Agenda and minutes

Apologies were received from Councillor Sylvester and Councillor Allen.  Councillor Shabbir was in attendance as substitute for Councillor Sylvester.

There were no declarations of interest or whipping declarations.

The minutes of the meeting held on 25 March 2014 were approved as an accurate record.

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 Associate Director of Performance Delivery, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) introduced the report which provided the Commission with information on proposals for the provision of the Community Personality Disorder Service and the current position regarding the service. It further provided Members with the consultation paper and information regarding Borderline Personality Disorder, Complex Cases Services and Lifeworks.

Observations and questions were raised and discussed including:

·         The representative from HealthWatch noted that Lifeworks would continue in Cambridge and wanted to know if this would draw money away from the county and Peterborough. The Associate Director of Performance Delivery responded that there had been a choice whether or not to keep a specialist personality disorder service and there was a commitment to keep this going.  The arrangement to continue Lifeworks in Cambridge would not affect the proposals.

·         Members referred to pages 20 to 34 of the report and the Impact of the Proposed Changes and asked for further context regarding the scale of the personality disorder issues in the City. Members were informed that Borderline Personality Disorder affected roughly 1% of the population and was the one which was most common. There would be roughly 55 people in Peterborough accessing the service. Distribution of resources had been based on population figures.  Community locality teams would continue to work with people.

·         Members noted that the timescales following outcomes of the consultation were to be confirmed and were concerned that there was no deadline. Members asked if there was further detail on the timescales. Members were advised that the outcomes would be presented to the Clinical Commissioning Group (CCG) Board meeting on 30 September. Responses would be collated shortly and the formal decision would be made by the CCG in conjunction with CPFT on 30 September.

·         Members noted under Lifeworks that the redesign of Complex Case Services (CCS) aimed to increase the capacity from an approximate caseload of 70 service users to about 240. Members wanted to know if this was because there had been an increase in cases or if it was part of a developing plan to focus more on people who were of higher risk. The Associate Director of Performance Delivery stated there was no increase in the prevalence, but it was about trying to provide a specialist service to a greater number of people. Previously there had been a small group of people receiving intensive long-term help. The new system represented a more expanded system based on a greater evidence base.

·         Members wanted to know if all partners were working closely in partnership with the CPFT to help develop and take this proposal forward. Members were informed that the CCG and the GP mental health leads had been involved in developing the process.  The consultation had gone out widely to many stakeholders such as A&E, Police, Probation and others who came into contact with service users. A project group was being established to develop proposals to further develop the service enhancing the support post-discharge in order to  ...  view the full minutes text for item 5.

The report was introduced by the Director of Corporate Affairs. At the time of publication of the agenda the outcome of the consultation had not been published.  A link to the End of Consultation Report which had recently been published on the Cambridgeshire and Peterborough Clinical Commissioning Groups website since the publication of the agenda had been sent to the Members of the Commission prior to the meeting.  The Director of Corporate Affairs went through the highlights of the report which covered a thematic analysis of the views of the public and organisations responding to the consultation and the CCG’s recommended responses to these themes.

Key Themes highlighted were:

• More joined up care: organising care around the patient.
• Better planning and Communication: delivering ‘seamless’ care.
• Bidders should be required to demonstrate how mental health would be integrated through the service.
• Security of data should be protected through a ‘single electronic record system’ adhering to statutory data protection standards.
• Proposals for joint working with voluntary sector organisations would need to be taken into consideration regarding bidders.
• There would need to be a focus on prevention in order to support older people to stay independent.
• Services should need to support people by working together to give effective co-ordination and continuity of care.
• Improved community services:  reducing emergency hospital admissions, re-admissions and long stays in hospital.
• End of Life Care
• Local issues should be taken into account, including equality of access to services and resourcing.
• Bidders should demonstrate how they intend to work with and support primary care.
• There should be clarity in contracts with regards to scope of lead provider services.
• Outcomes Framework: The CCG should review its capacity and capability to ensure the new contract is managed effectively.
• The CCG would need to work with all partners in the local health and social care system.
• Evaluation criteria should be applied in order to analyse the credibility of financial aspects of proposals.
• Performance should be evaluated and made available to increase staff satisfaction.
• Standard NHS contract clauses relating to poor performance should be used effectively, and compensation clauses should be included in the event of termination.
• All steps should be taken to ensure a safe and efficient transition, including certainty for the transfer of staff.

Observations and questions were raised and discussed including:

·         Members stated that the biggest issue for Peterborough was the Better Care Fund and asked if funding would still be available for this.  The Director of Corporate Affairs stated that the expectation was that this would continue but discussions were still ongoing.

