Agenda and minutes

The evacuation procedure was noted.

There were no interests declared.

Consideration was given to the minutes from the Committee meeting held on 15 December 2023.  Attention was drawn to the following item that was on the agenda:

·       Office for Health Improvement & Disparities - Community Water Fluoridation: Clarity was sought on what was agreed at the conclusion of this item, with some Members commenting that they were only in support of the planned consultation process, not necessarily the proposals to expand community water fluoridation in the North East of England.  Following a brief debate (which included the noting of some new related information that some Members had received from an anti-fluoride group, an entity which, according to other Members, had been previously discredited), it was agreed to amend the minutes to reflect that the Committee agreed to support the consultation process only.

AGREED that the minutes of the Committee meeting on 15 December 2023, subject to the identified amendment for the ‘Office for Health Improvement & Disparities - Community Water Fluoridation’ item be approved as a correct record.

To consider an update on the recent restructure of the North East and North Cumbria Integrated Care Board (NENC ICB).

The Committee received an update following the recent restructuring of North East and North Cumbria Integrated Care Board (NENC ICB).  Led by the NENC ICB Director of Policy, Involvement and Stakeholder Affairs, content included:

·       ICB 2.0 Organisational Restructure: A new way of working

·       Significant change

·       Executive team

·       The NENC way

·       Local Delivery Team comparison

·       Contracting and devolution of budgets

·       Networks and workstreams

·       Example - Clinical Networks and ODNs

·       Initial work - Networks and Alliances

·       Still work to do…

The Committee was informed that the NHS typically went through a period of restructure approximately every decade.  However, the formal implementation of the new national Integrated Care System (ICS) less than two years ago (mid-2022) already involved the merging of eight former Clinical Commissioning Groups (CCGs) into one regional organisation – the NENC ICB.  In addition, from the onset of these new arrangements, further responsibilities were adopted and other subsequent delegations (i.e. pharmacy / optometry and dental in April 2023) had followed, with more anticipated in relation to specialist commissioning.  Despite their relative infancy, ICBs had been instructed to reduce running costs by 30%, a task the NENC ICB was still working through (though around 100 posts had already been lost) – this exercise involved collaboration with each of the 14 Local Authority areas within the NENC footprint, reflecting the ICBs ‘place-based’ working approach.

Moving forward, several key elements would underpin ‘the NENC way’ – these included a clinically-led (multi-disciplinary) and managerially-enabled focus, a structure involving eight directorates with eight executive directors, and enabling and delivery teams (the latter seeing six teams mapped to the 14 Local Authority partners, one of which would be ‘Tees Valley’ (comprising five Local Authorities)) concentrated on the delivering the vision and constitutional standards.  Local committees mapped to each Local Authority area would continue.

Networks and workstreams were charted, with some inherited, some developing, and all at different levels of maturity.  Clinical networks were either managed by NHS England or were transitioning to the ICB.  Operational Delivery Networks (ODNs), managed within acute provider organisations but accountable to NHS England, outlined how pathways needed to work – these were listed along with the NENC clinical networks.  Regarding the latter, thematic groupings / alliances were being developed to give a better strategic view of specific health conditions.

In terms of work still to do, it was expected that the mapping of system, clinical, corporate and operational delivery networks and workstreams would conclude by April 2024, and that a set of recommendations would then be created which contributed towards a streamlined organisation (reducing duplication), ensured work was aligned to the NENC ICBs Better Health and Wellbeing for All strategy, and enabled teams to deliver in accordance with a clear Terms of Reference.  Clarity around funding and reporting mechanisms, as well as the provision of effective communication across the wider health and care system, was also envisaged.

Thanking the NENC ICB representative for the presentation, the Committee immediately drew attention to the quoted loss of 100 posts (following the request to  ...  view the full minutes text for item TVH32/23

Representatives of Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) 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 Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) were in attendance to provide their annual presentation to the Committee in relation to the organisation’s Quality Account, a document which NHS Trusts had a duty to produce each year.  The TEWV Chief Nurse, supported by the TEWV Care Group Director MHSOP / AMH and the TEWV Lived Experience Director for Durham, Tees Valley and Forensics, covered the following elements:

·       Quality Account Quality Priorities 2023/24

·       Priority 1: Care Planning

·       Priority 2: Feeling Safe

·       Priority 3: Embed the New Patient Safety Incident Response Framework (PSIRF)

·       Setting the 2024/25 Quality Priorities

·       Timeline

Agreed by the TEWV Quality Assurance Committee in May 2023, the Trust’s quality priorities for 2023-2024 were developed following discussion and review of quality data, risks and future innovations in collaboration with colleagues, patients, families and carers.  Delivering on these priorities supported the ongoing mission to ensure that safe, quality care was at the heart of all TEWV did in line with its Our Journey to Change initiative and Quality Strategy.

