To approve as a correct record the minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on 12 March 2018.

The Minutes of the Health and Wellbeing Overview and Scrutiny Committee held on the 12 March 2018 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.

No HealthWatch items were raised.

Roger Harris, Corporate Director of Adults Housing and Health, presented the report that updated Members on the New Models of Care innovation that had been launched in Tilbury and Chadwell as part of Phase 2 of the Thurrock transformation programme in collaboration with local health partners, the voluntary and community sector. Roger Harris referred Members to the four principles:

1.         The development of a new Primary Care Workforce – to address the shortages of GP’s and improve the Primary Care offer.

2.         Improved identification and early treatment of people with Long Term Conditions.

3.         The redesign of the health and social care workforce and all community based solutions.

4.         The development of four Integrated Medical Centres to ensure that we have 21st Century local facilities.

Tania Sitch, Integrated Care for Thurrock Council and North East London Foundation Trust, explained the development of this new exciting project to Members and how the new 12 new workers would support the 8 practices in Tilbury and Chadwell to ensure that GPs are used where most needed and to reduce waiting times. That the implementation of the integrated workforce will bring together health, mental health, social care and the voluntary sector to ensure more coordinated care and a more personal response. Those 13 programmes devised to improve the identification of treatment with evaluation being undertaken by Public Health England and the University of Birmingham to ensure that it was robust and that outcomes were focused.

Mandy Ansell stated that this project would involve and be joined up with Health, Social Care and the Health and Wellbeing Board Strategies.

Roger Harris stated the Integrated Medical Centres were being designed to support the Council and Clinical Commissioning Group for primary care services. The design of the Tilbury and Chadwell site had now been commissioned and that this would probably be the first of the 4 sites being developed with health partners. The second site being Stanford and Corringham based on a similar model as the Tilbury and Chadwell site, the third at Purfleet as part of the Purfleet Regeneration Programme which would soon be commissioning an architect and design team. The fourth site would be at Grays Thurrock Hospital which would concentrate on services covering the whole of Thurrock e.g. the Minor Injuries Unit (MIU). The development plan would be 3 years with lots of work including planning applications, business cases and signing of leases. That huge commitment had been made by Thurrock Council and Health providers.

The Chair thanked Officers for their very interesting presentation.

Councillor Rigby questioned would the Integrated Medical Centres reduce GP appointment times and had this model been undertaken elsewhere. Tania Sitch stated that similar trials had been undertaken but not to the extent that Thurrock are proposing with this being one of the first ever model of shared services.

Mandy Ansell stated that Thurrock had been identified as one of the worst under doctored areas in the country with the recruitment of doctors being one of the biggest challenges. Thurrock  ...  view the full minutes text for item 5.

Mandy Ansell, Accountable Officer, Thurrock NHS Clinical Commissioning Group, updated Members on the current position of the Learning Disability Health Checks following the Clinical Commissioning Group taking over the commissioning arrangements in April 2016. At this time there had been a poor uptake of only 34%. In 2017 following the hard work of the Clinical Commissioning Group an established list of 64% had been achieved. Mandy Ansell was pleased to announce to Members that this year a 77% established list had been achieved. This was helped with more flexibility as to when the health checks could be undertaken and where they take place. HealthWatch had also worked hard on care plans. Mandy Ansell stated that not all practices had taken up this service and that those patients requiring learning disability health checks would be seen at other practices. That Jackie Doyle-Price, Member of Parliament for Thurrock, had recognised these achievements as a future model to be used nationally and that goals had been set for next year to push this figure even higher.

Councillor Rigby questioned whether this service could be offered to all residents. Mandy Ansell stated that any resident on a GPs list can request a health check. Those residents over 40 years of age should have a routine health check. The National Health Service had lines of health delivery that had to be undertaken such as Elderly Health Checks and checks for Looked After Children. The Quality and Outcome Framework was to help fund GPs to improve the quality of health care being delivered with life time questions being asked of residents at early appointments.

The Chair stated that the importance of disabled people being identified and provided with services was crucial.

Councillor Rigby questioned why residents undertaking a disability health check were invited in for a health check but not all other residents. Mandy Ansell stated that the disability health checks were being undertaken from a particular funded stream which offered this facility. There were other schemes where primary care could be obtained and it was vital that residents took responsibility for their own health and looked after each other.

The Chair stated that the importance of the proposed Integrated Medical Centre would encourage all residents to undertake these health checks.

Councillor Akinbohun questioned why some practices had not taken up the service. Mandy Ansell explained that the National Health Service commissioned GP practices with core services and then practices can chose to add services to their portfolio, known as Directed Enhanced Services. These services are offered as an income but not all practices chose to participate. Those practices that do participate would be paid per health check.

Councillor Allen stated that all Thurrock residents should be entitled to a body MOT every 18 months that could identify early indications of poor health. Mandy Ansell stated that all residents are entitled to have health checks at practices which would normally be undertaken by a practice nurse. If following this health check, referral was required an appointment  ...  view the full minutes text for item 6.

Mandy Ansell, Accountable Officer, Thurrock NHS Clinical Commissioning Group, presented to Members an update of Sustainability and Transformation Partnership with new arrangements for larger planning footprints for the future of health and care services with the main focus for hospitals was the reconfiguration. The Sustainability and Transformation Partnership configured of Clinical Commissioning Groups, Acute Trusts and Community Partners. That it was the statutory responsibility of the Clinical Commissioning Group to work together with partners, be accountable and ensure the services are in the right place. That the consultation recognised that the 3 hospitals were not sustainable as they currently stand. That last year’s bad winter had a detrimental effect on accident and emergency service with elective surgeries being cancelled due to the pressures put on Basildon Hospital. Part of the Sustainability and Transformation Partnership focused on the future of Orsett Hospital.

