Agenda and minutes

Apologies for absence were received from Councillor Allen and Councillor Peach attended as substitute.

There were no declarations of interest or whipping declarations.

The minutes of the meeting held on 19 September 2013 were approved as an accurate record with the exception of the following which was noted.  David Whiles, Healthwatch representative advised that both he and Matthew Purcell, Youth Council Representative were present at the meeting on 19 September but this had not been recorded.

The decision notice for each decision will bear the date on which it is published and will specify that the decision may then be implemented on the expiry of 3 working days after the publication of the decision (not including the date of publication), unless a request for call-in of the decision is received from any two Members of a Scrutiny Committee or Scrutiny Commissions..  If a request for call-in of a decision is received, implementation of the decision remains suspended for consideration by the relevant Scrutiny Committee or Commission.

There were no requests for Call-in to consider.

The report provided the Commission with an update on the Clinical Commissioning Groups response to the 2013 France Report.  The Director – Quality, Safety & Patient Experience / Nurse and Member of the CCG Board introduced the report.  The Francis report was published on 6 February 2013 following a public enquiry into complete failures of care at the Mid Staffordshire NHS Foundation Trust.  The Director informed the Commission of what actions the Clinical Commissioning Group had undertaken in response to the Francis report.

Observations and questions were raised and discussed including:

·         Were there lessons that could be learnt more widely regarding the commissioning of services from other providers and if so how are the CCG addressing them?  Members were informed that there were lessons to be learnt and in particular to nurse staffing levels.  It was anticipated that the government response expected during the autumn would provide guidance on this.

·         Members sought clarification on how soft intelligence for GP’s would be provided and how it would work.  Members were advised that GP’s had a lot of knowledge as they saw patients on a daily basis and they could feed back to other providers the patient experience of the care delivered from their Trust.  Patients quite often did not want to make a complaint or make a fuss about the care they had been given.   Without the hard evidence of a complaint it was difficult for the Trust to take any action.  In the absence of a complaint the GP could anonymise the information received from the patient and send it to the CCG.  The CCG would then theme the information received and would then be able to see if there were any emerging issues that needed to be reported to a provider.

·         Was the soft intelligence gathered through conversations with patients or through questionnaires and surveys?  Members were advised that soft intelligence was gathered through general conversation   with patients   and patent surveys regarding patient experience that were available through GP Practices and the Trust.  If something was noted during a general conversation with a patient the doctor would email the CCG who would then record it on a general database.

·         Is the type of nursing required being taken into consideration when the profiling of staff takes place?   Members were informed that the type of nursing was taken into consideration within a nursing team and there would be a skill mix.  There would be a combination of qualified and unqualified nursing staff dependant on the setting and requirements e.g. the needs in an intensive care setting would be very different to the needs of other settings like mental health and community settings.

·         Was there a simple questionnaire that patients could complete when being released from hospital to indicate what their patient care had been like.  Members were advised that on discharge or just after discharge depending on the provider patients were asked if they would complete the friends and family experience score.  This was a simple tool which asked if the patient  ...  view the full minutes text for item 5.

The Assistant Director, Quality Information and Performance introduced the report which provided the Commission with a summary of performance delivery against the four priorities within the Adult Social Care Outcomes Framework.   Included in the report was an overview of progress against key projects and the current position as at the end of September 2013 (Quarter 2).  It was noted that the performance report was in a new format and that the survey related questions had been removed as these were only refreshed once a year.  An updated copy of the Performance Report was tabled at the meeting.

Observations and questions were raised and discussed including:

·         Members noted with regard to the resettlement of the residents from Greenwood House and Welland House that only just over 50% of resettled residents had en-suite facilities in their new accommodation.  Why was this?  Members were advised that this was the choice of the service user as to which home they went to and not all residential homes had en-suite facilities available.  All residents were however settled in their accommodation.

