DURHAM COUNTY COUNCIL

ADULTS, WELLBEING AND HEALTH OVERVIEW AND SCRUTINY COMMITTEE

At a Meeting of Adults, Wellbeing and Health Overview and Scrutiny Committee held in Committee Room 2, County Hall, Durham on Monday 2 March 2015 at 9.30 am

Present:

Councillor R Todd (Chairman)

Members of the Committee: Councillors J Armstrong, S Forster, K Hopper, E Huntington, H Liddle, P Stradling and O Temple

Co-opted Members: Mrs B Carr and Mrs R Hassoon and Mr P Taylor

Also Present: Councillors O Gunn and M Nicholls

1 Apologies

Apologies for absence were received from Councillors A Bonner, P Brookes, J Buckham, J Charlton, P Crathorne, M Davinson, B Harrison, P Lawton, O Milburn, L Pounder, A Savory and W Stelling

2 Substitute Members

There were no substitute Members in attendance.

3 Minutes

The minutes of the meeting held on 2 March 2015 were confirmed as a correct record and signed by the Chairman.

4 Declarations of Interest, if any

Councillor S Forster declared an interest as Chair of Malborough Patient Reference Group.

5 Any Items from Co-opted Members or Interested Parties

There were no items from Co-opted Members or Interested Parties. 6 Media Issues

The Principal Scrutiny Officer provided the Committee with details of the following items which had appeared in the press:-

 Plans revealed to expand and Durham A&E departments – Northern Echo - 26 February 2015 - HEALTH bosses have revealed plans to “significantly” expand capacity at under pressure accident and emergency departments in the North-East. In response to the growing pressure, NHS officials are drawing up new plans to expand accident and emergency at Darlington Memorial Hospital and the University Hospital of North Durham.  to control £6bn NHS budget – BBC News Website - 25 February 2015 - Greater Manchester is to become the first English region to get full control of its health spending, as part of an extension of devolved powers. Chancellor George Osborne said the £6bn health and social care budget would be taken over by the region's councils and health groups.  Petition launched in bid to save screening clinic – Northern Echo – 27 February 2015 - The fight to save a breast cancer clinic at a north east hospital has been stepped up after a petition was launched. A review group has recommended to bosses at and Darlington NHS FT that breast cancer services should operate at only two sites and have chosen Darlington Memorial Hospital and University Hospital North Durham to host them.

7 County Durham and Darlington NHS Foundation Trust - Emerging Clinical Strategy

The Committee received a report and presentation from representatives of County Durham and Darlington NHS FT that provided an update on the Emerging Clinical Strategy (for copy of report and presentation see file of Minutes).

The Principal Scrutiny Officer introduced the report that highlighted the emerging clinical strategy.

Diane Murphy, Clinical Director of Service Transformation, County Durham and Darlington NHS FT, gave a detailed presentation about ‘Right First Time, Every Time’ clinical strategy and highlighted the following areas:-

 Ambition – vision, delivering strategies, strategic principles, four touchstones and mission  Context  Vision – Right person, Right place, Right time, Everytime, 24/7  Board Seminar held on 26 November 2014  Breakthrough Areas –  Transforming Unscheduled Care  Integration and Care Closer to Home  Centres for Excellence  Capital Plans  Quality Matters – Safety, Effectiveness & Patient experience  Next steps – planning, business cases, outcomes and engagement The Chairman thanked Ms Murphy for her presentation.

Mrs R Hassoon enquired as to whether people admitted to A&E at the end of life where asked the appropriate questions about how they wanted to be cared for. Ms Murphy said that this was carried out at A&E and in an ambulance if being transported that way, as often patients were alone. The assumption could not be made that relatives would always make decisions on behalf of the patient.

Mrs Hassoon agreed to the money allocated to mobile working in the community but expressed concerns regarding confidentiality. Mr E Lovell, County Durham and Darlington NHS FT said that this issue has been longstanding and information held electronically was held securely. He assured the Committee that they could provide better safer care with records being accessible remotely. He was aware of the issues around security but said there were much more benefits.

Councillor S Forster suggested that the system for receiving people at A&E needs to change as often people are left waiting in ambulances or stuck at the entrance. Ms Murphy reported that despite pressures they had improved handovers at A&E at Durham but recognised that ambulances need to be freed up more quickly for use in the community. This would be developed for the new A&E build at Durham.

