Agenda and minutes

The evacuation procedure was noted.

There were no interests declared.

Consideration was given to the minutes from the Committee meeting held on 21 February 2023.

AGREED that the minutes of the meeting on 21 February 2023 be approved as a correct record and signed by the Chair.

Representatives of NTHFT will be in attendance in order to outline performance against the Trust’s quality priorities for 2022-2023 and inform the Committee of the emerging priorities for the next year.

Representatives of North Tees and Hartlepool NHS Foundation Trust (NTHFT) were in attendance to provide their annual presentation to the Committee on the Trust’s Quality Account.  Led by the Head of Performance and Business Intelligence and supported by the Associate Director of Nursing, Effectiveness and Clinical Standards, highlights and developments in relation to the Trust’s performance over the course of 2022-2023 were outlined as follows:

•         Quality Account Priorities: Members were reminded of the three key NHS priorities regarding quality, namely ‘Patient Safety’, ‘Effectiveness of Care’, and ‘Patient Experience’.  Within these three main categories, NTHFT had several further Quality Account priorities for 2022-2023 (most had rolled over during the last few years), all of which would be detailed in the final published document.  These included:

Patient Safety

•         Mortality: Compared to the same timescale for 2020-2021 (December to November), the 2021-2022 measure for in-hospital mortalities (Hospital Standardised Mortality Ratio (HSMR)) had increased.  However, in-hospital deaths plus those up to 30 days post-acute Trust discharge (Summary level Hospital Mortality Indicator (SHMI)) had slightly decreased in 2021-2022 compared to 2020-2021 (reporting period: September to August).  The Committee was reminded that COVID-19 activity was not included in the SHMI measure as pandemics were classed as anomalies and would skew the data due to a lack of historical comparison.

As had been reported for a number of years now, NTHFT once again performed very well in comparison to other Trusts across the region, and the country, in terms of HSMR and SHMI.  Historically, this was not always the case, though the underlying reasons for previously higher rates was principally due to not capturing how poorly patients were – this resulted in significant changes in how the Trust operated (including strengthening documentation and embracing technology).

The Trust’s raw mortality (people dying in hospital – includes COVID deaths) data continued to be fairly consistent, though the COVID-impacted spikes in April 2020 (initial emergence) and December 2020 / January 2021 were acknowledged.

Reflecting on the HSMR and SHMI indicator charts for the region, the Committee noted the differences between NTHFT and South Tees Hospitals NHS Foundation Trust (STHFT).  As was often the case within the NHS, the two Trusts did not share many compatible platforms, though did work together to try to join-up systems where possible and appropriate.  Officers also confirmed that mortality indicators could be broken down further (i.e. rates for different age groups) if required.

•         Dementia: The increasing trend in patients admitted with a dementia / delirium diagnosis was being maintained, with a slight rise in 2022-2023 (April to December 2022) cases compared to the same period in 2021-2022.  As well as the inpatient care given to those with these conditions, the NTHFT Frailty Team also provided support to people in their own home and helped prevent admission to hospital.  The Trust’s excellent discharge team also plays a significant role in supporting those with dementia / delirium, and the NTHFT pathway for identifying and recording this condition remained robust.

In light of the rising  ...  view the full minutes text for item ASCH/59/22

Progress report for the previously completed Hospital Discharge (Phase 2 - discharge to an individual's own home) review.

Cllr Evaline Cunningham wished it to be recorded for transparency purposes only that she was a trustee of Eastern Ravens Trust.

Consideration was given to the assessment of progress on the implementation of the outstanding recommendations from the Scrutiny Review of Hospital Discharge (Phase 2 – discharge to an individual’s own home).  This was the third update following the Committee’s agreement of the Action Plan in January 2022 and key developments were noted as follows:

·       Recommendation 2 (Existing arrangements around the identification of carers when they themselves are admitted to hospital for treatment, as well as options for post-discharge support until they can resume their caring role, be reviewed by all relevant partners to ensure a joined-up approach): Agreed actions for North Tees and Hartlepool NHS Foundation Trust (NTHFT) in relation to this recommendation were now deemed ‘fully achieved’, with electronic patient records (EPR) due to be implemented across all adult inpatient areas in spring 2023.  The Trust had established collaborative working with Stockton-on-Tees Borough Council (SBC) and voluntary, community and social enterprise (VCSE) organisations to maintain arrangements for the identification of carers.

·       Recommendation 5 (Local NHS Trusts / Healthwatch Stockton-on-Tees provide the Committee with any available discharge-specific feedback from patients / families / carers in relation to those discharged back to their own homes): Despite several attempts to engage with Healthwatch Stockton-on-Tees, they had not provided an update on their agreed action.  This element of the recommendation would therefore have to be assessed as ‘not achieved’.

The Committee expressed disappointment that Healthwatch Stockton-on-Tees had not undertaken work they had committed to as part of the collation of the post-review Action Plan, though did acknowledge the resource limitations the organisation were experiencing, and also understood that their evolving work programme may have impacted upon the intention to conduct the agreed audit on those patients discharged back to their own home.

AGREED that the Hospital Discharge (Phase 2) progress update be noted, the assessments for progress be confirmed, and the Action Plan be signed-off as complete (no further updates required).

Progress report for the previously completed Day Opportunities for Adults review.

Cllr Clare Gamble wished it to be recorded for transparency purposes only that she was an employee of Catalyst.

