Agenda and minutes

Apologies for absence were received from Councillors Cassidy and Fonseca and Karen Chouhan, Chair, Healthwatch Leicester.

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

Councillor Dempster declared an Other Disclosable Interest in Minute No 83 (University Hospitals of Leicester Quality Accounts) as a patient of the Rheumatology Department UHL.

In accordance with the Council’s Code of Conduct the interest was not considered so significant that it was likely to prejudice Councillor Dempster’s judgement of the public interest.  Councillor Dempster was not, therefore, required to withdraw from the meeting during consideration and discussion on the item.

The minutes of the meetings held on 4 January, 2 March and 29 March 2017 have/will shortly be circulated and the Commission will be asked to confirm them as a correct record.

The minutes can be found on the Council’s website at the following link:-

http://www.cabinet.leicester.gov.uk:8071/ieListMeetings.aspx?CId=737&Year=0

RESOLVED:

that the minutes of the meetings held on 4 January 2017, 2 March 2017 and 29 March 2017 be approved as a correct record.

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 Chair to make any announcements as necessary.

The Chair announced that arrangements were being made to hold a further meeting of the Leicestershire, Leicester and Rutland Joint Health Scrutiny Meeting in late May.  Members would be notified of the date when the arrangements had been finalised.

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

Mr David Bradley to submit the following representation:-

“Concerns were raised by myself 12 months ago about the care and treatment of autistic adults in Leicester both in terms of the lack of adequate and appropriate facilities within the NHS and a poorly managed process to return such patients back into the community.

At the time, the previous chair requested a report on the outcome of further discussions on the matter and questioned whether the policy could be changed to improve the care of people diagnosed with Asperger’s or autism.

I am aware that a case study has been carried out by Mark Griffiths into particular failings in the CPA process, but I am not aware of any report or policy changes with regard to the care of adults with autism whilst held in hospital where there is a distinct lack of understanding or training in dealing with the complex issues of such cases. I note that the CQC also found deficiencies in providing necessary psychological therapies for such patients.

Similarly I would still like to question the effectiveness of the Care and Treatment Review process in achieving its aims of returning adults with learning disabilities or autism back into the community, where it is painfully obvious that there are not enough specialist residential establishments in Leicester to receive them. The result being that patients are kept in hospital far longer than is beneficial for their health and wellbeing, or they are transferred out of the region again adding additional cost to their care and treatment.

When will this commission hold LPT to account for not providing appropriate care for autistic adults whilst in recovery and hold Social Services to account for not engaging with health services to prepare and provide appropriate care packages in the community?

I refer the Commission to the Statutory Guidance for Local Authorities and NHS organisations to support implementation of the Adult Autism Strategy (March 2015) – page 31 – Local Authorities, NHS bodies with commissioning responsibility should JOINTLY – Develop and update local JOINT commissioning plans for services for adults with autism, based on effective JOINT strategic needs assessment, and review them annually, for example with the local Health and Wellbeing Board.”

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

Mr David Bradley submitted the following representation:-

“Concerns were raised by myself 12 months ago about the care and treatment of autistic adults in Leicester both in terms of the lack of adequate and appropriate facilities within the NHS and a poorly managed process to return such patients back into the community.

At the time, the previous chair requested a report on the outcome of further discussions on the matter and questioned whether the policy could be changed to improve the care of people diagnosed with Asperger’s or autism.

I am aware that a case study has been carried out by Mark Griffiths into particular failings in the CPA process, but I am not aware of any report or policy changes with regard to the care of adults with autism whilst held in hospital where there is a distinct lack of understanding or training in dealing with the complex issues of such cases. I note that the CQC also found deficiencies in providing necessary psychological therapies for such patients.

Similarly I would still like to question the effectiveness of the Care and Treatment Review process in achieving its aims of returning adults with learning disabilities or autism back into the community, where it is painfully obvious that there are not enough specialist residential establishments in Leicester to receive them. The result being that patients are kept in hospital far longer than is beneficial for their health and wellbeing, or they are transferred out of the region again adding additional cost to their care and treatment.

When will this commission hold LPT to account for not providing appropriate care for autistic adults whilst in recovery and hold Social Services to account for not engaging with health services to prepare and provide appropriate care packages in the community?

