Agenda and minutes

The evacuation procedure was noted.

There were no interests declared.

To approve the minutes of the last meeting held on 28 July 2023.

Consideration was due to be given to the minutes from the Committee meeting held on 28 July 2023. However, approval of these minutes would need to be deferred to the next Committee meeting in December 2023 as attendance at this meeting was inquorate.

AGREED that consideration of the minutes of the Committee meeting on 28 July 2023 be deferred until the next Committee meeting in December 2023.

The Committee received a presentation on the implementation of the North East and North Cumbria Integrated Care Strategy and associated Joint Forward Plan (included within the papers). Led by the North East and North Cumbria Integrated Care Board (NENC ICB) Director of Strategy and Planning, and supported by the NENC ICB Director of Place Based Delivery (In-Hospital Care), key aspects included:

Ø  Process: Developing the Joint Forward Plan

o   National Guidance

o   NHS Plan aligned to our Partnerships

o   How the Plans fit together

o   Process and Timeline

o   Feedback

Ø  Content: Sections of the Joint Forward Plan

o   North East and North Cumbria Plan

o   Service Action Plans

o   Enabler Action Plans

o   Place Action Plans

Ø  Tees Valley Priorities and Strategic Context

Ø  March 2024 Refresh

As per national guidance, the overarching purpose of the Joint Forward Plan (JFP) was to demonstrate how the ICB and its associated NHS Trusts would arrange and / or provide NHS services across the totality of healthcare. Allied to this, it would need to show how legal requirements for the ICB would be met, as well as support the delivery of the NHS Mandate and NHS Long-Term Plan across its footprint (the latter of which would end during the five-year period covered by the JFP (2023/24-2028/29) and would require a refresh).

The medium-term JFP sits between the 10-year partnership-based Integrated Care Strategy (focusing on population health), and the annual NHS Operating Plan (focusing on NHS activity, finance, performance, and workforce). It comprises a host of detailed Action Plans and acts as a summary document. The timeline for its construction was outlined, including opportunities for stakeholder feedback (which was widely encouraged, properly considered, and sometimes acted upon within the context of varying and occasionally directly opposing views). The final version was approved at last week’s ICB meeting, and there were plans for an easy-read document given its existing detail and length. An annual update would take place each March (though maintaining the five-year horizon), and the ICB would seek input from the public, service-users, families / carers, Elected Members, partners, etc., at any point in time.

Feedback received on the proposed content of the JFP revealed several themes. Ensuring the appropriate use of language (to aid readability and avoid stigmatisation) was a key element, as was the need for clarity around the plan’s objectives (including measurable indicators). Balancing local focus within a North East and North Cumbria footprint was always likely to be a challenge given the large geographic area the plan covers, though health and care issues were often replicated across numerous different locations.

Reflecting the system-wide priorities established through the NENC Integrated Care Partnership (ICP) Better health and wellbeing for all strategy, the JFP comprised fifteen service Action Plans which now included trauma-informed services (not originally within the draft version) as well as women’s health (acknowledging that provision was not always right for all women and recognising the national women’s health strategy). Underpinning progress on these fifteen topics were several ‘enabler’  ...  view the full minutes text for item TVH/16/23

Consideration was given to an update on the current situation regarding the Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) Child and Adolescent Mental Health Services (CAMHS). Presented by the TEWV CAMHS Head of Service, and supported by the TEWV Managing Director – Durham, Tees Valley and Forensic Care Group and Deputy Chief Executive, content in relation to children and young people services was as follows:

·         Within the context of TEWVs previous Care Quality Commission (CQC) inspection outcomes and the issues this had raised (waiting lists, processes to manage risk, etc.), the five key areas of focus were outlined:

o   Waits: including what to do whilst waiting.

o   Staffing: vital issue, with a significant pressure area around Consultant Psychiatrists; realigning budgets; looking at skills mix and working with medical leadership to address gaps.

o   Caseload / caseload management: constantly reviewing; size of caseloads was previously flagged by the CQC – this had since been addressed.

o   Training: do this in partnership with acute Trusts and the voluntary sector (e.g. Oliver McGowan training).

o   Community Transformation: strong partnership arrangements within Tees Valley – helps to deliver services in different ways.

Work to develop the service and address concerns raised by the CQC had continued, and it was hoped that improvements made would be reflected when the CQC next inspects.

·         The iThrive framework was explained, with the broad expectation that around 80% of those approaching CAMHS will only require advice to continue ‘thriving’. Of the remaining 20%, around two-thirds to three-quarters would require focused goals-based input (e.g. low-intensity cognitive behavioural therapy (CBT)), with the rest being split between either those who need more extensive and specialised goals-based help, and those who have not benefitted from or are unable to use help, but are of such a risk that they are still in contact with services.

