Agenda and minutes

County Councillor Chris Henig attended in place of County Councillor Nikki Penney, and Councillor Renee Blow attended in place of Councillor Mick Titherington (South Ribble Borough Council) for this meeting only.

Apologies for absence were presented on behalf of County Councillor Bev Murray

Guests

The Chair welcomed:

·  CC Jennifer Mein – Chair of the Health & Wellbeing Board and Leader of the County Council

·  Sakthi Karunanithi, Director of Public Health

·  Richard Cooke, Health Equity, Welfare and Partnership Manager

·  Gill Brown, Chief Executive of Healthwatch

Members are asked to consider any Pecuniary and Non-Pecuniary Interests they may have to disclose to the meeting in relation to matters under consideration on the Agenda.

There were no disclosures of interest relating to matters on the agenda.

The Minutes of the Health Scrutiny Committee meeting held on the 13 October 2015 were presented and agreed.

Resolved: That the Minutes of the Health Scrutiny Committee held on the 13 October 2015 be confirmed and signed by the Chair.

Report to follow

The report was introduced by County Councillor Jennifer Mein, Chair of the Health and Wellbeing Board and Leader of the County Council, and was presented by Dr Sakthi Karunanithi, Director of Public Health. It provided an update on the progress made by the Health and Wellbeing Board (HWBB).

Sakthi used a PowerPoint presentation which briefly explained the role of the HWBB; it referred to a review of the Board which had been undertaken in April 2015, and set out some recent developments and future priorities.

He emphasised that the Board was working in an environment in which resources were diminishing and demand was rising, which could lead to a serious gap in funding.

Members were invited to comment and raise questions and a summary of the main points arising from the discussion is set out below:

·  There was concern about proposals related to the transformation of care for people with learning disabilities and in particular transport provision for disabled adults and the consequent effect on carers. It was recognised that the proposals were well-intentioned but it was felt that they were not practical. In response CC Mein explained that some very difficult decisions would have to be taken in light of the financial pressures facing the county council. She assured the Committee that all budget proposals to be considered had an associated equality impact assessment; no decisions would be taken lightly and mitigation would be put in place wherever possible.

·  The Chair pointed out that this Committee was to receive a report on services for adults with learning disabilities at its January meeting.

·  The Chair noted that services for people with mental health problems were under strain and expressed concern about the cost and appropriateness of moving people to facilities many miles away from their home; he asked that this Committee be involved in any review of these services. Sakthi emphasised that mental health and emotional wellbeing were a priority for the HWBB.

·  It was explained that it was the role of the HWBB to ensure that appropriate plans were in place to improve the health and wellbeing of the people of Lancashire and that reports to the HWBB were part of the assurance process. Agenda and minutes could be read on line and members of the public were able to attend meetings to observe. Members were advised that if they required more detail on a particular topic they would be directed to the most appropriate officer/partner.

·  In response to a specific question about Occupational Therapy and what service users could expect in the current financial climate, the Chair reported that the Steering Group was hoping to receive a presentation about this service; he added that any member with a particular interest in any matter coming before the Steering Group could ask to attend the relevant meeting.

·  It was explained that 'Healthier Lancashire' was a programme currently being scoped and would be considered by the HWBB; significant changes would be needed to meet rising demand and solutions were not yet  ...  view the full minutes text for item 4.

Gill Brown, Chief Executive of Healthwatch Lancashire provided the Committee with a detailed presentation on the evolution of Healthwatch, its responsibilities and strategy, and examples of current and planned work. A copy of her presentation is appended to these minutes.

There was a lengthy discussion about the work of Healthwatch and in particular the pressures facing the care home sector. It was considered important that the sector be offered support and solutions for the difficulties it was facing and to improve services. It was believed that there was potential for the current crisis in the care sector to destabilise the NHS and it was suggested that this might be an important topic to come before this Committee.

Regarding  a specific question about whether the conditions for staff were inspected as part of the 'enter and view' project, it was explained that much depended on what staff were prepared to say and that sometimes they were inhibited by the presence of the care home manager. It was explained that Healthwatch did not just look for things going wrong but also at good practice which would be shared with others.

It was recognised that there were many dedicated care staff working in the care sector and it was suggested that sometimes, where homes were falling short of required standards, it was the care home owners, looking to save money, who were responsible for poor standards. It was considered most important not to shy away from robust questioning to understand what was really happening.

