Decisions

An update on the Samlesbury Aerospace Enterprise Zone.

The Cabinet approved the recommendation(s) as set out in the report.

The Cabinet approved the recommendation(s) as set out in the report.

The Transport Asset Management Plan 2015 - 2030 was approved by the Cabinet Member for Highways and Transport on 10June 2014 and identified the key strategic priorities of the county council.

It is proposed to publish a review of the progress made during phase 1 of the Transport Asset Management Plan which ran from 1 April 2015 to 31 March 2020 and report the latest condition of our assets.

The Cabinet approved the recommendation(s) as set out in the report.

A report on Eden Project North.

The Cabinet approved the recommendation(s) as set out in the report.

Given the continued unprecedented circumstances brought about by the Covid 19 outbreak, the Procurement Service has undertaken a further review of contracts which would otherwise have commenced re-procurement work in the next 6 to 12 months, but resources in the service areas continues to be focussed on Covid related activity. Approval is sought to extend contracts.

This is deemed to be a Key Decision and the provisions of Standing Order C19 have been complied with.

The Cabinet approved the recommendation(s) as set out in the report.

In line with the county council's procurement rules, this report sets out a recommendation to approve the commencement of the following procurement exercises:

(i) Agency Staff Neutral Vendor Managed Service

(ii) Framework Agreement for Professional and Technical Services

and to note an amendment to a previously agreed procurement procedure:

(iii) Amendment to plant and vehicle hire report approved by Cabinet on 3 October 2019.

This is deemed to be a Key Decision and the requirements of Standing Order C19 have been complied with.

The Cabinet approved the recommendation(s) as set out in the report.

This report provides details of the Lancashire County Council Adult Social Care Winter Plan for 2020/21, and the additional capacity that will be mobilised to meet the anticipated demand.

This is deemed to be a Key Decision and the provisions of Standing Order C19 have been complied with.

The Cabinet approved the recommendation(s) as set out in the report.

The Leader of the County Council approved the recommendation(s) as set out in the report.

Resolved: That the appointment of Chair and Deputy Chair; the membership of the committee and the terms of reference, as presented, be noted.

The Chair welcomed Dr Amanda Doyle, GP and Integrated Care Strategy lead for Lancashire and South Cumbria and Jackie Bell, Head of Service for 111, North West Ambulance Service NHS Trust. A report outlining the process and implementation of the new NHS 111 First initiative was presented

The following points were highlighted:

·  The new appointment system for those who would normally self-present at A&E supported social distancing and aimed to reduce overcrowding, waiting times and subsequently COVID-19 infection rates. The new system would support a better flow of work, made best use of available technology and should improve clinical outcomes, as all attendees will have had a remote assessment prior to their A&E appointment. The clinician carrying out the assessment would book the most appropriate appointment depending on the issue and the service user would not be required to re-dial another service. It was emphasised that the new way of working was not for urgent 999 calls and life threatening situations. A&E self-admissions represented approximately 60% of the A&E intake.

·  The new system had been launched in Blackpool and Warrington with Royal Blackburn to follow in October. These initial launches were to assess effectiveness and outcomes, to make any necessary amendments prior to the national campaign launch which would communicate the new process of ringing 111. By the end of November all A&E departments would be live with the system. Feedback so far from patients and staff had been very positive and hospitals were keen to launch the programme to prepare for winter.

·  The aim was for 20% of self-referrers to access 111 First, however initial monitoring indicated that the uptake would be higher. Therefore it would be a significant challenge to ensure the recruitment of health advisers and assessment clinicians was sufficient to support demand. Recruitment for health advisers was on schedule.

·  The clinical assessments would be at a local level to ensure the most appropriate services for the area were signposted.

In response to questions from members the following information was clarified:

·  There had been a significant and sustained pressure on the 111 service, related to calls about access to testing rather than in relation 111 First. The messages on testing websites were being changed to reduce these calls. Blackpool had been identified for an initial launch as an area that made low numbers of calls to 111 but had high presentations at A&E.

·  Staff with experience of 111 First and all patients ringing 111 who were subsequently booked in to a service were being surveyed. Once more sites were live the feedback results would provide a more robust and effective base for sound evaluation.

·  As a national programme, the service would be centrally funded. Additional capital funding to house additional staff resource would also be required. It was anticipated that the programme would eventually yield savings once firmly established.

