To approve as a correct record the minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on 12 January 2023.

The minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on 12 January 2023 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. To agree any relevant briefing notes submitted to the Committee.

There were no urgent items.

No interests were declared.

No issues were raised by Healthwatch under this item.

Tiffany Hemming provided the Committee with an update on the IMC’s. She confirmed the two updated business cases for Purfleet and Tilbury are still with NHSE. They are still progressing with the development of the Gray’s outline business case. They are also working on returning services that were relocated from Basildon hospital to Orsett hospital during the pandemic.

Tiffany Hemming further updated the Committee that the Corringham IMC has started its Obesity service. A respiratory hub has also been running over the winter period and she commented that both of these services were good news for the local population. The GP Fellowes continues to successfully recruit although it is a very slow process. GP’s continue to show interest in joining and some have now started. Five GP Practices have been successfully bid for by a provider called Spirit Health and they will be taking them over in the coming months with a view to improving the service provided.

Councillor Pothecary expressed disappointment that there is still no feedback on the business cases which have been with NHSE for some time now. She was also disappointed that the GP Fellowes was not moving at the pace she had hoped for. She queried what is being done to ensure interest is actually translating into more GP’s in Thurrock. She also questioned which specific services will be moving from Orsett Hospital back to Basildon.

Tiffany Hemming clarified that a huge amount of work is ongoing regarding the GP Fellowes. Purpose built adverts have been created with individual testimonials from GP’s working in Thurrock. They are speaking with GP’s that are about to finish their training and persuading them to come to Thurrock to work. Some spots that are earmarked are for people who haven’t finished their training yet so they cannot progress yet. They have focused on making the job offer as attractive as possible and Fellowes means they come to learn more in their specialist area as well as being a GP. She reassured the Committee that she is of the view that they will secure the 12 GP Fellowes.

She also confirmed that the two services returning to Basildon Hospital from Orsett Hospital are Clinical Haematology and Rheumatology Infusions.

Councillor Pothecary queried when the 12 GP Fellowes will be in place.

Tiffany Hemming stated that she wouldn’t like to speculate.

The Chair asked how many GP Fellowes are working in the Corringham IMC today.

Tiffany Hemming responded that she was unable to answer this question. She clarified that they work out of Corringham IMC as a base and therefore may provide services at different locations. She stated that she will come back to the Chair with exact numbers.

The Director of Adult Social Care and Community Development confirmed that he thought there was 3 in post but that might not be correct.

Councillor Ralph raised that it has been 9 months since the outline business case was put out for the other IMC’s, he queried if they are looking at a  ...  view the full minutes text for item 48.

Katie Arnold provided a PowerPoint presentation to the Committee on Pathology Services which can be found on the following link: -

(Public Pack)Pathology Services Presentation Agenda Supplement for Health and Wellbeing Overview and Scrutiny Committee, 09/03/2023 19:00 (thurrock.gov.uk)

Katie Arnold explained that the Mid and South Essex NHS Trust has made a commitment to establish a single integrated pathology service model. Currently, Basildon and Southend Hospital use Pathology First and there is an in-house service at Broomfield Hospital. External consultants are of the view that an integrated service will provide a better service to patients. It will change and simplify laboratory processes. It will not change access for patients and blood tests can still be obtained from a variety of locations. They are currently engaging with stakeholders. The intention is for a full business case to be taken to the Trust Board for approval by late Spring. If approved, a competitive market engagement process will be launched in June 2023, with the aim of completing this by Spring 2024. The aim will be to move to a new integrated service by the end of 2024. The procurement process aligns with the expiry of the contract with Pathology First which comes to an end in 2024.

The presentation was paused to allow for questions on Pathology services.

The Chair raised concern that if there was a problem at the one laboratory this could have problems for the whole of Essex.

Councillor Polley highlighted that she was very grateful that blood testing services had returned to South Ockendon and especially to Stephen Porter for making that happen. Councillor Polley noted that it was quite complicated to make an appointment for a blood test and when she had tried to book an appointment at South Ockendon this doesn’t come up as an option via Swift Queue.

Katie Arnold responded that the online booking system for blood tests is swift queue. Feedback has generally been positive about Swift Queue. However, when they started the phlebotomy service at Corringham, residents were finding it hard to find the location. This was fed back to pathology first and they corrected it. Katie Arnold stated that she will feed back to Pathology First the issues surrounding the South Ockendon option not showing on the website. They will also update their information about where you can get a blood test. The Thurrock Community Diagnostic Centre will also be offering phlebotomy services when it opens in Spring 2024. Thurrock Community Hospital does offer walk-in appointments too.

