Agenda and draft minutes

The evacuation procedure was noted.

There were no interests declared.

Consideration was given to the minutes from the Committee meeting held on 28 July 2023.

AGREED that the minutes of the Committee meeting on 28 July 2023 be approved as a correct record.

Consideration was given to the notes from the Committee meeting (not quorate) held on 6 October 2023.

AGREED that the record of the Committee meeting (not quorate) on 6 October 2023 be noted for information.

To consider an update on plans for community water fluoridation for the North East of England.

The Committee received a presentation on updated plans for community water fluoridation for the North East of England. Led by the Office for Health Improvement and Disparities (OHID) Regional Director / NHS Regional Director of Public Health (North East & Yorkshire), and supported by the Consultant in Dental Public Health, NHS England (North East & Yorkshire) and the Stockton-on-Tees Borough Council (SBC) Director of Public Health, content included:

Ø  Outline of current status

Ø  Oral health across Tees Valley 2019-2022

Ø  Significant inequalities across Local Authorities

Ø  General Anaesthetic (GA): Numbers and rates (2022-2023)

Ø  Evidence-based interventions to improve oral health

Ø  Consultation narrative

Ø  Achieving consensus across the North East

Ø  Where are we now?

Ø  Recommendations

Summarising the existing position with regards this initiative (which included Government support and funding, the preparation of the statutory 12-week consultation requirement, and communication / decision-making responsibilities), it was noted that Hartlepool and some parts of County Durham already had naturally fluoridated water, and other areas (Newcastle, North Tyneside and parts of Northumberland) had artificial water fluoridation. Significantly, associated capital and revenue costs (which previously sat with Local Authorities under the Public Health grant) for expanding this across the North East would be the responsibility of the Department of Health and Social Care (DHSC).

Outlining the changes in prevalence of dental decay in 5-year-olds across the North East between 2019 and 2022, officers stated that there could be up to 134 teeth being extracted under general anaesthetic in a single day within County Durham for Durham and Darlington children. Reference was made to a table which compared the most and least deprived wards in Teesside (without fluoridated water) with Hartlepool (which already had fluoridated water) – this 2017 data demonstrated the positive impact of fluoridation which was particularly significant for those in the most deprived areas. In terms of inequalities, it was also noted that there can be up to a ten-fold difference in decayed, missing or filled teeth (DMFT) rates between the most and least deprived wards within a single Teesside Local Authority footprint.

The use of general anaesthetic in relation to dental decay during 2022-2023 was highlighted. The wider impacts of this were also emphasised, with children usually requiring at least three days off school, around 38% enduring sleepless nights, and around 70% reporting pain.

Public Health England data was provided which showed the return on investment of oral health improvement programmes for 0-5-year-olds. Targeted supervised toothbrushing and fluoride varnish programmes, as well as the provision of toothbrushes / paste by post and by health visitors, were all found to effectively reduce tooth decay. However, by a very significant margin (nearly three times more than the second most effective), water fluoridation had the greatest impact.

Detail was provided on the rationale, aims and next steps around the proposed expansion of water fluoridation across the North East. Ultimately, this initiative would help everyone (especially those who needed it the most), would lead to positive changes in oral health for young children, and would  ...  view the full minutes text for item TVH24/23

To consider an update on NHS primary care dental services and dental access recovery developments.

Further to a presentation given to the Committee in March 2023, Members received an update on NHS primary care dental services and dental access recovery developments. The North East and North Cumbria Integrated Care Board (NENC ICB) Director of Place Based Delivery provided information on:

Ø  Summary Overview of NHS Dentistry

Ø  Context

Ø  Commissioned Capacity

Ø  Other Primary and Community Dental Services

Ø  Urgent Dental Care Services

Ø  Challenges to Access

Ø  Our Approach to Tackling These Challenges – Three Phases

Ø  Immediate Actions Undertaken

Ø  Dental Access Recommissioning (UDAs)

Ø  Further Action and Next Steps

Ø  Advice for Patients with an Urgent Dental Treatment Need

NHS England delegated responsibility to the North East and North Cumbria Integrated Care Board (NENC ICB) for commissioning dental services from 1 April 2023 (with professionals who had previously led on this transferring to the ICB). Whilst private dental services were not commissioned, regulations did not prohibit the provision of private dentistry by NHS dental practices. From a purely NHS perspective, although patients could contact any practice to access care, the issue remained that not all practices could meet demand, and the backlog of treatment needs (involving increased complexity) arising as a result of the COVID-19 pandemic remained high.