·         Members wanted to know if the resettlement of residents had gone well and according to plan.  Members were advised that there was a team manager who was overseeing the resettlement and she had informed the   Assistant Director that for some individuals it had been quite a difficult transfer and some had to move quite quickly into nursing care.  The team manager had reported that overall people were well settled in their new accommodation and had a better quality of interaction where they were now. 

·         Members referred to Priority Four: “Safeguarding adults whose circumstances make them vulnerable and protecting them from harm”.  Members noted that the table on page 15 of the report, paragraph 5.4.2 showing the percentage of safeguarding investigations completed within 20 working days had a large gap between the target of 85% and the actual number completed within 20 days which was around 50%.  Can this be explained?  Members were informed that the investigations were often complex and involved other providers for example the police who were perhaps undertaking criminal investigations. This often caused a delay.  More data was now being collected to try and understand why the investigations were taking so long and how PCC could co-ordinate this better.

·         Was there an escalation process in place to try and get the issues resolved sooner?  Members were informed that historically there had not been an escalation process in place but this was being looked at.

·         Councillor McKean thanked the Assistant Director for the new format for the performance report which was much easier to understand.

·         Members sought clarification with regard to page 18 of the report, Priority 2: “Delaying and reducing the need for care and support and the number of permanent admissions to residential care homes for older people per 100,000 of the population”.  The comparator Av. was 617.2 but the figure alongside was 327.0 and was indicated as green.  What did this mean?  Members were advised that the figure  ...  view the full minutes text for item 6.

The Assistant Director, Quality Information and Performance introduced the report which provided the Commission with the Peterborough Safeguarding Adults Board Annual Report for 2012-2013.  The report evidenced the achievements of the Safeguarding Adults Board and developments in the field of safeguarding adults.  The report was a multi-agency report.

Observations and questions were raised and discussed including:

·         Members referred to a chart detailing board members attendance at meetings over the year 2012-2013.  It was noted that there had been limited attendance from Peterborough City Council Children’s Services.  Were they expected to attend and had the attendance improved this year.  Members were informed that their attendance was expected but could not advise if the attendance had improved during the current year.

·         The print out of the report showed some yellow notes on some pages but they had not come out properly.  Members wanted to know if the information was important.   Members were directed to the web version where the information was clearer.  The yellow notes were important sound bites from the main document. 

·         Members referred to page 36 of the report, Figure 4 Source of referral.  Why had referrals by social care staff reduced year on year but referrals from Health had risen year on year?  Members were advised that the decrease in referrals from social care staff was due to them having a better understanding of the thresholds of what a safeguarding issue was and how it should be dealt with if it was not a safeguarding issue.  The increase in health referrals was positive as this indicated a wider awareness amongst health professionals around neglect.

·         Members referred to page 37 of the report, Figure 6: Location of alleged abuse and the largest amount of alleged abuse was either in care homes or in own home.  Why were these two locations the highest?  Members were advised adult abuse investigations were adults that were vulnerable generally by means of ill health or social care needs so were more likely to be in a residential home or own home.  More commentary could be provided around this.

·         Members referred to the following statement in the report: “It was identified that in comparison to the national average and our comparator authorities the number of Deprivation of Liberty Safeguard (DOL) referrals in Peterborough was low.  Of particular concern was the low number of referral requests received from the Peterborough care home providers.”  What did this mean?  Members were advised that Deprivation of Liberty Safeguard was a piece of legislation that had come out in recent years.  It was about restricting someone’s liberty/movements without seeking approval to do so first.  An assessment would take place to see if it would be in their best interests to do so.  This tended to relate to people with mental health problems in voluntary in patient units and people suffering with dementia in residential and nursing care homes.  There had been concern that compared to national figures there had been quite a low number of referrals being made. This  ...  view the full minutes text for item 7.