·       Priority 1: Care Planning: The Trust had identified several aims for completion by 31 March 2024 involving new system developments, measurable goals within care plans, the publication of new policies and procedures, and data collection / monitoring mechanisms to assess the effectiveness of clinical interventions.  Whilst it was stated that performance impact was not yet where the Trust would want it, progress during the year was then outlined, a key element of which was the delayed implementation of (and associated training on) the new CITO patient record system which went live on 5 February 2024.  Other areas noted included the continuation of region-wide work with relevant stakeholders to move away from the Care Programme Approach (CPA) (the five principles signalling how systems should start to do this were subsequently listed), the now fortnightly meeting of the Personalising Care Planning Oversight Group to provide oversight and assurance to other workstreams / groups, and the continuation of the Care Planning Co-production Group which informed TEWV from a lived experience perspective.

In related matters, six priorities for personalised care were highlighted – workforce (job descriptions), workforce (what is our offer?), data (e.g. waiting time metrics), interoperability (ICBs), managing risk and accountability, and working with partner organisations.  Regarding the latter, it was noted that TEWV was often one of a number of entities involved in an individual’s care, therefore effective links with partners (including schools) was important.  Understanding data around inequalities and how this may help identify different needs (and therefore service requirements) across various geographical areas was also emphasised.  From a wider perspective, the seven NENC ICB priorities around care planning were also outlined.

·       Priority 2: Feeling Safe: To ascertain a better understanding of why some patients did not feel safe on TEWVs wards, as well as what would help foster a greater sense of safety, the Trust engaged with individuals using its inpatient services.  Feedback on both these elements was relayed, with common themes being a lack of  ...  view the full minutes text for item TVH33/23

Representatives of North East Ambulance Service NHS Foundation Trust (NEAS) 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.

A representative of North East Ambulance Service NHS Foundation Trust (NEAS) was in attendance to provide a presentation to the Committee in relation to the organisation’s Quality Account, a document which NHS Trusts had a duty to produce each year.  The NEAS Assistant Director – Communications and Engagement (who relayed apologies from the NEAS Deputy Director of Quality and Safety (Deputy Lead Nurse)) covered the following elements:

·       Overview of quality report requirements

·       2023/24 performance (1 April – 31 December 2023)

o   Patient safety

o   Patient experience and feedback

o   999 incident volumes

o   Category 1 response performance (including benchmarking)

o   Category 2 response performance (including benchmarking)

o   Category 3 & 4 response performance (including benchmarking)

o   Hospital handover performance

·       Update 2023/24 quality priorities

Following a brief overview of the process requirements (consultation / publication) relating to the annual Quality Account (including that there was no obligation to obtain external auditor assurance this year), details were outlined on NEAS performance during the first three-quarters of 2023-2024 (April to December 2023).  Regarding patient safety, the number of recorded serious incidents (140) was significantly higher than for the whole of 2022-2023 (61), though the criteria for what constituted a ‘serious incident’ had changed to a case where the required response time had been exceeded by more than one hour (it was noted that the recording of serious incidents was not consistent across the country, so benchmarking against other Trusts was not possible).  For the ‘proportion of safety incidents per 1,000 calls’ measure, whilst the April to December 2023 figure (2.2%) was also up on the 2022-2023 data (1.8%), the final quarter for this year (January to March 2024) would likely reduce the overall rate for 2023-2024.

In terms of patient experience and feedback, it was pointed out that the top three themes for complaints (staff attitude, timeliness of response, and quality of care) also appeared as themes for appreciations / compliments that NEAS received.  Complaint numbers had been reducing since 2019-2020, and the number of appreciations for April to December 2023 (922) had already exceeded the number for the whole of 2022-2023 (812) and had surpassed the previous record (914) set in 2019-2020.

999 incident volumes between February 2023 and January 2024 (inclusive) had followed a similar trend for both the Tees Valley and Trust-wide footprint, with a broadly consistent number from March to November 2023, and a predictable increase in December 2023 and January 2024.

For the most serious ‘category 1’ incidents (cardiac / respiratory arrest), Tees Valley performance compared favourably with the data for the entire NEAS patch, with mean response times consistently below the Trust-wide average for all months from February 2023 to January 2024.  Whilst June 2023 and December 2023 saw NEAS go slightly above the average mean target response time (seven minutes) for category 1 cases, it was the only ambulance Trust in the country to be below this target in January 2024, something it was very proud of, and which reflected the significant amount of work which had  ...  view the full minutes text for item TVH34/23

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

Since this was the final meeting scheduled for the current municipal year, the Chair thanked Members for their contribution to the items which were considered during 2023-2024.  As per the established rotational arrangements, support of the Committee would pass onto Hartlepool Borough Council for the 2024-2025 municipal year.

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