It was emphasised that whilst the relevant NHS webpage may indicate a practice was not taking on new patients for NHS treatment, individuals were encouraged to contact a practice to confirm this was the latest position as the website was not always up-to-date and availability was often changing. Given the existing pressures, practices were being encouraged to prioritise patients for treatment based on clinical need and urgency, therefore appointments for some routine treatments (such as dental check-ups) may still be delayed. That said, if teeth and gums were healthy, a check-up or scale and polish may not be needed every six months.

Regarding NHS dental contracts, commissioned capacity for 2023-2024 was just under 1.3 million units of dental activity (UDAs) across the Tees Valley – this should be sufficient if it could be accessed. In addition to routine general dental practice, other commissioned provision included urgent dental care services (in-hours and out-of-hours appointments via NHS 111), community dental services (CDS – for vulnerable patients with additional needs that cannot be met within high street practices), advanced mandatory (minor oral surgery services), and domiciliary care, sedation and orthodontic services.

Access challenges were outlined, including the pandemic legacy and ensuing backlog, recruitment and retention of dentists remaining an issue (particularly for NHS provision) which inhibits a practice’s ability to deliver full commissioned capacity, and the ongoing need for national contract reform (the NENC ICB cannot control this but would welcome change). A significant factor (replicated across the UK) was the handing back of contracts, a number of which had been returned since the ICB took over commissioning responsibilities from April 2023 – this had created difficulties in accessing NHS dentists across many areas of the North East (including, from a Tees Valley perspective, Darlington).

Three distinct  ...  view the full minutes text for item TVH25/23

To consider a presentation on proposals for changes to non-surgical oncology services from representatives of NHS England and the Northern Cancer Alliance.

Consideration was given to proposals for changes to non-surgical oncology (Systemic Anti-Cancer Treatment (SACT) (chemotherapy-related) and radiotherapy) services across the North East. Supplemented by additional background context outlining challenges associated with the existing offer and the preferred model for future delivery, representatives of NHS England and the Northern Cancer Alliance gave a presentation which included the following:

Ø  Why non-surgical services need to change

Ø  Overview of oncology services and original outpatient appointment sites

Ø  Principles for strategic review and strategic model development

Ø  Options considered, decision-making, and preferred option

Ø  Example patient pathway and proposed hub locations

Ø  Benefits of a tumour-specific hub

Ø  Clinical model – peer review (September 2023) and outcomes

Ø  Engagement and communication

Ø  Impact assessments – health and travel (to date and for preferred option)

Ø  Next steps

The rationale for altering the existing service model was outlined, a key aspect of which was the nationally recognised shortage in oncologist workforce (identified as far back as 2020). Other factors included a regional variation in current provision and access, the anticipation of new drugs associated with this pathway causing increased demand, and the general increase in cancer incidences.

Mapping the present offer across the North East and North Cumbria Integrated Care System (NENC ICS) footprint, two specialist cancer centres at Newcastle (Freeman Hospital) and South Tees (James Cook) included radiotherapy treatment, with chemotherapy delivery units based at 19 sites (the proposals did not change the sites for these services). However, the historical model of outpatient provision was no longer fit for purpose, with inequity of access developing over time, a lack of resilience within the workforce, and an increase in referrals and complexity of cases contributing to delivery pressures.

The principles underpinning a strategic review of these services was noted, with key features including the need for patient-focused, clinically-led, care which was delivered as close to home as possible. Given the expected widening of the gap between supply and demand for the regional oncology workforce in the next five years, ensuring oncologist time was used for maximum efficiency was crucial, as was providing safe levels of specialist cover alongside opportunities to enhance resilience through peer support and learning.

