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City of York Council |
Committee Minutes |
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Meeting |
Health and Adult Social Care Policy and Scrutiny Committee |
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Date |
2 November 2021 |
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Present
In Attendance |
Councillors Doughty (Chair), Hook (Vice-Chair), Heaton, K Taylor, Vassie and Wann
Councillor Runciman (Executive Member for Health and Adult Social Care and Chair of Health and Wellbeing Board) |
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Apologies |
Councillor Barnes |
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7. Declarations of Interest
Members were asked to declare, at this point in the meeting, any personal interests not included on the Register of Interests, or any prejudicial or discloseable pecuniary interests they may have in respect of the business on the agenda.
None were declared at this point in the meeting but during agenda item 6, 2021/22 Finance and Performance First Quarter Report, Cllr K Taylor declared a personal non prejudicial interest in that he was a Non-Executive Director on the WorkwithYork Board.
8. Public Participation
It was reported that there had been no registrations to speak at the meeting under the Council’s Public Participation Scheme.
9. Minutes
Resolved: That the minutes of the previous meeting held on 29 July 2021 be approved and then signed as a correct record.
10. An update regarding Foss Park Hospital, including details of the most recent CQC inspection.
Members considered a report that updated them on the development and completion of Foss Park hospital in York.
Officers from the Tees, Esk and Wear Valleys NHS Foundation Trust had joined the meeting remotely to provide an update on the progress to date including the recent Care Quality Commission (CQC) Inspection of inpatient services and to answer any questions raised.
The Strategic Project Manager provided a Foss Park overview, as highlighted within the report, and he noted that:
· The new purpose-designed 72 bed hospital provided two adult single sex wards and two older people’s wards, one for people with dementia and one for people with mental health conditions such as severe depression or anxiety.
· All 72 bedrooms were single bedrooms with en-suite facilities and each bedroom corridor had rooms on one side and garden views on the other, so that no two rooms faced each other.
· Tees, Esk and Wear Valleys (TEWV) had invested approximately £40m (including VAT, fees and land purchase) from internal cash resources to support this development and TWEV owned the land and the building, enabling them to manage and maintain the building to the standard required.
· The hospital name and the names of the individual wards were chosen through a democratic focus group approach and the final decision was made for the individual wards to be named, Ebor Ward (female adult beds), Minster Ward (male adult beds), Moor Croft Ward (18 older person’s functional beds) and Wold View Ward (18 older person’s organic (dementia) beds).
· Foss Park hospital accommodated service users from York and Selby, including Harrogate and the hospital provided 36 adult beds in total (previously there were 38 beds available). In mitigating the shortfall, 2 beds were available at Cross Lane Hospital in Scarborough.
The Director of Operations provided a CQC inspection overview. She made reference to the actions taken since the January 2021 inspection of the acute wards for adults of working age and psychiatric intensive care units across the whole trust, which was rated inadequate for both safe and well-led.
The Director provided assurance that effective systems were now in place to keep patients safe and that further improvements were underway.
Members noted that the improvement programme would be overseen and reviewed by an external Quality Assurance Board, which included representatives from NHS England and the CQC and the actions taken to address the CQC concerns, which were highlighted within the report and included:
· Rapid quality improvement events to improve the risk management systems and introduce simplified processes.
· New training programmes for staff, including master classes on the new processes and on developing a good quality risk assessment.
· Every inpatient record had been audited across the trust.
· Risk was now addressed for all inpatient admissions using the new safer summary safety plan.
· All staffing had been reviewed and additional investment had been approved for frontline staff posts.
· The re-inspection in May 2021 took place over 9 wards, including Ebor and Minster at Foss Park Hospital. On 27 August the CQC published its report following the re-inspection giving the rating ‘requires improvements’ and the CQC no longer had significant concerns relating to risk management of service users.
· Improvements would continue to be embedded across the trust to provide a positive impact on patient care.
Members also noted the feedback from carers and the advocate regarding the Ebor Ward and in response to Members questions, it was noted that:
· The trust had committed an extra £5.4m for extra staffing for inpatient wards and these were being advertised. North Yorkshire, including Fosspark Hospital would use their allocation to secure additional administrative support, increase nursing capacity and to support practice development.
· Four consultants had been recruited to address some of the challenges within the services.
· A robust bed management system had been introduced and was assessed every day. As at 2 November 2021, there were 12 beds vacant across North Yorkshire and York. Beds were managed as a whole across North Yorkshire and since the opening of Foss Park some patients have had to be placed outside of their local area.
· The trust continued to utilise best practice clinical processes to ensure that only patients who required inpatient treatment were admitted, those who cannot be managed through increased packages of community intervention from the mental health teams.
· The Quality Assurance Schedule would consistently monitor the improvements, the care on the wards and ensure the right support would be offered to staff to sustain and embed the improvements in their practice on a daily basis.
· A new strategic framework had been implemented across the trust and a new Chief Executive was in place. The strategic framework would support the trust over the next 5 years and plans were in place to progress the actions that the CQC had identified.
· The Oxehealth Digital Care Assistant provided sensory monitoring of patients in their rooms. It did not replace nursing care but prompted staff to any key environmental changes, which could signal a physical change in a service users’ presentation. Patients were made aware of this system and its objective.
· Staff worked hard to keep patients safe and were experienced in meeting people’s individual challenging needs and conditions.
Officers were thanked for their comprehensive report and for attending the meeting to provide a detailed update.
