Agenda and minutes

At this point in the meeting Members are asked to declare any personal, prejudicial or disclosable pecuniary interests they may have in the business on the agenda. A list of general personal interests previously declared are attached.

Members were invited to declare at this point in the meeting any personal, prejudicial or disclosable pecuniary interests, other than those listed on the standing declarations attached to the agenda, that they might have had.

Councillor Cuthbertson declared a personal interest in the business on the agenda as a current patient at York Hospital.

Councillor Fraser declared a personal interest in the business on the agenda as a retired member of UNISON and Unite (TGWU/ACTS sections).

Councillor Hodgson declared a personal interest in the remit of the Committee as a former employee of York Hospital and as a member of UNISON.

Councillor Riches declared a personal interest in the business on the agenda as the Council appointee to the governing body of York Hospital.

No other interests were declared.

To approve and sign the minutes of the meeting held on 12 September 2012.

RESOLVED:       That the minutes of the Health Overview and Scrutiny Committee held on 12 September 2012 be approved and signed by the Chair as a correct record.

At this point in the meeting, members of the public who have registered their wish to speak regarding an item on the agenda or an issue within the Committee’s remit can do so. The deadline for registering is Tuesday 23 October 2012 at 5.00pm.

It was reported that there had been one registration to speak under the Council’s Public Participation Scheme.

John Yates from York Older People’s Assembly raised comments on agenda item 6 (Transition Update Report). He spoke about the free NHS Health Check that was offered to people and hoped that this would continue.

He highlighted that these checks were important as they would highlight potential problems early and that this was particularly important for men, who he felt were less likely to visit the doctor. He added that he felt that the tests should be obligatory for those that were or had reached retirement age.

He did accept that some services would probably be cut during the transition of responsibilities for public health from the Primary Care Trust to the Local Authority, but asked Members to recognise the priority of the tests and reject moves to remove them. He added that the tests’ preventative measures would also achieve cost savings in the future.

The Director of Public Health circulated a document to Members which informed them of the Free NHS Health Check that had been spoken about. This was attached to the republished agenda after the meeting.

The Director of Public Health spoke to Members about the tests and informed them that;

·        The tests would be carried out for every five years for those within the age group of 44-70.

·        That the programme of testing was currently under development and that the Council would have the responsibility for ensuring that the checks were carried out.

·        That it was one of a number of mandatory tasks that the Council had to do. Additionally, it was highlighted as a commitment in the NHS Constitution. This would mean that patients would be a legally entitled to ask for a health check.

·        Those patients who had not already been diagnosed with certain conditions would be offered a free NHS Health Check.

·        That new regulations from the government would also mean that the level of consumption of alcohol would be tested from April and that there would be a promotion of dementia awareness in the age group  of 60-74 year olds.

·        That although tests for bowel cancer were not part of the free  NHS Health Check, a screening programme existed.

The Chief Executives from York Teaching Hospital NHS Foundation Trust and NHS North Yorkshire and York will be in attendance at today’s meeting along with the Chief Finance Officer from the Vale of York Clinical Commissioning Group. They will be discussing the Financial Status of NHS North Yorkshire and York and the handover process to the Vale of York Clinical Commissioning Group and some of the challenges that this will bring.

Members received a verbal report from the following people; Chris Long, the Chief Executive of NHS North Yorkshire and York, Patrick Crowley, the Chief Executive of York Teaching Hospital NHS Foundation Trust, Adrian Snarr, the Chief Financial Officer from the Vale of York Clinical Commissioning Group and Alan Maynard, the Chair of Vale of York Clinical Commissioning Group.

In his report to the Committee regarding the financial status of the NHS in North Yorkshire and York, Chris Long informed Members that;

·        NHS North Yorkshire and York had agreed (with the Department of Health) a £19 million deficit in the current year’s budget.

·        That a further £24,000 still needed to be achieved through efficiency savings in order to cover the deficit, and that KPMG had been brought in to look at how this figure could be achieved and whether it was viable.

·        That KPMG and Chief Executives from providers to the NHS would present a set of proposals in mid November.

·        That following the release of the proposals a consultation with the Health & Social Care and Voluntary Sector would take place.

·        That the main focus of reforms should concentrate on how robust services could be provided in the community, rather than an over-reliance on using hospitals.

Adrian Snarr, the Chief Financial Officer from the Vale of York Clinical Commissioning Group (VOYCCG) gave an update to Members on the financial position of the VOYCCG. He gave a background to Members on the transfer of functions from the Primary Care Trust (PCT) to VOYCCG. In relation to the financial situation he told Members that;

·        Neighbourhood Care Teams were in development to reduce the reliance of patients and doctors using hospitals in the first instance.

