To approve as a correct record the minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on the 7 September 2017.

The Minutes of the Health and Wellbeing Overview and Scrutiny Committee held on the 7 September 2017 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.

Firstly, Councillor Snell congratulated Members and Officer for the saving of the East Tilbury Medical Centre from closure. This was very pleasing news for the residents of East Tilbury.

Kim James stated that HealthWatch would like an item added to the health and wellbeing overview and scrutiny work programme to highlight the increasing concern of the lack of support for residents with personality disorders or those with challenging behaviours. That there were no specific services for them and these responsibilities were now falling to the voluntary services to support and take in the most vulnerable. Roger Harris stated that the existing services had to co-ordinate and engage better and that an overview of the services should be undertaken to see whether services were appropriate.

Councillor Collins asked how many people were affected. Kim James stated that eight homeless people regularly turned up at the Bee Hive for food and clothes vouchers and that there were about 30 people in Thurrock with personality disorders who were unable to get the services required.

Councillor Collins questioned what services were being offered. Kim James stated that there were many needs but housing being a specific problem, food vouchers, clothes, getting places in night shelters. Kim James also stated that some of these were people came from outside of the borough.

Council Snell agreed that this item should be addressed and be added to the work programme for March 2018 but to ensure that measures were put in place before that time.

Presentation will be made on the night.

At the request of Members, Tom Abell the Chief Transformation Officer, had been invited back to update Members on issues that had raised and recorded from the 3 July 2017, Health and Wellbeing Overview and Scrutiny Committee.

Tom Abell briefed Members on the Joint Executive Group and the Site Leadership Team which were now at full complement who were charged with the day to day running of Basildon Hospital through the balanced scorecard which monitored the performance of the hospital. It was clear that senior staff were now walking the wards speaking with staff and patients, to which was paramount with all directors dedicated to do this. This would help address some issues. Tom Abell briefed Members on the nine quality priorities which included:

1.         Reducing mortality and improving end of life care

2.         Safer Maternity care

3.         Sign up to safety

4.         Reducing available patient deterioration

5.         Reducing health care associated infections

6.         Reducing medication harms

7.         Improving patient experience and satisfaction

8.         Improving nutrition and hydration

9.         Mental health crisis response pathways

Tom Abell further briefed Members on the number of complaints received by category and division and stated that more could be learnt from complaints that could provide a good insight into how patient experience care at the hospital. Further promotion of staff on how to raise a complaint had commenced to try and tackle concerns or complaints. That the reflection of practices, training, supervision, and policy changes and poor communication were ongoing challenges that need to be made more consistent.

Tom Abell stated that November had been a challenging month on performance for Basildon Hospital with waiting times outside the standard 4 hour waiting time.

Tom Abell stated that a huge focus on improving cancer patient pathways and have a commitment to meet the national target by November 2017. Graphs were shown to Members that related to how Basildon Hospital measured the number of patients who had waited beyond the key milestone points, 62+ and 104+ days, on a cancer pathway. Tom Abell stated that processes were being streamlined but all patients were seen within two weeks of their referral. That transformation, communication and engagement were key areas that were hinged on having well supported staff.

Councillor Snell thanked Tom Abell for the report.

Councillor Collins questioned the fluctuation of complaints in the report. Tom Abell stated that these were seasonal with the dip in July down to the holiday season and that negative press articles seemed to result in more negative complaints.

Councillor Collins questioned whether the activity of services used by people from outside of Thurrock had increased. Tom Abell stated that this was kept under review but no significant changes at this time had been identified.

Councillor V Holloway stated that the presentation had not covered what residents want to hear and it should have been more dedicated to what investments Basildon Hospital were making, how this would affect them, staff numbers, how staff were being trained and what was being done to  ...  view the full minutes text for item 27.

Tom Abell, Managing Chief Transformation Officer, presented the report that provided members with an update on the progress of the Mid and South Essex Sustainability and Transformation Partnership (STP). That no decision had been made to go to consultation on the 29 November 2017 due to a leakage of the consultation papers. The proposal included to improve specialised hospital services by bringing them together into one place with three 24/7 accident and emergency departments. That no services would be released from Orsett Hospital until the same services were available at one of these locations. Those proposals may change once comments from the consultation have been received, these will be analysed following the 14 week consultation period.

Councillor Snell thanked Tom Abell for the report and how encouraging this report had been.

Councillor Gerrish questioned what assessments had been undertaken in the transferring of some of the outpatients from Orsett Hospital. Tom Abell stated that those services were also used by residents from Brentwood and Basildon therefore they would be moved separately to those areas.