Following various consultation and engagement with stakeholders (including the public), four future options were identified, one of which was to continue with the current model (already established as unviable). Two others involved either centralisation to the existing cancer centres or a decentralised model – however, these were both problematic due to travel / estate implications and lone-working / inequity of service development concerns respectively. The fourth option – clinical networks with tumour-specific hubs and treatments as close to home as possible – was therefore the preferred choice. Once the ongoing engagement and further development phase had concluded, it was intended that the agreed model would be signed off by March 2024.

The preferred option was explored in more detail, with example patient pathways, proposed hub locations, and the benefits of a tumour-specific hub demonstrated. Assurance  ...  view the full minutes text for item TVH26/23

To consider the annual winter planning update from representatives of the North East and North Cumbria Integrated Care Board (NENC ICB).

The Committee received its annual winter planning update. Provided by the North East and North Cumbria Integrated Care Board (NENC ICB) Director of Place Based Delivery, key aspects included:

Ø  Context

Ø  National Guidance

Ø  2023-2024 Winter Planning

o   Local Accident & Emergency Delivery Board (LADB)

o   System Control Centre (SCC)

o   Tees Valley Incident Command Coordination Centre (ICCC)

o   Urgent and Emergency Care Highlight Report

o   Winter Plans and Business Cases

Ø  Risks and Challenges

Like all services up and down the country, the Tees Valley health system remained under significant and sustained pressure – this was impacting upon performance, particularly on flow through hospitals. Influencing factors included staffing issues across all partners, pathway and estate limitations at some sites, increased demand (linked to the elective backlog), higher acuity of patients (resulting in longer stays in hospital), and discharge delays (due to NHS Trust issues and social care / home care staffing pressures). This demonstrated a complex system-wide problem which required a system-wide response.

National guidance to address these widespread challenges was outlined, including delivery plans for recovering urgent and emergency care (January 2023), and recovering access to primary care (May 2023). Regarding the former, focus on five key areas was highlighted: increasing capacity, increasing workforce size / flexibility, improving discharge, expanding care outside hospital, and making it easier to access the right care. In addition, 10 high-impact interventions had been worked through and implemented in some form – this included reducing variation in same day emergency care (SDEC), acute frailty service provision, and in-patient care / length of stay, as well as virtual wards, single point of access, and acute respiratory infection (ARI) hubs.

From a sub-regional perspective, several entities were in place to respond to the additional challenges brought on by the winter season. The Tees Valley Local Accident & Emergency Delivery Board (LADB), System Control Centres (SCC), and the Incident Command Co-ordination Centre (ICCC) – Tees Valley (established as a result of COVID-19 and maintained to ensure connectivity between partners) were all highlighted. Specific attention was drawn to the LADB which was supported in monitoring key performance metrics via the development of an urgent and emergency care (UEC) highlight report – this pulled data from each partner along with supplementary narrative to determine key risks for discussion within the meeting. Robust data helped make good, informed decisions, and the LADB had access to real-time information.

Further detail on the process behind planning for the winter period was relayed, a key element of which was the development of a system resilience template (building in Key Lines of Enquiries (KLOEs)) to identify risks. A red / amber / green (RAG) rating was then given based on perceived risk, with the amber elements (in plans, but risks associated with delivery) highlighted in greater depth (note: there were no KLOEs marked red (no evidence of existing implementation or in system plans)). For each priority area listed, a clear Action Plan lay behind it and the overarching risk register was routinely monitored.

A  ...  view the full minutes text for item TVH27/23

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

The next formal meeting was scheduled for 15 March 2024, with intended items including both the Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) and North East Ambulance Service NHS Foundation Trust (NEAS) Quality Accounts, as well as developments around palliative and end-of-life care.

Regarding the ‘To be scheduled’ section, Members requested that TEWV be approached in relation to the previously suggested briefing on the use of physical restraint / intervention – it was proposed that an informal (remote) session be arranged which should take place prior to the next formal Committee meeting in March 2024.

AGREED that:

1)    the Committee’s work programme for 2023-2024 be noted.

2)    Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) be contacted regarding the scheduling of an informal (remote) session in relation to the Trust’s use of physical restraint / intervention (to take place before the next formal Committee meeting in March 2024).