were well-documented, her work with stakeholders across the region highlighted the need for more support. Noting the drop in breastfeeding rates by six weeks and cost of living challenges for those formula feeding, she called for stronger support structures and resources to help parents make informed decisions and work towards a city where all babies could have the best start in life.
9. York and Scarborough Teaching Hospitals NHS Foundation Trust CQC Update (5:44 pm)
Members considered an update from York and Scarborough Teaching Hospitals NHS Foundation Trust on the approach the Trust was taking to address issues identified by the last Care Quality Commission inspection. This followed a previous update to the committee in September 2023.
The Trust’s Chief Executive and Chief Nurse provided an overview and responded to questions from the committee. It was noted that:
· The ‘must do’ and ‘should do’ actions issued by the CQC had been amalgamated into 73 actions as part of the Trust’s ‘Journey to Excellence’ improvement plan, overseen by a fortnightly programme board. These actions required robust evidence to be signed off, with 40 actions having been so to date, with a further eight completed pending final approval.
· Extensions had been approved for 13 actions to ensure consistent audit feedback that they were being met, and the CQC were aware of this. This included some ‘must do’ actions, including an electronic mental health assessment for Emergency Departments.
· 10 off-track actions required an extension; these needed time to embed and there were no major concerns around achieving them. An exception was Emergency Care workload; it was likely that this would be put into normal monitoring processes following discussion with the CQC.
· The CQC had been invited later back in the month. Its assessment processes had changed and re-inspections, which could take place at any time, would focus on specific areas.The Trust provided monthly assurance updates to the CQC.
· The Trust was required to deliver a 7% financial efficiency programme in 2024-25, comparable to neighbouring Trusts. Everything possible was being done to prevent these efficiencies having an impact on the quality of patient care. While staff regularly went above and beyond, this entailed management of service levels within the existing resource settlement. All partners across the broader health and care system were facing similar financial challenges.
· Balancing improvements with delivery of the efficiency programme was a key risk, but nurse staffing changes to improve safety in Emergency Department waiting areas were fully sustainable and processes were in place to support teams if issues arose.
· The Trust continued to follow national guidance around the management of Covid-19, which remained a challenge including around staffing. Specific care plans were put in place for clinically vulnerable patients.
· In relation to the Trust’s relationship with the Council, there was an emphasis on continuing to work together constructively to innovate and strengthen the integration of services.
Resolved: To note the Trust’s response to the CQC inspection and the wider Journey to Excellence focused improvement programme.
Reason: To keep the committee updated on the progress of the Trust’s improvement programme.
10. Breastfeeding and Infant Feeding (6:19 pm)
Members considered an update on the Breastfeeding and Infant Feeding Delivery Plan. This followed a previous report to the committee in December 2023.
The Director of Public Health and the Infant Feeding Lead provided an overview and responded to questions from the committee. The Chair also invited Dr Ndzi, the public participant, to join the discussion. It was noted that:
· The Public Health team was expanding its work in this area through the York Breastfeeding and Infant Feeding Partnership, including working towards UNICEF Baby Friendly Initiative (BFI) accreditation, developing a food insecurity pathway, and adopting a ‘Feeding Friendly City’ approach. This collaborative work would be informed by feedback on current service provision.
· Breastfeeding rates in York fell from an average of 74% at delivery to 44% by 6-8 weeks. This drop was more pronounced in wards with higher rates of deprivation, falling to 29% in the most deprived ward. Work was in progress to reach families in these areas through family hubs, which were now included in BFI standards, as well as through baby and toddler groups, to provide advice and support including around expressing, and gather feedback.
· Quarterly auditing of families’ experiences of care formed part of BFI accreditation, and audits could be tailored to ask additional questions. It was an ambition to collect a deeper level of data to better understand the reasons for falling rates within wards.
· It was hoped that the multi-agency pathway which had been developed to support families experiencing food insecurity would be live by the end of the summer. This would include vouchers to provide formula for families in crisis issued by the Healthy Child Service and community midwifery, alongside wraparound support and advice including signposting to relevant advice organisations who could offer support around accessing benefits, fuel costs, and budgeting.
· Work was being done with maternity services to improve the consistency of in-hospital breastfeeding support. It was important that those unable to breastfeed felt fully supported, and strategic and specialist clinical work was underway to achieve this.
· Local efforts to counter the exploitative marketing of formula milk focused on the supportive networks across the city, but the Council’s voice was added to national campaigns when appropriate. It was noted that the Competition and Markets Authority was currently investigating formula milk pricing, and inappropriate marketing claims could be reported.
· Peer support was invaluable, and while organisations such as Treasure Chest ran groups across the city, it was a challenge to engage families in wards where breastfeeding rates were lower. It was an ambition to undertake specific impact work with women in those areas to help develop peer support networks. A text or call-back service was also an aspiration.
· Initial communications work was underway for a ‘Feeding Friendly City’ approach to foster an enabling environment for breastfeeding in York. This would be informed by successful initiatives from other towns and cities, and would include a public health campaign, education and training around safe feeding practices, and engagement with businesses and venues to support them to be ‘feeding friendly’ however babies were being fed. A ‘nudge’ approach would be considered as part of this work.
· Local efforts for World Breastfeeding Week in August would focus on supporting families to make informed choices on infant feeding, particularly around preparation during pregnancy.
The Executive Member for Health, Wellbeing and Adult Social Care was in attendance and indicated her support for a ‘Feeding Friendly City’ approach.
Resolved:
i. To note and support the work being undertaken to achieve the ambition of protecting, promoting and supporting breastfeeding and safe infant feeding practices.
ii. To support the approach to York becoming a ‘feeding friendly city’.
Reason: To keep the committee updated and to support and promote breastfeeding and safe infant feeding in York.
11. Work Plan (7:19 pm)
The committee considered its work plan for the 2024/25 municipal year. It was noted that:
· The previously deferred report on the Homelessness Future Resettlement Pathway was not the agenda for the present meeting. Members indicated their desire to discuss the report at an early opportunity, and the question of ensuring the timeliness of future work plan items was also raised.
· With reference to Public Health work on Autism and ADHD, it was confirmed that officers were in the process of producing a Health Needs Assessment on the needs of those with Autism and ADHD. A report on this subject was scheduled to be considered by the committee in November, and would be followed at a later date in 2025 by a co-produced city Autism and ADHD strategy informed by the Health Needs Assessment. An update on progress with the strategy would be given at the November meeting.
· It was suggested that certain areas of Adult Social Care finance, including around supporting those with complex needs based outside the city, could be considered in more depth during discussion of an upcoming Finance and Performance Monitor Report.
· The Chair noted that the committee had previously requested that the Audit and Governance Committee review the ending of the Early Intervention and Prevention Contract with the Salvation Army. She noted that while this was now a matter for the Audit and Governance Committee, interested members could register to speak at that committee’s next meeting when a report on the subject was due to be considered.
Resolved:
i. To note the committee’s work plan.
ii. That the Chair and Vice-Chair liaise with officers to ensure suitable agendas for upcoming meetings, including requesting that the Homelessness Future Resettlement Pathway be brought back at an early opportunity.
Reason: To keep the committee’s work plan updated.
Cllr J Burton, Chair
[The meeting started at 5.33 pm and finished at 7.27 pm].