I refer the Commission to the Statutory Guidance for Local Authorities and NHS organisations to support implementation of the Adult Autism Strategy (March 2015) – page 31 – Local Authorities, NHS bodies with commissioning responsibility should JOINTLY – Develop and update local JOINT commissioning plans for services for adults with autism, based on effective JOINT strategic needs assessment, and review them annually, for example with the local Health and Wellbeing Board.”

The Chair stated that the Adult Social Care Scrutiny Commission had considered several reports on Autism at its meeting in December 2016 and would receive a further update in August 2017.  A number of issued raised by Mr Bradley were related to NHS issues and NHS colleagues would be asked to respond to them in writing directly to Mr Bradley with a copy to the Commission members.

The Strategic Director of Adult Social Care commented that whilst social services staff engaged in the discharge process, NHS Staff were responsible for taking the lead co-ordinating role for the patient’s care whilst they remained in a hospital setting and it was identified that they continued  ...  view the full minutes text for item 79.

To receive a presentation from the Leicester City Clinical Commissioning Group on the CQC review for Looked After Children and Safeguarding.

Adrian Spanswick, Lead Nurse Adult Safeguarding, Leicester City CCG and Chris West, Director of Quality, Leicester City, CCG gave a presentation on behalf of the Leicester City Clinical Commissioning Group on the CQC review for Looked After Children and Safeguarding.

It was noted that:-

f)    The CQC Action Plan was divided into 11 sections and attributable to the following organisations:

·       Leicester City CCG

·       NHS England

·       Leicester City Local Authority

·       Leicestershire Partnership Trust

·       University Hospitals of Leicester NHS Trust

·       SSAFA

·       Leicester Recovery Partnership

·       Staffordshire and Stoke on Trent NHS Partnership Trust

g)   The 11 sections in the action plan covered the 59 recommendations highlighted by the CQC.  However, there were 172 planned actions identified in the CCG plan to achieve improved outcomes following the CQC review.

h)  Significant progress had been made by March 2017 against the delivery of the action plan. This included:

•     143 (of 172) planned actions had been completed.

•     28 planned actions were currently being implemented and were on            track.

•     1 action, dependent on national work (Child Protection Information Sharing Project), was currently in progress but behind anticipated delivery.

i)    The CCG continued to work with partner organisations to collate evidence of progress against actions relating to each recommendation. This involved detailed confirmation and challenge from the CCG Hosted Safeguarding Team on each provider’s submission as part of the CCG quality monitoring process.  The  ...  view the full minutes text for item 80.

At 18.35 pm the Chair adjourned for 10 minutes to enable those officers, councillors and members of the public who had attended for the previous item to leave the meeting.

At 18.45 pm the meeting reconvened with Councillors Dempster, Chaplin, Cleaver, Sangster and Unsworth present.

To receive a report from the University Hospitals of Leicester NHS Trust (UHL) providing an overview of the outcome of Care Quality Commission (CQC) comprehensive inspection of the Trust.

The Commission received a report from the University Hospitals of Leicester NHS Trust (UHL) providing an overview of the outcome of Care Quality Commission (CQC) comprehensive inspection of the Trust.

Julie Smith Director of Nursing UHL NHS Trust and Sharon Hotson Director of Clinical Quality, UHL NHS Trust, attended the meeting to present the report and respond to Member’s questions.

It was noted that:-

a)         The Inspection took place in June 2016 and the Inspection Report was published on 26 January 2017.  The Inspection had been carried out at all 3 UHL sites.  The Trust had received an overall rating of ‘Requires Improvement’.  However, a number of individual practices had been rated as outstanding; including the CHD service at Glenfield.  It had also been rated as outstanding in the previous inspection in 2014 and had maintained making many improvements since then.

b)         It was considered that good progress had being made in the general direction of travel since 2014 and the Trust acknowledged there was always more to do.  There was a positive culture within the Trust and its leadership had made sure that staff knew about the challenges being faced and what was being done to address them.

c)         The Trust had made a number of improvements since June 2016 and it had provided evidence to the CQC on these improvements.  It was pleasing that the conditions previously imposed on the Trust’s licence by the CQC in 2015 had been removed in November 2016.

d)         The Trust had been highly praised for ‘caring’ by staff and there were still challenges around the emergency pathway.  The Trust had been praised for its robust plans for the care of deteriorating patients.  Sepsis had been an area of considerable focus and challenge and UHL had made such considerable improvements in responding to the national performance indicators that it had been nominated for a national safety award.  The Trust still had many challenges around its aging estate.

e)         A Quality Summit had been held on 28 March 2017 and the initial feedback from the CQC indicated that they were satisfied with the progress being made and the Trust was making good progress to meet its aims of being rated ‘Good’ in future inspections.