·  Staff numbers would be increased for the additional calls and work was underway with the estates team to undertake rapid expansion of office space to accommodate them. However due to numbers of staff working from home some extra office space was immediately available.

·  The service would cover the whole of the North West Ambulance Service Trust area, with the initial call being taken at a centralised location. However clinical assessment would be at a local level. There was a mandatory six week training course for health advisers (111 call takers), which resulted in staff following an algorithm designed by clinicians for non-clinical users. Following that, new staff were individually mentored for two weeks. Rigorous standards were followed and staff were provided with regular feedback regarding the quality of their calls. The training was firmly embedded and outcomes were audited.

·  If a GP appointment was booked this was done in real time. However some surgeries were asking for a list to enable them to call back the patient to book the appointment, dependent on surgery procedures regarding infection control.

·  It was not usual for someone with a need that could be met by social prescribing to present to A&E, however the clinical assessment would determine if social prescribing was the appropriate pathway for the call.

Resolved: That:

1)  The report regarding the implementation of the national NHS 111 First programme, as presented, be noted.

2)  The findings and evaluation of the new NHS 111 First programme be presented to the Health Scrutiny Committee in six months' time.

Josh Mynott, Democratic & Member Services Manager, Legal, Governance & Registrars was welcomed to the meeting. Josh Mynott emphasised the importance of focussed and targeted work planning to improve outcomes and robust scrutiny and how this could be achieved by developing specific and detailed lines of questioning.

Members reviewed the topics listed for consideration by the Health Scrutiny Committee on the single combined work programme for all Lancashire County Council scrutiny committees.

Members requested that the following topics be included on the Health Scrutiny Committee workplan:

·  An update on NHS 111 First in March 2021.

·  A report from the Our Health Our Care task and finish group prior to May 2021.

·  An update on Commissioning Reform in Lancashire and South Cumbria..

·  It was confirmed that an update on suicide prevention in Lancashire would be brought to the November meeting. It was requested that this include information on resourcing and the appointment of district mental health and suicide prevention champions.

Resolved: That the items listed for the Health Scrutiny Committee on the single combined work programme be agreed subject to the inclusion of the matters requested and listed in the minutes above.

The committee considered a report providing an overview of matters considered by the Health Scrutiny Steering Group at its meetings on 22 June and 15 July 2020.

Councillor Margaret France expressed that as a member of the Council of Governors for the Lancashire Teaching Hospitals NHS Foundation Trust and a member of the Our Health Our Care Stakeholder Reference Panel, there may be a conflict of interest if she were to be confirmed as a member of the proposed task and finish group to consider forthcoming proposals from the local NHS on the future of Chorley and South Ribble A&E. It was explained that Chorley Council's nominated substitute member for Councillor France could take up the seat instead or alternatively for the county council to write to Chorley Council to nominate a replacement member. Resolved That:

1)  The report of the Steering Group, as presented, be received.

2)  The establishment of a task and finish group consisting of seven county councillors and the two co-opted members from Chorley Council and South Ribble Council to review the forthcoming proposals from the Our Health Our Care programme on the future of Chorley and South Ribble A&E, be agreed.

The Chair welcomed Sue Lott, Head of Service Adult Social Care Health, Sumaiya Sufi, Quality Improvement and Safety Specialist and Abdul Razaq, Consultant in Public Health to the meeting. The Lancashire County Council staff were invited to present a report detailing the support that had been provided to adult social care providers and the Adult Social Care Winter Plan.  Lynsey Davies-Coward from Willowbrook Homecare and Martin Layton from Caritas Care were also in attendance to provide feedback to the committee on their experience of county council support during the initial stages of the pandemic.

The following information was highlighted with regard to support provided to adult social care providers:

·  Support had been given to (in the region of) 600 adult social care providers including care homes, home care agencies and supported living providers. The support included welfare calls to check they had the information required, along with sufficient food and medication supplies. Providers were also offered access to a financial assistance scheme for COVID-19 related costs. In addition, a not for profit organisation was commissioned to offer a package of emotional and wellbeing support.

·  As the information, advice and guidance from central government was changing rapidly, it had been necessary to provide regular timely communication and this was disseminated via a weekly webinar, attended by the council's infection control team and a newsletter. Bespoke webinars responding to requests from providers were also arranged. All information and webinars were uploaded to a custom-made website, along with education tools to enable providers to train staff. This support continued to help providers manage new outbreaks.

