Agenda and minutes

The evacuation procedure was noted.

There were no interests declared.

To approve the minutes of the last meeting held on 24 October 2023.

Consideration was given to the minutes from the Committee meeting held on 24 October 2023.

Members were reminded of the information that had been circulated since the October 2023 meeting in relation to the Well-Led Programme and the uptake of medication training by care home providers.  With reference to the former, Members noted their presence at a recent Activity Co-ordinator ‘Day at the Beach’ event – this was an excellent session and attendance at any similar initiative in the future was strongly recommended for both Members and senior officers.

AGREED that the minutes of the meeting on 24 October 2023 be approved as a correct record and signed by the Chair.

To consider a submission on this scrutiny topic from the Cleveland Local Medical Committee (LMC).

This second evidence-gathering session for the Committee’s review of Access to GPs and Primary Medical Care focused on a submission from the Cleveland Local Medical Committee (LMC).  Introduced by the Interim CEO and Company Secretary of Cleveland LMC (who had been a GP for nearly 20 years), a presentation was given which covered the following:

•           What is General Practice?

•           Who are Cleveland LMC?

•           What do Cleveland LMC do?

•           National trends regarding GP access

•           General Practice capacity

•           Funding pressures

•           Care navigation

•           Views on Recovery Plan

•           What is needed?

•           Further reading

Fully recognising that GP access was currently a priority issue for the public, it was emphasised that the existing situation within Stockton-on-Tees was very much aligned to the national picture when it came to challenges associated with accessing services.  During an overview of the differing strands of the overarching general practice offer, it was noted that the digital GP option was not hugely popular locally (compared to take-up within bigger cities such as London and Birmingham), and that private GP use was also low within the Borough due to a lack of demand (perhaps reflective of it being a less affluent area).

As the representative body for all general practices and GPs within Tees, having the authority to speak and negotiate on behalf of so many can present its own challenges.  Cleveland LMC was funded solely by its practices on a voluntary basis and was independent of other organisations (there were no conflicts of interest) and any political party (though did take an interest in political developments).

Cleveland LMC supported its constituents in multiple ways, including the dissemination of formal guidance (e.g. another Local Authority area had experienced issues around people getting registered with practices), escalating concerns to national negotiators, and providing contract implementation advice.  It also assisted with dispute resolution (which was currently a frequent occurrence), fed into the British Medical Association (BMA), and was linked-in with national communications teams.  Cleveland LMC was well respected by the BMA, but its views were not as well received by the Government or NHS England – the imposition of contracts being a particular concern at present.

Also acting as a job advert service, it was normal to have more than 10 GP vacancies at any one time, with recruitment proving more challenging in Teesside than in other regions (young trainees had shown a tendency to want to work in Newcastle or York).  As such, access was not seen as a huge priority for practices – the focus was much more on workload, workforce capacity, reducing regulation, financial stability / sustainability, and ensuring patient safety.  Whilst it liaised with other LMCs across the country, Cleveland LMC would like to meet more frequently with regional / local stakeholders to ensure positive outcomes (not just for the sake of meeting).

National trends around GP access painted a very concerning picture.  Population growth and a reduction in GP numbers had combined to put significant pressure on the  ...  view the full minutes text for item ASCH/31/23

Senior representatives of North Tees and Hartlepool NHS Foundation Trust (NTHFT) were present to update the Committee on developments involving its maternity services following issues identified by the Care Quality Commission (CQC) in 2022.  As well as updating Members on the actions taken in response to these CQC outcomes, NTHFT had also been asked to provide details of its review of the community midwifery offer after concerns were raised by the Committee in early-2023.

Led by the NTHFT Associate Director of Midwifery and supported by the NTHFT Chief Nurse / Director of Patient Safety and Quality, a presentation was given which covered:

•           Perinatal Organisational Structure: Significant changes made in relation to these services with a shift in terminology to ‘perinatal’ and alignment with the neonatal offer (reflecting a national drive for restructuring existing maternity provision).  The Trust’s introduction of a ‘quadumvirate’ (four key posts within the perinatal structure) was nationally recognised as best practice in terms of organisational composition, of which the Associate Director of Midwifery post was one of three additional professional leadership roles which had been implemented as part of a transformational plan.

•           Perinatal Services Governance: NTHFT had commenced an NHS programme which focused on strengthening culture within its maternity offer – this was expected to take over six months and would enable learning which could be applied to other Trust areas / networks.  A key consideration around governance was also to ensure the voice of service-users was appropriately sought, considered and, where necessary, acted upon – this was an important aspect of the ‘Ward to Board’ / ‘Board to Ward Governance’ ethos.

•           CQC Improvements (5 Must Dos; 1 Should Do): Focused inspection undertaken by the CQC in 2022 which identified areas for improvement – all ‘must do’ actions had since been signed-off as complete.  Example included of detail, evidence and ongoing monitoring arrangements for one of the ‘must do’ elements – this information was accessible to staff and this assurance mechanism would be adopted throughout the Trust’s perinatal structure.

