Agenda and minutes

The evacuation procedure was noted.

There were no interests declared.

To approve the minutes of the last meeting held on 23 January 2024.

Consideration was given to the minutes from the Committee meeting held on 23 January 2024.

AGREED that the minutes of the meeting on 23 January 2024 be approved as a correct record and signed by the Chair.

The Committee was presented with the latest TSAB Annual Report for 2022-2023 (full report and Strategic Business Plan for 2022-2025 was provided in advance) by the current TSAB Independent Chair.  Supported by the Stockton-on-Tees Borough Council (SBC) Assistant Director – Adult Social Care / PSW, the following key elements were highlighted:

•           Context: TSAB was a partnership of four Local Authorities, not an organisation.  It remained vital that Local Authorities understood their role with regards safeguarding (a statutory responsibility that sits with Councils) – namely that they have an adult safeguarding Board, and that this produces an Annual Report and conducts safeguarding reviews in relation to serious incidents.

TSAB was a unique set-up as no other area had four Local Authorities coming together to form a Board (with SBC hosting the TSAB Business Unit).  This was seen as a positive arrangement as it allowed for economies of scale in terms of resource costs (bolstered by contributions from health and police), and also fostered in-built independence with involved Local Authorities scrutinising each other as well as the input of key partners.  The Independent Chair would be leaving in April 2024 after four years in the role.

•           Partnerships: The work of the six statutory Board partners (four Local Authorities plus Cleveland Police and the NHS North East and North Cumbria Integrated Care Board) was supported by 23 non-statutory organisations across Teesside and beyond.  The involvement of prison / probation services and housing providers were particularly important elements, something which other parts of the country did not benefit from.

The Board’s sub-groups led on key pieces of work in order to achieve the aims and objectives set out in the Board’s Strategic Business Plan, with all Local Authorities playing their part in chairing and supporting one.  A number of Task and Finish Groups had also convened during 2022-2023 to look at specific workstreams.

•           Safeguarding Data: There had been a 10% increase in safeguarding concerns received, and a 6% increase in Section 42 enquiries carried out, during 2022-2023 compared to the previous year (2021-2022).  Regarding the enquiries undertaken, the most common location of risk across Teesside remained a person’s own home (46%), followed by care homes (36%).  The top four areas of abuse were neglect and acts of omission (28%), physical (20%), self-neglect (12%), and financial and material abuse (12%), all of which had increased in comparison to 2021-2022 along with cases of sexual abuse and modern slavery.

As reflected within the appendix to the TSAB Annual Report, the anomalies highlighted during consideration of the previous report (2021-2022) in relation to the recording of Stockton-on-Tees safeguarding data had now been resolved (which accounted for the large jump in the number of safeguarding concerns reported for the Borough).

•           Performance Indicators: All four of the Board’s 2022-2023 performance indicators (PIs) were achieved.  It was noted that there used to be a further PI around the conversion rate for the number of safeguarding concerns that led to a Section 42 enquiry – however,  ...  view the full minutes text for item ASCH/52/23

A briefing report was presented by the Stockton-on-Tees Borough Council (SBC) Assistant Director – Adult Social Care / PSW giving some background to changes in the Council’s safeguarding performance reporting and aiming to contextualise the increase in the number of safeguarding concerns this year.

Reference was made to concerns raised by the Committee about the lower number of safeguarding concerns being reported by Stockton-on-Tees compared to other Tees Valley Local Authorities during the January 2023 presentation of the Teeswide Safeguarding Adults Board (TSAB) Annual Report 2021-2022.  It was explained that, in Stockton-on-Tees, all safeguarding concerns were triaged by the SBC First Contact Team, and concerns not requiring any further action were dealt with.  The SBC Safeguarding Team took responsibility for cases where more investigation was needed or where the Section 42 enquiry threshold was met.  The SBC Safeguarding Team captured data for the Council’s safeguarding returns; any work undertaken by SBC First Contact was not being measured and there was therefore under-reporting of the total number of safeguarding concerns.

Since this time, performance recording had now been changed and all safeguarding concerns reported to SBC were now being measured (in alignment with the other Local Authorities involved with TSAB).  This led to an anticipated increase in the number of concerns for the 2022-2023 year, though it was noted that the triaging of concerns had not changed.  An assurance audit of safeguarding concerns triaged at SBC First Contact as ‘No Further Action’ was completed, showing effective and consistent decision-making.  All referrals and decisions were recorded on the LAS system for Adult Social Care.  The number of safeguarding concerns being reported should remain high from now, as data previously held only at SBC First Contact was being captured.

Specific analysis was included on Deprivation of Liberty Safeguarding (DoLS) activity, with national, regional and local data incorporated into the report for comparison.  In 2022-2023, per 100,000 population, the number of individuals with a DoLS application, the number of applications, and the number of completed applications, were all higher than the national average – this was viewed as positive because it meant that the relevant people were afforded protection, and deprivations of liberty were lawful.

