Council and democracy

To approve as a correct record the minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on 18 June 2020.

Minutes of the Health and Wellbeing Overview and Scrutiny Committee held on the 18 June 2020 were approved as a correct record.

Councillor Holloway raised her concerns on the appointment of a Vice Chair to this committee and not having a Vice Chair in place for this meeting had shown a lack of respect to the committee. The Chair explained that the appointments of Vice Chairs had to be made at Council and that September’s meeting would be the next time for this to be agreed.

Councillor Holloway referred to the Chair’s comments made at the June committee on how difficult it was for male victims of domestic violence to get help in Thurrock and he had asked whether there had been any funding appraisals or sources of information support for male victims to which Councillor Holloway had explained that services were offered to both men and woman as it was important that everyone received support. Councillor Holloway then went on to say that domestic violence and sexual violence prominently impacted and affected women and quoted that it was in the high 90%. The Chair had stated that figure was incorrect and had been aware of only one male shelter and added that a 2012 figure of 44% victims were male and saw a large percentage of males coming through with the work that he undertook. Councillor Holloway then continued to state she had contacted SERICC who provided support to adults and children, male or female, who confirmed that in April 2019 to March 2020 1216 Thurrock victims of which 1179 were female and 37 male had been helped, that was 97%. Councillor Holloway had also contacted Changing Pathways and from 2019 to 2020 all the people they had supported were female, that was 100% and so far had supported two males. Councillor Holloway then questioned where Councillor Ralph had got that 40% figure from eight years ago as she was unable to find it and stated it was important that Members were aware of facts before being presented with domestic violence and sexual violence disproportionately impacting women. The Chair stated that from the history of domestic violence and sexual violence men had trouble coming forward and speaking out about their abuse and how they had suffered, that figure was a lot lower than the 95% towards woman than it was to men. The Chair offered this item to be added to the work programme for the next meeting where a full debate could be undertaken regarding the figures on sexual violence and domestic violence involving all parties. Councillor Holloway stated that this was a complex issue as to why men do not come forward and it would be the chair’s prerogative if this was an item to be brought to committee. Councillor Holloway summed by saying that when studies of the different kinds of violence that were perpetrated on men and women, it would show that the violence perpetrated on woman was always more severe.

Councillor Muldowney raised her  ...  view the full minutes text for item 58.

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.

No urgent items were raised.

Councillor Ralph declared that he was a private tutor in mental health who had worked for other providers throughout Essex and the wider area including Thurrock Mind.

Healthwatch had no matters to raise.

Lee Henley, Strategic Lead, Information Management presented the Annual Adult Social Care Complaints report covering the period 1 April 2019 to the 31 March 2020. Members were referred to the Appendix which summarised the representations received for this period.

Councillor Muldowney questioned whether the number of complaint and compliment responses received were down due to COVID and whether the concerns raised at the last meeting that residents still felt that services would be taken away from them if they made complaints had been addressed. Lee Henley stated that the drop in the number was not COVID related as this report was for the period that ended March 2020. Lee Henley stated that the drop in compliments may be due to these not being sent to the complaints team for logging onto the system. In relation to the drop in complaints, this was despite the complaints team linking in with internal teams and writing to commissioned providers to ensure complaints were being captured and sent to the complaints team. Lee Henley stated leaflets were being provided to commissioned providers to put up in care homes, in order to provide information to individuals on how to complain.

The Chair asked how easy it was for someone to make a complaint. Lee Henley stated the process was easy with different channels that people could use to make complaints such as telephone, email or letter and stated that anything that met the definition of a complaint would be dealt with as a complaint. Roger Harris reassured members from a service point of view that complaints were taken very seriously and was included as part of the induction of all staff, leaflets were provided for care homes and the complainants confidentiality was protected at all stages. There may be incidents where service users may feel vulnerable and worried if they were to make a complaint they may lose their services and although there was no evidence to support this, Lee Henley’s team would be used as the team was independent from adult social care who would give an element of confidentiality and independence. Service users were also encouraged to use advocates, HealthWatch and other numerous channels that service users could raise complaints. Roger Harris stated that receiving more complaints would be a good thing as this would help with complacency, learning and an opportunity to change the way services work.

Councillor Redsell stated this was a good report and questioned whether the “not available” or “not applicable” comments on the report were due to COVID. Roger Harris reminded members that this report covered the period up to the 31 March 2020 with a very limited period that would overlap with COVID.

Councillor Holloway stated that vulnerable people may still have concerns on the repercussions of making a complaint and questioned how the different means of reporting a complaint would reassure that person. As that person may think that complaints submitted, in whatever format, would have repercussions. Roger Harris stated that there were numerous channels outside  ...  view the full minutes text for item 62.

Ian Wake, Director of Public Health, provided Members with an update on COVID within in Thurrock.

·         A snap shot of the COVID-19 Surveillance Dashboard for the 3 September 2020 was provided which provided details of the Exceedance RAG Report, Daily Tests and Confirmed Cases, Case Data, Contact Tracing, NHS Test and Trace and Google Mobility Report.

·         That Thurrock remained at threat level zero.