The Director of Public Health introduced the report which provided the Commission with an overview of progress in relation to the transfer of Public Health which transferred to the council in April 2013.  Included in the report was a performance report which reported on the public health outcomes framework priorities:

1.    Improving the wider determinants of health

2.    Health improvement

3.    Health protection

4.    Healthcare Public Health and preventing premature mortality

Also included in the report was the Public Health England Health Profile 2013 for Peterborough.

Observations and questions were raised and discussed including:

·         A discussion was held with regard to the layout of the performance report and the inclusion of comparable data and Members gave the Director of Public Health some key points of how to provide clearer information within the report.

·         Members referred to the Health Improvement Programme and key metric for the Health Checks Programme which was RAG rated as green but the arrow indicated it was reducing.  Was the RAG rating correct?   Members were advised that the Health Checks programme was doing well and Peterborough was best in region.  The arrow was incorrectly representing this and needed to be changed.

·         Members referred to the Health Protection Programme and treatment completion for tuberculosis (TB).  Why was there such a high rate of treatment completion in Peterborough against the England rate?  Members were advised that the rate of TB in Peterborough had increased by 50% over the past three years.  Work was being undertaken with the community based TB service and the hospital with the Public Health England team to look at this increase in depth.  One issue was that TB was a particular problem where people lived in close proximity for example in houses of multiple occupancy.  Health care services for TB were commissioned by the Clinical Commissioning Group.

·         The Director for Public Health informed members that one of the issues for the new Public Health team since being transferred over to the Local Authority was making sure that there was the right level of specialist capacity to deal with the serious issues in the city.  The current level was not right.

·         Members referred to the recent announcement of the proposed closure of the children’s centres.   Would this impact on the health of young children as some of the services provided from the Children’s Centres would be stopped.  Members were informed that the council had taken on additional resources to target work in particular with disadvantaged families, the Connecting Families, Troubled Families agenda. There would also be additional Health Visitors.  Other services would pick up some of the services delivered from the Children’s Centres buildings.

·         Members commented that over the years there had been various strategies put in place to reduce teenage pregnancies but they could never seem to get on top of it.  Will this situation ever change?  Members were informed that earlier in the year there had been a reduction of 20% in teenage pregnancies showing an improvement.  It should be noted that the number  ...  view the full minutes text for item 8.

The report provided the Commission with information on the publication of the Longer Lives Tool-Kit by Public Health England (PHE).  PHE had launched a new website, Longer Lives, which illustrated how premature mortality (deaths under 75) varied between local authorities in England. The four most common causes of premature deaths in England were heart disease and stroke, lung disease, liver disease, and cancer.   The report provided a focus on mortality and life expectancy data for Peterborough.  Peterborough had been identified as significantly worse in England with regard to premature deaths caused by heart disease and stroke and lung disease.  These two areas had therefore been focused on for areas of action going forward.

Observations and questions were raised and discussed including:

·         How do you know that the actions that are being invested in are the right ones and the right use of resources are being used to make a difference?  Members were informed that the use of NICE guidance to show the evidence of effectiveness and economic value of interventions would be used.  It was important that where money was being spent it could be demonstrated that it was value for money and based on evidence.

·         Members noted the Directors comments with regard to the two main causes for premature deaths in Peterborough and felt that the Health and Wellbeing Board should focus on these areas.

The Chair noted that the Director of Public Health would be leaving the council and thanked her for all of her hard work around Public Health and wished her every success for the future.

RECOMMENDATION

The Commission recommend that the Health and Wellbeing Board focus on reducing premature deaths which have been caused by heart disease and stroke and lung disease.  

Peterborough had been identified through the Longer Lives Tool Kit as being significantly worse in England with regard to premature deaths caused by heart disease and stroke and lung disease.  The Health and Wellbeing Board to advise the Commission if any actions were being taken to reduce the impact of premature deaths due to these causes.