ACTION AGREED

1.    The Commission noted the report and the End of Consultation report on the Proposals to improve older people’s healthcare and adult community services and requested that the Director of Corporate Affairs and the preferred bidder when chosen report to the Commission at the November meeting.

2.    The Commission agreed to the continuation of the Joint Working Group to comment on how bidders take on proposals and look at future scrutiny during mobilisation and transition.  ...  view the full minutes text for item 6.

The Acting Chief Executive presented the report which provided the Commission with an overview of the outcome of the Care Quality Commission Inspection of Peterborough and Stamford Hospitals NHS Foundation Trust that was undertaken in March 2014. The CQC had released its report on the Trust’s inspection on 16 May 2014 which had highlighted that the Trust ‘requires improvement’ however many of the individual scores were higher and there were no immediate actions that needed to be taken.  Members were informed that the inspection regime was a new regime and the inspection focused on five questions across a range of services:

·         Are services safe?

·         Are they effective?

·         Are they caring?

·         Are they well-led?

·         Are they responsive to patients’ needs?

The Acting Chief Executive also gave a presentation on actions being taken which is attached at Appendix 1.

Observations and questions were raised and discussed including:

·         Members commented that they were pleased with the report overall.

·         Members asked what the reduction in falls of 4% meant as the figure expressed as a percentage was unclear.  The Acting Chief Executive informed Members that 4% was a reduction in the falls since last year but was unsure of the absolute figure.  A lot of hard work went into reducing the number of falls and there had been a noticeable reduction of falls with significant harm. There were many vulnerable patients in a hospital environment who fall and it was difficult to significantly reduce falls.

·         Members asked why recommendations were all “should do” rather than “must do” and expressed concern that phrasing the recommendations in this way would be less likely to restore public confidence. The Acting Chief Executive stated that this was the wording used by the CQC because the findings of the inspection did not require immediate action and reflected time scales rather than priority.

·         Members asked if the new paediatric area would compromise the four-hour target in A&E. Members were informed that the four-hour target was already difficult to meet. However it was hoped that the paediatric area would not affect waiting times and the dedicated space was necessary.

·         Members asked if plans were in place to address the issues highlighted in the inspection prior to the inspection. The Acting Chief Executive stated that there were already plans in place to address all of the issues but the inspection had focused the need to get things done and timelines had therefore been re-evaluated.

·         Members asked if the report had had a detrimental effect on the morale of the staff. The Acting Chief Executive stated that there had been some disappointment expressed however there had been extensive communication to all staff.

·         Members asked if it were possible to visit the hospital to see evidence of the actions being taken.  Members were advised that this would be possible and could be arranged.

·         Members asked what would happen if a patient were admitted to A & E and then needed to go onto a specific ward but there were no available beds. The Acting  ...  view the full minutes text for item 7.

The Director for Communities who is also Chair of the Health and Wellbeing Programme Board introduced the report. The report provided the Commission with an opportunity to comment on the feedback letter received from the Peer Review of the Health and Wellbeing Board and the development of a draft action plan following the review. The Health and Wellbeing Board commissioned the Peer Review in March 2014 the purpose of which was to help identify where the Board was doing well and where it needed to improve.  One of the key areas identified was that there needed to be stronger involvement by scrutiny with the Health and Wellbeing Board to ensure the Board was carrying out its statutory functions.

Observations and questions were raised and discussed including:

·         Members commented that the remit for the Commission was wide and various organisations and stakeholders requested to attend the Commission.  There would need to be consideration as to how the Commission could effectively scrutinise the work of the Board within such a limited time frame at meetings and workload of the Commission. The Director for Communities responded that the Peer Review required Scrutiny to ensure that the Board focused on the greatest needs in Peterborough which had been identified through the Joint Strategic Needs Analysis.

·         Members asked why all the RAG ratings were green. The Director for Communities said that this was a draft action plan and the RAG ratings had not been completed and therefore should not be considered, what was relevant was the text.

·         Members noted that the actions listed in the action plan did not have deadline dates. The Director for Communities advised that the Programme Board would be agreeing upon deadline dates and this would be submitted to the Commission.

ACTION

The Commission noted the report.

The Senior Governance Officer introduced the report which provided the Committee with a review of the work undertaken by the Committee during 2013/14 and the opportunity to approve the draft work programme for 2014/15.

The Director of Corporate Affairs, CCG informed the Commission that the Preferred Bidder would not be selected until 30 September and requested that the Preferred Bidder attend Scrutiny in November.  The Commission agreed to this request.

ACTIONS AGREED

The Committee noted the report and approved the draft Work Programme for 2014/15.

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.

Wednesday 10 September 2014

10^th September 2014.