·         Despite ongoing challenges, TEWVs ‘Getting Help’ and ‘Getting More Help’ teams compared favourably with national benchmarks, the Specialist Eating Disorders team was consistently compliant with national access standards, and Crisis and Intensive Home Therapy teams performed consistently well with high call handling rates and compliance with the four-hour response requirement for urgent referrals (both typically 90-96%). The Committee was reminded that TEWVs in-patient CAMHS provision within the Tees Valley region had ceased and was instead being provided by another Trust at the old West Lane Hospital, Middlesbrough site. However, TEWV was still jointly responsible for overseeing / managing the crisis pathway.

·         There was a key pressure around neurodevelopmental assessments (autism and ADHD), demand for which had significantly increased since the emergence and impact of COVID. Assessment completed today had waited 18 months to two years, and the waiting list continued to grow. This was a national issue and was an area of focus for the Trust as part of whole-system planning and ICB commissioning.

·         Several elements in the ongoing management and delivery of services were highlighted, including the Trust’s ‘Keeping in Touch (KIT)’ process (which helps mitigate any risks associated with  ...  view the full minutes text for item TVH/17/23

Consideration was given to an update on the current situation regarding the Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) adult learning disability respite provision. Led by TEWVs Durham, Tees Valley and Forensic Care Group Director of Operations & Transformation (CAMHS & LD), and supported by the TEWV Managing Director – Durham, Tees Valley and Forensic Care Group and Deputy Chief Executive, past and current context was noted as follows:

·         TEWV is commissioned to provide adult learning disability (ALD) respite services for the population of Teesside from two sites – Asgarth (Durham Road, Stockton – 6 beds) and Bankfields Court (Middlesbrough – 5 beds).

·         As previously noted during the last update to the Committee (December 2021), in 2019, the Care Quality Commission (CQC) identified that these facilities did not meet Mixed Sex Accommodation (MSA) guidance – action was undertaken to comply with requirements, a by-product of which was a reduction in the number of days families were able to access services.

·         In 2020, a project steering group completed a comprehensive review of delivery models and building options. This work was paused due to the pandemic but restarted recently upon the appointment of a new director and general manager in ALD services – this included engagement with families, around 70 of which access this offer.

·         The estate is a significant challenge, with both buildings remaining in poor condition due to age.

The Committee was then informed of TEWVs vision for these services, the longer-term aim being to provide creative health and social care options that are responsive, with fair and equitable access, reflective of the evolving needs of the population, and go beyond a solely bed-based service. Recent developments towards this goal included the re-opening of conversations with stakeholders systemwide (including Local Authorities across Teesside and the NENC ICB) to explore new models of sustainable respite provision across ALD in Teesside, engaging with regulators to inform registration requirements linked to ‘Right Care, Right Support, Right Culture’, and the September 2023 appointment of a Programme Lead for transforming TEWVs ALD bed model. Officers provided assurance that TEWV remained in regular contact with families regarding the existing situation and fully recognised the profound disabilities of those accessing its services.

Members responded by requesting clarification around whether the number of beds available at the two sites had reduced – officers agreed to confirm any recent changes following this meeting.

Reflecting on the existing offer, the Committee noted that some may misguidedly view the service as a hospital, and questioned if TEWV was proposing that respite provision should be delivered by social care partners. Drawing attention to the regulatory requirement on TEWV to provide a certain level of service based on the licence it holds, officers confirmed that nothing was being ruled out in terms of future delivery options, though providing the best support for families would remain the priority. Potential alternatives to the existing offer would need to be worked through with partners as part of a broader conversation on ALD services, and assurance was  ...  view the full minutes text for item TVH/18/23

Consideration was given to the Committee’s work programme for 2023-2024.

Discussion ensued around the potential agenda for the next Committee meeting on 15 December 2023. It was agreed to retain the intended items on winter planning, strategic options for non-surgical oncology, and community water fluoridation, as well as add an update on NHS dentistry (to complement the latter). The North East Ambulance Service NHS Foundation Trust (NEAS) and Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) performance updates would instead be requested as part of the two Trusts Quality Account submissions at the Committee meeting scheduled for March 2024.

Reference was also made to the list of ‘To be scheduled’ items included within the work programme document. Members discussed potential options for covering these issues either as part of a formal Committee meeting or outside these quarterly dates via informal sessions / email updates.

AGREED that the Committee’s work programme for 2023-2024 be noted.