Agenda and minutes

The Evacuation procedure was noted.

There were no interests declared.

To approve the minutes of the last meeting held on 18 July 2023

Consideration was given to the minutes from the Committee meeting held on 18 July 2023.

Further to the proposal at the conclusion of the ‘CQC / PAMMS Inspection Results - Quarterly Summary (Q4 2022-2023)’ item, a document charting the number of care providers currently operating across the Borough had subsequently been forwarded and then circulated to Members for information (a hard-copy of which was also tabled at this meeting).

AGREED that the minutes of the meeting on 18 July 2023 be approved as a correct record and signed by the Chair.

The Committee considered the Healthwatch Stockton-on-Tees – Annual Report 2022-2023. Local Healthwatch organisations are required to produce an Annual Report setting out their aims and achievements, and this latest document, an overview of which was given by the Chair of Healthwatch Stockton-on-Tees’ who was in attendance, included the following:

•           Message from our Chair

•           About us

•           Highlights from our year

•           Listening to your experiences

•           Advice and information

•           Volunteers

•           Finance and future priorities

•           Statutory statements

With reference to an accompanying presentation which summarised the content of the Annual Report, it was noted that Healthwatch Stockton-on-Tees was commissioned by Stockton-on-Tees Borough Council (SBC) with the aim of understanding the needs and experiences of those who use local services.  As an independent champion for people across the Borough, Healthwatch Stockton-on-Tees employ four staff members and have 13 volunteers (Healthwatch Champions) assisting its work.

Priorities and key achievements across the past year were noted, including the initial development of Youthwatch (a platform for young people to have their say about health and care services), involvement with the Integrated Care System (ICS) at a national, regional and local level, and contributions to the Public Health Growing Healthy Stockton-on-Tees consultation.  The 10-year Healthwatch celebration event (which the local team led on) was also an important milestone during 2022-2023, as was the implementation of the Healthwatch Hero initiative which highlights individuals whose voice and determination to make a difference has supported improvement of services.

The top three priorities for 2023-2024 were outlined, namely a Growing Older Project (a local review to support a response to the national requirement to improve the planning process for when families can no longer support their family member to stay at home), Pharmacy (involving the Enter and View process), and a rolling programme of coffee mornings (to help reach deprived areas and aid in reducing health inequalities).  An array of supporting intentions was also listed, including partnership-working around the establishment of the new Mental Health Hub, the development of a Healthwatch Heroes cohort, and the continuing evolvement of the role within the ICS, particularly at ‘place’ (local) level.

Committee comments / questions began with some further probing around the Youthwatch concept.  It was stated that a number of meetings had been held to progress this initiative which had included engagement with young people, some of whom had attended Healthwatch Stockton-on-Tees Board meetings.  A suggestion was made that there may be benefits in contacting Bright Minds Big Futures (BMBF), a national award-winning youth-led movement, working together with SBC to make the Borough a great place to grow up.

In giving its support for the stated future priorities, the Committee queried whether one of these, namely the rolling programme of coffee mornings, would tap into existing gatherings or involve new opportunities.  In response, Members heard that the focus was more on new offers as opposed to those already in existence, though the Chair was happy to discuss this further with Healthwatch colleagues.  In related matters, Healthwatch Stockton-on-Tees  ...  view the full minutes text for item ASCH/12/23

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 (April to June 2023 (inclusive)), with attention drawn to the following:

Providers rated ‘Good’ overall (6)

• South Tees Hospitals NHS Foundation Trust (STHFT) had been upgraded from a previous overall rating of ‘Requires Improvement’.

• Dale Care – Stockton Home Care, The Poplars Care Home, Hadrian Park and Saxon Lodge had maintained their grading following a previous overall rating of ‘Good’.

• Stockton-on-Tees Shared Lived Scheme had not been previously inspected.

Providers rated ‘Requires Improvement’ overall (3)

• PIPS (Positive Individual Proactive Support) Office (based in Middlesbrough but which provided services within Stockton-on-Tees) had breaches in relation to safe care / treatment and good governance regulations which led to the service being downgraded from their previous overall rating of ‘Good’.