Resolved: That the update be noted.
Reason: To keep the Committee updated.
11. Report of the Chair of Health and Wellbeing Board
Members considered a report that provided an update on the work of the Health and Wellbeing Board (HWBB) since they last reported to this Committee in February 2020.
The Chair of the Health and Wellbeing Board and the Consultant in Public Health for City of York Council and the Vale of York Clinical Commissioning Group were in attendance to provide an update and answer Members questions.
During the update, the next steps were highlighted, including the forthcoming change from the Clinical Commissioning Group (CCG) to the Integrated Care System (ICS), the work that was ongoing to create a replacement for the YorOK Board and the progress being made on the implementation of the HENRY Programme.
During discussion and in answer to Members questions, it was noted that:
· The HENRY (Health, Exercise and Nutrition in the Really Young) Programme would support families to provide the best possible healthy start for babies and children, particularly linked to obesity and weight problems in the first 5 years
· The Active Travel Service was working to support health initiatives with parents/schools and the service had joined the Healthy Weight Steering Group to lead on health and environmental gains to improve the lives of people that live in York.
· During the pandemic, new public health and health service challenges emerged, meaning the HWBB’s priorities fluctuated and changed. The HWBB influences the priorities of many services, with exemplars in suicide prevention and mental health which was now a priority throughout the system.
· The forthcoming changes within the ICS (Integrated Care System) could be a challenge but discussions would continue to ensure the local authority’s voice was heard and did not lose influence within the new arrangements, structures and strategic documents.
· During the first year of the ICS some areas would operate in transition and shadow form until dates were set for coming formal. The due diligence during the transition would be well managed and the CCG were regularly discussing their close down and would ensure staff were well cared for.
· The University of York had evaluated the early intervention support given by the Local Area Coordinators and a further evaluation on the financial benefits was now being undertaken.
· Healthwatch York talked to users of the services to ensure patient’s voices were heard. Their reports were of a very high quality and their recommendations were monitored by a sub group and the HWBB also had oversight at its meetings.
The Chair noted that Healthwatch York had been invited to attend the meeting in January 2022 to take part in the discussion on dentistry. He also noted that the ICS governance arrangements would be discussed by this Committee at its meeting in April 2022.
The Chair of the HWBB and the Consultant in Public Health were thanked for their update.
Resolved: That the update be noted.
Resolved: To keep Members up to date with the work of the Health and Welllbeing Board
12. 2021-22 Finance and Performance First Quarter Report - Health and Adult Social Care
Members considered a report that analysed the latest performance for 2021/22 and forecasted the financial outturn position by reference to the service plans and budgets for all relevant Adult Social Care and Public Health services falling under the responsibility of the Directors of Adult Social Care and Public Health.
The Head of Finance for Adult Social Care and the Strategic Support Manager for Adults and Public Health were both in attendance to present the report and answer any questions raised.
During the officers update, it was noted that:
· The projected outturn position for Adult Social Care was a forecasted overspend of £1.729k and a further £1.3m of savings needed to be achieved by the end of the financial year.
· The Hospital Discharge Programme would now continue until the end of the financial year.
· Public Health was expected to underspend, mainly due to vacancies, the reserves would be transferred to fund future budget commitments.
· The Quarter 2 Finance and Monitoring Report would be considered by Executive on 18 November 2021.
In answer to questions raised, it was confirmed that:
· There were several working groups within the People Directorate looking to stabilise and support the directorate and there was a finance and performance workstream specifically looking at the financial position. Chief Officers were also reconfiguring existing meetings to focus on the financial position.
· It would be challenging to meet the additional £1.3m savings but revised governance arrangements would be implemented to comprehensively monitor the budget for adult social care and keep it at the top of the agenda.
· There had been an increasing number of initial contacts to adult social care (ASC) during the past year, partly caused by the Covid 19 pandemic.
· Devolution was a potential work stream to help improve the financial situation but joint brokerage was more likely to help the position and could result in commissioning care wider than the York foot print.
· Opportunities would be investigated to work more closely with the community and voluntary sector.
· Various recruitment campaigns and strategies were taking place to support the social care workforce.
· A series of strategic service reviews would be taking place to help set a sustainable budget for the foreseeable future.
· Schemes were readily available for any rapid budget announcements from central government but equally officers would look to grow the areas already in place to support short term preventative spend.
· A Cost Control Board met on alternate Wednesdays to consider permanent/temporary vacancies and the best recruitment approach to reduce the use of temporary staff.
· Plans were in place to structure how savings would be delivered, implemented and monitored to enable the budget setting process to be even more robust.
Officers were thanked for their report and update.
Resolved: That the report be noted.
Reason: To keep the Committee updated on the latest financial and performance position for 2020-21
13. Work Plan
Members consider the Committee’s draft work plan for the 2021/22 municipal year.
Following discussion it was:
Resolved:
(i) That an update on the Integrated Care Service (ICS) governance arrangements be received at the 27 April 2022 meeting.
(ii) That where possible, reports be made available for all items on the work plan.
(iii) In order to broaden the discussion on dentistry, at the 24 January 2022 meeting, an invite be extended to other professionals/organisations/general public.
(iv) That when available, an update on the evaluation being undertaken on Local Area Coordinators be received at a future meeting.
Reason: To keep the work plan updated.
Cllr Doughty, Chair
[The meeting started at 5.30 pm and finished at 7.25 pm].