Agenda and minutes

Apologies for absence were received from Councillor Aldred and Councillor Westley.

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

No declarations were made.

The Minutes of the meeting of the Health and Wellbeing Scrutiny Commission held on 4 July 2019 are attached and Members are asked to confirm them as a correct record.

Further to minute 10, “Primary Care Hub Access at the Merlyn Vaz Health and Social Care Centre”, it was noted that the discussions on how an analysis of patient experiences following the introduction of a hybrid system for accessing services at the Merlyn Vaz Centre could be undertaken had not been held yet. 

Further to minute 15, “Work Programme”, it was noted that scrutiny of issues such as education Health Care Plans for children, childhood obesity and children’s mental health services would be undertaken with the Children, Young People and Schools Scrutiny Commission at he January meeting of the Health and Wellbeing Scrutiny Commission.

AGREED:

that the minutes of the meeting of the Health and Wellbeing Scrutiny Commission held on 4 July 2019 be confirmed as a correct record, subject to the first line of paragraph 12 of minute 10, “Primary Care Hub Access at the Merlyn Vaz Health and Social Care Centre”, being amended as follows (new wording in italics):

“Sarah Prema Harsha Kotecha, Chair of Healthwatch, advised that Healthwatch had visited two hubs …”

No announcements were made.

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 received.

The following representation has been received from Ms Lucy Chaplin:

“Are health providers aware that by offering mental health support through mainly telephone-based services that phone companies - particularly mobile phone companies - do not inform users that they may have used up contracted minutes and accumulated large phone bills in accessing the support they need? 

While it is very helpful to be able to call the crisis team, and other services, it is very difficult to keep track of time. Indeed why should someone who is already so unwell that they need these services have the additional burden of thinking about their phone bill?

Has any part of the NHS looked into this, or discussed the issue with mobile phone companies, as many patients with severe mental health problems are already on reduced income, indeed many are classed as homeless, and cannot afford huge phone bills. When people can't pay the bill their phones are barred by companies, which actually cuts patients off from ALL the support networks they have. 

This is like an additional tax, and additional stress, on those who are ill with poor mental health, as is discriminatory. 

Responses from the CCG and LPT would be welcome. 

I would also ask that the Leicester City Council Health and Wellbeing scrutiny commission agrees to take this up with NHS England and asks that there are agreements with phone companies about making those telephone services COMPLETELY freephone - in order that already vulnerable people are not faced with huge bills just for accessing the services they need. 

Is Leicestershire the only place where this happens? 

I've also copied in Keith Vaz as my local MP and Jon Ashworth MP as the shadow Health secretary as they could also take this up nationally. 

It is a scandal that while society tries to breakdown the stigma of poor mental health, the telephone companies are making a lot of money from people accessing help, especially when that help is mostly available only via telephone.”

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

Ms Lucy Chaplin submitted the following representation:

“Are health providers aware that by offering mental health support through mainly telephone-based services that phone companies - particularly mobile phone companies - do not inform users that they may have used up contracted minutes and accumulated large phone bills in accessing the support they need? 

While it is very helpful to be able to call the crisis team, and other services, it is very difficult to keep track of time. Indeed why should someone who is already so unwell that they need these services have the additional burden of thinking about their phone bill?

Has any part of the NHS looked into this, or discussed the issue with mobile phone companies, as many patients with severe mental health problems are already on reduced income, indeed many are classed as homeless, and cannot afford huge phone bills. When people can't pay the bill their phones are barred by companies, which actually cuts patients off from ALL the support networks they have. 

This is like an additional tax, and additional stress, on those who are ill with poor mental health, as is discriminatory. 

Responses from the CCG and LPT would be welcome. 

I would also ask that the Leicester City Council Health and Wellbeing scrutiny commission agrees to take this up with NHS England and asks that there are agreements with phone companies about making those telephone services COMPLETELY freephone - in order that already vulnerable people are not faced with huge bills just for accessing the services they need. 

Is Leicestershire the only place where this happens? 

I've also copied in Keith Vaz as my local MP and Jon Ashworth MP as the shadow Health secretary as they could also take this up nationally. 

It is a scandal that while society tries to breakdown the stigma of poor mental health, the telephone companies are making a lot of money from people accessing help, especially when that help is mostly available only via telephone.”

On behalf of Leicester City Clinical Commissioning Group, Richard Morris (Director of Corporate Affairs) gave the following response:

“We would like to thank Ms Chaplin for raising these issues. We have spoken with Leicestershire Partnership NHS Trust who have provided the following response:

‘Where phone-based support is offered to our patients and service users we want to ensure it is accessible and affordable. Our 24-hour mental health crisis support line, commissioned from our partners at Turning Point, is free to call from landlines and most mobile networks and a call-back service is also offered via email request. Similarly, our suite of ChatHealth support services provide confidential support via a secure text messaging service.

