To approve as a correct record the minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on 13 October 2015.

The Minutes of the Health and Wellbeing Overview and Scrutiny Committee, held on 13 October 2015, were approved as a correct record.

Councillor Halden requested that a minute item on Urgent Business is changed to the following:

Councillor Halden voiced concerns stating that if Dr Deshpande, Mandy Ansell and Ian Wake had expressed a lack of confidence in the report, and if they were concerned how would other members be expected to have any confidence. The proposed change in service would not improve the cancer patient pathways he would support the Chair’s recommendation to refuse.

The Committee agreed to this change.

To receive additional items that the Chair is of the opinion should be considered as a matter of urgency, in accordance with Section 100B (4) (b) of the Local Government Act 1972.

There were no items of urgent business.

There were no declarations of interest.

This item is reserved to discuss any issues raised by the HealthWatch co-opted member or designated representative.

Kim James, the HealthWatch co-opted member, raised two items for the Committee’s attention.

Learning Disability Health Checks

This will be covered in Agenda Item 6.

Domiciliary Care

Concerns how fragile Domiciliary Care is in Thurrock and to ensure that HealthWatch work together with Adult Social Services for a resolution.

Roger Harris updated the Committee that this was the biggest risk being faced at the moment and that Adult Social Care was working very closely with two providers. Swift intervention with one provider resulted in packages of care back in house over the last couple of weeks another provider having given six months’ notice.

The Chair asked the Officer that the Committee could be reassured that there had been no loss of service.

The Officer confirmed that no absolute guarantee could be given, as the next couple of weeks will be difficult with staff working on the packages of care that are now back in house.

Councillor B. Rice would like to put on record for this Committee her thanks to the Adult Social Care team who have continued to work hard and commitment to ensure the service is covered.

Councillor Gupta asked the Officer how many people are affected by the packages of care coming back in house. The Officer confirmed that 80 packages of care had been brought back in house from the first provider and that approximately 250-300 packages of care from the second provider. A total amount of packages of care in the borough is approximately 500-600.

Councillor Halden commented that a working group may be appropriate to look at reconfiguring the service and that this may result in some policy changes.

The Chair asked the Officer to bring this item back to the Health Overview & Scrutiny Committee (HOSC) in January. The Officer confirmed that the service would need to be redesigned and remodelled with a substantial consultation period. The Officer stated that to ensure this was carried out appropriately he asked the Chair for some time to get this right before presenting the report. The Chair agreed to have this report back to HOSC when ready.

RESOLVED:

That the report on Domiciliary Care be brought back to the Health Overview and Scrutiny Committee when an update is available.

The Officer presented the report that provided Members with the details of the current arrangements in respect of the enhanced service agreement with General Practitioner (GP) practices in Thurrock. The report highlighted the issues and delivery in respect of this agreement and an action plan to improve the delivery and uptake of the service.

Last year’s figures show the uptake in Thurrock is unacceptably poor with only 17 per cent of possible Learning Disability checks carried out and completed in line with the Enhanced Service in 2014/15.

The report also detailed the current state of play in respect of the update and delivery of the Enhanced Service in Thurrock.

Data is also provided in the report which identified the current state of play in respect of the levels of activity which is extracted from GP systems.

Councillor Halden asked how practices who demonstrated a nought per cent in 2013/14 year can be given the opportunity to do the same in 2014/15. Councillor Halden also stated that surely surgeries would be in breach of contract for not undertaking what they signed up to do.

Councillor Key asked NHS England what the reasons were for surgeries not meeting targets and what the plan was to get the 100 per cent uptake. Alastair McIntyre stated that there were a number of reasons but mainly that the enhanced service checks were not the highest priority. To get a 100 per cent uptake was a very tough ask and that further discussions between NHS England and CCG would take place to address this.

Councillor Gupta asked for clarification on where do patients go of the surgeries that declined to take up the offer of the Enhanced Service. Mandy Ansell confirmed that these patients are referred to a separate provider that offers this Enhanced Service.

Councillor Gupta asked how many residents had undergone the enhance service checks. It was confirmed that data was not to hand for this quarter.

Ian Wake compared the figures for Thurrock with Southend and Rochford where a much greater level of health check coverage had been achieved.  He stated that he found it hard to believe that demand for Learning Disability Health Checks from people in Thurrock would be significantly lower, and suggested that this was therefore a problem with the current providers.

Kim James said that HealthWatch had been working on this for nearly seven years with no results or answers. Kim stated that the same conversations were being held and the same answers being given but nothing is being delivered. NHS England were failing the residents of Thurrock and solutions were urgently needed. Kim commented that groups in the community had written to NHS England but had not received any responses.

The Chair agreed with comments raised by Members and Officers and stated that with the practices in place, surgeries should be saying no when there is no intention of them carrying the Enhanced Services.

Roger Harris stated that he applauded those that had declined to take up the  ...  view the full minutes text for item 26.

Mandy Ansell (Acting) Interim Accountable Officer from the Thurrock NHS Clinical Commissioning Group, presented the Members with a summary of the key issues with regards to Primary Care and provided an overview of the steps being taken to address the primary care provision in Tilbury.

Mandy stated that from 30 November 2015 following the closure of the South Essex Emergency Doctors Service (SEEDS), Integrated Care 24 (IC24) will now be providing out of hours service from 1 December 2015. This service will be available at the same location of the Thurrock Community Hospital.

A discussion took place between Members and Officers on the Thursday afternoon closure of some GP surgeries. NHS England confirmed and expected all surgeries to open Thursday afternoons and that IC24 were not contracted to pick up any cover. Alastair McIntyre stated that the expectation was for all practices to open Thursday afternoons and will enforce this.