·  Challenges faced included courier collection of tests and delays receiving test results and this had been escalated to establish a resolution. Repeat testing was in place – weekly for staff and every 28 days for residents.

·  A council managed temporary staffing agency was available for providers encountering staff shortages due to self-isolating and sickness absence.

·  The council also sourced personal protective equipment when needed and the service had received feedback stating that this support had helped providers to manage the pandemic and remain confident that provision of services could continue. The team continued to work with the Lancashire Resilience Forum to ensure personal protective equipment needs could be met.

·  As lockdown restrictions eased, some care homes had been reluctant to change the constraints in place regarding visiting. Lancashire County Council had worked with care homes to provide guidance and resources regarding how to make visiting safe to support infection control.

The private social care providers in attendance made the following comments:

·  Lancashire County Council had been instrumental in allowing providers to sustain vital services during this challenging time. Particularly in the areas of training, personal protective equipment provision, communication and financial support.

·  Government guidance had centred on care homes, therefore the Lancashire County Council portal had been an invaluable single point of access for providers of domiciliary care. It was emphasised that multi-disciplinary teams were available to support outbreaks in assisted living settings. In addition, domiciliary care providers didn’t qualify for home testing and the council had supported providers in accessing tests.

·  Personal welfare calls and mental health support had been beneficial as there had been an increase in the levels of anxiety and depression in the care team.

·  Concern was expressed regarding the ongoing staff testing and the lack of clear guidance and continuity of information as providers were preparing for the winter period.

In response to questions from members the following information was clarified:

·  The council had been reassured by the Department of Health and Social Care that all care homes, including those for younger people with disabilities, would be prioritised for testing and receipt of results. The Director of Public Health, Local Resilience Forum and the North West Association of Directors for Adult Social Care, promoted local government issues at a national level to improve the challenges around access to testing.

·  The council would continue to support providers throughout winter and was exploring how the current processes in place could be incorporated in the longer term. Information gleaned from welfare calls to providers would help the team to focus support in the most effective way. Care providers at the meeting, emphasised that business continuity plans had been prepared with their contract manager at Lancashire County Council to prepare for the impact of the winter period.

·  Healthwatch Lancashire would be publishing a further report regarding the experiences related to the management of the pandemic, of care home managers, staff, residents and family members. The survey identified areas for improvement, particularly for family members of those people in supported living and extra care facilities. Focus groups would be established to examine issues raised and how the council can support providers to improve experiences. Providers had also undertaken surveys with service users and had received an overall positive response. They were looking at implementing processes to improve in areas identified, such as managing service user expectations regarding consistency of carers allocated to service users.

A high number of staff and managers had responded to the survey, however this wasn't the case for residents, as had previously been the case when feedback was requested. The numbers of responses to the Healthwatch survey would be shared with members outside of the meeting.

·  The team was unaware of any plans from the Department of Health and Social Care to carry out repeat testing for assisted care staff. However if this became an issue it would be raised with the Lancashire Resilience Forum. 

The following information was highlighted with regard to COVID-19 testing in Lancashire:

·  Testing was carried out in regional testing units (RTU), mobile testing units (MTU) and local testing sites (LTS). As an interim measure, five community testing stations had been set up in the Preston, Hyndburn, Burnley and Pendle areas, which had carried out approximately 20,000 tests since inception at the end of July. There had been a recent surge in local demand, which had resulted in a lack of workforce, long queues and the supply of testing kits being exhausted. It was intended that these stations would be phased out and replaced by 14 fixed local testing sites across all 12 districts in Lancashire (plus one in Blackpool and Blackburn with Darwen) increasing to two in each by December. This was a national initiative and the request was awaiting Department of Health and Social Care clearance.

·  The kits used at the community testing site were intended as a temporary measure and test results were reliant on local rather national systems. Results were returned within 2-3, occasionally 4 days. For comparison, currently 3% of national test results were returned within 24 hours and 24% within 48 hours. Discussions were underway to prioritise testing for high risk areas – currently Preston and Pendle.  It was anticipated that the community testing stations would move from a 7 day operation to 5 days, in response to the limited number of kits available and to aid the resilience of staff who were working under intense pressure from members of the public.  There had been incidents of inappropriate usage at the community sites, for example, people requesting tests before going on holiday, for employment checks or before attending hospital. This was largely due to the national unavailability of tests. Approximately 5-600 tests were being carried out per week and this had risen to 1500 across all sites on 15 September 2020. It was emphasised that the sites were not designed to support the unavailability of national testing appointments.

