Agenda and minutes

The Chair welcomed those present and led introductions.

Apologies for absence were received from Ruth Lake.

Members are asked to declare any interests they may have in the business on the agenda.

Members were asked to declare any pecuniary or other interest they may have in the business to be discussed.

There were no such declarations.

Members of the Commission will be asked to confirm the minutes of the meeting held on 17^th January 2023 as a correct record.

Due to a delay in their production the minutes of the last meeting were not received.

AGREED:

That the minutes of the previous meeting be circulated to Members as soon as practically possible and brought to the next meeting for approval.

Nothing to report at this time.

The Monitoring Officer to report on the receipt of any petitions submitted in accordance with the Council’s procedures.

The Monitoring Officer reported that no petitions had been submitted in accordance with the Council’s procedures.

The Monitoring Officer to report on the receipt of any questions, representations and statements of case submitted in accordance with the Council’s procedures.

The Monitoring Officer reported that no questions, representations and statements of case had been submitted in accordance with the Council’s procedures.

Members of the Committee to receive a report providing an overview of the urgent and emergency care system through the peak winter months, highlighting summary actions from the LLR winter plan.

Members of the Committee received a report providing an overview of the urgent and emergency care system through the peak winter months.

Rachna Vyas Chief Operating Officer presented details of key actions from the Leicester, Leicestershire, and Rutland winter plan as well as outlining preparation for 23/24 and lessons learnt to inform one-year and five-year plans across LLR.

Attention was drawn to the following points:

·         System Control Centre (SCC) was launched on 1 December 2022 as per national directive, this would act as a single point of contact for health partners to manage the flow of patients through the system on a daily basis as well as providing for escalation, operational support and reporting purposes.

·         Whilst demand had stabilised through the start of Q4, all parts of the system remained busy in terms of acuity and demand.

·         Primary care continued to be under pressure and an unprecedented number of walk-in presentations in emergency dept. had been seen. Steps were taken to address that with an additional 1,577 appointments provided during December to minimise overcrowding ED and streaming patients presenting with specific conditions to an offsite primary care provider. The impact of that had been significant.

·         There had also been a focus on providing respiratory support for adults and children with the trial of Acute Respiratory Hubs that had provided almost 9.5k appointments. Feedback showed these were easily accessible and people were not having to seek support elsewhere.

·         The Unscheduled Care Coordination Hub was a positive step to taking patients who were appropriate to be seen elsewhere off ambulance queues leading to a reduction of between 20-40 people on a daily basis.

·         Virtual wards had been introduced across 10 specialities and this was giving people ability to be cared for in their own home with support as needed.

·         Delayed discharges were at the 2^nd lowest in the country and an integrated discharge function across health and care services had launched in February 2023 to support and facilitate patients being discharged.

Members discussed the report which included the following comments:

·         The government short term funding had been received at the beginning of the year which enabled the service to plan better however health partners welcomed any support from members to get sustainable income going forward.

·         As regards the Virtual Ward, it was necessary for the person to have internet, however a full assessment was made with the patient and their carer to ensure that they had the right equipment, if they did not have a network link it did not necessarily exclude them, but the team were working patient by patient to ensure the right needs were met.

·         In terms of the risk of virtual care leading to isolation, contact was maintained with the patient on a daily basis, and they could also phone and speak to a nurse for advice and assurance.

·         Regarding patient vulnerabilities and people at risk, there would be an appropriate conversation as part of the assessment to determine suitability for virtual wards, and it was recognised  ...  view the full minutes text for item 63.

Members of the Committee to receive a report that provides a consolidated overview of UHL’s maternity services learning in respect of the following:

·         Review of Maternity services in Shrewsbury & Telford (Ockenden report)

·         Review of Maternity & Neonatal services in East Kent (Kirkup report)

This report aims to provide the Committee with information about maternity services’ current performance and includes reference to the Perinatal Surveillance Scorecard.

6.30pm Councillor O’Donnell left the meeting. The meeting remained quorate with 3 members present.

Members of the Committee received a report providing an update on maternity services following the publication of the Ockenden and Kirkup reports, and the maternity services current performance including reference to the Perinatal Surveillance Scorecard.

Julie Hogg introduced the report reminding members of the previous update and the ongoing progress with compliance expected against the  immediate and essential actions.

Members were advised that UHL continued to implement and embed the actions and overall, there had been good progress, although there was still work to do on 3 of the actions following the Insight Visit: Listening to women and families; Staff training and working together; Informed Consent.