Members made the following comments:-

a)         It was not helpful when inspection regime criteria changed as this made comparisons with previous inspection reports difficult and the inspection process unsustainable.

b)         The comments of ‘outstanding’ in relation to CHD services were extremely welcome; particularly in the context of the current national review which was seeking to close the service at Glenfield.

c)         It was important to remember that the proposals to reduce acute care from 3 to 2 sites would not resolve all issues facing the Trust and the proposal still required public consultation before it could happen.

In response it was noted that:-

a)         The new Emergency Department at the Royal Infirmary site was due to open on 26 April 2017 and that should allow considerable improvements to be made  ...  view the full minutes text for item 82.

The University Hospitals of Leicester NHS Trust to submit a report on the Draft Quality Account for 2016/17.  The Commission is invited t review the draft Quality Account and provide feedback by Monday 1 May 2017, as part of the statutory Quality Account process.

The University Hospitals of Leicester NHS Trust submitted a report on the Draft Quality Account for 2016/17.  The Commission was invited to review the draft Quality Account and provide feedback by Monday 1 May 2017, as part of the statutory Quality Account process.

The Chair commented that it was not an easy report to read and suggested that in future years council officers could give advice on style and format for a covering report so that it would be more meaningful for Members to make comments. It was fully recognised that the current report was written to an NHS formula.

In response it was stated that:-

a)         The structure of the report was pre-scripted by a NHS toolkit.  Trusts had asked for some time for it to be written in a more relaxed style because it was recognised that it was not an easy format to be readily understood by the public.  The Trust was in the process of preparing a more accessible and easier to read report for the public. 

b)         Any response from the Council had to be included in its entirety (unedited) in the comments section of the report.  The Council could comment on any item in the report or on any other issues which were of concern to the Council.

c)         Comments made in previous years had been taken into account in the production of this year’s report but there were still difficulties in presenting the quality matrix in an easier format.

d)         The report provided an account of the Trust’s performance to the public, its partners and its Board.  It was intended to reflect upon the quality of services provided but it should also provide a balanced picture to include and recognise the challenges being faced, together with commentary on the improvements the Trust wished to achieve in the following year.  It was particularly pleasing that the Trust performance on infection control was one of the best nationally.  There were still challenges to be faced especially around capacity and the Emergency Department but there were plans to achieve improvement.

e)         The final draft would be submitted to the Trust’s Board in June, following the inclusion of comments received and then it would be audited by the KPMG for quality assurance against the NHS checklist and data requirements.

AGREED:

That the draft Quality Accounts be received and that the Chair of the Commission be given delegated authority in conjunction with the Scrutiny Policy Manager to prepare a response to the draft Quality Accounts and circulate it to members of the Commission for comment prior to them being submitted to UHL.

The Leicester City Clinical Commissioning Group to submit a report on Shared Care Agreements.

The Leicester City Clinical Commissioning Group submitted a report on Shared Care Agreements.  Dr Danahar, GP Lead for Prescribing and Lesley Gant, Head of Medicines Optimization attended the meeting to present the report and respond to members’ questions.

It was noted that:-

a)         Shared Care Agreements (SCAs) aimed to facilitate the seamless transfer of an individual patient from secondary care to general practice to allow patients with complex conditions and drugs treatment regimes to be cared for closer to home.  The full range of medical conditions where SCAs could be used were outlined in the report.

b)         The process and monitoring requirements surrounding SCAs were robust and provided safeguards for the patient.  An SCA was an agreement and, if the patient’s GP agreed to take on the care in the agreement, the shared care arrangements would start and monitoring would take place between the GP and the secondary care commissioners via e-mail.  Not all GP practices accepted SCA’s and where this was refused by the GP, the patient’s care continued to be provided by the secondary care sector.  In these instances the CCG worked with the GP to provide support aimed at enabling the GP to work towards accepting SCA’s in the future.  From October to December 2016 103 SCA’s had been refused by GPs in the LLR area.  The refusal in the City was approximately a third of the total refusals and this equated, on average, to less that I per practice per quarter.  More than half of the refusals by GPs were of a temporary nature until further support or training could be provided. It was thought that the total number of refusals not accepted altogether was in the region of 40 for the quarter.