·  The national trace positive contact system involved contacting those who had tested positive and asking them to provide details of those they had been in close contact with. Local areas were supporting the national system if they were unable to contact positive cases within 24 hours. Pendle was the first district to participate and Hyndburn, Burnley, Blackpool and Preston now also supported this with trained contact tracers. Currently the national contact tracers had been unable to contact 23% of positive cases in Lancashire. Reasons for this included incorrect details being held or a lack of response. Lancaster and West Lancashire districts were in the process of training contact tracers, which would take two weeks. Once contacted, people who had tested positive were provided with welfare and self-isolation information and asked to provide details of their close contacts. This information was then fed back into the national system. Every positive case required 10 – 12 contacts and there was not enough local resource to accommodate this considerable task. No assurance had been given from central government that they would provide dedicated staff for a fully localised test and trace support system.

Members emphasised that a fully localised test and trace system was crucial for it to be fully effective, as local tracers would have the benefit of local knowledge when contacting people.

·  A key component of winter preparation was the flu immunisation programme and this year would include additional vulnerable groups, including those living in long stay facilities, those who were shielding and health and care staff. Additionally, any surplus vaccine would be offered to people aged 50-64. Uptake of the vaccine was being widely promoted to ensure the maximum number of vulnerable people and those that care for them received the vaccine.

In response to questions from members the following information was clarified:

·  Each district area had a COVID-19 prevention business continuity plan within their overall management arrangements.

·  The walk-in community testing stations were seeing a surge in demand due to the unavailability of tests at the national testing stations which were by appointment only. Supply of testing kits for community testing stations were constrained as this type of testing station was only established as a stop gap until local community stations had been setup. It was confirmed that the testing station at Preston had exhausted their supply.

·  Members commented that long queues, unclear messages about who should be attending community testing sites, who should self-isolate/be tested if a pupil within a school bubble tested positive and messages regarding a shortage of kits were discouraging people to come forward for testing. In addition, low numbers of the Black, Asian and Minority Ethnic communities were presenting for tests.

It was clarified that the county council's Head of Service for Communications, regularly sent out public updates. A new communication was imminent that addressed many of the points raised regarding the usage and prioritisation of testing and was awaiting approval from the Director of Public Health. Additionally significant amounts of work had been undertaken to heighten awareness across Black, Asian and Minority Ethnic communities and to encourage vulnerable groups to come forward for testing. Data regarding the ethnicity of those coming forward was tracked weekly and patterns varied widely over time and by area. The Lancashire Resilience Forum continued to promote a consistent message that all communities should come forward for testing. The national message that those who were asymptomatic should not present for testing did not apply to Lancashire's areas of intervention - Preston and Pendle. However demand was exceeding supply of kits and staff at community testing stations could not compensate for the lack of availability at national testing sites.

·  There were no plans to open a community testing centre in Rossendale.

·  Clarification was being sought as to whether mobile testing units and local testing sites would prioritise local people. The Department for Health and Social Care had assured the Local Resilience Forum that this would be the case, however this was inconsistent with the public experience. 

·  A national research programme that was part of a study led by Imperial College London was sampling communities to check the prevalence of the virus to understand how and to what level, the virus was circulating around local communities.

Resolved: That

1)  The report as presented, be noted.

2)  The committee endorse the work of the Adult Social Care team in supporting providers during the COVID-19 pandemic and in developing the Winter Plan, to ensure the authority continues to meet its statutory duties under the Care Act (2014).

3)  The committee support the establishment of devolved local test, trace and contact system to be included in the Winter Plan.

This report proposes changes to the Terms of Reference for the Cabinet Working Group for Museums following a decision by Full Council that secured further funding for Queen Street Mill Museum, Helmshore Textile Mills Museum and the Conservation Studio.

The Cabinet approved the recommendation(s) with the following amendment to the Terms of Reference of the committee.

That, the following should be added to the Roles and Functions, listed in the Terms of Reference of the committee:

"Consider the recruitment, training and re-training of technicians and apprentices for the technical jobs in the mills and also look to current and forthcoming government funded schemes in support of a sustainable future for all our museums."