The Head of Commissioning, OP/PD/SI/HIV & Carers introduced the report which provided an update on the status of the draft dementia strategy and the commissioning of the dementia resource centre and the development of Peterborough into a dementia friendly city.  The strategy which was in the final stages of completion had been made simpler and more accessible to a wider range of people.  The Dementia Resource Centre had been through a procurement process and several bids had been received and the Alzheimer’s Society had been selected as the provider.  Following a formal search by Corporate Property 441 Lincoln Road, Millfield had been identified as a suitable location for the Dementia Resource Centre.  Members were informed of the following achievements with regard to establishing a dementia friendly city:

• Setting up Dementia Cafes (Rotary Club and Sue Ryder both hosting sessions from October 2013);
• Setting up a Local Dementia Action Alliance to drive the initiative forward - an independent collective made up of members that have pledged to make a difference to the lives of people with dementia;
• Engaging local business in becoming more dementia friendly and joining the local action alliance – Boots Chemists, Queensgate, Post Office, Rotary Club, Ramblers Association in the process of joining;
• Being accepted on to the Dementia Friendly Recognition programme- this allows the Local Action Alliance to award businesses that meet the dementia friendly criteria with a symbol to let the general public know they are dementia friendly;
• Supporting carers of people with dementia to review local facilities and recommending what would make them more dementia friendly

Observations and questions were raised and discussed including:

§  Where were the Dementia Cafes held?  Members were advised that the Dementia Cafes would be held in various places across the city including, Sue Ryder at Thorpe Hall and 441 Lincoln Road.  Ideally there would be cafes around the city and open every day of the week.

§  Had 441 Lincoln Road and the Cafes got adequate parking and adequate bus routes to them?  Will they be open at the time the bus routes are in operation and will the facilities be assessed for disabled access.  Members were informed that accessibility had been critical to where the Dementia Resource Centre would be located.  Opening hours would be 9.00am to 5.00pm but also evening opening and weekend opening to allow for flexibility.  The Dementia Resource Centre was on one of the main bus routes and there was a large car park on site.  All Cafes would be assessed for accessibility and parking.

§  Members suggested that the site of the extra care facility and walk in centre at Alma Road which was now up for sale should be considered.  Members were informed that this was considered to be a brown field site and Enterprise had been asked to cost this up as an option for a new build.

§  Members referred to page 72 of the report and the mention of 30 Dementia Champions and wanted to know what organisations they came  ...  view the full minutes text for item 10.

The Senior Governance Officer introduced the report which provided the Committee with an update on the progress being made towards organising the Scrutiny in a Day event on 17 January 2014 which would focus on the impacts of Welfare Reform.

The following comments and suggestions were made:

·         A Member of the Committee questioned whether any of the event should be in a public session and felt it would be better in held in private.   The Senior Governance Officer advised that all Scrutiny meetings were held in public.

·         Members sought clarification that there would be representation from Adult Health and Public Health.  The Senior Governance Officer advised that there was also an Officer Working Party planning the event alongside the Member Working Party and this included an officer from Health services who was providing information for the event.  The Senior Governance Officer would ensure that Adult Health and Public Health was included.

ACTION AGREED

The Committee agreed that the Senior Governance Officer take the comments made by the Committee back to the Member Working Party for consideration.

The Commission received the latest version of the Forward Plan of  Key Decisions, containing key decisions that the Leader of the Council anticipated the Cabinet or individual Cabinet Members would make during the course of the following four months.  Members were invited to comment on the Forward Plan of Key Decisions and, where appropriate, identify any relevant areas for inclusion in the Commission’s work programme.

ACTION AGREED

The Commission noted the Forward Plan of Key Decisions

Members considered the Commission’s Work Programme for 2013/14 and discussed possible items for inclusion.

ACTION AGREED

To confirm the work programme for 2013/14 and the Senior Governance Officer to include any additional items as requested during the meeting.  Additional items to be included were:

• The Clinical Commissioning Group to include in their next report details of the current deficit.

Wednesday 22 January 2014

Wednesday 22 January 2013

The meeting began at 7.00pm and finished at 9.35pm