Members considered the report and noted the following comments:

·         As far as provision for physical and mental support of young mums there was a team that looked after the caseload of women with vulnerabilities and that included young mums. The team were responsible for ensuring continuity of care throughout the pregnancy and to build trust and confidence with those women.

·         All women including younger mums and those in care were given a risk assessment and their care was tailored to them. Midwives provided care in the home or at a hub on a personalised basis to match the care to the needs of the woman.

·         In relation to pregnant refugee and asylum seekers there was a clear pathway and guidance in place, and there was raised awareness that these women were seen in adverse outcomes as some of this groups were from overseas and they hadn’t sought maternity care.

·         Maternity Voices Partnership (MVP) was very important, and the experience was made better for women if they were able to talk within local communities about the services available. MVP encouraged people to come to maternity services and could help improve outcomes by changing pathways for women that engaged.

·         A key change as a result of the Ockenden report was around the experience and treatment of those suffering still birth and there was now a full team in place covering each day.

The Chair thanked officers for the report and noted there were several other areas reflected in red on the Perinatal Surveillance Scorecard that required improvement and requested a further update on that in due course. The Chair also commented on the experience of those suffering still birth and noted that the treatment from hospital was excellent and this was an important area of care.

AGREED:

1.    That the contents of the report be noted,

2.    That a further update report, including the points specifically requested above, be provided to a meeting of the commission in the new municipal year.

Members of the Committee to receive a report providing an update on the recommissioning of Healthy Together (0-19 Health Child Programme) and the ongoing Public Consultation together with recommendations arising from the consultation outcomes.

Members of the Committee received a report providing an update on the recommissioning of the Healthy Together (0-19 Health Child Programme) service and the ongoing public consultation.

Clare Mills, Public Health Lead Commissioner and Colin Cross, Leicestershire Partnership Trust (LPT) introduced the report providing insight to the range of services in the Healthy Together package and the proposed changes to the service specification that would help improve and streamline the service.

Members noted the need to save money and how the £200,000 budget cut would be managed as well as changes at a national level to High Impact Areas. Members also noted that an engagement exercise had been carried out over 18 months listening to the views of young people and parents to help shape the proposed changes. The key changes proposed were currently out to public consultation until 9^th April 2023 and a number of events were taking place to encourage wider feedback.

Members were advised of the process undertaken to help determine the best and most cost effective provider for services, which included competitive tender and the proposal to recommission via section 75 (NHS Act 2006), noting that work done to explore the viability of this option included a marketing event (2019) followed by an exercise inviting expressions of interest from potential providers. The public consultation would help inform decision making as to whether to use a Section 75 or not.

In terms of the consultation taking place, this was exploring both the use of a Section 75 as a recommissioning tool and the proposed changes to service provision. The consultation had been divided into two parts, one for people aged 18+, and the other was aimed at capturing the young person’s voice and had been simplified and carefully worded for younger people to understand. This focused specifically on the proposed changes to the Digital Health Contact which could directly impact young people. So far there was not a high response from younger people and there had been further talk with the Youth Advisory Board on the approach to take and the team would be looking to young people groups directly to get their feedback and continue working hard to give young people a voice in the consultation.

As regards the provision of mental health support it was informed that school nurses offered low level support which was more around emotional support and through the LPT young people could have access to other services that support mental health, and this was very much integrated into the offer.

In terms of the budget reduction of £200k, it was acknowledged there was always a risk when taking money out of a budget and this was a significant reduction however the service specification had been thoroughly reviewed and considered to ensure that essential and equitable services could be safely provided.

In relation to s75 NHS Act 2006, it was explained that this allowed flexibilities to enable NHS organisations and local authorities to use partnership agreements so they can respond more  ...  view the full minutes text for item 65.

Members of the Committee to receive a report providing details of the Sexual Health Services public consultation, the interim results and next steps.

Members of the Committee received a report providing details of the Sexual Health Services public consultation together with the interim results and proposed next steps.

Laura French, Public Health Consultant introduced the report providing background information about the service area, the process for accessing sexual health services and noting that this was a complex wide ranging service involving contraception, family planning, sex education, psycho sexual counselling service amongst other things.

Members noted that:

·         The current contract for providing sexual health services to the city was due to end in March 2024 and the process of re-procurement had begun.

·         Although there was a mandatory period of consultation a lot of work had been done to encourage engagement online.

·         The online consultation survey opened on 12 January 2023 and closed on 12 March 2023

·         To date the response rate showed over 200 responses from mostly members of the public but also from some organisations and professionals.