• The Robert Atkinson Centre had breaches in relation to good governance and fit / proper persons employed regulations which led to the service being downgraded from the previous overall rating of ‘Good’.

• Partners4Care Limited had breaches in relation to good governance regulations which led to the service being downgraded from the previous overall rating of ‘Good’.

The remaining report was in relation to The Dental Healthcare Centre and Cleveland Cosmetic and Dental Implant Clinic. The CQC inspects but does not rate dentists, and this report identified enforcement action around the ‘Well-Led’ domain to ensure good governance and only fit / proper persons were employed.  It was subsequently stated that the service had since closed (though this did not seem to be acknowledged on the CQC website).

It was noted that two of the three services receiving a ‘Requires Improvement’ rating during this quarter were Care at Home providers, a sector which the Committee had extensively reviewed during the 2022-2023 municipal year.  An update on the agreed actions in relation to the Committee’s final report recommendations was due in early-2024.

Members raised a number of questions around the content of this latest quarterly update. Firstly, it was queried when the CQC would start inspecting the ‘Effective’, ‘Caring’ and ‘Responsive’ domains on a more regular basis.  Regarding The Robert Atkinson Centre report, the Committee wondered if the required post-inspection Action Plan had been received by the CQC and whether it was robust enough to improve quality and safety standards.  Finally, whilst the CQC had upgraded STHFT to ‘Good’, it also told it to take action to bring services into line with 10 legal requirements (related to emergency and urgent care services, medical care, surgery and critical care, as well as some Trust-wide requirements) – as such, since the Trust was not meeting legal requirements, how could it be deemed ‘Good’?  These queries would be relayed to the CQC.

The section on Provider Assessment and Market Management Solutions (PAMMS) inspections (Appendix 2) was noted – there were no reports published during this period (April to June 2023 (inclusive)).  However, a  ...  view the full minutes text for item ASCH/13/23

Due to illness, the officer who was scheduled to present the PAMMS Annual Report (Care Homes) – 2022-2023 could not be in attendance.  As such, it had been agreed by the Chair to defer this agenda item until the next Committee meeting in October 2023.

AGREED that the PAMMS Annual Report (Care Homes) – 2022-2023 agenda item be deferred until the next Committee meeting in October 2023.

Progress report for the previously completed Care Homes for Older People review.

Consideration was given to the assessments of progress on the implementation of the recommendations from the Committee’s previously completed review of Care Homes for Older People.  This was the fifth progress update following the Committee’s agreement of the Action Plan in July 2020, with developments in relation to the outstanding agreed action noted as follows:

• Recommendation 6 (That all care homes be required to work towards Dementia Friendly accreditation as part of the new contract arrangements.): Through the Better Care Fund (BCF), SBC had commissioned Hand-in-Hand ULO (a non-profit making organisation) to deliver Positive Approach to Care (PAC) training for staff in care homes for older people, mental health and learning disabilities (Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) did not have the capacity to deliver this training as originally envisaged).  Starting in September 2023, 20 half-day sessions for care staff (reaching in the region of around 150-200 employees) and 4 full-day sessions for managers / senior staff would be delivered in 12 months.

It was also noted that, in addition to the seven care homes which had already been accredited with dementia friendly status (surpassing the original target group of five), the Council was working with a further five providers to achieve a similar standing.

Reflecting on the progress outlined, the Committee expressed its desire for all providers to reach the required level around the issue of dementia since they cared for some of the most vulnerable people in the sector.  In response, officers echoed this ambition and stated that work would continue with the 30+ homes across the Borough so that dementia friendly accreditation would be viewed as the norm rather than the exception.

AGREED that the Care Homes for Older People progress update be noted, the assessment for progress be confirmed, and the overarching Action Plan approved by the Committee following the original review be signed-off as complete (no further updates required).

- To receive a background briefing in relation to this scrutiny topic.