·         The rate of cases per 100,000 population (for last 7 days) was 5.16.

·         Thurrock was ranked 135 nationally.

·         The number of tests and positively rate had increased over the last seven days.

·         The increase in community cases would be closely monitored.

·         There had been a decrease in average age of those testing positive.

·         There had been no evidence of increased health or care service use.

The Chair thanked Ian Wake for the very detailed presentation at very short notice and questioned whether the increase of those aged 30 was an indication that they had travelled on holiday. Ian Wake stated that was an interesting point as there had been some evidence that there had been some seeding especially from abroad but with the numbers so low it would be hard to confirm this.

Councillor Muldowney questioned what impact this would have on children going back to school. Ian Wake stated that more the epidemic had gone on a lot more had been learnt about risk and it was now known that not everyone was at equal risk with the risk increasing to those over the age of 50. Therefore if children were to get infected they would more than likely not have any serious health problems. That there was evidence that children would not contract COVID in the first place and less likely to transmit it if they were to contract it.

Councillor Rigby questioned at what threat level would have to be raised to before any thought of any local interventions and low local would these local interventions be. Ian Wake stated that being at zero threat level there had not been any interventions as there were detailed protocols for various risk settings with a full range of preventative work that would need to be continued within those settings. For example in care homes, video for school children and parents and the team were monitoring risks all the time. That a large scale lockdown intervention would be determined from advice from Public Health England to Central Government who would focus on the top 20 nationally, with Thurrock at 135 we were a long way from any national intervention at Thurrock level. Thurrock threat level would be raised to level 1 if there were any indication of sustained community transmission or a major outbreak in a setting or a substantial increase in hospital transmissions.

Councillor Holloway thanked Ian Wake for the update and thanked him and his team for the work undertaking in keeping the cases low in Thurrock and suggested that this report be a standing item on the work programme to which the Chair agreed.  ...  view the full minutes text for item 63.

Tania Sitch, Partnership Director, Adults Health and Social Care Thurrock (NELFT and Thurrock Council) and Stephanie Dawe (Chief Nurse and Executive Director of Integrated Care (Essex & Kent) NELFT) presented the report and stated that in response to the need to create additional Community Hospital Beds quickly to respond to the Covid Pandemic, Brentwood Community Hospital was reconfigured and Mayfield Community Hospital Beds were moved temporarily to Brentwood Community Hospital in April 2020. The Mid and South Essex partners had to agree a medium-term solution to manage the demand for community inpatient beds during the surge over the winter period. Stephanie Dawe thanked the Thurrock residents for their understanding through this challenging time and the impact this may have had on local people and that following a review by all partners looking at all of the 19 possible options the decision had been made to:

·         Hold 20 beds in Halstead

·         16 beds in CICC, Rochford

·         50 beds in Brentwood Community Hospital

·         24 beds to be returned to Mayfield Ward, Thurrock Hospital

·         16 stroke beds to St Peters, Maldon

·         6 stroke beds to CICC, Rochford

·         Totalling 110 beds for immediate care and 22 beds for stroke.

The Chair thanked Officers for the report and stated that it was pleasing news that the beds were returning to the Mayfield.

Councillor Holloway asked for confirmation on the 24 beds that had been removed from Thurrock Hospital all 24 beds would now be returned and asked when this would take place. Stephanie Dawe confirmed this was the case and these beds should be returned by the end of September, early October, to which Councillor Holloway stated this was fantastic news.

Councillor Holloway raised her concern that in six months’ time a further review may take place that would remove those beds again and asked for reassurances that these services would remain permanently in Thurrock. Councillor Holloway also referred to the Business Case and noted there had been no mention of patients or businesses being included in this. Stephanie Dawe stated that resources would always be required in Thurrock to provide the best health care for all residents in the community. That senior clinicians would be involved in this process and longer term work would continue to look at what was right for individuals. Councillor Holloway agreed with the principles but questioned whether health professionals would look to work in Thurrock but see that services were being moved out and would question whether this was the right place for them to live and work. Stephanie Dawe stated that patients would be continually offered home as their first destination and be able to provide specialist services locally therefore Thurrock would still be seen as a great place to live and work and would certainly encourage that.

Councillor Halden welcomed the decision to return those beds back to Mayfield and that the decision at the time to move those beds was wise and sensible it was now wise and sensible to return those beds. With winter pressures  ...  view the full minutes text for item 64.

Catherine Wilson, Strategic Lead Commissioning and Procurement, presented the report that outlined the issue of the gap between what the Council charged for domiciliary care and the actual cost the Council paid providers. Members were provided with a brief background to the report and were directed to the different charging options that were being proposed for the public consultation for internally provided and externally commissioned domiciliary care.

The Chair thanked Officers for the report and asked Councillor Halden to speak.

Councillor Halden stated he respected the scrutiny of this committee and as he had stated in his Annual Report presented at Council, care fees would need to be increased and this had now been undertaken in the most transparent way possible. With the gap increase between the cost of services and what was charged for services would create a great instability in the service and the gap had to be closed. Councillor Halden continued to state that he preferred Option 3 of the three options being presented to Members this evening, as this option would be tapped over a number of years, be able to close the gap and allow the Council to programme in above an inflation increase for the providers of domiciliary care. Councillor Halden finally stated that for a stable system that Thurrock residents could always rely on, the Council needed a flexible system to pay the workers more but needed to make sure the revenue was there. Councillor Halden thanked the Chair for giving him the opportunity to speak and left the meeting.

