Council and democracy

To approve as a correct record the minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on 15 September 2016.

The Minutes of the Health and Wellbeing Overview and Scrutiny Committee held on the 15 September 2016 were approved as a correct record.

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.

No interests were declared.

In Kim James’s absence no items were raised by HealthWatch.

Wendy Smith the Interim Communications Lead, Mid and South Essex Success Regime for NHS England presented the report which informed Members of the considerable amount of the work that had been undertaken since this item was raised at the 9 June 2016, Health and Wellbeing Overview and Scrutiny Committee which included:

•           Developed localities where General Practitioners (GPs) services, community, mental health, social care and other public services worked closer together.

•           Thurrock Clinical Commissioning Groups (CCG) led on the development of the new model of care for frailty looking after older and frail people in the community.

•           Working groups looking at emergency and acute care, surgery, women and children services.

Wendy Smith stated that the work currently being undertaken on the mid and south Essex Success Regime had tended to be the main focus which was attracting the most attention, although not necessarily the most important. Any potential changes in the hospitals would require detailed public consultations and a particular National Health Service (NHS) process would need to be followed.

A group of around 70-80 doctors and nurses from across the three hospitals involved had come up with their thoughts on a single Specialised Emergency Hospital. All three sites would have accident and emergency care and also separate out the planned operations from emergency care which would give an opportunity to use the capacity at the specialised hospital to develop a centre of excellence. Wendy Smith stated that discussions and workshops had taken place supported by Thurrock Healthwatch.

It had been anticipated that a business case would have been ready for national assurance at this point but Wendy Smith stated that agreement had been sought to extend the period for developing the business care for further engagement. The Options Appraisal Process had been extended until early February 2017 with the Business Case being ready by the beginning of March 2017.

Councillor Watkins thanked Wendy Smith for the report but asked what the timescales were for pushing this work forward to ensure that the level of general practitioners was as it should be in Thurrock. Wendy Smith stated that it was difficult to put a detailed timescale to this as this was still a developing process but stated that the further engagement required would not put a halt to any of the work already undertaken on the primary care services in Thurrock.

Councillor Watkins asked for assurance that the engagement and consultation process should include those elderly residents that could not necessarily travel to the proposed hospital destinations. Wendy Smith stated that from the 20 workshops held travel distances was one of the biggest topic discussed.

The Chair and Members agreed that a Success Regime Update be added to the work programme.

The Chair asked for assurance for residents who had concerns on the quality and capacity of the ambulance services. Wendy Smith stated that this information would form part of further discussion and consultation documents but there were downsides which included the consideration of carers and families of  ...  view the full minutes text for item 28.

Kay Goodacre, Corporate Finance Officer, presented the report that summarised the main changes to the Medium Term Financial Strategy for the period 2017/18 through to 2019/20 and the governance structure for the Council Spending Review and Transformation Programme, including the budget planning table enabling agreement of the budget in February 2017.

The report updated the committee on the proposals currently being considered and how this would affect budgets with the assumption that an increase of 3.99 per cent be made to the council tax each year, which included the 2 per cent adult social care precept.

The Officer briefed members on the strategy to close the budget gap which had been set out in the Medium Term Financial Strategy and would focus on 3 key areas:

•           Income generation – increases to the Council’s commercial trading base.

•           Achieving more/same for less – further transformational projects and contract reviews.

•           Demand management/early intervention – example given included the Area Co-ordinators and Community Hubs.

Roger Harris informed Members the specifically items that related to the position in adult social care which had recently attracted some national media coverage and highlighted the problems such as the increase in costs and demand. Roger Harris briefly covered the range of pressures facing the adult social care budget but stated that the numbers into adult social care had stabilised but the unit costs had increased due to complex health needs.

The measures put in place to control the costs and manage the demand where covered by Roger Harris but stated that the position going forward that the social care sector across the board are facing a difficult budget position next year and briefed Members on the short, medium and long term solutions.

