Agenda and minutes

          The Minutes of the meeting held 4 March 2014 having been printed and circulated were signed as a correct record.

        The Board was advised that no public questions had been received.

The Minutes of the Health and Wellbeing Board of its meeting held on 12 March 2014 were submitted to the Board for consideration.

RESOLVED: That the minutes be noted.

The Board considered a report of the Strategic Director, Communities which gave Members an update in relation to the current projects/areas of work associated with improvements in Urgent Care. 

The Board also received a presentation from Mr Simon Wright, Chief Operating Officer/Deputy Chief Executive of Warrington and Halton Hospitals NHS Foundation Trust in respect of the progress towards the development of Urgent Care Centres in Runcorn and Widnes.

The Board was advised that demand on NHS hospital resources had increased dramatically over the past 10 years, with a 35% increase in emergency hospital admissions and a 65% increase in secondary care episodes for those over 75 years.

It was reported that the Governance Structure associated with the Urgent Care system in Halton was attached at Appendix 1 to the report.  It was reported that the Urgent Care agenda was a complex and challenging, which required high quality and accessible primary, community and social care services to be in place to provide alternatives to A&E attendance and admittance to hospital for the local population.  The Board noted the local activity in Halton in respect of NHS services set out in paragraph 3.9 of the report. The Board also noted the areas that were improving but were presenting a challenge and the areas that remained a significant challenge.

The Board discussed and noted the local developments currently having an impact on the urgent care system within Halton, set out in paragraphs 3.17 to 3.23 of the report.

The following points arose from the presentation:-

·             The Board welcomed the proposals as it would reduce the number of people attending A&E as they could be treated locally;

·             Clarity was sought on the timetable for phase two of the project and whether it would result in patients attending the Urgent Care Centres rather than their GPs. In response, it was reported that some people would use the Centre rather than their GP but this would release time for GPs to develop other services which they are currently unable to do because of time constraints.  It was reported that there were no formal timelines for Phase 2 of the project.  However, it was anticipated that Phase 2 would be completed by summer 2015;

·             Concern was raised that on the following points in relation to the building in Widnes; access was limited; there was already a massive car parking issue and increased usage of the building would exacerbate this issue; the lift was not suitable for wheelchair access and because of the design of the building it was very cold in the winter.  In response, it was reported that 175 car parking spaces would be made available across from the Unit.  Patients would be encouraged to part at the unit and staff on the car park which would also create additional parking for patients  The situation was being monitored and it was anticipated that it would eventually alleviate parking problems in that area.  It was also reported that the ground floor services would be moved  ...  view the full minutes text for item 4.

Note: (Councillor Gerrard declared a Disclosable Pecuniary Interest in the following items of business 5C,5D,6A, 6B and 6D and a Disclosable Other Interest in Item 6C due to a close relatives holding positions including management of 5Boroughs and Halton and Warrington Partnerships) and left the meeting)

The Board considered a report of the Strategic Director, Communities which presented Members with details of the proposals for change and expansion of the Clatterbridge Cancer Centre Services, the rationale for these changes and the implications.  The following representatives from Clatterbridge Hospital attended the meeting to present the proposals: Fiona Jones - Project Director, Dr. Nicky Thorp - Assistant Medical Director, Emer Scott - Associate Director of Strategic Communications. Ms Jacqueline Robinson, NHS Cheshire & Merseyside Commissioning Support Unit.

The Board was advised that formal notification had been received from NHS England (NHSE) Cheshire, Warrington and Wirral Area Team Specialised Commissioning, as the accountable commissioners, and Clatterbridge Cancer Centre (CCC) NHS Foundation Trust, as the providers of cancer care for the people in Halton, of the proposed changes to the services provided by CCC. The details of the proposals, the background and consultation plan were attached at Appendix 1-6 of the report.

It was reported that the Board would need to consider the proposals and agree that they constituted a significant variation to the services provided to the residents of Halton. If this was agreed then the proposals would be subject to joint scrutiny as determined by the protocol for establishment of joint health scrutiny arrangements for Cheshire and Merseyside.  The protocol had been agreed by full Council in April 2014. Following the agreed protocol, it was likely that the lead Authority would be Liverpool or Wirral.

The following comments arose from the discussion:-

·             The Board raised concern at the transport issue and the cost of car parking for residents indicating that Halton was a deprived area and there would be a substantial cost for the residents.  It was also reported that to get to The Royal in Liverpool, Halton residents would have to take three buses, which resulted in a long journey and a significant cost to the resident.  Concern was also raised that numerous services were being placed in The Royal Hospital, Liverpool and the footfall would significantly increase. In response, it was reported that car parking on the Liverpool and Clatterbridge sites would be free.  It was also reported that discussions would take place with Merseytravel to enhance the bus services.  In addition, it was reported that the proposals would give patients greater options and some of those patients would be treated more locally than at the present time.  An assurance was given that Members would receive more detailed information on transport via the patient journeys that will be developed in the future;

·             Clarity was sought on waiting times and whether they would be affected or improved.  In response, it was reported that the waiting times at Clatterbridge were very good.  However, patients only attended the services provided by Clatterbridge further down the patients pathway as they had already been diagnosed or had surgery.  However, it was reported that the increased capacity would make treatments more accessible;

·             It was suggested that Fazakerley would have been the ideal location for such services as it was easily accessible and was  ...  view the full minutes text for item 5.

The Board considered a report of the Strategic Director, Policy and Resources, regarding the Quarter Monitoring Reports for the fourth quarter of 2013-14. The report detailed progress of key performance milestones and performance targets relating to Healthy Halton and described factors affecting the service.