Councillor Sammons echoed Councillor Polley’s comments and she highlighted that she also did not find Swift Queue very efficient and the appointments offered were very delayed. It was easier to just drive to Thurrock Community hospital and use the walk-in service.

Councillor Pothecary highlighted that when she used Swift Queue the Thurrock locations seemed to be listed under Basildon which might be causing the problems. A separate Thurrock section would be much easier to use.

Katie Arnold agreed to feed back Councillor Pothecary’s comments.  ...  view the full minutes text for item 49.

The Strategic Lead for Commissioning and Procurement presented the report to the Committee. She explained that they are seeking agreement to a contract extension for Domiciliary Care, the Out of Hours Service and the Bridging Service until 31^st March 2025. 

In relation to Domiciliary care there are 2 reasons for requesting an extension. Firstly, there is a need to maintain a stable care market. Care providers worked exceptionally hard throughout the pandemic and it has taken its toll. The second reason is to allow time to redesign the service. They want to work on an evaluation of the wellbeing teams and create a holistic response for people. Extending the contract for 2 years will give them time to do that.

The Strategic Lead for Commissioning and Procurement explained that the budget is there for the domiciliary care provision as all services referred to are statutory services and within the base budget there is room for a fee uplift for domiciliary care providers if that is decided. Approval of Commissioners and the S151 officer would be required for any fee uplift.

The Strategic Lead for Commissioning and Procurement highlighted that the number of carers went up significantly during the pandemic nationally and also in Thurrock. They are looking to extend the contract for the unpaid carers information advice service by 20 months so that response can continue for carers. They would also like them to complete carers assessments on behalf of the Local Authority. The extension will maintain the stability of the service.

The Chair noted that the report was very detailed. He stated that he understood the market pressures at the moment and the rationale behind the requested extension.

The Director of Adult Social Care and Community Development added that it should be added to recommendation 1.2 that as a result of advice received at informal cabinet on Monday to include after delegation of the S151 Officer and Commissioners, consultation with the Portfolio holder and Corporate Director for Adult, Housing and Health. That addition has been made to the Cabinet report.

RESOLVED:

1.1      That Health and Wellbeing Overview and Scrutiny Committee agree the content and approach within the report.

1.2   That Health and Well Being Overview and Scrutiny Committee recommend to Cabinet to agree the proposals outlined within the report after delegation of the S151 Officer, Commissioners, consultation with the Portfolio holder and Corporate Director for Adult, Housing and Health.

The Service Manager for Contract Compliance and Brokerage presented the report to the Committee. She explained that Thurrock historically did not tender residential care contracts. There is a small care market in Thurrock with just 12 homes for elderly residents and 25 for working age adults. In Thurrock they contract with every care provider located within the Borough and have Local authority funded placements in each home. The current contracts expire on 31^st August. The Service Manager for Contract Compliance and Brokerage confirmed they are seeking a contract period of 5 years which may, by mutual agreement, be extended for a further 24-month period, up to a maximum of 7 years. There will be a 6 months’ notice period to exit this contract, if this contractual approach no longer offers value for money for the local authority the contract can be terminated and reprocured in a different way.

Councillor Pothecary thanked the Service Manager for Contract Compliance and Brokerage for the report and for explaining why tendering isn’t necessarily helpful. Councillor Pothecary noted 40% were placed outside of the borough and queried if there is a breakdown of that 40% in relation to choice versus necessity.

The Service Manager for Contract Compliance and Brokerage confirmed that very little of that percentage would be down to necessity as they manage vacancies well. Sometimes its not a good idea for service users to be in Thurrock due to drug misuse and it may hinder their rehabilitation to be based in Thurrock.

Councillor Polley commended the service satisfaction levels and queried if there is any concern one provider may apply for all the care homes.

The Service Manager for Contract Compliance and Brokerage responded that it was very unlikely as almost all the care homes were individually owned. The likelihood of them all selling to one organisation would be low.

The Director of Adult Social Care and Community Development highlighted that the relationship with providers is really good and they are trusted and trust the care homes in equal measure.

The Service Manager for Contract Compliance and Brokerage thanked Councillor Polley for her comments complimenting the carer’s care towards residents and stated that she will feed this back.

Councillor Sammons queried if homes didn’t win the tender would residents be expected to move.