Councillor Fish asked what the impact of the savings would be on those individuals on a care plan. Roger Harris stated that each individual care plan would need to be drilled down to establish any savings that could be made as placement circumstances may change. Any changes to a care plan would be driven by the individual care needs which would be the statutory duty of the council as care needs do change.

Councillor Fish asked if the service re-design was being done in co-production. Roger Harris stated that yes this was and was looking at successful models such as the Thurrock Lifestyle Solutions which had been done using the co-production method.

Councillor Fish asked would only those people with critical needs receive the funded packages. Roger Harris stated that there was now a national eligible criteria and would still be based on an individual’s care needs.

The Chair asked how the reassessment process was being undertaken and to ensure that individuals were getting the care required rather than making individuals more anxious with unnecessary checks. Roger Harris stated that these checks would be undertaken on a one to one basis based on individual needs and as part of an annual review.

Councillor Collins asked Officers to explain Micro Enterprise. Roger Harris stated  ...  view the full minutes text for item 29.

Members requested at the 9 June 2016, Health and Wellbeing Overview and Scrutiny Committee, that this report be brought back for further update.

Funmi Worrell, Public Health Registrar, presented the report and thoroughly explained to Members that this report had been produced as part of the core Public Health offer to the National Health Service (NHS) Thurrock Clinical Commissioning Group (CCG) and that the report and action plan considered all elements of the cancer care pathway, from prevention, screening and the referral process through to diagnosis, treatment and survival.

Funmi Worrell referred Members to the Cancer Action Implementation Plan which identified past and future actions made by the Thurrock Cancer Action Implementation Group.

The Chair thanked Funmi Worrell for the detailed report.

Councillor Watkins asked whether the screening services could be incorporated into secondary school activities to ensure that younger children are educated from an early age and possibly offering these screening services at events such as football matches or local promotion events to capture those patients that may be afraid or scared to have check-ups and may feel more comfortable in larger numbers to ask for information. Funmi Worrell stated that the most appropriate health actions would be taken and that not all services would be age appropriate. The aim would be to target audiences using campaigns and national promotions and informed Members that the Bowel Cancer campaign will be launched in January 2017.

Councillor Watkins asked what improvements had been made from the statistics provided. Funmi Worrell stated that the 2 week indicator of patient’s referral with suspected cancer and that the one year survival rates year had improved.

Councillor Fish stated that only 11 out of the 32 practice populations achieved the minimum 70 per cent coverage was a concern and asked Officers what concrete outcomes would be taken forward. Funmi Worrell stated that details of those practices performing poorly were available and targeted on how they could be improved. This item was also discussed at the Clinical Effectiveness Group.

Councillor Snell asked what was being done to identify those patients that missed appointments. Funmi Worrell stated that there was a system in place which contacted patients who had missed appointments to try and arrange another or the general practitioner would make contact to find out if there was an underlying problem with the patient not attending.

Councillor Sheridan asked Officers if anything could be done to educating residents to the dangers of using sun beds. Funmi Worrell commented that this was a big issue and that discussions between Public Health and Trading Standards had taken place.

Councillor Sheridan asked whether a “mole” chart could be made available especially in locker rooms in schools and gym changing rooms. Funmi Worrell stated that there was already a national campaign focussing on skin cancer in your people.

Councillor Collins asked Officers how the various lengths of time that survival rates were calculated.  Funmi Worrell stated information was available for 1 and 5 year cancer survival rates and that we  ...  view the full minutes text for item 30.

Roger Harris, Corporate Director of Adults, Housing and Health, presented the report that provided Members with an update on the current local domiciliary care situation and the effects that the current difficulties had on the service delivery in Thurrock. Roger Harris stated that the situation was extremely serious in Thurrock for the main three reasons:

1.         Recruitment of carers into domiciliary care roles.

2.         Rates paid by the Council to providers.

3.         The quality of some providers in Thurrock was quite poor.

The report detailed the new direction of travel to support people at home and how this new approach would be an integral part of the second phase of Building Positive Futures, Living Well in Thurrock. It provided Members with an update on the progression of the Living Well at Home Project and how the current crisis had impacted on the delivery and implementation of the pilot.