·        That the VOYCCG was looking into starting a referral review to make sure that patients would be seen by the correct person.

·        It was noted that the decision on referral would be made by a clinician in the particular speciality to which the case was related.

·        That a process of “Shared Decision Making” would be implemented which would include a greater involvement by the patient and the clinician in deciding what treatment they wished to have, and in what way and where they wished to be treated.

·        That the VOYCCG were advising GP’s on which drugs to prescribe, as these varied in price and accounted for a large amount of the budget for GP’s.

·        That areas still existed where potential financial savings could be made, but the identification of savings was heavily influenced by the level of patient education.

Questions from Members related to the following issues;

·        How would “Shared Decision Making” provide a cost saving?

·        How would GP practices be monitored to discourage automatic referrals to hospitals for treatment which could be done elsewhere?

·        Would the reduction of hours of service for minor injury units in Malton and Selby have a knock on effect on to district hospitals?

In response to the question about Shared Decision Making, it was reported that it could potentially produce savings  ...  view the full minutes text for item 36.

This report provides the Committee with an update on the relocation of York’s NHS walk in centre, formerly located on Monkgate, to the urgent care centre based in York Hospital’s emergency department. It also outlines future involvement and engagement plans. The Deputy Operations Manager at York Teaching Hospital NHS Foundation Trust will be in attendance at the meeting to present the report.

Members received a report which gave them an update on changes to the Urgent Care Centre (UCC) at York Hospital.

The Director of Operations at York Hospital, Mandy McGale, attended the meeting to present the report and answer any questions that Members’ might have had.

Discussion in response to the report featured the following observations;

·        That a large number of patients who attended the Accident & Emergency (A&E) department at the hospital did so because they could not get access to their GP.

·        That there was also some evidence that GPs sometimes signpost  A & E.

·        That the issue of time and access were significant in the numbers of people using A & E;. given that the A&E department could not turn people away there was a perception that there would be a shorter waiting time in comparison to making an appointment with a GP.

·        That it was felt that GPs would always recommend to patients to make an appointment with them, but if their condition changed during that time to go to A & E rather than elsewhere.

·        Some patients found it difficult to get an appointment with a GP at the weekend (either via their own GP or through the Out of Hours Service – they therefore went to A & E).

·        A & E and UCC were managed as one whole service within the hospital. Patients who presented were assessed on a clinical basis as to which service they were directed to

RESOLVED:       That the report and update be noted.

REASON:           To update the Committee on the changes made to the Urgent Care Centre.

This report updates the Committee on the following;

·        The Transfer of Public Health functions to the City of York Council

·        The establishment of the City of York Health & Wellbeing Board

·        The commissioning of Healthwatch for the City of York pursuant to the Health and Social Care Act 2012

Members received a report which updated them on the transfer of Public Health Functions to the Council, the establishment of the City of York Health and Wellbeing Board and the commissioning of Healthwatch for the city.

The Scrutiny Officer informed Members that a new statutory responsibility meant that the Director of Public Health would have to produce an annual report on the state of the city’s health from April 2013. She added that the Committee could decide on whether they wished to receive this report.

As the first year would be an incomplete year the Director of Public Health suggested that he might write a report about his first 100 days in post as the Director, and asked whether the Committee would receive this.

The Chair responded that the Committee would welcome a report from the Director and suggested that the findings in his report might then be added into the Joint Strategic Needs Assessment (JSNA).

RESOLVED:       (i)      That the report be noted.

(ii)      That the Director of Public Health produce an update report detailing the record of his first one hundred days in post.

REASON:           To update the Committee on the developments involved in the transfer of Public Health functions to the City of York Council.

Members are asked to consider the Committee’s updated work plan for the municipal year 2012/13.

Members considered the Committee’s updated work plan for the municipal year 2012/13.

It was agreed that the scoping report for the review into Community Mental Health Services in the Care of Adolescents be moved to the December 2012 meeting.

It was suggested that Safeguarding Assurance Report be moved to the January meeting, to allow for an even distribution of work and a report on ‘Quality Monitoring – Residential, Nursing Homecare Services be added for the January 2013 meeting. It was also noted that the Director of Public Health’s Annual Report needed to be added to the work plan in March 2013.

RESOLVED:       That the following changes be made to the Committee’s work plan¹;

(i)           That the scoping report for the Community Mental Health Services in Care of Adolescents review be moved to be considered at the meeting in December.

(ii)          That the report on Safeguarding Assurance be considered at the Committee’s January meeting.

(iii)        That the first annual report (covering the first 100 days in post) from the Director of Public Health be added to the work plan for March 2013. 

REASON:           In order to keep the Committee’s work plan up to date.