That the Clinical Commissioning Group worked closely with Basildon Hospital with a decision being made on the 6 July 2018 on what services would be transferred out of the hospital.

Mandy Ansell offered Members the opportunity of an induction and an understanding of the roles undertaken by the Clinical Commissioning Group.

Councillor Allen questioned the bad weather crisis and asked whether this was just at Basildon Hospital or nationally.  Mandy Ansell stated that this nationally with most elective surgeries being cancelled. That this had been a very stressful period for the National Health Service.

Councillor Allen stated that Basildon Hospital covered a huge area and had failures in the past been related to too many people attending. Mandy Ansell stated that there were a considerable amount of patient flows out of Southend, Dartford and Queens into Basildon Hospital but the hospital was coping well to meet the needs. That Basildon Hospital relied on agency staff and that staff targets had to be met but was performing well with the current workforce situation. That the 62 day cancer target was slightly below for Thurrock and that the Clinical Commissioning Group had commissioned a deep dive.

The Chair questioned where the new models of care that covered all the hospitals would be situated geographically. Mandy Ansell stated that the model of care would be segmented by service, by age, be measured by an 18 weeks pathway, diagnosis would be sent by GP and decision made on the need for surgery or other intervention.

That one proposal would be to put controlled COLD work in place where they would not be interrupted by emergencies. One area of concern was Cancer that required specialist surgery with the Burns Unit currently at the Mid Essex hospital.  Each hospital would have an accident and emergency at each location.

Councillor Akinbohun questioned whether the public consultation was effective in the decision making. Mandy Ansell stated that it was a statutory obligation to consult with members of the public and patients. By law consultations were undertaken with the Health and Wellbeing Overview and Scrutiny Committee, HealthWatch, disability groups and specific care groups to understand what was important  ...  view the full minutes text for item 7.

Roger Harris, Corporate Director of Adults Housing and Health, presented the report which outlined Thurrock’s agreement to join with Essex and Southend to participate in the Joint Health and Wellbeing Overview and Scrutiny Committee that covered the Sustainability and Transformation Programme. The report provided Members with an update, purpose of the work and Thurrock representation of the Joint Health and Wellbeing Overview and Scrutiny Committee. That all 3 authorities had decided to keep their power to refer matters to the Secretary of State locally rather than delegate this power to the Joint Health and Wellbeing Overview and Scrutiny Committee. Roger Harris referred Members to the Terms of Reference in Appendix 1. That Councillor Holloway had been elected vice chair of the Joint Health and Wellbeing Overview and Scrutiny Committee at the last meeting. That the next informal meeting was scheduled for the 19 June to be held in Chelmsford with a formal meeting scheduled for the 30 August which would be held in Thurrock. The Joint Health and Wellbeing Overview and Scrutiny had 2 of the 4 Thurrock seats filled by Councillor Holloway and Councillor Fish but had 2 vacancies to fill.

The Chair asked Members whether there were any nominations. Councillor Rigby volunteered to sit on the committee but stated that she would not be able to attend on the 19 June due to undertaking some mandatory licensing training.

The Chair questioned whether political proportionality should apply to the Joint Health and Wellbeing Overview and Scrutiny Committee and should a Thurrock Independent member be nominated. Councillor Allen, as Thurrock Independent Vice Chair to the Health and Wellbeing Overview and Scrutiny Committee was unable to commit at this time.

The Chair requested that the democratic services contact the Leader of the Thurrock Independent to ask whether he would like to nominate a member.

RESOLVED

1.         That the Health and Wellbeing Overview and Scrutiny Committee noted the terms of reference for the Joint Health and Wellbeing Overview and Scrutiny Committee with Essex and Southend.

2.         That the Health and Wellbeing Overview and Scrutiny Committee appointed a further Member, Councillor Elizabeth Rigby, to represent Thurrock Health and Wellbeing Overview and Scrutiny Committee at the Joint Health and Wellbeing Overview and Scrutiny Committee.

3.         That the remaining seat would be offered for nomination to Members of the Thurrock Independent party.

4.         That the Health and Wellbeing Overview and Scrutiny Committee agreed the approach to the Joint Health and Wellbeing Overview and Scrutiny Committee outlined in the report.

The Chair asked Members if there were any items to be added or discussed for the work programme for the 2018-19 municipal year.

Members agreed that the Mental Health Peer Challenge be added to the work programme for the 8 September 2018 committee.

Members agreed that the Thurrock Integrated Care Alliance be removed from the 8 September 2018 committee and placed on the 8 November 2018 committee.

Members agreed that the Cancer Wait Times be removed from the 8 September 2018 committee and placed on the 8 November 2018 committee.

Members agreed that the Verbal Update on Learning Disability Health Checks be added to the work programme for the municipal year 2019/20.

Members agreed that the Sustainability and Transformation Partnership be added to the work programme for the municipal year 2019/20.

RESOLVED

1.         That the item Mental Health Peer Challenge be added to the 8 September 2018 committee.

2.         That the item Thurrock Integrated Care Alliance be added to the 8 November 2018 committee.

3.         That the item Cancer Wait Times be added to the 8 November 2018 committee.

4.         That the item Verbal Update on Learning Disability Health Checks be added to the 2019/20 work programme.

5.         That the item Sustainability and Transformation Partnership be added to the 2019/20 work programme.