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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 |
22 November 2022 |
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Present |
Councillors Doughty (Chair), Hook (Vice-Chair), Heaton, Vassie, Cullwick and Wells |
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Apologies
In Attendance |
Councillor Barnes
Sharon Stoltz, Director of Public Health Anita Dobson, Nurse Consultant Public Health Simon Morritt, Chief Executive, York & Scarborough Teaching Hospitals NHS Foundation Trust Caroline Johnson, Deputy Director of Quality Governance, York & Scarborough Teaching Hospitals NHS Foundation Trust Zoe Campbell, Managing Director, Tees, Esk & Wear Valleys NHS Foundation Trust (remotely) Jamaila Hussain, Corporate Director of Adult Social Care and Integration |
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18. Declarations of Interest (4:30pm)
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.
19. Minutes (4:32pm)
Resolved: That the minutes of the previous meeting held on 28 September 2022 be approved as a correct record and be signed by the Chair.
20. Public Participation (4:32pm)
It was reported that there had been no registrations to speak at the meeting under the Council’s Public Participation Scheme.
21. Recommissioning of Sexual Health and Contraception Services (4:33pm)
Members considered a report that sought their feedback on the options available to the council for the recommissioning of sexual health and contraception services, and to approve the decision to delegate the award of the contract to the Director of Public Health, ahead of it being considered by Executive in February 2023.
The Director of Public Health and the Nurse Consultant provided an overview. They highlighted the key issues within the sexual health service and the proposed procurement strategy for recommissioning the service when existing contracts end in 2024.
The key points raised during the presentation of the report included:
· Local authorities had a statutory duty to commission specialist sexual health and contraception services for their population.
· The integrated sexual health service, including the specialist element of the service, was currently awarded to York &
Scarborough Teaching Hospitals NHS Foundation Trust.
· The contract would be awarded for five years with an option to extend by a further five years. Extensions would be based on performance related quality measures and delivery of key health outcomes.
· If no suitable market response was received, the option of entering into a Section 75 partnership agreement with the Trust would be explored.
· A benchmarking exercise showed that other local authorities on average spent 16.44% of their Public Health Grant allocation on sexual health services, with York spending around 24%. This was due to York having the largest proportion of 15 to 24 year olds in its population, who were the highest users of sexual health services.
Members were also informed that City of York Council currently had a Section 75 agreement with the NHS Humber and North Yorkshire Integrated Care Board for the provision of Long Acting Reversible Contraception (LARC) in primary care. Under this Section 75 agreement, the council had an obligation to commission a LARC service that covered both NHS gynaecological LARC and the council’s contraceptive LARC services until 2026. The LARC element therefore would be dealt with separately and the legal options for this would be explored more fully in the Executive report.
[Cllr Vassie joined the meeting at 4:30pm.
An adjournment took place between 4:42pm and 4:44pm.
The Corporate Director of Adult Social Care and Integration joined the meeting at 4:45pm.]
During discussion and in answer to questions raised from Members, it was noted that:
· Consultation exercises were underway, as well as a service user questionnaire and a wider stakeholder survey. On completion, a report would be produced for Executive outlining the feedback received.
· The service specification was currently being developed, subject to feedback as part of the consultation. The specification would set out City of York Council’s ambition for the transformation of sexual health services in York.
· Conversations with York St John University and the University of York would continue to support and inform the service specification.
· The contracts would be benchmarked against the Public Health Outcomes Framework.
The Committee noted the options available and the challenging cost implications to deliver this specialist service and welcomed a contract with a stable local provider.
Resolved: That the recommendations below be presented to the Executive for decision:
(i) Authorise officers within City of York Council to approach the market to inform the commissioning and procurement of a sexual health service to start from 01 July 2024.
(ii) Authorise the Director of Public Health, in discussion with the Executive Member with responsibility for the Public Health portfolio, to accept the highest scoring tender in accordance with evaluation criteria and award a contract.
(iii)Delegate authority to the Director of Public Health to manage this contract including any variations and planned extensions as per City of York Council policy and procedures.
Reason: To meet the council’s statutory responsibilities under the Health and Social Care Act 2012 and enable sexual health services to be available to York residents that are clinically safe, value for money and responsive to local need.
22. Care Quality Commission (CQC) Inspection Update - York and Scarborough Teaching Hospitals NHS Foundation Trust (5:18pm)
Members considered a report that provided an update on the two inspections undertaken at York and Scarborough Teaching Hospital NHS Foundation Trust (the Trust) in March and October 2022 by the Care Quality Commission (CQC).
The Chief Executive and the Deputy Director of Quality Governance of the Trust provided an overview. They informed Members of the immediate safety actions that had been implemented to address the concerns raised from both inspections and the assurances that had been provided to the CQC, which included:
· The implementation of a comprehensive action plan with delivery being overseen by a Quality and Regulatory Assurance Group.