Councillor E Huntington said that with end of life care the approach taken needed to be that of common sense and needed to be managed well. Feeding people and giving them a drink was an example of this. Ms Murphy informed the Committee that each patient is given a risk assessment, including nutrition and that a common sense approach was taken. She added that training programmes are given to all staff and work was ongoing about making sure patients had drinks as national evidence had been received recently around people developing acute kidney problems through lack of hydration.

Referring to acute services in the area, Councillor J Armstrong suggested that it would be beneficial to know what is available at each site as would help alleviate any confusion to the general public. The Chairman agreed that there was a general misconception about what services you could access where and suggested that a breakdown is presented to a future meeting. Mr Lovell said that it was important to engage in a wider public consultation as a lot of services were available at that the public may not be aware of.

Referring to the timescales of work, Mr Lovell informed the Committee that the mobile working could start immediately, Darlington A&E would be completed by 2016 and planning was underway for Durham A&E.

Councillor M Nicholls said that it was good to see people living longer but asked how the Trust dealt with social isolation. Ms Murphy said that when a patient was discharged plans were put in place to deal with the aftercare. She said that GP practices were identifying the most vulnerable people at risk of isolation and all parties would need to be able to deal with that.

Mr P Taylor asked if there were any plans to develop a community hospital environment and if there was scope to develop a training school in the area. This would also help with the high levels of unemployment. Ms Murphy explained that there were six community hospitals in the area at Chester-le-Street, Shotley Bridge, , , and Bishop Auckland. A Community Team Working Group, including GP and CCG representatives were looking at community hospitals as each offer something different. How to get best value and the best use of facilities was being explored. With regards to nurse recruitment Ms Murphy advised that this was university led and each decide on how many places were available.

Councillor Forster referred to the use of Gateshead Hospital and pointed out that people from the east of the County also use Sunderland Hospitals. Ms Murphy said that North Durham CCG had commissioning arrangements with the QE at Gateshead if the level of pressure was high in Durham.

Councillor O Gunn thanked Mr Lovell for a recent meeting she had attended regarding the closure of the breast clinic at Bishop Auckland. She said that transport had been raised at this meeting as was an issue for some patients that were already experiencing high levels of stress. Mr Lovell said that they had a bus service in the past but was underused. He would take this issue back to the Trust.

Councillor K Hopper said that there had also been issues with transportation in South West Durham and said that the cost of parking and finding a space contributed to the stress of the patient.

Resolved: (i) That the information detailed in the report and presentation be noted. (ii) That the Trust bring further updates of the emerging clinical strategy to Committee including details of the formal consultation process.

8 Five Year Forward View

The Committee considered a joint report and presentation from representatives of North Durham CCG and Durham Dales, Easington and Sedgefield CCG that gave an overview of the national five year forward view and the next steps (for copy of report and presentation see file of Minutes).

Joseph Chandy, Director of Primary Care Development, DDES CCG gave a presentation that highlighted the following aspects of the Five Year Forward View:

 Principles  Four Key Themes –  Prevention  Empowering patients  Engaging communities  NHS as a social movement  New Models of Care -  Multispecialty Community Providers  Primary & Acute Care System  Urgent & Emergency Care Networks  Other Models of Care  Impact  Next Steps

The Chairman thanked Mr Chandy for his presentation.

Rachel Rooney, Strategy and Development Manager, North Durham CCG said that updates would be brought back to committee and that areas within the paper would specifically look at pathways such as dementia and would benefit the local community.

Mr Chandy said that North Durham and DDES CCGs had been granted authority for fully delegated commissioning arrangements and that conflicts of interest and the framework would be in place shortly.

Councillor J Armstrong suggested that this comes back to Committee in the next six months to give arrangements time to bed in. He asked that communications on any changes be shared with Members at the earliest opportunity. Mr Chandy confirmed that this was the case but with the change of pace from NHS it was not always possible to align with Committee dates.

Councillor S Forster expressed concerns about the future of the walk in centre at as used by two GP practices and had consulting rooms.