The following comments arose from the discussion:-

·             Respiratory Health and the development of the Action Plan - the Board requested that this be reported to the Board;

·             Public Health targets, amber indicators, it was highlighted that as it is the end of year, these indicators should be amber or red.  It was agreed that information on this matter would be circulated to all Members of the Board; and

·             Raising awareness of bowel, breast and lung cancer - Clarity was sought on why data was not available.  In response, it was reported that information on this matter would be circulated to all Members of the Board.

RESOLVED: That the report and comments raised be noted.

The Board considered a report of the Strategic Director, Communities which information to the Health Policy & Performance Board on the progress in achieving targets contained within the 2011 – 2016 Sustainable Community Strategy for Halton.

The Board was advised the Sustainable Community Strategy for Halton, and the performance measures and targets contained within the report would remain central to the delivery of community outcomes. It was therefore important that progress was monitored and that Members were satisfied that adequate plans were in place to ensure that the Council and its partners achieved the improvement targets that had been agreed.

The Board was also advised that Appendix 1 to the report outlined the progress for the period to year end 31 March 2014 which included a summary of all indicators for a Healthy Halton.

The Board complimented Officers on the report and requested that in future reports could include a commentary on the yellow indicators.

RESOLVED: That the report and comment raised be noted.

The Board considered a report of the Strategic Director, Communities which gave Members an update on key issues and the progression of the agenda for safeguarding ‘vulnerable adults’ (i.e. adults at risk of abuse) in Halton.

The Board was advised that The Deprivation of Liberty Safeguards (DoLS) was one aspect of the Mental Capacity Act (2005). The Safeguards were to ensure that people in care homes and hospitals were cared for in a way that does not inappropriately restrict their freedom, and if necessary restrictions would only applied in a safe and correct way, and that this was only done when it was in the best interests of the person and there was no other way to provide appropriate care.

The Board was further advised that the recent Supreme Court ruling was significant in the determination of whether arrangements made for the care and/or treatment of an individual lacking capacity to consent to those arrangements amounted to a deprivation of liberty. The ruling clarified that there be a revised test for a deprivation of liberty and the two key questions should be asked; Is the person subject to continuous supervision and control? And is the person free to leave?

It was reported that the judgment was important as it holds that a DoL could occur in a domestic setting where the State was responsible for imposing those arrangements. This would include a placement in a supported living arrangement in the community. Therefore, where there is, or is likely to be, a deprivation of liberty in such placements that must be authorised by the Court of Protection.  An action plan was currently being developed to fully scope and address the implications of this judgement.

The Board noted the various activities that had taken place that were set out in paragraph 3.7 to 3.9 of the report.

It was noted that Halton’s level of participation was at bronze level due to it being the point that all Councils had to start.

RESOLVED: That the report and comment raised be noted.

The Board considered a report of the Strategic Director, Communities which provided Members with an update on the work of the Care Homes Project.  The Appendix to the report contained the Interim Report of the Halton Care Home Project undertaken in March 2014.

The Board was advised that Halton Care Homes project had been in operation since July 2013. The project aimed to improve the quality of care within homes in the Borough through: review of current care practices; analysis of the range and ease of access residents have to health and social care services and identify sustainable ways to improve treatment, care and support.

The Board was further advised that the project had identified that the care provided by homes they have worked with has been of a high standard. The project had worked closely with the full range of Halton’s community health and social care services. A clinical reference group had been supporting the aims of the project and some immediate solutions to issues had been implemented. The project had also grouped some of the key issues into seven areas: communication; end of life care; physical care; pharmacy; equipment; primary care utilisation and activities.  It was reported that further work was ongoing to identify an appropriate level of clinical support to continue the work of the project.

The following comments arose from the discussion:-

·             Clarity was sought on who made the decision on whether to call out a GP or not in a care home.  It was reported that people in care homes were being admitted into hospital as a result of the GP not being called at an earlier stage.  In response, it was reported that this training and development would help to address this matter i.e. staff could be trained to test for such things as a urine infection and if the stick proved to show an infection, the GP could be called in at an early stage;

·             Concern was raised that GPs had different preferred methods for communication and some GPs would not accept telephone calls.  In response, it was reported that the report would be presented to the GPs next month with clear recommendations for communication practices with care homes to ensure there was a consistent approach across all GP practices with the care homes.  It was also reported that GPs were keen to adopt a consistent approach to this issue;

·             It was highlighted that in some care homes, individuality was lost as they were treated as patients not as a ‘person’.  In response, it was reported that work was taking place on leadership and management within care homes with good practices being shared and consideration given to how they could be adopted in their care home setting i.e. a tv room made to look like a theatre and activities taking place during the day that residents can dip in and out of.  This would create a culture where they would challenge each other.  The importance of activities in the care home setting was  ...  view the full minutes text for item 9.

The Board considered a report of the Strategic Director, Communities which presented the Annual Report for the Health Policy and Performance Board for April 2013- March 2014 attached as Appendix 1 to the report.

          It was reported that during 2012 -13 the Board had looked in detail at many of Halton’s Health and Social Care priorities. Further details of these were outlined within the Annual Report set out in Appendix 1 to the report.

The Chairman took the opportunity to thank Officers and Members for their contribution to the Board and Working Groups during the last municipal year.

RESOLVED: That the report be noted.

The Board considered a report of the Strategic Director, Communities, which presented Members with details of the Care at Home Provision Scrutiny topic as outlined in the Topic Brief attached as Appendix 1 to the report.

RESOLVED: That

(1)        the report and comments raised be noted;

(2)        the Topic Brief outlined in Appendix 1 to the report be approved; and

(3)        the following Councillors be nominated as Members of the Care at Home Provision Topic Group; Councillors: Baker, E Cargill, Horabin, M Lloyd-Jones, C Loftus, Sinnott, Wallace and

Mr T Baker.