Agenda and minutes

The evacuation procedure was noted.

There were no interests declared.

To approve the minutes of the last meeting held on 19 September 2023.

Consideration was given to the minutes from the Committee meeting held on 19 September 2023.

Members were reminded that information had recently been circulated via email following a request for more detail on the Wellbeing (Mental Health) Hub (highlighted during the ‘Healthwatch Stockton-on-Tees – Annual Report 2022-2023’ item) and relaying responses by the Care Quality Commission (CQC) after queries were raised by the Committee during the ‘CQC / PAMMS Inspection Results – Quarterly Summary (Q1 2023-2024)’ item.

AGREED that the minutes of the meeting on 19 September 2023 be approved as a correct record and signed by the Chair.

The Committee received a presentation on the Stockton-on-Tees Borough Council (SBC) Well-Led Programme which provided an update on developments around this leadership initiative.  Led by a SBC Transformation Manager, and supported by three care home leaders who had been through the programme, key features of the presentation included:

• Why the Well-Led Leadership Programme was introduced: Historically, Care Quality Commission (CQC) inspections had resulted in the identification of issues within the ‘Well-Led’ domain (one of its five key inspection elements).  In 2018, 50% of the Borough’s care homes were rated ‘Requires Improvement’ in relation to leadership; in some cases, this was deemed ‘Inadequate’. 

• What the programme entails: This initiative was not a training programme which led to a qualification.  Instead, it was an innovative approach to developing strong leadership across the residential care home sector, promoting and supporting new ways of working, challenging the status quo, and embracing (sometimes bold) change.

• Who was involved in the programme’s creation: A collaborative approach with stakeholders wrapped around the local care home sector – this included the former Tees Valley Clinical Commissioning Group, NHS Leadership Academy (North East and Yorkshire), the CQC, SBC, and local care home providers.

• How the programme works and what it seeks to achieve: Providers previously worked in isolation and were often competing against each other.  The programme sought to establish effective networks which enabled local care home leaders to share good practice and learn from each other’s experiences.  It specifically looks at problem-solving and improving professional practices via systematic observations and data collection, and seeks to strengthen an organisation through the development of several key pillars – leadership, working with change, culture, systems navigation, equality / diversity / inclusion, coaching, and values / ethics.

• Impact of the first and second cohort (2019-2020): Tangible difference was identified as a result of participation in the programme, with more providers receiving an overall rating of ‘Outstanding’ or ‘Good’ following subsequent CQC inspections and less receiving ‘Requires Improvement’. 

• Impact of the programme between 2019 and 2023: Numerous benefits have been attributed to this ‘well-led’ initiative since its inception, including greater co-operation, increasing tools and confidence to lead a service well, the creation of networks / celebration events / forums for sharing good practice (aiding improvements in service quality), and positive relations with regulators and inspectors.  Ultimately, CQC ratings had improved, and of the 73 people who had participated in the programme, 78% of those were still at their care service within the Borough (demonstrating impact on retention).  It was also noted that the programme kept going despite the challenges arising from the emergence of COVID-19 (moved to remote sessions).

• Care home leader reflections on their experiences and the benefits it had brought them following their involvement: Several quotes from those who had participated in the programme were included.  In addition, three care home leaders were in attendance (two who went through the first cohort and one who participated in the latest) to relay the impact of  ...  view the full minutes text for item ASCH/21/23

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

Consideration was given to the assessments of progress on the implementation of the recommendations from the Committee’s previously completed review of Day Opportunities for Adults.  This was the second progress update following the Committee’s agreement of the Action Plan in June 2022, with developments in relation to the outstanding agreed actions noted 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:):

e) Considerations around the potential for assisting with identified transportation needs (e.g. ensuring public / private transport options are accessible and respond to the needs of people who use day opportunities): The Teeswide Dementia Friendly Community Network had continued to work with the SBC Licensing team and had trained over 500 taxi drivers.  No sessions for bus drivers had been completed.

Members expressed disappointment at the lack of training sessions with bus providers to help raise awareness on how they can deliver their services to people who use day opportunities, as well as concern around the clarity of bus stop locations in Stockton High Street (it was felt that SBC had a key role here and that this was not all down to the bus companies).  In related matters, the issue of wheelchair-accessible taxis had also been raised within the Licensing Committee, and that whilst such vehicles were more expensive, attempts were being made to introduce more of these into the existing fleet.

f) Changes to the existing budget for SBC in-house and commissioned services: The planned quarterly dashboard, including data on day opportunities spend, was produced in March 2023 and shared across the team.  Work had also been completed to realign staff responsibilities to match changes in demand.

The Committee reaffirmed the need for the continued monitoring of the uptake of services to ensure that the Council’s offer was providing value-for-money.  Whilst it was positive that some individuals chose, and were able, to manage their own personal finances in terms of accessing day opportunities, it was important to track changes in demand for existing services.  Officers agreed to share dashboard-related information as part of the next update on progress.