The Lancashire Visually Impaired Forum invited the Highways Service to attend their meetings and asked that consideration be given to developing a Street Charter based on the Royal National Institute of Blind People's toolkit as part of their Inclusive Journeys campaign.

Officers have worked with the Lancashire Visually Impaired Forum and with officers from Preston City Council to develop the attached document at Appendix 'A' which draws together existing policies and procedures relating to the management of the public realm. Cabinet approval is sought for the approval of the Street Charter (Appendix 'A' refers) as an advice document to inform public realm work in the Preston City area as a pilot scheme and to engage with the remaining 11 district councils in Lancashire with a view to agreeing similar approval of the Street Charter.

The Cabinet approved the recommendation(s) as set out in the report.

A report on the financial resilience of the Care Home Sector.

The Cabinet approved the recommendation(s) as set out in the report.

The Winter Service Plan has recently been reviewed against the National Winter Service Research Group Practical Guide. It is proposed to amend Winter Service Policy 9 to adopt the spread rates contained in the national guidance, as per Appendix 'A'.

This is deemed to be a Key Decision and the provisions of Standing Order C20 have been complied with.

The Cabinet approved the recommendation(s) as set out in the report.

A report on the required infrastructure upgrades on the Platt's Lane closed landfill site, Burscough and the Pimbo closed landfill site, Skelmersdale.

The Cabinet approved the recommendation(s) as set out in the report.

The Cabinet approved the recommendation(s) as set out in the report.

This report focusses on alternative provision for children and young people in Lancashire. It provides an overview of the alternative provision that is currently available across the county, how this is being used and the potential impact this may be having on key outcomes for children and young people.

This information, in conjunction with that from other relevant local and national initiatives, including the SEND Sufficiency Strategy, the Strategy for Behaviour and the 2019 review of alternative provision in Lancashire, has been used to inform the development of an Alternative Provision Strategy. This strategy is presented as the proposed approach to alternative provision for children and young people across the county, over the next four years.

The Cabinet approved the recommendation(s) as set out in the report.

In line with the county council's procurement rules, this report sets out a recommendation to approve the commencement of the following procurement exercises:

(i) Supply of groceries, drinks and frozen food products

(ii) Grounds maintenance services

(iii) Waste concessions contract

This is deemed to be a Key Decision and the provisions of Standing Order C19 have been complied with.

The Cabinet approved the recommendation(s) as set out in the report.

The Cabinet approved the recommendation(s) as set out in the report.

The Chair welcomed County Councillor Albert Atkinson, Cabinet Member for Technical Services, Rural Affairs and Waste Management; Rachel Crompton, Flood Risk Manager; John Davies, Head of Service Highways; and Marcus Leigh, Highways Service Manager – Infrastructure; to the meeting to present the written responses to the committee's recommendations on strengthening flood risk management and preparedness.

County Councillor Albert Atkinson, Cabinet Member for Technical Services, Rural Affairs and Waste Management, thanked the committee and the members of Strengthening Flood Risk Management and Preparedness Task and Finish Group for their comprehensive report. The recommendations of the task group had been looked at in great detail and the Cabinet Member accepted all of the recommendations. Timescales for proposed actions were also set out in the response.

A number of comments and issues were raised by members in relation to the written responses and the following was noted:

·  Assurance was sought by the committee that the ongoing review of staffing levels within the Flood Risk Management Team, would not result in a reduction in the number of staff supporting the function.

It was reported that following a recent restructure of the Highways Management Service a review of where the Flood Risk Management Team needed strengthening was currently underway. In addition a new manager post had been created within the team. Councillors suggested this information be communicated to Flood Action Groups to quash local rumour.

·  The acceptance of the cabinet member to create a culvert policy was welcomed by the committee. The importance of locating historic culverts was highlighted. In addition it was felt that a map identifying locations of riparian responsibilities across the county would be advantageous.

·  On surface water attenuation for new highways sponsored by the county council, it was reported that plans for current projects had already been completed and work was underway. It was pointed out that if the county council discovered aspects that could alleviate flooding then the appropriate action would be taken.

·  On concerns regarding riparian owners' responsibilities it was explained that the subject matter was felt to be of a technical /specialist nature that provided a barrier to some owners in understanding their responsibilities. It was reported that the county council was exploring new ways of explaining riparian responsibilities to residents and local landowners.