There was concern that often CQC (Care Quality Commission) recommendations and follow-up visits did not lead to sufficient positive changes and too many care homes were in need of improvement or, in some cases, inadequate. The point was made that many care home residents suffered from dementia and were not able to express themselves, and there was also sometimes a fear of intimidation in speaking out. It was therefore important to ensure CQC recommendations were carried out robustly.

The Committee was informed that Healthwatch had met with the CQC inspection team and fed back concerns following their visits and they also referred concerns to commissioners to ensure the home was 'on their radar'. It was emphasised that the 'enter and view' team were very well trained and this included dementia training.

There was concern about where residents could go if the home in which they were staying closed down particularly given the pressure on the NHS and the lack of available beds. It was agreed that this was an important question and there was a serious need for action to address this.

It was suggested that the issues around care services needed to be considered in a holistic way not just care homes, for example district councils should be involved because of their role in housing provision, and studies had shown that remote support via technology in people's homes had significantly reduced the number of GP callouts to those people. It was agreed that there was an opportunity  ...  view the full minutes text for item 5.

It was reported that on 14 September the Steering Group had met to consider its current ways of working and discuss ideas and suggestions for the future, and also to consider whether a 'tool kit' for task groups would be useful to members to enable their full participation and involvement in future task group reviews.

In response to concerns raised by CC Holgate about GPs using the Urgent Care Centre (UCC) at Chorley Hospital Ian Crossley, acting Chief Officer and Nicola Walsh, Interim Head of Operations and Delivery from Chorley South Ribble/Greater Preston CCG attended the meeting to provide members with a status update and discuss the plans for the future. A summary of the meeting was at Appendix A to the report now presented.

On 5 October the Steering Group had met with Paul Simic, Chief Executive from the Lancashire Care Association (LCA) to discuss issues around falls in care homes and the challenges faced by the care home sector to address these issues. Following that meeting the Steering Group had agreed to host a meeting of Registered Care Managers which would provide an opportunity to discuss wider issues and the main challenges. Janice Scanlon, from the Trust Development Authority (TDA) also attended the meeting to talk about the appointment of non-executive directors and the support they can access. A summary of the meeting was at Appendix B to the report now presented.

Resolved: That the report of the Steering Group be received.

Appendix A to the report now presented set out a draft work plan for both the Health Scrutiny Committee and its Steering Group, including current Task Group reviews.

It was reported that a report about Services for Adults with Learning Disabilities would now be presented to the January meeting, and the report, originally scheduled for January, about Joint Working in light of the Budget impact would now be presented to the April meeting.

Resolved: That the work plan, as amended, be noted.

The Committee's attention was drawn to forthcoming decisions and decisions recently made by the Cabinet and individual Cabinet Members in areas relevant to the remit of the committee, in order that this could inform possible future areas of work. 

Recent and forthcoming decisions taken by Cabinet Members or the Cabinet can be accessed here:

http://council.lancashire.gov.uk/mgDelegatedDecisions.aspx?bcr=1

Resolved: That the report be received.

An item of urgent business may only be considered under this heading where, by reason of special circumstances to be recorded in the Minutes, the Chair of the meeting is of the opinion that the item should be considered at the meeting as a matter of urgency.  Wherever possible, the Chief Executive should be given advance warning of any Member’s intention to raise a matter under this heading.

The Chair reported that University Hospitals Morecambe Bay Trust (UHMBT) had arranged a special session for Health Scrutiny Committee members of both Lancashire and Cumbria to take place in Kendal on 11 January 2016, before the next meeting of this Committee. The aim was to enable members of both authorities to learn the Trust's vision for their hospital buildings, their longer term plans and possible changes over the next 12 months. This would assist with future scrutiny of the Trust's performance and activities.

The Chair asked members to approve the session with UHMBT on 11 January as an approved duty.

Resolved: That the session arranged by UHMBT, to take place on 11 January 2016, be treated as an approved duty of the Committee.

The next meeting of the Health Scrutiny Committee will be held on Tuesday 26 January 2016 at 10.30am at County Hall, Preston.

It was noted that the next meeting of the Committee would be held on Tuesday 26 January 2016 at 10.30am at County Hall, Preston.