• 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): Representatives from the Adult Social Care teams, as well as Lanark and day services, attended a ‘Planning for Adulthood’ event on 23 March 2023 – this was well received, and highlighted required work around transitions to ensure the right types of service / infrastructure were in place.  Key staff will attend a follow-up event at Newtown Community Centre on 27 November 2023.

Members requested feedback on the November 2023 event as part of the next update on progress.

• Recommendation 4 (SBC to  ...  view the full minutes text for item ASCH/22/23

The Committee was presented with the PAMMS Annual Report (Care Homes) for 2022-2023.  Led by the SBC Quality Assurance and Compliance Manager, key content was relayed as follows:

• The Provider Assessment and Market Management Solutions (PAMMS) is an online assessment tool developed in collaboration with Association of Directors of Adult Social Services (ADASS) East and regional Local Authorities.  It was designed to assist users in assessing the quality of care delivered by providers.  The assessment was a requirement of the Framework Agreement (the Contract) with providers, and they were contractually obliged to engage with the process.

• A summary of assessments for contracted care homes undertaken by the SBC Quality Assurance and Compliance (QuAC) Team throughout 2022-2023 showed that 17 services had received a ‘Good’ overall PAMMS rating, 14 services had been graded ‘Requires Improvement’ overall, and one service was deemed ‘Poor’ (a home which had since closed).

2021-2022 overall ratings were also included for comparison – this indicated that 28 services were previously considered ‘Good’ (11 more than in 2022-2023), four services were previously graded ‘Requires Improvement’ (10 less than in 2022-2023), and no services were previously deemed ‘Poor’ (one less than in 2022-2023).  Windsor Court’s upgrading from ‘Requires Improvement’ in 2021-2022 to ‘Good’ in 2022-2023 was well deserved given the efforts made by the provider.

• Key themes from assessments that scored a ‘Good’ rating were listed – these included comprehensive, clear and concise care plans with personalised detail (evidencing people’s preferences and routines), well-managed medication (including checking consent prior to administering), robust processes around safe staff recruitment, and the promotion of choice and independence to residents by staff.  Offering residents a choice of meals and evidence of a varied activity programme, tailored to the needs of the individual as well as groups, were also key.

• Key themes arising from those assessments that scored ‘Requires Improvement’ or ‘Poor’ showed shortfalls in the completion of staff recruitment records (including gaps in previous employment and DBS checks), inconsistencies in relation to the quality and content of care plans, and issues regarding the management of medication.  Other concerns surrounded infection, prevention and control (ICP) procedures, the décor of some homes, and a lack of contractual compliance around staff induction, supervision and training.

• In an attempt to improve the quality / robustness of providers’ medication management / processes, SBC undertook a co-ordinated support approach in conjunction with the NECS Medicines Optimisation Team around the medicine elements of the PAMMS tool throughout 2022-2023.

• As per established practice, following a PAMMS inspection, an Action Plan is developed highlighting those areas that need an improvement in quality / compliance to ensure they are being delivered to a ‘Good’ standard.  The Action Plans are monitored regularly by the responsible QuAC Officer for progress, and will be only signed off as compliant and complete when all identified areas demonstrate and evidence the required level of quality and service delivery.  Key themes regarding PAMMS outcomes are also shared with the Care Quality Commission (CQC)  ...  view the full minutes text for item ASCH/23/23

To consider information on this scrutiny topic from the North East and North Cumbria Integrated Care Board (NENC ICB).

Following the Committee’s approval of the scope and plan for the Access to GPs and Primary Medical Care review (preceded by the consideration of a background briefing in relation to this scrutiny topic) at the last meeting in September 2023, this first evidence-gathering session involved an initial submission from the North East and North Cumbria Integrated Care Board (NENC ICB).  Led by the NENC ICB Commissioning Lead – Primary Care, an extensive presentation addressing several key lines of enquiry covered the following:

•           What is General Practice?

•           GP Contracts and Regulations

•           Other Key Agencies

•           Core Funding and Expenditure

•           Primary Care Networks (PCNs) and Directed Enhanced Services (DES)

•           Overview of General Practices in Stockton

•           Practice and PCN Workforce

•           Primary Care Appointment Activity

•           Enhanced Access Utilisation

•           GP Patient Survey – 2023 Results

•           Access Challenges

•           Primary Care Access Recovery Plan (PCARP)

•           Empowered Patients

•           Implementing Modern General Practice Access

•           Building Capacity and Cutting Bureaucracy

•           Progress To Date

•           PCN Capacity and Access Improvement Plans

•           National Public Relations Campaign for GP Access

•           Links to Key Documents

A ‘Stockton-on-Tees Data Pack’ had also been provided to supplement the presentation – this included a map of the Borough’s general practices and branch sites, practice list sizes, opening hours, current CQC ratings, staffing levels, GP numbers (headcount and full-time equivalent as a ratio to patient list size), and patient online management information.  Appointment data (at a Borough and Tees Valley level) was also detailed, as was a breakdown of GP survey results per Stockton-on-Tees practice.