Councillor Halden commented that the report provided a vague commitment and that the committee was expecting something more coherent. Councillor Halden had concerns that there was not a long term vision.

Councillor B. Rice commented that there was a firm commitment to the change of surgeries in Tilbury and to plan ahead to improve the primary care in Thurrock. Councillor B. Rice thanked Ian Wake for all the analysis work undertaken to get the project to this stage and that future plans were required to move this project forward.

Councillor B. Rice welcomed the SEEDS plan apart from the surgeries still not opening on a Thursday afternoon and that residents welcomed that the location had not changed.

An update on the Locality Based Primary Care Weekend Hubs was given by Mandy Ansell that hubs were up and running and extra capacity was provided if Saturday mornings were fully booked. The Sunday service is proving less popular in some locations but it is very popular in Tilbury. A new IT platform will provide the option for directly bookable appointments and provide the service for patients that can be seen between 4-8 hours without the need to go to A&E from the end of January 2016.

An update on the recruitment of GPs in Thurrock was discussed and the fact that Thurrock has one of the worse levels of under-doctoring which potentially leads to chronic problems.

Councillor Halden stated that the report presented was principally focused on Tilbury and asked the Officer why there was no reference to other wards. Councillor Halden also voiced concern that this report was due to focus on the whole of Thurrock and not specific areas as minuted on the 23 July 2015. Mandy Ansell stated that the report concentrated on Tilbury and Purfleet due to the high needs and the regeneration projects that were on-going in these areas.

Alastair McIntyre commented that the recruitment of GPs was generally difficult not just in Thurrock.

Mandy Ansell confirmed that the four weekend hubs were working well and were being well publicised to residents of Thurrock. An article  ...  view the full minutes text for item 27.

Mandy Ansell (Acting) Interim Accountable Officer of NHS Thurrock Clinical Commissioning Group presenting the report to Members which set out the outcomes of the work undertaken by Boston Consulting Group between 29 September 2015 and 2 November 2015. There were 40 stakeholders including patient representatives that were involved with the outcome of what the Essex Success Regime should focus on and how to deliver this service.

The report highlighted that NHS England, Monitor and the Trust Development Agency had decided that the Essex Success Regime will focus on Mid Essex and South Essex including the two unitary authorities of Southend and Thurrock.

The process to recruit an Essex Programme Director was unsuccessful and therefore a Chair, David Fish, had been appointed instead to lead the work.

Roger Harris stated that he had concerns on the focus of the report and that when fundamental problems were not tackled the same problems will come back.

All members agreed that there was no definition on what success looks like and when we will know. Mandy Ansell confirmed that further work with stakeholders was in hand with a further briefing scheduled for Friday 4 December.

The Chair asked Mandy Ansell why it is such a big project. Mandy Ansell stated that she could not comment but Thurrock Clinical Commissioning Group had a very clear vision for primary care and confirmed that the four Clinical Commissioning Groups had plans to meet next week for the first time to look at this challenging piece of work.

Councillor B. Rice commented that the report seemed to be very complex where nobody seemed to understand what it meant.

The Chair agreed with Members that the report contained nothing new and that money was being spent on a project that no-one seemed to understand.

The Chair stated that the recommendation should be rewording to remove the words “the progress so far of”. All members agreed to this change.

RESOLVED

1.         That the Health & Wellbeing Overview & Scrutiny Committee note the Essex Success Regime.

2.         That the report on Essex Success Regime should not be brought back to the Committee until there is further substantial information for the Committee to note.

Mandy Ansell and Alastair McIntyre left the committee room at 20.45.

Roger Harris, Director of Adults, Health and Commissioning presented the report to Members which provided an update on how adult social care is performing in delivering key priorities and the progress which has been made on the actions highlighted in the 2014 Local Account.

The report included examples of the achievements and positive progress made over the last 12 months against the 10 key priorities and also included examples of the things that need more work to be done on with the priorities for the next year.

The report also contained a summary of Thurrock’s performance on the performance indicators in the national adult social care outcomes framework.

Councillor Key thanked the Officer for the report and stated that the content of the report was a credit to Councillor B. Rice, Roger Harris, Ian Wake and the adult social care team for the work carried out.

Councillor Halden commented on the positive outcomes of the Mental Health Strategy and asked if this should be an item on the Health Overview & Scrutiny work programme. The Officer confirmed that this item was discussed at the Health & Wellbeing Board where a lot of work had already been carried out in consultation with Mental Health Groups. Discussions will take place between the Chair and Vice Chair to establish which scrutiny committee this should fall in.

Councillor Gupta referred to the Committee to the Carers Strategy and asked for clarification on assessments. The Officer confirmed that due to the changes of the Care Act has now put carers on an equal legal footing as services users as they now have right to an assessment. The Officer confirmed that CARIADS (Carers Advice and Information Service) had been operating for over a year on behalf of the Council to give the support and advice to carers.

Councillor B. Rice thanked the Members for their kind words and personally thanked Roger Harris, Ian Wake and their team’s efforts and commitment.

The Chair agreed with the Members comments and personally thanked the team for their enormous efforts in supporting the residents of Thurrock.

RESOLVED

That the Health and Wellbeing Overview and Scrutiny Committee consider and note the report.

The Chair and Members agreed that the following items be added to the work programme:

·         That an update on Learning Disability Health Checks be included on the work programme for February 2016.

·         That an update on Primary Care be included on the work programme for March 2016.

Members were in agreement with the proposed changes to the work programme, following which the Chair requested that an updated work programme be circulated to the Committee and Officers following the meeting.

RESOLVED

That the work programme be noted subject to the amendment details above.