Where individuals are given landline numbers we also aim to ensure they have information about the other options open to them. However, if there is more we can do we will certainly consider it and we are grateful for this helpful feedback. We will be reviewing it as part of our plans to develop of a single  ...  view the full minutes text for item 22.

Angela Hillery, Chief Executive Officer, and Anne-Maria Newham, Director of Nursing (AHPs & Quality), from the Leicestershire Partnership NHS Trust (LPT) will give a presentation providing the Commission with details on the current Care Quality Commission position for LPT, assurance around actions that have been taken following recent inspections and the Trust’s approach to monitoring and embedding these actions.  The Commission is recommended to consider the presentation and comment as appropriate.

Angela Hillery, Chief Executive Officer, and Anne-Maria Newham, Director of Nursing (AHPs & Quality), from the Leicestershire Partnership NHS Trust (LPT) gave a presentation providing the Commission with details on the current Care Quality Commission (CQC) position for LPT, assurance around actions that had been taken following recent inspections and the Trust’s approach to monitoring and embedding these actions.  A copy of this presentation is attached at the end of these minutes for information.

During the presentation, Ms Hillery drew particular attention to the following:

·           Full information on the results of the CQC regulatory inspections was available on the LPT’s website (www.leicspart.nhs.uk);

·           The STEP up to GREAT strategy was the focus for the whole Trust. A director had been assigned to each area of the strategy, and these directors had responsibility and accountability for taking their areas forward.  The Programme Management office supported them in doing this;

·           Nationally, the use of dormitory accommodation in mental health units was considered unacceptable.  The LPT endorsed this view and was trying to find capital funding to eliminate it in the Trust’s facilities;

·           Staff were at the heart of change, so a number of Change Champions had been recruited across the organisation.  Approximately 80 people had volunteered for this role and had provided useful insights in to the organisation culture, what worked and what did not work;

·           The CQC had undertaken an unannounced inspection in June 2019 and had identified some encouraging improvements.  For example, improvements had been made in recording patients’ physical healthcare and monitoring patients with ongoing physical healthcare problems, so mental health services did not just focus on mental health.  Fire safety also was much improved, part of which was enforcement of the ‘No Smoking’ policy.  However, most mental health units nationally found this difficult to implement, as people attending these units often were in distress and smoking provided them some relief from this;

·           As the waiting list of children and young people waiting for treatment had increased and the demand for neurodevelopment assessment remained high, work needed to be undertaken with the Trust’s commissioning partners to improve access to these services and ensure they were appropriate;

·           An intensive support team from NHS England had looked at the commissioning and provision of Child and Adolescent Mental Health Services (CAMHS);

·           Awarding a rating was not part of the process of the inspection undertaken in June, but the Warning Notice was removed following that inspection; and

·           The LPT would have a re-inspection sometime from October or November 2019 onwards, when it was hoped that some improvement would be seen.

Ms Newham assured the Commission that the LPT was not being complacent about this work.  It was recognised that the Trust had not worked well co-operatively in the past, but this had been addressed.  It also was recognised that the Trust had not provided good responses to complaints in the past, particularly telephone complaints, and this also was being addressed.

Rachel Bilsborough, Divisional Director Community Health with the LPT, stressed that staff on  ...  view the full minutes text for item 23.

The Leicester, Leicestershire and Rutland 2019/20-2023/24 Primary Care Strategy is submitted by the Leicester City, West Leicestershire and East Leicestershire & Rutland Clinical Commissioning Groups.  The Commission is recommended to scrutinise the Strategy and comment as appropriate.

The Leicester, Leicestershire and Rutland 2019/20-2023/24 Primary Care Strategy was submitted by the Leicester City, West Leicestershire and East Leicestershire & Rutland Clinical Commissioning Groups (CCGs). 

Tim Sacks, Chief Operating Officer at East Leicestershire and Rutland Clinical Commissioning Group, explained that the CCGs had been asked to produce the Strategy, to show how primary care practice would be driven forward, including how it was envisaged Primary Care Networks (PCNs) would work together and impact on the functions of CCGs.  This therefore was a high-level plan, from which an operational plan would be developed.

The Strategy would be delivered through the PCNs, but meetings to discuss how this would be achieved had only just started, so it was anticipated that it would take time to implement the Strategy.  Directors across the three organisations were taking the lead on portfolios within the Strategy to ensure their delivery.