The Service Manager for Contract Compliance and Brokerage explained that the Local Authority could only give them the rate agreed in the tender process but they couldn’t restrict the choice. The Service Manager for Contract Compliance and Brokerage was of the view they would be unlikely to move residents but the rate may change for new residents.

Councillor Polley highlighted that because of the position the council is in, she wants it to be clear that they are not selling off care homes.

The Director of Adult Social Care and Community Development responded that this is about maintaining the market we have without having to involve smaller providers in a lengthy tender process.

Councillor Pothecary queried recommendation 1.3.  ...  view the full minutes text for item 51.

Councillor D Arnold explained that Thurrock has the second lowest spend on adult social care in the region. However, one third of the overall budget is spent on adult social care. 85 % of the budget is spent on just 7 % of the people living in Thurrock and that means only 15% can be spent on the remaining 93% of the population. Acute care packages are very expensive and any reduction in service level would carry enormous risk. Thurrock transformation programme is vital to support people from developing more complex illnesses and helping people stay healthier for longer. Transformation is needed now more than ever. The development of Wellbeing teams will allow for a team of professionals to talk to each other and work off the same assessment benefitting residents from having to have assessment after assessment. Transformation will also benefit staff too, Thurrock has an ageing working population in this area and it is not necessarily a popular career route for young people. Social Work apprenticeships are being offered. Councillor D Arnold highlighted that Thurrock positively has one of the lowest staff turnover rates in Thurrock for social workers.

The Chair raised that Thurrock First can help those with mental health problems where this impacts on them in other ways such as effecting their tenancy.

Councillor D Arnold agreed they could improve the communications around Thurrock First. They can give people that immediate link into help with the wellbeing team and urgent community response teams.

The Director for Adult Social Care and Community Development explained that Thurrock first primarily is a first point of contact for those who require community care or help with mental health. GP’s would probably refer those with mental health concerns into Gray’s Hall in the first instance. There is nothing to stop the Council increasing the accessibility to Thurrock First. A lot of mental health condition referrals come to their attention through community work. He further explained that a multi-disciplinary approach is required and they are looking to pull together services that can deal with the complexities involved where it is not uniquely mental health or substance misuse that leads to people leading a chaotic lifestyle. Good solutions need to be found and where you live and having a stable accommodation are so important.

The Chair commented that Thurrock carers service appeared to be centralised in Grays and queried if it could be rolled out in Corringham or Tilbury.

Councillor D Arnold confirmed it is an online service too. The Local Area Coordinators pick up carers in the community. They ask people if they know anyone caring for anyone at home.

The Chair raised whether anything more could have been done by the council regarding the IMC’s.

Councillor D Arnold said she had not been involved from the start and had been going round in circles trying to unpick what had happened. They need to draw a line under this and move forward. Once it is known what NHS England have got to  ...  view the full minutes text for item 52.

The Chair commented that he would like to bring back Basildon hospital to provide an update on the CQC reports for the next meeting. He would also like to schedule an overview on Mental Health.

The Strategic lead for Commissioning and Procurement presented the report. She outlined that in December 2021, the Government published a white paper, ‘People at the Heart of Care’ that outlined a 10-year vision for adult social care.  As part of these reforms the Market Sustainability and Fair Cost of Care Fund was announced. She explained that by having such a low self-funder market and by also allowing people with capital in excess of the existing cap to access our contracts (this is not usual practice in other local authorities that have a larger self-funding population) we are not exposed to the same risks as many other local authorities.  

The Local Authority need to complete a market sustainability plan (MSP). The purpose of this is to demonstrate how local markets are sustainable as we move forward with the reforms.  The exercise identified positives eg quality of care provided and quality of relationship with providers. The main risk identified is the retention and recruitment of the workforce and being able to maintain a mixed size of homes. Although the reforms have been delayed until 2025, it is still a requirement to submit the final MSP to government. At the time of preparing this report the submission date has not been formally confirmed but is believed to be 31 March 2023.

Councillor Pothecary just wanted an update on feedback as in the report at para 2.5 it states ‘we were advised that we would receive feedback on the draft to help shape our final submission – no feedback has been received from government’.

The Strategic lead for Commissioning and Procurement confirmed no feedback has been received as yet. The deadline also hasn’t been confirmed but we are working to the 31 March 2023 deadline. They have shared the document with the eastern region and feedback from peers has been good.

The Committee went into exempt session.

RESOLVED:

1.1          To agree the attached Market Sustainability Plan prior to Cabinet and subsequent submission to the Department of Health and Social Care (DHSC) minus the two bullet points on page 84 of Appendix 1 as the fee has not been agreed yet.