Mrs R Hassoon asked how patients would see any changes if the Trust was taking over GP practices. Mr Chandy advised that patients would see improvements to the service and Ms Rooney said that all partners would be working together to deliver a good service as people’s needs continue to change. Mrs Hassoon asked how people with mental health needs would make appointments and was advised that the CCG was bound by the national GP contract and would ensure they met the patient’s needs.

Resolved:- That the recommendations contained within the report be noted.

9 Planning progress update and Draft Commissioning intentions for 2015/16

The Committee considered a report from the Chief Operating Officer of North Durham and Durham Dales, Easington and Sedgefield CCG that gave an update on the progress of the two year operational plans (for copy see file of Minutes).

Rachel Rooney, Strategy and Development Manager, North Durham CCG informed the Committee that the joint paper looks at draft commissioning arrangements and has seven priority areas:-  Mental Health  Learning Disabilities  Urgent Care  Diabetes  Frail and Elderly  Primary Care Transformation  End of Life Care She highlighted the timetable and advised that the final plan would be submitted by the end of March 2015. Councillor J Armstrong stressed the importance of monitoring the plans as they progressed.

Mr Lovell mentioned that the two appendices, draft Commissioning Intentions, were an indicator that the CCGs were working towards the same objectives, and Mr Chandy confirmed that they were aligned as both CCGs were ambitious to meet the needs.

Resolved:- That the report be received.

10 Cardiovascular disease (CVD) prevention strategic framework for County Durham

The Committee received a report from the Director of Public Health that set out the principles, supporting evidence and priorities for a cardiovascular disease (CVD) prevention strategic framework (for copy see file of Minutes).

Dr M Lavender, Consultant in Public Health explained that the framework was about preventing the disease including heart attacks, heart disease and strokes. Public Health were advising on how to change lifestyle and improve health overall that would help combat these factors. CVD prevalence for deprived and affluent communities were predicted to rise by 2020. This was due to a number of contributory factors including an increase in older people and an improved survival rate.

The Committee were advised that the key messages from the report were about how to build on the progress made so far and to continue to prevent early deaths from CVD whilst reducing health inequalities.

The Chairman said that a lot of work was ongoing that was progressing and improving. He welcomed the approach to engage with people about lifestyle, wellbeing and diet.

Mr Chandy referred to the stroke unit at Durham and the hospitals in Durham that provided a good service and treat people quickly and thanked them for the support that was in place.

Councillor E Huntington referred to the improvement made to community based services that had a positive impact on lifestyle and agreed that prevention work was so important.

Dr Lavender said that the service were trying to deal with the whole problem of someone’s health and wellbeing and give them more choices and targets.

Referring to the Check4life programme Mr Taylor asked what was being done to promote take up in GP practices. The Chairman agreed that take up was stronger in some areas than others. Dr Lavender said that progress was being made and there had been significant take up in the DDES areas of the County.

Resolved:- That the report be noted. 11 Pharmaceutical Needs Assessment

The Committee received a report from the Consultant in Public Health that informed of the development of the Pharmaceutical Needs Assessment (PNA) and the process that led to its sign off by the Joint Health and Wellbeing Board in January before publication in March 2015 (for copy see file of Minutes).

Ms Clare Jones, Pharmacist advised that the PNA sits within the Joint Strategic Needs Assessment and looks at the current provision of pharmacy services and identifies any gaps. The document had been signed off by the Health and Wellbeing Board and was published every three years. The document was used when people wanted to use pharmacy premises or to commission pharmacies. She went on to inform the Committee that there was scope to develop commissioned services and highlighted three key areas:-  Supporting the elderly with medicines and ensuring a seamless transition in terms of hospital and community pharmacies.  Deprived areas – reaching the local community and providing services such as smoking cessation.  Social Isolation agenda – supporting the use of medicine boxes and tying in with care pathways work.

Mr Taylor said that more marketing and promotion as to what is available at a pharmacist would be beneficial as was often the first point of contact. Ms Jones said that there were ongoing national campaigns about putting the pharmacy first. She added that there was also work ongoing about developing the pathway between the 111 service and pharmacies, both nationally and regionally.

Mrs Hassoon expressed concerns at the lack of privacy when visiting a pharmacy and Ms Jones confirmed that each have a different set up but would have a privacy area available, as set by national guidelines.

Resolved:- That the report be noted.