The Chair stated that the increase of fees was feasible and was reassured that it would only be 10% that would need to pay an increase fee.

Councillor Holloway stated that Options 1 and 2 provided figures but the recommended Option 3 there was not a breakdown of how much each year would bring in. Roger Harris stated the increase was approximately a third each year but it was very difficult to provide an exact figure as the Council had to undertake individual financial assessments on everyone and everyone’s situations may be different. Councillor Holloway stated she was not happy with the increases and that it was still an incredible increase even for those 10% even when this was spread over three years. Councillor Holloway welcomed that some services had been ruled out she still had concerns that the increase had not been considered as part of a range of proposals and questioned were there any other options. Councillor Holloway requested her comments be noted for the Cabinet Paper and had not felt comfortable looking at this financial discussion on its own and asked the Chair to add to the work programme the detailed financial proposals that would be proposed for the department for fees and charges and for any other future cuts for the committee to scrutiny. Roger Harris replied by saying that at this stage the committee were only be asked to support the statutory consultation and when the recommendations come  ...  view the full minutes text for item 65.

Roger Harris, Corporate Director of Adults, Housing and Health, presented this very positive report to Members that outlined the proposal for the service model of care at the Medina Road development and the next steps for the delivery of this new service. Members were also asked to support the proposal to commence the procurement of a service provider to implement this new service into Thurrock.

The Chair thanked Officers for the positive report and stated this was an opportunity to offer long life support in Thurrock and hopefully this service would remain in Thurrock.

Councillor Redsell asked for some clarity on Page 92, Paragraph 2.5 “have a local connection or live within the borough”. Roger Harris stated that this may be someone who had originated from Thurrock but had moved into residential care outside of the borough who may now wish to move back to Thurrock.

Councillor Massey gave praise to the report and stated that the Council should build on this and do more.

Councillor Muldowney welcomed the specialist development that provided a great provision for children and families in Thurrock.

Councillor Redsell questioned why had there been an increase in the number of those being diagnosed with autism. Roger Harris stated that the number had definitely increased as more people were being recognised, that means of recognition had improved and become clearer.

The Chair agreed with the recommendations of the report and recommended that the report go to Cabinet.

RESOLVED

1.         That the Health and Wellbeing Overview and Scrutiny Committee reviewed the future design of the service model to support people living at Medina Road.

2.         That the Health and Wellbeing Overview and Scrutiny Committee supported the proposal to commence the procurement of the support for Medina Road.

Roger Harris, Corporate Director of Adults Housing and Health, presented the report that the Memorandum of Understanding currently being considered was to formalise and build on the existing partnership arrangements and relationships across the Mid and South Essex footprint. Roger Harris stated that the Memorandum of Understanding was the product of a lot of work undertaken and thanked all those involved from an STP to local level. Mark Tebbs echoed Roger Harris’s comments that this was a very important report that laid the foundations for the way forward and settled the debate around system place and neighbourhood. That the report reflected the development of alliance working, the involvement in primary care networks in an alliance infrastructure and identified some challenges on the next steps around how the alliance would evolved and be developed.

Ian Wake, Director of Public Health, welcomed the report and referred Members to the Principles for Integrated Working set out on pages 113 and 114 of the document, especially Principle 5 – Subsidiarity – made the point that we should plan at the lowest footprint level possible unless there was a really good case to do something at a wider footprint level. That Principle 7 – Pragmatic Pluralism – needed to aim for a quality of outcome amongst the population. That the Council needed to continue to hold itself to account on what they had signed up to. 

Councillor Holloway welcomed the report and thanked Officers for the hard work undertaken in getting the report to this committee. That the report was very substantial but stated what was important was “Place”, that Thurrock was the core of our service delivery even though we were part of Mid and South Essex and would be thought of first.

The Chair thanked and noted Councillor Holloway’s level of input into this.

Councillor Muldowney stated although it was a substantial document it had been good to see elements such as the focus on Place, addressing inequalities in health care deliveries and health across the area. That it was good that the Health and Wellbeing Overview and Scrutiny Committee would keep their scrutiny role alongside Essex and Southend scrutiny committees.

The Chair thanked Officers for the report and stated it was now for the committee to continue with their scrutiny.

RESOLVED

That the Health and Wellbeing Overview and Scrutiny Committee noted and commented on the Memorandum of Understanding.

Members discussed the work programme.

The Chair referred to the Care Quality Commission (CQC) rating of the Maternity Unit at Basildon University Hospital as inadequate with failings found in six serious cases and requested that a report be presented at the next meeting.

Members agreed to have a COVID Update as a standard item on the work programme.

Councillors Holloway, Muldowney and Massey requested a line by line budget options providing the options that had been given to the portfolio holder, taking into account that the Council had to make £20 million of savings next year which was a very large amount of money that would not have had any scrutiny