Roger Harris highlighted the delays in the service, the waiting lists and the number of missed calls which were being addressed and monitored through the weekly improvement meetings.

Roger Harris stated that there was no immediate resolution that the situation would be fixed.

The Chair thanked Roger Harris for his honesty and asked if he could give Members his 100 per cent assurance that Thurrock residents that were currently looked after that they were safe and satisfied with the service.

Roger Harris stated that he could not give 100 per cent reassurance that the service currently provided was fully or delivering the quality expected. Individual care packages would be looked at on a one to one basis and rated using Red Amber Green (RAG). Roger Harris’s concern was that the service was not sustainable and that long term solutions were required.

RESOLVED

1.         That the Health and Wellbeing Overview and Scrutiny Committee note the current situation as regards to domiciliary care in Thurrock and the measures being taken by the department to stabilise the situation.

2.         That the Health and Wellbeing Overview and Scrutiny Committee agree the future redesign of the service model to support people to live well at home.

3.         That the item be added to the work programme for 17 January 2017.

Ian Wake, Director of Public Health, presented the Thurrock Annual Public Health Report to Members that focused on the sustainability of Thurrock’s Health, Wellbeing and Social Care system with particular focus on the long term conditions management.

An Executive Summary was being prepared and would be presented at Cabinet and Full Council.

Ian Wake stated that it was a statutory duty to produce this independent report on the state of the health and population of the people that Thurrock Council serve.

Ian Wake and his team decided on a topic of relevance to Members and the presentation picked up on the key issues and challenges of how the Council could make the adult and social care system financially and operationally sustainable.

The main key issues were:

•           Key Health Challenges – The Demographic Time Bomb

•           Whole Systems Approach Needed

•           The Financial Opportunity

•           How Thurrock was Under-Doctored

•           GP Practices – Long Term Health Conditions

•           Finding the Missing Thousands

•           Emergency Hospital Admissions

•           Adult Social Care

•           Hospital Admissions

•           Key Recommendations

The Chair thanked Ian Wake for the fascinating report and for condensing all that information into the presentation. Thanks were also given to Ian’s team for all their hard work.

At 9.15pm the Chair moved a motion to allow the meeting to continue beyond the 2 ½ hour time limit so that all members’ questions are heard. All members agreed to finish by 9.45pm.

Councillor Sheridan thanked Ian Wake for a really good, simplified and interesting report.

Councillor Fish asked whether the pressure could be taken off general practitioners if people took more responsibility for their own health. Ian Wake stated absolutely yes and that a poor diet and lack of exercise was a key risk factor for high blood pressure. The issue Ian Wake had was how to persuade people to do this. Changes to the environment and regeneration plans could be addressed.

Councillor Watkins thanked Ian Wake for an excellent report and asked whether the 999 service would be addressed as to how a caller’s request for an ambulance was being treated and rated. Ian Wake stated that the 30 per cent figure was an outrage but compared to other council statistics of 40 per cent, it appeared Thurrock were less likely to abuse the ambulance service.

There were certain cohorts that abused the ambulance service and wasted tax payer’s money.

Councillor Watkins stated that it was essential that Basildon and Brentwood Councils worked collectively with Thurrock.

Councillor Watkins asked if the 101 Service could provide an assistance and help facility to those unsure if an ambulance would be required or not. Ian Wake agreed that this would be a good idea, but due to the demand for the service and how people’s perceptive of what services they are entitled to had changed over the years.

Councillor Collins referred to the Diabetics Type 2 figures and asked how residents of Thurrock could be encouraged to exercise more. Ian Wake stated that companies  ...  view the full minutes text for item 32.

The Chair asked Members if there were any items to be added or discussed for the work programme for the remainder of the municipal year.

RESOLVED

1.        It was noted that the item Success Regime be added to the work programme for 15 March 2017 committee.

2.         It was noted that the item Domiciliary Care be added to the work programme for 17 January 2017 committee.

3.        It was noted that the item Cancer Deep Dive be added to the work programme for 15 March 2017 committee.