·         Responses had been received from a wide range of age groups although the majority were 18-25 years old and female, however it was to be noted that a lot of people had chosen not to answer the gender questions.

·         A series of face to face engagement events had been carried out and it was expected there would be more of that with community groups and facilitated through the community champions network.

·         Answers reflected peoples preference for flexibility of access i.e., online and a mixture of drop-in and fixed appointments, other responses had highlighted the need for better communication of the services available and how people could access that i.e., getting an implant or obtaining free condoms.

·         The main consultation was now closed, and the results would be compiled into a detailed report alongside other feedback and outcomes.

The Chair thanked officers for the report and welcomed the inclusion of comment boxes in the consultation rather than just tick boxes.

There was a brief discussion about the suggestion of young people accessing free condoms through vending machines, where those would be sited and whether the opportunity for conversation e.g., about safe sex practices was being lost. It was acknowledged there was always a balance to be had and that safeguarding was an important element however access to sexual services needed to be non-threatening to encourage people to use them. The use of vending machines was not hugely sophisticated, and the service would take some minimum information about the person like their name and date of birth, but it was about balance and overall, it was better to have access to the condoms than not accessing the service. It was important also to maintain an ongoing dialogue with young people and this was being done through schools to maintain safe sexual habits. It was noted that the clinic within the Haymarket Centre worked well being in the city centre as people could visit easily and discretely.

The Chair thanked officers for the report.

AGREED:

                        That the contents of the report be noted.

Members of the Committee to receive the Annual Report of the Child Death Overview Panel for the period 2021-22.

Members of the Committee received the Annual Report of the Leicester, Leicestershire and Rutland Child Death Overview Panel for the period 2021-22.

Rob Howard, Consultant in Public Health and Chair of the Child Death Overview Panel (CDOP) introduced the report and advised members of the Child Death Overview Panel’s statutory duty to review all deaths of children normally resident in the area and to produce an annual report.

Members attention was drawn to the following points:

·         The purpose of a review was not an investigation as other investigations were conducted through the police and coroner.

·         The CDOP review was the final part looking at the story of what happened to that child and supporting the family through the worst possible circumstances and identifying if there was any learning that could come out or whether there were any moderation factors that could be put in place to prevent another death.

·         The number of child deaths during 2021-22 were higher than the previous few years, and although there was some concern at that it was noted that the panel now looked at all deaths no matter the gestation age whereas before there was a cut-off point.

·         Another factor to the number of deaths could be seen around covid and the lock downs in that during the lock down there were fewer deaths among children with life limiting conditions as they were not dying from secondary causes but as society re-opened there was exposure to more infections and that has led to a rise in deaths.

·         A rise in infant mortality had been seen in the city, this was an indicator of the health of the community and a direct link to deprivation which had increased over 10 years of austerity and was being looked at in detail.

·         The common modifiable factors, e.g., parental smoking and smoking in the home, maternal obesity leading to complication in pregnancy, and unsafe sleeping practices especially where people were out of a routine.

Members noted that Safe Sleep Week had recently taken place and a video about keeping young ones safe had been produced “Live Well Little Ones”.

Members also noted that the report looked at suicide and self-harm; although numbers were relatively small those cases were audited, and consideration given to how services for families could be improved.

Members expressed alarm that around 1 in 5 deaths could be avoided if children lived in less deprived areas.  There was a discussion about inequalities and how the impact of events like covid, cost of living and deprivation lead to fundamental and deep seated issues around equity.

Members felt it was crucial that this data and knowledge was shared to show it was not all right for these deaths to be happening in society.

Members noted that as a local authority, in terms of what it was trying to do with services within the resources available it was still prioritising and focusing on this area to address the situation.

The Chair thanked officers for the report and commented  ...  view the full minutes text for item 67.

The Scrutiny Policy Officer to provide update on the Health and Wellbeing Scrutiny Commission’s Work Programme. 

The contents of the Work Programme and suggestions made during the course of this meeting for inclusion at future meetings were noted.

None notified.

As this was the last meeting of the municipal year the Chair took the opportunity to thank members of the committee, officers and external stakeholders for their contributions to the meetings during the year.

Councillor Aldred expressed thanks to the Chair for her handling of the meetings and extended that thanks to the Executive Member, the Director of Public Health and the public health team.

The Chair also thanked the democratic services and scrutiny teams for their support provided to meetings.

The meeting closed at 7.40 pm.