In response to Members’ questions the following responses were received:-

a)         In instances where the SCA was refused by the GP, the secondary care commissioner would try to resolve the issues.  The responsibility for the patient’s care would remain with the specialist practitioner in the secondary care sector.  Very few SCA’s involved patients who were already in hospital, so this did not impact directly upon patients’ length of stay in hospital.  A number of SCA’s involved patients with rheumatoid conditions and GP’s would monitor any side effects the patient may have to the medication they received and would discuss changes to the medication with the specialist practitioner where appropriate.

b)         Should a GP practice close the patient could transfer to another practice, which could then consider taking over the patient’s SCA. If not then the patient’s care would revert to the secondary care specialist.

c)         The secondary care specialist would first discuss the possible use of an SCA with a patient before any referral was made to a GP.  If a patient refused to have treatment in a safe environment then the treatment could be withdrawn.  Equally if the patient did not fully comply with the monitoring arrangements with the GP then this would be flagged on the system  ...  view the full minutes text for item 84.

The Director of Public Health to submit a report providing an update in Oral Health in Leicester. 

The Director of Public Health submitted a report providing an update in Oral Health in Leicester.  Tiffany Burch, Specialty Registrar Public Health, presented the report and responded to members questions.

During the presentation of the report the following comments were noted:-

a)         Since the introduction of the Oral Health Promotion Strategy 2014-17, the Council had made dramatic improvements in the oral health of 5 year olds.  The intention of the strategy was to see a 10% increase in the number of 5 year olds who were decay free by 2019.  At the time the strategy was launched, the Council had the worst performance in the county.  Dental health survey results released by Public Health England in May 2016 showed an 8% improvement in just 2 years moving the Council from bottom to 4^th worst performer in country.  The scale of the improvements would normally be expected to take much longer to achieve.  It was hoped that the initial target of 10% improvement would be achieved when the next survey results were released in 2017.

b)         The Council had received an award from the Royal Society of Public Health for its programme of oral health improvement and the Chief Dental Officer was also looking at how the Leicester model could be fed into a national programme.

c)         18 primary schools, 84 nursery and playgroups and I special school were now participating in the Supervised Brushing programme.

d)         50,000 Oral Health Resources Packs (free toothbrushes and toothpaste) had been distributed in the last two years by schools, Health Visitors, Family Nurses Partnership and Travelling Families Team.

e)         The supervised toothbrushing pilot for special schools carried out at Ellesmere College had now been completed and the Happy Teeth Happy Smiles Team were using the success of the pilot to roll out the programme to other special schools.

f)          4 dental practices have received the Happy Teeth Happy Smiles accreditation with a further practice close to accreditation.

g)         Staff were working with the Leicester Pharmaceutical Committee to incorporate oral health in the Healthy Living Pharmacy Accreditation Scheme.

h)        The use of social media had been found to be highly successful and would continue to be used.

Members welcomed the improvement achieved in such a relatively short space of time and made the following suggestions to continue the good progress made:-

a)         The Oral Health Resource Pack could be included in the food bank distribution.

b)         Consideration should be given to running Supervised Toothbrushing at Community Centres during school holiday periods so that parents can be involved with their children.

c)         Consider attending a street party for children being organised in Highfields on 12 August 2017.

d)         Consider contacting working men’s clubs in the city as most club committees work with families and encourage them to use the clubs.

The Chair commented that she hoped there would be no budget cuts to oral health budget as it needed to be increased by inflation to keep on track.  It was important to maintain funding as  ...  view the full minutes text for item 85.

The Scrutiny Policy Manager submits a document that outlines the Health and Wellbeing Scrutiny Commission’s Work Programme for 2016/17.  The Commission is asked to consider the Programme and make comments and/or amendments as it considers necessary.

The Scrutiny Support Officer submitted a document that outlined the Health and Wellbeing Scrutiny Commission’s Work Programme for 2014/15.

AGREED:

That the Work Programme be noted and that the suggestion of adding autism to the Work Programme and also working jointly with the Adult Social Care Scrutiny Commission on this be noted.

The Chair closed the meeting at 8.06 pm.