From a Stockton-on-Tees perspective, there were 10% more DoLS applications in 2022-2023 compared to the previous year – this appeared to be largely due to the Discharge to Assess process.  Completed DoLS applications (per 100,000 population) during this period was the highest regionally and among Local Authority peers in England (and much higher than the national average).  70 DoLS applications were not yet signed off at the end of the reporting period (nationally, this was 126,000, indicating backlogs in the system), though were in the process of completion.  There was no waiting list for DoLS in Stockton-on-Tees, and the average time between receipt of application and completion was 11 days across urgent and standard authorisations (significantly lower than the national average of 156 days) – this evidenced SBCs continued compliance with the DoLS framework.  Any objections / challenges were  ...  view the full minutes text for item ASCH/53/23

To consider patient / public views on this scrutiny topic (to follow).

The fifth (and final) evidence-gathering session for the Committee’s review of Access to GPs and Primary Medical Care (focusing on patient / public views) was due to take place at this meeting.  However, it was explained that information was still awaited from identified contributors, whilst other elements were still being collected / collated.  As such, and following consultation with the Chair prior to this meeting, the patient / public views session would therefore be deferred until the next Committee meeting in March 2024.

In preparation for this concluding part of the evidence-gathering phase, information recently received from Healthwatch Stockton-on-Tees regarding feedback on the Borough’s general practices was circulated – Members were asked to bring this along to the March 2024 meeting for consideration alongside other anticipated material which would be presented.

AGREED that the final evidence-gathering session (patient / public views) for the ongoing Access to GPs and Primary Medical Care review be deferred until the next Committee meeting in March 2024.

Consideration was given to the latest quarterly summary regarding Care Quality Commission (CQC) inspections for services operating within the Borough (Appendix 1).  Five inspection reports were published during this period (October to December 2023 (inclusive)), with attention drawn to the following Stockton-on-Tees Borough Council (SBC) contracted providers:

Providers rated ‘Good’ overall (2)

•           Parkside Court Extra Care Scheme had been upgraded from a previous overall rating of ‘Requires Improvement’.

•           Alexandra House had maintained its grading following a previous overall rating of ‘Good’.

The remaining three reports were in relation to non-contracted providers.  A focused inspection of the home care agency, Nightingales Community Care Limited saw it maintain its overall rating of ‘Good’, whilst Grace Dental Care (dentist) required no actions (note: ratings not given for dentists).  Finally, Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) received unannounced inspections of four of its inpatient mental health services, and short-notice (24 hours) announced inspections of two of its community services – the ‘well-led’ key question for the Trust was also inspected.  TEWVs overall rating remained at ‘Requires Improvement’, though a number of concerns were found in relation to systems and processes at a senior level, a lack of suitably trained staff to deliver safe care in all services, estate issues presenting risks to quality and safety, a failure to reduce overall rates of restraint use, long waits to access services, supervision / appraisal shortfalls, an inability to consistently collate, analyse and present information about quality and performance to identify risk / challenge or support effective decision-making, and a backlog of 100 serious incidents requiring investigation.

Given the Committee’s history in raising significant concerns about TEWV (culminating in a letter being sent to the Secretary of State for Health and Social Care in April 2022 calling for a public inquiry into the Trust), Members expressed alarm at the outcomes from this latest CQC inspection.  Noting that TEWV were well into their much-quoted ‘improvement journey’, it was therefore deeply disappointing to read of continuing issues on a scale that had been similarly evident in other CQC publications over recent years.

Discussion ensued regarding the previous attempts to hold TEWV to account over these seemingly repeating problems, and reference was made to the early-2022 consideration of the Trust’s response to a previous concerning CQC report by the Tees Valley Joint Health Scrutiny Committee.  Despite reaching out to other represented Local Authorities for support, the Committee ended up submitting its call for a public inquiry in isolation.

Members drew attention to the repeated assurances previously given by TEWV that improvements were being made.  However, whilst the CQC did indeed note some positive developments, it was clear that services were not working as they should be (indeed, it was observed that some of the findings appeared to demonstrate basic / fundamental skills shortages).  The role of the Governors in terms of oversight was raised, and it was subsequently agreed that the Trust’s Lead Governor should be invited to a future Committee meeting to respond to  ...  view the full minutes text for item ASCH/55/23

Consideration was given to the minutes of Health and Wellbeing Board meetings which took place in September 2023, October 2023 and November 2023. 

AGREED that the minutes of Health and Wellbeing Board meetings which took place in September 2023, October 2023 and November 2023 be noted.

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 March 2024 where the annual presentation on the latest North Tees and Hartlepool NHS Foundation Trust (NTHFT) Quality Account would be provided.  The deferred final evidence-gathering session for the ongoing Access to GPs and Primary Medical Care review would also be held, and the first progress update in relation to the Committee’s previously completed review of Care at Home would be presented.

Looking ahead to next year’s work programme, Members were informed of two items which were likely to feature during 2024-2025 – the first was a briefing on the new Care and Health Innovation Zone (spring / summer), and the second would be a Community Spaces update (autumn) following a request made at the last SBC Executive Scrutiny Committee meeting in January 2024.

Two additional health-related developments were also noted – the recently published Care Quality Commission (CQC) national maternity survey results 2023 (including NTHFT-specific data) which had been circulated to the Committee for information, and the Centre for Governance and Scrutiny (CfGS) health scrutiny training session held earlier in February 2024 which some Members attended (the recording of which had since been shared with the Committee).

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