Agenda and minutes

The evacuation procedure was noted.

There were no interests declared.

To approve the minutes of the last meeting held on Tuesday 20^th February 2024

Consideration was given to the minutes from the Committee meeting held on 20 February 2024.

AGREED that the minutes of the meeting on 20 February 2024 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 2023-2024 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 organisation’s Quality Account, a document which NHS Trusts had a duty to produce each year.

Beginning with a reminder of NTHFTs four key principles (putting our population first, transforming our services, valuing people, and health and wellbeing), the NTHFT Associate Director of Nursing, Effectiveness and Clinical Standards, supported by the NTHFT Associate Director of Nursing, Clinical Safety and Deputy DIPC, outlined highlights and developments in relation to the Trust’s performance (aligned to some of its Quality Account priorities) over the course of 2023-2024 as follows:

Patient Safety

•         Mortality Indicators: As of 1 April 2023, NTHFT no longer reported on the measure for in-hospital mortalities (Hospital Standardised Mortality Ratio (HSMR)) – however, this was included for information, with an increase in the January 2022 to December 2022 ratio compared to the December 2020 to November 2021 ratio.  In-hospital deaths plus those up to 30 days post-acute Trust discharge (Summary level Hospital Mortality Indicator (SHMI)) had decreased in 2022-2023 compared to the same reporting period (September to August) in 2021-2022 – a positive development considering the established inequalities within the local population and the associated challenges these create.  As far as the SHMI measure was concerned, NTHFT continued to perform very well in comparison to other Trusts across the region and nationally.  Trust raw mortality (people dying in hospital) data remained reasonably consistent when compared to previous years.

•         Dementia: The number of patients admitted with a diagnosis of dementia / delirium was largely consistent between April 2023 and November 2023 (ranging between 301 and 334 per month), and broadly replicated monthly admissions for these conditions during the same reporting period for both 2021-2022 and 2022-2023.  However, there had been a large drop in December 2023 (174), something the Trust was in the process of investigating.

•         Infection Control: Within the context of a challenging national outlook around Clostridium difficile (C Difficile), both of the Trust’s measures for this infection type had increased in 2023-2024 compared to the same reporting period (April to December) in 2022-2023 – cases detected in the hospital two or more days after admission (Hospital onset healthcare associated (HOHA)) had gone up by 11; cases that occurred in the community, or within two days of admission, when the patient had been an inpatient in the Trust reporting the case in the previous four weeks (Community onset healthcare associated (COHA)) was up by 5.  Both measures were over the NTHFT threshold.

There was a mixed picture regarding cases of other healthcare-associated infections during 2023-2024 compared with the same reporting period (April to December) for 2022-2023.  Methicillin-Resistant Staphylococcus Aureus (MRSA) (up from 1 to 2), Methicillin-Sensitive Staphylococcus Aureus (MSSA) (up from 29 to 37) and Escherichia coli (E.coli) (up from 63 to 68) cases had all increased during 2023-2024.  However, cases of Klebsiella species (Kleb sp) bacteraemia (down from 20 to 18), Pseudomonas aeruginosa (Ps a)  ...  view the full minutes text for item ASCH/61/23

Progress report for the previously completed Care at Home review.

Consideration was given to the assessments of progress on the implementation of the recommendations from the Committee’s previously completed review of Care at Home.

This was the first progress update following the Committee’s agreement of the Action Plan in February 2023, with all approved actions for recommendations 1, 3, 8, 9, 14 and 15 marked as ‘fully achieved’.  Some actions (the responsibility of the Stockton-on-Tees Borough Council (SBC) Quality and Compliance Team) relating to recommendations 4, 5, 6 and 12 were recorded as ‘on-track’ as further evidence of implementation as part of the quality assurance process was required before these could be considered complete (officers noted that Care at Home providers were very much on board with these actions, though).  Developments in relation to the following were then recorded:

•         Recommendation 2 (A regular feature is included within Stockton News regarding the local Care at Home sector (i.e. good news story, staffing opportunities, etc.): Whilst two Care at Home stories had been showcased in Stockton News since the Committee’s review was completed, officers acknowledged there was more to do in terms of communicating developments about the sector, particularly as providers move into new contracting arrangements later in 2024.

•         Recommendation 7 (SBC, in conjunction with local providers, continues in its efforts to raise the profile of the care sector within the Borough. To boost the status of care workers and give reassurance to those individuals / families seeking support, this should include lobbying for Care at Home staff to be regulated through a national register (e.g. inclusion within the Health and Care Professions Council) and investigating the feasibility of a local register): The concept of Care at Home staff being regulated through the introduction of a national register would be raised at a forthcoming Association of Directors of Adult Social Services (ADASS) meeting.

•         Recommendation 10 (The use of 15-minute welfare calls is minimised and used only when appropriate as part of a wider package of care): 10 people were currently on the tele-assist programme which had been developed to complement / proxy support for people accessing welfare calls, with work undertaken via SBC OneCall around training and education.  Initial feedback from service-users was very positive, though further monitoring was required, with welfare calls being reviewed as part of the transfer to the new contracting arrangements.