Whilst the existing GP contract stated that ‘practices must provide essential services at such times, within core hours, as are appropriate to meet the reasonable needs of its patients’, it was noted that there was no precise definition as to what constituted ‘essential’ nor ‘reasonable needs’ (‘core hours’ were specified, though).  The current five-year contract was in its final year, though details regarding subsequent contract plans had yet to be communicated.

In terms of funding, in addition to the core funding via the Global Sum, practices rely on other forms of income to cover expenditure.  One of these streams is the Quality and Outcomes Framework (QOF) scheme which, whilst not part of the core contract, can be beneficial for practices and is therefore rarely ignored.  A patient list size of around 7,000-8,000 was considered financially sustainable – in Stockton-on-Tees, the average list size was 9,808 – the smallest being 2,303 and the largest 21,555 (as at 1 January 2023).

Regarding the primary care appointment activity, the data did not include ‘dropped’ calls which had previously been difficult to track – however, new telephony systems (as part of the phasing out of analogue phones) do collect this information, and the Borough’s practices could be asked to supply this data if required.  Statistics in relation to enhanced access utilisation indicated that significantly less people used the Sunday service in Eaglescliffe (it was stated that patients should be offered  ...  view the full minutes text for item ASCH/24/23

Consideration was given to the latest Regional Health Scrutiny Update report summarising developments regarding the Tees Valley Joint Health Scrutiny Committee, the Sustainability and Transformation Plan (STP) / Integrated Care System (ICS) Joint Health Scrutiny Committee, and the North East Regional Health Scrutiny Committee.  Attention was drawn to the following:

• Tees Valley Joint Health Scrutiny Committee: Two meetings had taken place since the previous update report.  The first (and first of the 2023-2024 municipal year) was on 28 July 2023 where items included NENC ICB / local NHS Trust updates in relation to Tees Valley Breast Care Services and 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 Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) presentation on their Lived Experience / Co-Creation work and the impact of their Lived Experience Directors.

The last meeting took place on 6 October 2023 (note: the meeting was not quorate) with agenda items covering the North East and North Cumbria Integrated Care Strategy and accompanying Joint Forward Plan (JFP), along with TEWV updates on Child and Adolescent Mental Health Services (CAMHS) and Adult Learning Disability Respite Provision.  The next meeting was scheduled for 15 December 2023 – anticipated items include a winter plan update, future plans for non-surgical oncology, an update on the state of dentistry, and community water fluoridation proposals.

Further to the appearance of senior NEAS representatives at the July 2023 meeting, a link regarding the Trust’s subsequent AGM in September 2023 (which the Chair of the Tees Valley Joint Health Scrutiny Committee / SBC Adult Social Care and Health Select Committee attended) was provided for information.

• Sustainability and Transformation Plan (STP) / Integrated Care System (ICS) Joint Health Scrutiny Committee: No further developments regarding this Joint Committee since the previous update in July 2023.  In related matters, continuing efforts to tackle smoking rates and its impact were highlighted, as well as a report on health inequalities and the piloting of a new app-based booking system for gastroenterology patients at North Tees and Hartlepool NHS Foundation Trust.

AGREED that the Regional Health Scrutiny Update report be noted.

Consideration was given to the minutes of Health and Wellbeing Board meetings which took place in May 2023, June 2023 and July 2023.  Attention was drawn to the following:

• 28 June 2023: Under the ‘Pharmaceutical Needs Assessment 2022 Update’ item, reference was made to developments in relation to the Borough’s pharmacy provision.  Members were reminded that Healthwatch Stockton-on-Tees had identified pharmacies as one of their key priority areas for 2023-2024.

• 26 July 2023: It was noted that the ‘Vaping Update – Presentation from FRESH’ item was the catalyst for an in-year scrutiny topic suggestion on access to and impact of vaping.  This had since been added to the scrutiny work programme and was scheduled to be undertaken by the Crime and Disorder Select Committee in 2024.

AGREED that the minutes of Health and Wellbeing Board meetings which took place in May 2023, June 2023 and July 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 21 November 2023 and was scheduled to feature the next CQC / PAMMS quarterly update on published inspection reports (Q2 2023-2024) and the second evidence-gathering session in relation to the Access to GPs and Primary Medical Care review.  An update from senior representatives of North Tees and Hartlepool NHS Foundation Trust regarding the Trust’s maternity services was also intended.

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