To facilitate this, new funding was being provided, which included funding for the PCNs and for 12 or 13 additional clinical staff.  Initial funding was for five years and it was hoped that during the first year funding would have been accessed, staff appointed and trained, and patients would be seeing improvements in access and care.  Government guidance indicated that funding would only be released when the additional clinical staff had been employed.  There also had been an increase in funding for GP practices this year, with an additional 1.5% being provided for core practice services.

The Commission expressed some concern that structures were being funded, not services.  In reply, Mr Sacks explained that the roles in PCNs were very specific, so with the additional staff delivering other services more time was available in practices for providing core services.

It was stressed that the differences between PCNs, (for example, in demographics and resources), needed to be taken in to account.  Services therefore needed to be locally responsive and to address the concerns of patients in each area, so would be commissioned accordingly.  Practices could ask to move between PCNs, or they could be expelled from a PCN, which could change the resources and demographics of those PCNs and it was anticipated that there would be some movement over time.

Improvements in primary care would be determined through analysis of data by NHS England and the establishment of local benchmarks.  The three basic aims of improving care, access and outcomes had been set by the CCGs and would be achieved through delivery in the seven key contract areas.  At present, performance indicators for these had not been created, so work was underway to establish the base line.  Risk stratification scores and national standards of care also would be used to direct service delivery and improvement.  Progress with the Strategy was monitored through the national workforce survey, which was held every three months and to which all practices were required to respond.

This structure meant that it was possible that improvements would not be reflected in patient surveys during the first year, but it would be disappointing  ...  view the full minutes text for item 24.

The Leicester, Leicestershire and Rutland Clinical Commissioning Groups (CCGs) submit a report describing the Community Services Redesign project to date,  setting out the future model that the CCGs will commission, describing what impact that will have on the care people receive and what that will mean to other parts of the health and care system in Leicester, Leicestershire and Rutland, as well as the next steps in the CCGs’ work on community health services.  The Commission is recommended to consider the report and comment as appropriate.

The Leicester, Leicestershire and Rutland Clinical Commissioning Groups (CCGs) submitted a report describing the Community Services Redesign project to date.  The report set out the future model that the CCGs would commission, describing what impact that would have on the care people received and what that would mean to other parts of the health and care system in Leicester, Leicestershire and Rutland.  The report also outlined the next steps in the CCGs’ work on community health services.

Tamsin Hooton, CCG Director Lead for Community Services Redesign, introduced the report, making the following points:

·           Adult community health services in Leicester, Leicestershire and Rutland were being reviewed as they had not been commissioned to work with other health care providers in a way that was consistent with how health care would be provided in the future;

·           Some of the perceived deficits it was hoped to address included services for people in crisis and the capacity of community nursing services;

·           A new model of care had been developed, based on feedback, which showed that a lot of services were not seen as being joined up;

·           A new model of home-based care had been designed, comprising of three parts: neighbourhood community nursing and therapy services, Home First services and Locality Decision units;

·           As part of this, investment was being made in greater GP capacity through Primary Care Networks;

·           The key change in the first phase of introducing the new model would be the reorganisation of teams within the Leicestershire Partnership NHS Trust (LPT) by the end of 2019 and increasing capacity through to early 2020;

·            A system transformation working group had been established and included various partners, such as University Hospitals of Leicester NHS Trust (UHL); and

·           The success of the redesign would be assessed by a steering group comprised of various partners looking at the impact that the redesign had on people’s experiences, including whether they were able to stay at home, and the impact on community hospitals.

Rachel Bilsborough, Divisional Director Community Health with LPT, advised the Commission that the redesign was being co-produced by health care professionals, Healthwatch and patients, carers and users.  Service users would be the same people as previously and they would have the same needs, but the care received would be changing under the redesign.  The LPT Board would consider the proposals on 30 August 2019.

Members noted that the service already had a strong relationship with the City Council and this would be built on through the redesign, but Council staff would remain working for the Council.  Ms Hooton also noted that the City Council’s Adult Social Care service had been very engaged in the redesign of Community Services, helping with things such as the testing of new models.

The Commission noted that a significant workforce challenge would be in the number of therapy staff employed, as this currently was lower than national averages.  In addition, integrating therapy services and acute social care could be problematic, as people were being discharged to go home for  ...  view the full minutes text for item 25.

The current work programme for the Commission is attached.  Members are asked to consider this and to make comments and/or amendments as considered necessary.

AGREED:

The work programme for the Commission be received and noted.

The meeting closed at 8.15 pm