·  It was acknowledged that all risk management authorities were working within the constraints of a fragmented system. One member of the task and finish group had hoped that its work would have identified measures to reduce risk, improve resilience, speed recovery and build a single voice to influence change at a national level and felt that the outcome of the work was letters rather than leadership. In addition the member felt that they were unable to report back to their residents on what had changed as a result of the work undertaken. Furthermore it was felt that the county council did not recognise the value of flood action groups and the expertise they had and felt that the response to medium term recommendation M8 to enable participation from flood action groups at Making Space for Water meetings was dismissive.

·  It was suggested that a flood risk management summit could be sponsored by the committee at some time in the future.

·  Members of the committee requested to receive copies of the letters to be issued to the relevant Secretary of States.

It was noted that a number of timescales for actions to be completed by were set for December 2020. It was suggested that an update on those actions be presented to the committee at its meeting scheduled on 12 January 2021 and or all risk management authorities and flood action groups to be kept informed of the work of the committee. Subject to elections being held in 2021 and pre-election period a further update on progress be provided in March/April 2021.

Resolved: That;

1.  The responses by the Cabinet Member for Technical Services, Rural Affairs and Waste Management be received.

2.  Copies of the letters to the Secretary of State for Environment, Food and Rural Affairs and the Secretary of State for Housing, Communities and Local Government be circulated to the External Scrutiny Committee.

3.  An update on the measures to be completed by December 2020 be presented to the External Scrutiny Committee at its meeting scheduled on 12 January 2021.

4.  The Cabinet Member for Technical Services, Rural Affairs and Waste Management, and, the Flood Risk Management Team be thanked for all the work they had done.

The work programmes for both the Health scrutiny Committee and its Steering Group were presented to the Committee.

Resolved: that the report be noted

The report presented an overview of matters considered by the Health and Scrutiny Steering Group at its meetings held on 20 November 2019 and 18 December 2019.

Resolved: that the report of the Steering Group be received

The Chair welcomed Dr Amanda Doyle, GP and Integrated Care Strategy lead for Lancashire and South Cumbria and Kevin McGee, Chief Executive for East Lancashire Hospitals Trust and Blackpool Teaching Hospitals NHS Foundation Trust. A report was presented regarding the local NHS response to the Covid 19 pandemic.

The following points were highlighted:

·  There had been a national and local change of governance arrangements, following the declaration of a level four healthcare incident by NHS England. This resulted in NHS England taking control of all healthcare resource. A local governance structure was put in place to oversee local implementation.

·  Phase one was the initial emergency response, involving planning for and managing the impact and subsequent increased demand. The actions at this stage included stepping down non-essential work. The governance arrangements were divided into two cells - hospital and out of hospital, both of which included a range of leaders who worked closely with the Local Resilience Forum (LRF) to effectively manage decision making. Some programme work regarding system development, transformation and commissioning reform had been adjourned in order to focus on the incident.

·  The hospital cell co-ordinated the work of the main hospital sites across Lancashire to support the initial surge of Covid patients, concentrating on increasing capacity for critical care and beds. The considerable numbers that had been initially forecasted for critical care were not realised. The additional requirements for personal protective equipment (PPE) had been met through mutual support across the cells and working collectively as a system.

·  The initial phase required moving staff to support the most urgent areas and this necessitated some temporary service changes to ensure service quality and the deployment of staff to the most urgent areas such as respiratory care and A&E. This included the temporary closure of Chorley A&E, the birth unit at Blackburn and the minor injuries unit at Blackpool. These clinical decisions had to be made quickly and the decisions were communicated widely with stakeholders and the public, emphasising that they were temporary measures required to respond to the crisis. Any permanent change would follow the statutory guidance and fulfil the required engagement process. Other changes included significant visiting restrictions, following national guidance to support infection control. The cell continued to work closely with LRF and other bodies to ensure changes to public services were publicised. This way of working enabled new best practice to be established in terms of sharing data between organisations in a controlled way, which facilitated improved communication and action.

·  The work was now moving toward restoration of services and taking learning points from good practice joint working to develop future practice. There had been a significant reduction in Covid 19 patients across Lancashire, however the hospitals were prepared in terms of capacity for any future surges in cases. Planning for winter was in progress alongside focusing on cancer and diagnostic activity. It was noted that restoration work would be implemented in a planned and considered way to take into account the need for staff to rest and recuperate prior to winter to support their ongoing resilience.