•           National Safer Care Recommendations: Increased national focus on maternity services following high-profile failings elsewhere in the country.  NTHFT was on-track for compliance with both the Maternity Incentive Scheme and the Ockenden Report: Immediate and Essential Actions which fed into the maternity and neonatal three-year delivery plan.  The Trust had received positive feedback following visits led by the North East and North Cumbria Integrated Care Board (NENC ICB) and a peer review, with notable changes recognised – this was empowering for the whole service and its staff.

•           Community Midwifery Services: Led by the regional midwife team, an external review of this provision started in July 2023 which included the hosting of several workshops, sessions with staff, and the triangulation of local intelligence (complaints / compliments).  Engagement with the Maternity and Neonatal Voice Partnership (MNVP) was also initiated, and an interim report had since been produced which would be considered by the senior team.  The Trust had secured investment from the regional midwife team to  ...  view the full minutes text for item ASCH/32/23

CQC / PAMMS Inspection Results – Quarterly Summary (Q2 2023-2024)

Consideration was given to the latest quarterly summary regarding Care Quality Commission (CQC) inspections for services operating within the Borough (Appendix 1).  10 inspection reports were published during this period (July to September 2023 (inclusive)), with attention drawn to the following SBC contracted providers:

Providers rated ‘Good’ overall (3)

•           Roseworth Lodge Care Home had been upgraded from a previous overall rating of ‘Inadequate’.

•           Primrose Court Nursing Home had been upgraded from a previous overall rating of ‘Requires Improvement’.

•           Care & Support Solutions had maintained its grading following a previous overall rating of ‘Good’.

Referencing Roseworth Lodge, the SBC Quality Assurance and Compliance (QuAC) Manager who was presenting the report commented that it was unusual for a provider to jump two grades since the last inspection.  Members were pleased to see these positive developments, particularly given the service had a good reputation previously.  Investment towards the décor was specifically welcomed.

Regarding Care & Support Solutions, the Committee asked if there were any updates following the CQCs recommendation that the service reviewed its systems to ensure training completion was effectively monitored.  The QuAC Manager noted that an Action Plan in relation to any required improvements, however minor, would be in place, though in this case the identified issues were deemed low risk.

Providers rated ‘Inadequate’ overall (1)

•           Willow View Care Home had breaches in relation to five regulations, namely dignity and respect, need for consent, safe care and treatment, good governance, and staffing – this led to the service being downgraded from the previous overall rating of ‘Requires Improvement’.

It was noted by the SBC Director of Adults, Health and Wellbeing that Willow View Care Home was being closely monitored at present and that a new manager was now in place who was liaising with the CQC.  Although improvements were already evident, the service remained under an embargo and therefore could not accept new admissions.

The remaining six reports were in relation to non-contracted providers.  Inspections of two home care agencies saw New Horizons 24/7 Pvt Limited downgraded to ‘Requires Improvement’ from the previous overall rating of ‘Good’ (breaches identified around staffing, record-keeping and oversight), whilst Sally and Sarah maintained its grading following a previous overall rating of ‘Good’.  Outcomes of primary medical care service inspections saw A Vita Limited (doctors / GP) graded ‘Requires Improvement’ (no previous rating), The Arrival Practice (GP) maintaining its grading following a previous overall rating of ‘Good’, and Smile Spa Limited (dentist) requiring no actions (note: ratings not given for dentists).  Finally, North East Ambulance Service NHS Foundation Trust received a focused inspection of its Emergency and Urgent Care (EUC) services and some of the ‘well-led’ key question for the Trust overall following previously identified concerns – no rating was given.

The section on Provider Assessment and Market Management Solutions (PAMMS) inspections (Appendix 2) was noted – there were three reports published during this period (July to September 2023 (inclusive)).  Comfort Call – Stockton  ...  view the full minutes text for item ASCH/33/23

Chair’s Update

The Chair had no further updates.

Work Programme 2023-2024

Consideration was given to the Committee’s current work programme.  The next meeting was due to take place on 19 December 2023 and was scheduled to feature the next evidence-gathering session in relation to the Access to GPs and Primary Medical Care review.  Two items which had recently been considered by SBC Cabinet would also be included on the agenda – namely the SBC Director of Public Health Annual Report 2022 and a Winter Planning Update.

It was intended that an overview of the CQC State of Care Annual Report 2022-2023, including reflections on the local health and care scene, would be provided at the December 2023 meeting.  However, the CQC had recently stated that representatives were unable to be in attendance for this annual item, nor could they attend the meeting in January 2024.  Members agreed that efforts should be made to ensure this important aspect of the Committee’s work programme was maintained.  In related matters, the SBC Director of Adults, Health and Wellbeing notified Members that reports following the CQCs adult social care inspections of the five pilot sites were now published and that a link would be forwarded so the Committee could access the outcomes of these.

AGREED that:

1)         the Chair’s Update and Adult Social Care and Health Select Committee Work Programme 2023-2024 be noted.

2)         a response be provided to the CQC emphasising the Committee’s desire for the annual State of Care presentation to be maintained.