· The implementation of a new electronic clinical record system Nucleus across all wards and the Emergency Department. This would replace the paper record system and provide a greater oversight and assurance of the fundamental of care delivery.
· Processes had been strengthened in relation to any closures of the maternity unit due to staffing pressures.
· Checks and challenges had been implemented to address the environmental issues raised within the Emergency Department.
· Two improvement plans in relation to Emergency Care at York Hospital and Maternity Services had been produced and shared with the CQC.
· The Trust remained in the inspection phase pending the well-led review which was taking place between 22-24 November 2022.
During discussion and in answer to questions raised from Members, it was noted that:
· The environmental issues flagged were also a consequence of the redevelopment of the Emergency Department.
· The Trust regularly collaborated with City of York Council, North Yorkshire County Council and East Riding of Yorkshire Council.
· The impacts of Covid and the intensive staffing pressures throughout the Trust had impacted the continuity of care.
· Since 2019, over 400 international nurses had been recruited and a team was currently in Kerala, India to recruit 100 more nurses.
· Positive steps were being taken to manage the delayed transfers of care, and the new Emergency Department should make significant improvements to services.
· A Head of Patient Experience had been recruited to work with families and patients to monitor satisfaction levels.
· Three Patient Safety Partners had been recruited to assess the governance processes.
Members noted the acute demand at the Trust had been consistently high for the past year, with staff shortages adding to the strain. They acknowledged that this increased pressure was unlikely to fall throughout the winter months and the Director of Public Health noted that the prevalence of all respiratory diseases was a significant concern this winter. She stated that the statistics showed that not enough residents across all ages were coming forward for their flu and/or Covid booster vaccinations. Encouraging more residents to take up the vaccines, including children aged 2 to 3 years and care workers would be focused on and officers agreed to provide Members with the latest statistics for York.
The complexities and pressures around delayed discharges were discussed and it was noted that collaboratively the Trust and City of York Council were working to ensure the right services were in place to reduce the number of patients staying in hospital unnecessarily.
Resolved:
(i) That the update and next steps be noted.
(ii) That the positive findings highlighted during the CQC inspection be noted.
(iii) That the areas assurance from the immediate safety actions implemented within the Trust following the identification of areas for improvement be noted.
(iv) That an update be received at a future meeting.
Reason: To keep Members updated.
[An adjournment took place between 6:09pm and 6:14pm]
23. An update regarding Foss Park Hospital Care Quality Commission (CQC) Inspection (6:15pm)
Members considered a report that provided an update on the 2 November 2021 report to the Committee regarding the Care Quality Commission (CQC) registration of Foss Park, the 2021 Trust wide inspection of acute wards for adults of working age and psychiatric intensive care units; and subsequent actions taken. It also included details of an inspection into Trust wide specialist community mental health services for children and young people which took place on 6 - 7 July 2022.
During discussion and in answer to questions raised from Members, the Managing Director of Tees, Esk & Wear Valleys NHS Foundation Trust noted that:
· Personal safes were now in use at Foss Park.
· The original CQC report focused on Trust wide services and the comments relating directly to York residents and Foss Park were very limited.
· There had been no extensive anti-ligature work required at Foss Park.
· Improvements had been made within anti-restrictive and safeguarding practices at Foss Park and the Managing Director agreed to provide Members with further statistics on the restricted and restraint incidents recorded.
· Recruitment and retention remained an ongoing concern and processes were being implemented to address this challenge.
· Streamlining caseloads would enable a more efficient service across the whole system and would support better outcomes for the patient.
· The majority of children and young people referred to Foss Park for an assessment from the generic Children and Adolescent Mental Health Service (CAMHS) were assessed within 12 weeks. The Trust roughly received 219 referrals per month, of those around 80 required a referral for a neurodevelopment assessment, which could take between 1 and 2 years to complete.
Members discussed the challenges and were particularly concerned with the referrals and waiting times for children and young people to be assessed. The Chair suggested that this should be a priority for the Committee to consider in the next municipal year.
The Managing Director agreed to provide Members with statistics relating to staffing levels and use of agency staff and she provided further assurances to Members that effective systems were now in place to keep patients safe and that further improvements were underway.
Resolved:
(i) That the update be noted.
(ii) That an update from TEWV be received in the next municipal year, including the Children and Adolescent Mental Health Service (CAMHS) provision in York.
Reason: To keep the Committee updated.
24. Work Plan (6:58pm)
Members considered the 2022/23 draft work plan for the Committee.
Resolved: That the work plan be noted.
Reason: To keep the Committee’s work plan updated.
Cllr Doughty, Chair
[The meeting started at 4.30pm and finished at 7.00pm].