·  A campaign was underway to emphasise the message that hospitals were safe to increase referral levels and to ensure the public could be confident coming into hospitals.

·  The out of hospital cell had concentrated on the redeployment of staff into areas of priority; PPE provision, testing staff and patients and antibody testing for staff. The cell had also worked closely with the care sector in terms of resilience, training, infection control and escalation plans to increase care home capacity to support hospital discharge for Covid patients who often had long term reablement needs. Work was ongoing with social care providers to expedite the discharge process for those waiting for packages of care, which had significantly reduced hospital occupancy. In addition those shielding had been offered food and routine healthcare at home. The mental health cell had provided a rapid crisis response to eliminate A&E presentation by establishing 24/7 urgent treatment centres. The mental health impact of the pandemic on the wider community and staff had been recognised and invested in, including the psychological effects of coping with trauma. An on-line mental health resilience hub had been developed and had been widely accessed.

·  Phase two planning allowed continued response to the crisis and preparation for subsequent surges; alongside increasing referrals, urgent diagnostics, encouraging those with serious conditions to return to typical healthcare settings for treatment and routine elective work. A significant amount of capital expenditure had been required to support the response and ongoing plan. Extra capacity was required for infection control processes, rehabilitation, critical care, screening, diagnostics and reducing the back log. This ongoing requirement for additional workforce was at a time of increased sickness absence and when staff were exhausted. The service reintroduction plan recognised the need to look at health system capacity and a model of healthcare that moved pathways away from critical settings to support infection control. This included a rapid increase in the use of technology, such as video consultations to allow access to services for disease management. All five trusts in the Lancashire and South Cumbria Integrated Care System (ICS) now offered virtual outpatient appointments ('attend anywhere'). In addition remote monitoring at home and in care homes had been implemented, such as the use of oxygen monitoring equipment. The benefits of this would be ongoing, including reducing travel times and providing quicker responses and reviews.

·  Vital next steps included monitoring and evaluation of processes and plans as well as ongoing communication with the public. A second wave of infections were anticipated later this year and preparation was required to protect and risk assess those groups who were more vulnerable to having a severe reaction to Covid. These included Black Asian Minority Ethnic (BAME) communities, the elderly and deprived households with pre-existing poor health. This would include promoting how they help themselves, for example controlling diabetes and managing weight. In addition focus would continue on working with the LRF, particularly supporting resilience throughout winter in the care sector and maintaining the beneficial services, processes and new ways of working that were implemented to manage the pandemic.

In response to questions from members, the following information was clarified:

·  The Lancashire and South Cumbria ICS had managed the mortality rates and spread of infection well, the latter meaning that a large proportion of the population had not come into contact with Covid. No area was immune to local spikes of infection, particularly considering the impact of lock down fatigue, causing people to dissent. The greatest concern lay in areas that attracted high numbers of visitors, such as Lytham and Blackpool. This would be planned for by protecting the vulnerable by enforcing and emphasising the importance of social distancing rules. Systems were also in place to respond to any infection surges, including critical care capacity, at short notice.

·  Early hospital discharge of untested patients to social care settings had been a national issue in the early stages of the pandemic due to limited testing capacity, however Lancashire had managed well in this respect. Levels of testing was no longer an issue and all discharges were expedited with the appropriate level of testing.

·  In terms of sharing data, a single cell co-ordinated data and information to inform cohesive local planning. Comprehensive data sharing agreements were in place to support the pooling and analysis of statistics. The challenge was from extrapolating test data from the two separate testing routes. Access to pillar one NHS test results had been rapid and easy to direct. However pillar two national mass testing, commissioned by the Ministry of Housing, Communities and Local Government's (from for example, drive through sites) hadn’t been accessible locally until very recently. Having access to national test data would significantly aid planning.

·  The private sector had been utilised for NHS patients to increase overall capacity to allow 'green' sites that were Covid free. This would continue to 31 March 2021 to address the backlog of necessary elective work. Beyond that, work was planned to make sections of NHS hospitals 'green' to segregate Covid cases to restore general activity.

·  Members asked if the resources were available for building resilience in preparation for a second spike of the pandemic, specifically targeting identified vulnerable groups.