•         Recommendation 11 (SBC continue to explore and deploy other options to support welfare, including tele-assist and technology): Two of the monthly engagement sessions with Care at Home providers had focused on assistive technology, with options showcased and referrals into SBC OneCall subsequently received from providers – continuing to proactively explore and highlight available technology was key as this can add significant value to the sector (as an enabler of, not a replacement for, good quality care).  Training had been undertaken on the Virtual Home concept, with SBC expected to go beyond the North East ADASS request for all Local Authorities to train 100 staff members during 2024-2025.

•         Recommendation 12 (Consideration be given  ...  view the full minutes text for item ASCH/62/23

To consider patient / public views on this scrutiny topic.

The fifth (and final) evidence-gathering session for the Committee’s review of Access to GPs and Primary Medical Care focused on patient / public views which had been gathered in relation to the Borough’s general practices.

In order to address several of the review’s key lines of enquiry that involved ascertaining the experiences of the local population when contacting / accessing general practices, a number of organisations / entities had been approached including:

•         Care Quality Commission (CQC): The CQC had been asked to provide a summary of compliments and complaints received in relation to Stockton-on-Tees general practices since the start of 2023.  To date, no information had been received.

•         North East and North Cumbria Integrated Care Board (NENC ICB): A request was made to the NENC ICB Primary Care Complaints Team for details of any recent issues raised in relation to Stockton-on-Tees general practices.  To date, no information had been received.

•         Healthwatch Stockton-on-Tees: The Healthwatch South Tees ‘Top Tips for Accessing Your GP Practice’ guide referenced during the Committee’s October 2023 meeting was shared for information.  Responses collected between February 2022 and February 2024 via Healthwatch Stockton-on-Tees’ ‘Share your views’ platform were then considered, with familiar themes around long call-waiting times, a lack of appointments (particularly face-to-face), and difficulties in using technology (introduced to facilitate improved access) all highlighted.  Other issues were also raised in relation to practice registration, problems with reception staff, and limited transport options, though several positive comments regarding local practices were also evident.

•         GP Patient Survey 2023: A reminder of the summarised results from the latest national GP patient survey (initially relayed at the first evidence-gathering session in October 2023) was included – this incorporated national, Tees Valley and Stockton-on-Tees comparisons, as well as data broken down for each of the Borough’s general practices, for selected access- / patient satisfaction-related questions.  It was noted that the 2024 survey results would be published around July / August 2024.

•         Patient Participation Groups (PPGs): Further to the request / collection of the existing patient / public feedback above, the Committee also issued its own survey to each of the 21 local practices’ PPGs.  11 completed surveys had been returned (covering a total of 10 practices) with responses colour-coded to indicate which Primary Care Network (PCN) the PPG was aligned to.  It was noted that some surveys appeared to have been sent on behalf of a PPG, whereas others were individual views from a member of a PPG.

Similar to the Healthwatch Stockton-on-Tees ‘Share your views’ feedback, identifiable themes in relation to GP access included shortages of / challenges in getting appointments, delays in getting telephone calls answered, and technology challenges for patients (particularly older people).  That said, PPGs had appeared to positively influence the development of practices’ telephone systems and improvements in communications / website / signposting.  Encouragingly, the large majority of respondents felt that their PPG was listened to by their practice.

When analysing responses to the question on how best practices could improve  ...  view the full minutes text for item ASCH/63/23

Chair’s Update

The Chair noted the following:

•         Tees Valley Joint Health Scrutiny Committee: The latest meeting, and final one of the current municipal year, took place last week (15 March 2024) and considered a North East and North Cumbria Integrated Care Board (NENC ICB) update on the organisation’s recent restructure, and Quality Account presentations from both Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) and North East Ambulance Service NHS Foundation Trust (NEAS).  Support and chairing responsibilities for 2024-2025 would move to Hartlepool Borough Council as part of the agreed rotational arrangements.

•         Care Quality Commission (CQC): The Chair had recently met with the local CQC Operations Manager to discuss future engagement between the Committee and the regulator.  A named CQC lead for the Borough had since been identified and an informal meeting with this officer would be arranged in the near future.

•         Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV): Further to the request made at the last Committee meeting in February 2024, the TEWV Lead Governor had been approached to attend a future meeting to respond to the latest CQC report on the Trust from a Governor perspective.  Confirmation of attendance was still awaited.

Work Programmes 2023-2024 & 2024-2025

Consideration was given to the Committee’s current work programme (2023-2024), as well as the initial work programme for the next municipal year (2024-2025).  The next meeting was due to take place on 16 April 2024 and would involve both a formal and informal element – the latter being used for a ‘summary of evidence / draft recommendations’ session in relation to the ongoing review of Access to GPs and Primary Medical Care.

AGREED that the Chair’s Update and Adult Social Care and Health Select Committee Work Programmes 2023-2024 and 2024-2025 be noted.