Consideration was given to the assessment of progress on the implementation of the recommendations from the Scrutiny Review of Day Opportunities for Adults.  This was the first update following the Committee’s agreement of the Action Plan in June 2022 and, in addition to the information outlined in the written submission, key developments were noted and commented upon as follows:

·       Recommendation 1 (SBC and its relevant partners continue working with people accessing services and their families / carers to understand demand for both traditional building-based day service provision and community-based activities. This should include:

a)    The creation of co-production groups that can support the future development of day opportunities: The arrangement of a co-production group for STEPs had followed a slightly different course due to the fact that more people tend to transition through this service than other day opportunity providers.

c)     Considerations around preferences of those with particular needs (including potential for mixing between those with differing needs) and differing demographics (e.g. younger adults): Further to their involvement in contributing to the design of the updated specification of the service, some of the families and informal carers of people who access Ware Street will also be sitting on the tender panel.  The expectation is that this will become normal practice in the future.

d)    Continuing investigations into access to meaningful opportunities as part of a residential placement: 35 different organisations were involved in the Activity Exhibition Showcase on 17 March 2023 at The Hub.

The Committee praised the developments around both the intergenerational Care Homes Games tournament that took place in November 2022 and the Care Homes Legends Games Event scheduled for 9 June 2023 – these innovative initiatives would have a positive impact for those individuals within a residential setting.

f)      Changes to the existing budget for SBC in-house and commissioned services: In addition to the financial monitoring work already undertaken, a new SBC Strategic Analyst was now in post to further understand historical activity and spend, and to support any review of potential future budget requirements.

·       Recommendation 3 (SBC Adults and Health and Children’s Services directorates reinforce joint-working to identify and support opportunities that are most meaningful to younger people (including a reflection on any updated results from the Disabled Children’s Team online survey), and strengthen the dissemination of information about existing services):

The Committee welcomed the stated progress and noted positive feedback from local people in relation to improved service communications during the transition process (a time which can be very unsettling for the young people in question and their families / carers).  With reference to the forthcoming ‘Planning for Adulthood’ event at Abbey Hill School later in March 2023, Members requested feedback on this as part of the next update on progress that would be required at a future Committee meeting.

·       Recommendation 4 (SBC to follow-up  ...  view the full minutes text for item ASCH/61/22

Consideration was given to the minutes of the Health and Wellbeing Board from the meetings in November 2022 and January 2023.  Attention was drawn to the following:

·       30 November 2022: The Board’s views of the draft North East and North Cumbria (NENC) Integrated Care Partnership (ICP) Integrated Care Strategy document was detailed, a draft which had been previously circulated to the Committee for information and any comment.

·       25 January 2023: Regarding the ‘Health Protection Collaborative Update’ item, the Committee Chair had requested a Public Health update in relation to similar themes covered in the winter health presentation – this would be circulated to Members for comment in the near future.

AGREED that the minutes of the Health and Wellbeing Board from the meetings in November 2022 and January 2023 be noted.

Consideration was given to the SBC Overview and Scrutiny – End-of-Term Report for 2019-2023 which provided a compilation of all scrutiny activity during the soon-to-be-completed four-year Council term.  The report included the latest annual infographic which gave brief summaries of the reviews undertaken by each of the Select Committees in 2022-2023 (Appendix 4).

In a slight change to the format used for the previous 2015-2019 end-of-term report, an ‘impact’ box was incorporated for each review to demonstrate how the Select Committees’ work had led to service change / improvement.  It was noted that the end-of-term report was being presented to all Select Committees during their final meetings in March 2023.  Similarly, the report would be considered at the last Executive Scrutiny Committee meeting at the end of March 2023.

The Committee reflected on the range of work undertaken during the past four years and commended Members, officers and external partners for their contribution to addressing some very challenging topics.

AGREED that the SBC Overview and Scrutiny – End-of-Term Report 2019-2023 be noted.

Work Programme 2022-2023

Consideration was given to the Committee’s current Work Programme.  Whilst this was the final meeting of the current four-year Council term, monitoring for two previously completed Committee reviews would carry forward into 2023-2024, namely Day Opportunities for Adults, and Care at Home.

Chair’s Update

The Chair provided the following updates:

·       North Tees and Hartlepool NHS Foundation Trust (NTHFT) Maternity Services: Following the update provided at the previous Committee meeting in February 2023, further clarity had been requested from NTHFT regarding its community midwifery service and the offer of post-natal home-visits / requirement for attendance at Endurance House – the Trust’s response would be circulated once received.  Members drew attention to additional concerns raised by those using the service which needed addressing.

·       Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV): Members were reminded of the recent publication of the fourth and final report into West Lane Hospital which had since been circulated to the Committee.

·       Scrutiny Review of Care at Home: A brief reply to the letter that was sent to the Minister of State at the Department of Health and Social Care regarding the Committee’s key findings had been received yesterday (20 March 2023) – the letter had been shared with the department’s social care policy officials for careful consideration.

·       Visit to the SBC Quality Assurance and Compliance (QuAC) Team: An opportunity to meet officers within the Council’s QuAC Team will be available on 25 April 2023 – electronic invitations will be issued shortly.

Since this was the Committee’s final meeting of the current Council term, the Chair thanked Members for their considerable contributions over the past four years, as well as the officers who had supported the Committee in its work.

In addition, the Vice-Chair paid tribute to the Chair (who was operating in such a capacity for the final time at this Committee meeting) for her dedicated and diligent efforts over several years in what was a very challenging role, and wished her well in the future.

AGREED that the Chair’s updates and the Adult Social Care and Health Select Committee Work Programme 2022-2023 be noted.