It was emphasised that prevention in its entirety and improving overall health outcomes, was a long term process. However in terms of the current situation, secondary prevention was targeted at those who were high risk or had a condition, concentrating on reducing complications and managing the risk.  For example working closely with those with diabetes, heart disease, chronic obstructive pulmonary disease (COPD) or asthma to control their condition and to ensure their treatment, prevention measures and medication were correct. The resources were available but the challenge was making sure high risk groups accessed routine chronic disease management and healthcare to ensure their condition was optimised in preparation for winter. The majority of this work could be done remotely.

·  The mortality rate was significantly increased for those with both types 1 and 2 diabetics compared to non-diabetics, however the risk was greater for type 1 diabetics.

·  Members asked for more information regarding methods of communication and engagement with disproportionately affected communities.

It was explained that this would be carried out jointly with the LRF, via the 'warning and informing' cell, who were addressing how best to target groups at greatest risk. Work had been undertaken across the Pennine Lancashire Integrated Care Partnership (ICP) with BAME groups, via a range of media (schools and places of worship) to help people understand their increased risk due to community factors and how to address this. Temporary accommodation had been sourced for the homeless and health issues had been targeted. In addition hospitals had used a range of different ways to communicate to their local communities, such as using websites, social media and local media to target groups and listen to ideas of how to improve.

It was requested that the specific methods of communication be disseminated outside of the meeting via the clerk. A member of a targeted high risk group highlighted that they had not received any information as had been described. It was suggested that methods of communication could be widened to include chief executives of district and county councils to brief their elected members.

It was noted that the NHS did report actions taken to the LRF, which did include council representation.

·  Members highlighted the complex needs of those living with dementia, in terms of physical and mental health and how isolation could impact on this. It was clarified that dementia wasn't initially included as a clinical medical condition that required shielding. However locally, GPs had included them as they recognised the importance for those with complex physical conditions to understand how they could access support and remember how to protect against infection. In addition the withdrawal of contact (necessary due to infection control measures put into place at care homes and day centres) could cause the condition to deteriorate. In response to this support had been provided to those who were isolated in the community by working with carers' support organisations and by offering routine healthcare services at home. It was acknowledged that it was a complex challenge that would need to be addressed for some time.

It was confirmed that the out of hospital cell were planning a consistent offer with sufficient capacity for vulnerable groups in light of the way access to support had changed. This would include social support, access to medication, issuing of flu jabs and monitoring of health conditions. However it was a challenge and all circumstances couldn't be fully mitigated.

Members commented that the strategy to protect vulnerable groups including dementia sufferers and their carers to prepare for another surge in cases needed to be communicated very clearly, as residents of Lancashire had expressed concerns and were unaware of how they would be protected and supported going forward.

·  It was confirmed that borough district councils were also part of the LRF and so were aware of all the actions and responses to the pandemic.

Resolved: That the report as presented be noted.

A draft copy of a combined work programme for all of the Lancashire County Council scrutiny committees was presented to the committee, alongside the committee work programme for 2019/20. Members were asked to discuss potential topics for addition on to the programme, including those that had been deferred from 2019/20. 

Members made the following comments:

·  The item for Health Scrutiny Committee: 'supporting the social care sector including domiciliary care workers' would benefit from more precise wording and detail to ensure robust scrutiny and positive critical challenge. Members wanted more clarity regarding whether the item was referencing how health services were working together with the social care sector to boost the quality of support.

It was confirmed that the development of the items was a member led process and it was a committee decision as to how the review be conducted.

·  In these uncertain times it would be beneficial if the combined work programme be flexible for the inclusion of any urgent items that may arise. In addition it was requested that there be an opportunity for members of the Health Scrutiny Committee to provide input to Scrutiny Officers alongside Scrutiny Chairs when developing the programme and identifying appropriate methods of scrutiny.

·  Concern was expressed that there were outstanding items from the last meeting and that the topic of NHS estate adequately supporting neighbourhood working was not on the combined plan

·  Additional questions and suggested topics for potential inclusion in the work programme regarding social care and test and trace would be shared with the Scrutiny Officer outside of the meeting.

Resolved: That

1. The development and delivery of the combined Scrutiny Committee Work Programme and identification of appropriate methods of scrutiny, be delegated to the Scrutiny Officers in consultation with the Scrutiny Chairs and input from any member.
2. The current Health Scrutiny Committee work programme (2019/20) be temporarily suspended and for this to be kept under review.