- To consider and agree the scope and project plan for the review.

Prior to the consideration of the scope and project plan for the Committee’s next in-depth scrutiny review regarding Access to GPs and Primary Medical Care, a background briefing was provided by the North East and North Cumbria Integrated Care Board (NENC ICB) Commissioning Lead – Primary Care.  This included:

•           Overview of general practice in Tees Valley (as of January 2023)

•           GMS / PMS / APMS Contract

•           Primary Care Network Contract Directed Enhanced Services (DES)

•           Enhanced Access

•           Primary Care appointment activity

•           GP Patient Survey 2023 – Stockton results

•           Causes of access challenges

•           Practice workforce

•           Increased PCN workforce

•           Links to key documents

During the briefing, several key elements were highlighted including the use of a triage process to assess need and navigate to the most appropriate service, and the primary care appointment activity statistics which, it was stressed, did not demonstrate the number of phone calls to practices.  With regards the GP patient survey results, it was cautioned that the response rate was limited and that this represented a mere snapshot at a given time.

Access challenges were focused upon, with ways of working impacted by the COVID pandemic (i.e. digital / online offers significantly accelerated), and the appetite for medical training limited in the context of other career opportunities (something the ICB was trying to address). It was emphasised that GPs were ‘generalists’ and see people about anything and everything – however, some individuals with more urgent needs were trying to access them instead of more appropriate services.

Links to relevant background context was provided at the conclusion of the briefing, one of which involved the critical delivery plan for recovering access to primary care. The Committee looked forward to exploring this high-profile issue and noted specific interest in enhanced access provision (including within care homes) and the impact of missed appointments.

Consideration was then given to the draft scope and project plan for the Scrutiny Review of Access to GPs and Primary Medical Care.  The key aims of this review would be to:

• Understand the existing local ‘access to GPs’ landscape in the context of national / regional developments around this ongoing issue.

• Ascertain current systems for accessing general practice services, the communication of these to the public, and how effective they are (including any variations across the Borough’s providers).

• Determine any areas which may assist in improving the experience of the local population, and practices themselves, when individuals wish to contact and / or access general practice services.

• Share any identified good practice within the Borough’s Primary Care Networks (PCNs).

Several contributors had been identified for this work, namely the NENC ICB, Local Medical Committee (LMC), Hartlepool & Stockton Health GP

Federation, Primary Care Networks (PCNs), individual practices, Healthwatch, and, crucially, residents of the Borough.

AGREED that the draft scope and project plan of the Access to GPs and Primary Medical Care review be approved.

Chair’s Update

The Chair noted the agenda items which were considered at the last Tees Valley Joint Health Scrutiny Committee meeting in July 2023 – these included Tees Valley Breast Care Services, Community Diagnostic Centres, a North East Ambulance Service NHS Foundation Trust (NEAS) response to recent CQC inspection outcomes and an independent review of the Trust, and a TEWV presentation on their Lived Experience / Co-Creation work and the impact of their Lived Experience Directors.  The next meeting was scheduled for 6 October 2023 where agenda items were due to cover the implementation of the North East and North Cumbria Integrated Care Strategy (including the role of Integrated Care Partnerships (ICPs)), as well as TEWV updates on Child and Adolescent Mental Health Services (CAMHS) and Respite Provision.

Attention was also drawn to this week’s NEAS Annual General Meeting (due to take place in Darlington on 21 September 2023 at 3.00pm) which the Chair would be attending.  Members were reminded to use the previously circulated booking link if they too wished to access the AGM – this would be re-issued following the meeting.

Work Programme 2023-2024

Consideration was given to the Committee’s current work programme.  The next meeting was due to take place on 24 October 2023 and would involve the first main evidence-gathering session for the Access to GPs and Primary Medical Care review.  Other scheduled items would include a Well-Led Programme update, the deferred PAMMS Annual Report (Care Homes) – 2022-2023, and the latest update on progress of the agreed actions following the previously completed Day Opportunities for Adults review.

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