Councillor Gerrish requested that the consultation looked at each service individually and how this would be delivered and where each service would be located. Tom Abell stated that the consultation was open to discussion and some flexibility.

Councillor Gerrish questioned where each service would be located. Tom Abell stated that accident and emergency would be Basildon Hospital; Orthopaedics should be at Broomfield and Cancer services at Southend Hospital.

Councillor Gerrish asked what consideration had been taken into account for those Thurrock residents looking to go to different hospitals for future service provisions. Tom Abell stated that shuttle services would be available to those patients and also to their relatives to ensure visiting could continue.

Councillor Snell stated that the Sustainability and Transformation Partnership would be the main item at the 18 January 2018 committee.

Councillor V Holloway questioned whether practical processes, such as transport, had been taken into account. Tom Abell stated that to ensure no further burden was put on the East of England Ambulance Service a treat and transfer service would be ran which would be manned by staff. To ensure that shuttle services were being offered at the right place and at the right times with routes being looked at.

Councillor V Holloway asked how quickly the specialist hospitals would be available. Tom Abell stated that when more was known on the timescale for Orsett Hospital to remain open then plans could be put in place and to get the facilities on board.

Councillor V Holloway stated that it had stood out that Orsett Hospital had formed part of this report and not as a separate report. Tom Abell stated that a separate report would be prepared for Orsett Hospital where the consultation would look at all the proposals with a set of questions being asked of residents and printed copies of the consultation would be available for local communities to see.

Councillor V Holloway requested that Members and residents be kept up  ...  view the full minutes text for item 28.

Roger Harris, Corporate Director Adults, Housing and Health presented the report that had set out the charges in relation to the services within the remit of the Health and Wellbeing Overview and Scrutiny Committee with any new charges taking effect from the 1 April 2018 subject to the approval from Cabinet.

Roger Harris referred Members to the Appendix to the report that highlighted the proposed fees and charges in detail. Roger Harris stated that no proposal to increase charges in 2018/19 would be made.

Councillor V Holloway questioned why there was an option in the Respite Adult Disability fees and charges. Roger Harris stated that it was for the Council to recommend that this option was not taken.

Neil Woodbridge questioned whether the fees and charges had now been maxed out with the level of responsibility and services available. Roger Harris stated that it was getting the right balance with most charges being for domiciliary care.

Councillor Gerrish questioned the “delegated authority” in recommendation 2. Roger Harris stated that this was a standard recommendation for all Fee and Charges Report that were being presented to all overview and scrutiny committees and confirmed that he could not see any requirement to change this mid-year.

Councillor Gerrish suggested a further recommendation be added so that “Any changes referred to by Cabinet would be referred back to the Health and Wellbeing Overview and Scrutiny Committee for comment”. The Chair and Members agreed.

RESOLVED

1.         That the Health and Wellbeing Overview and Scrutiny Committee noted the revised fees and that Health and Wellbeing Overview and Scrutiny Committee commented on the proposals currently being considered within the remit of this committee.

2.         That the Health and Wellbeing Overview and Scrutiny Committee noted that the Director delegated authority would be sought via Cabinet to allow the Fees and Charges to be varied within a financial year in response to legal, regulatory or commercial requirements.

3.         That any changes referred to by Cabinet would be referred back to the Health and Wellbeing Overview and Scrutiny Committee for comment.

Christopher Smith, from Adults Social Care, briefed Members on the report which detailed the proposals of a new development of a new residential and nursing home facility in South Ockendon that would have accommodation and services fit for the 21st century. Christopher Smith briefed members on the demand for this service and that the factors taken into account when looking at locations and the engagement undertaken with residents of South Ockendon. A further report will be presented to Cabinet in 2018 which would outline the design, financing, delivery and a more detailed proposal for development.

Councillor Snell stated that this was very encouraging with the proposed site being ideal and in the heart of the community.

Les Billingham stated that this was a unique attempt for those that really needed care and for those at end of life to receive the intense support required.

Councillor Gerrish stated that the proposal was really interesting and questioned the phasing of the project. Christopher Smith stated that firm proposals would be ready in 2018 to which the report would be presented to Cabinet to make the commitment on going forward.

Roger Harris stated that the Council owned the site and it was a good fit. A design team would be commissioned with planning applications being made in 2018.

Councillor V Holloway stated it was a very exciting plan and future proof and asked who exactly would use the facilities and would resident’s requirements be met. Les Billingham stated primarily the project would be residential and for the care of older persons who had intense packages of care. Although consideration could be taken to accommodating adults as the design proposal would have self-contained apartments.

Neil Woodbridge congratulated Officers on the paper and that it was very exciting times for Thurrock.

RESOLVED

1.         That the Health and Wellbeing Overview and Scrutiny Committee noted and supported the strategy for the development of a new residential facility, for the 21^st century, on the Whiteacre and Dilkes Wood sites, in conjunction with Health Partners.

2.         That the Health and Wellbeing Overview and Scrutiny Committee noted that the decision on the funding proposal, together with any associated decision on the procurement for the new facility will be referred to cabinet in 2018.

Ian Wake, Director of Public Health, presented the Case for Change report which had the new model of providing primary, community and mental health services, health improvement services and adult social care to Tilbury and Chadwell residents in a central and integrated way. Health and care providers were seeking to demonstrate a proof of concept with a view to replicating the model borough wide in order to form a new Accountable Care Partnership for Thurrock. Ian Wake presented a segmentation of Health Service usage by the population of Tilbury and Chadwell.  This demonstrated that 50% of all spend was attributable to 1.8% of the population, with the remaining 35% and 15% of spend being attributable to 6.2% and 91.6% of the population respectively. This analyses suggested that there were three distinct population cohorts that needed different types of service offer; 1.8% of the population that had complex and high levels of need and required an integrated health and care offer; 6.6% of the population that had some long term conditions that needed action to improve diagnosis and management of these within the community, and 91.6% that had episodic healthcare needs and needed improved access to Primary Care. Ian Wake referred Members to the models of care and explained the fundamental differences with an example of “what does a good life look like for you?”

Councillor Snell thanked Ian Wake for the exciting and uplifting report.

Councillor V Holloway echoed Councillor Snell’s comments and how well evidenced the report was.

Councillor Collins thanked Ian Wake for the positive comments and that the report brought humanity back into health care.

Ian Wake thanked Members for their praise and stated that the Public Health Team and the Clinical Commissioning Group had played a big part of preparing the report.

Ian Woodbridge thanked Ian Wake for the report and asked had any thoughts been given to how the community could be educated? Ian Wake stated that this will take time for residents to see how primary care can be provided differently.

Councillor Gerrish asked how the pilot would be assessed and would Key Performance Indicators have any impact. Ian Wake stated that evaluation played a vital part and was key to identifying the most important areas such as saving money, the population and outcomes.

Councillor Snell questioned whether there had been any resistance from general practitioners or pharmacists. Jeanette Hucey stated that general practitioners in the practices in Tilbury and Chadwell had formed a network and signed a Memorandum of Understanding to confirm their commitment to supporting delivery of the New Model of Care for Tilbury and Chadwell, and in particular, the Enhancing the Capacity and Capability of Primary Care work stream. This had set an example that we were aiming to replicate in the other three localities. Jeanette Hucey also stated that practices in the other localities were hearing about new initiatives little by little and were asking when they could be involved too.

Councillor Snell thanked all Officers for the report and  ...  view the full minutes text for item 31.

The Chair and Members agreed that the 18 January 2018 committee should be dedicated Sustainability and Transformation Partnership – Pre Consultation Business Case.

Members agreed that the report on Business Case for Tilbury Integrated Medical Centre be moved to the 22 March 2018 committee.

Members agreed that the report on Learning Disability Health Checks be moved to the 22 March 2018 committee.

Members agreed that the report on Thurrock First be moved to the 22 March 2018 committee.

Members agreed that the report on Updates on the Action Plan for Dementia be moved to the 22 March 2018 committee.

Members agreed that the report on Living Well in Thurrock be moved to the 22 March 2018 committee.

Members agreed that the report on General Practitioner 5 Year Forward Review be moved to the 22 March 2018 committee.

Members agreed that a report on Mental Health Services, Personality Disorders be added to the 22 March 2018 committee.

Members agreed that a report on Basildon Hospital be added to the first meeting of the next municipal year.

The Chair asked Members if there were any further items to be added or discussed for the work programme for the 2017/18 municipal year.

RESOLVED:

1.         That the item Sustainability and Transformation Partnership – Pre Consultation Business Case will be added to the work programme for the 18 January 2018 committee.

2.         That the item Business Case for Tilbury Integrated Medical Centre will be added to the work programme for the 22 March 2018 committee.

3.         That the item Learning Disability Health Checks be moved to the 22 March 2018 committee.

4.         That the item Thurrock First be moved to the 22 March 2018 committee.

5.         That the item Updates on the Action Plan for Dementia be moved to the 22 March 2018 committee.

6.         That the item Living Well in Thurrock be moved to the 22 March 2018 committee.

7.         That the item General Practitioner 5 Year Forward Review be moved to the 22 March 2018 committee.

8.         That the item Mental Health Services, Personality Disorders be added to the 22 March 2018 committee.

9.         That the item Basildon Hospital be added to the first meeting of the next municipal year.