Agenda and minutes

Councillor Ann Edgeller declared an interest as Partner Governor of the Midlands Partnership Foundation Trust (MPFT).

Councillor Richard Cox declared an interest in Item 4 Independent Mental Health hospitals, a family member was a former service user at George Bryant Hospital.

That the minutes of the meetings 20 September 2021 be approved and signed by the Chairman as a correct record subject to correction of the grammatical amendments identified.

Report of the Clinical Commissioning Groups (CCGs)

The Executive Director Nursing Staffordshire & Stoke on Trent 6 CCGs outlined the approach to quality assurance of key Mental Health and Learning Disability Independent Hospitals and described the mechanisms in place to ensure that patients in Staffordshire and in external provision were safe and receiving the best possible care.

Host commissioner guidance came into effect in January 2021 to oversee systems and quality and to demonstrate they met the criteria outlined.

A CQC review in March 2021 alerted the host commissioner of issues at Eldertree Lodge in Staffordshire, which resulted in management of the situation and closure of the premises. All patients were relocated within timelines and had settled well into new accommodation.

Following this, a gap analysis of processes was undertaken and working arrangements had been strengthened in Staffordshire, in line with the host commissioner guidance to include: patient monitoring every 6-8 weeks; link with placing commissioners; a provider failure operational process as part of the toolkit; face to face site visits to other providers; and a proactive programme of visits regularly taking place across the system. There was acute mental health provider support with specialist mental health patients and good connections with Safeguarding Children and Adults Boards. Some of the processes developed through lessons learned were being shared locally and nationally.

In terms of mental health provision 84 patients were in placement, half in area half out, 21 out of 26 of providers were rated as good by CQC but 2 independent providers were of concern and assurance was given that commissioners were working with them and all 3 patients in placement had received satisfactory safe and well checks.

The following comments and responses to members questions were noted:

·        following a Covid outbreak at John Munroe Group in Leek, other concerns were identified and CQC carried out a routine visit. An improvement plan has been put in place with regular monitoring visits. CQC had re-visited and John Munroe Group which was subject to further improvements.  

·        During the pandemic commissioners working from home were not able to carry out face to face visits unless there were specific circumstances. Since Eldertree Lodge failure, face to face visits have been carried out where there was the slightest concern.

·        CCG was working on a document with NHS England to capture all lessons learned from Eldertree Lodge failure, highlighting how to manage the situation and to deal with challenges of relocating high level of high-risk individuals.

·        Providers were independent providers and it was important to maintain quality and standards, and to ensurepatients who were amongst the most vulnerable residents in Staffordshire had a voice.

·        As placing commissioners of a learning disability or autism package of care out of County there was a responsibility to check the individual in placement on a minimum of eight weekly basis.

·        Host commissioner guidance placed the responsibility on each of the host commissioners to make sure the organisation was safe, to advise the placing commissioner of any issues and to meet to source alternative placement for individuals,  ...  view the full minutes text for item 36.

Report of the Clinical Commissioning Groups (CCGs)

The Accountable Officer 6 Staffordshire and Stoke on Trent CCGs outlined the process to develop proposals and business cases relating to Maternity, Urgent and Emergency Care (UEC), George Bryant Centre, Difficult Decisions, Community Diagnostic Hubs, and interdependencies between programmes. It was explained that feedback from this sense check phase and other relevant data would take the long list of proposals to a shortlist of proposals for consultation.

Concerns were raised relating to NHS guidance relating to no face to face engagement. It was confirmed that CCG were working in accordance with the NHS England and consultation institute guidance and that CCG was working with Healthwatch and other voluntary sector groups in the community to carry out face to face meetings, feedback from which would be included in feedback to this committee.  It was suggested that CCG pass the committee’s concerns on to NHS England.

The Chief Executive, Healthwatch Staffordshire advised that he championed the resident’s voice at meetings with Integrated Care System ICS colleagues. He clarified that not all people wanted face to face meetings some wanted digital consultation and that a Healthwatch survey was been undertaken to find out more about what people want.

The following comments and responses to members questions were noted:

·        In terms of engagement with public in a pandemic, CCG highlighted that it was important to find a balance to provide easy access without putting people at risk and fulfil statutory duties when consulting on Major transformations.

·        In 2019 Pre-pandemic engagement took place using face to face mechanisms, the current process was to sense check the feedback from that consultation through surveys and digital means. In the next stage of consultation a hybrid approach would be taken.

·        In relation to engagement matters discussed:

o   Access to digital consultations: there were concerns about digital exclusion.It was considered that digital consultation was better attended, more accessible for many and covered a wider audience.

o   Face to face: Members wanted to speed up processes to engage in face to face meetings. There were concerns that some of the public felt excluded and that hard to reach groups may be excluded.CCG had learned a lot and reached communities that may not have taken part before. Partners and Healthwatch were working together.

o   Face to face consultation was considered essential for Elderly people who have difficulty using digital for consultation or appointments. GP Access was a top priority nationally and Committee would consider the matter in more detail on 13 December 2021.

o   Terminology: the term ‘difficult decisions’ may be confusing to people.

·       Finance: All proposals consulted on had to be financially viable optionsunder the NHSI guidance for them to go forward. Cost benefit analysis would consider the benefits from a population perspective against the financial requirements.

·       Data: It was confirmed that records of how many people were consulted, how they were contacted and where getting responses from were maintained.  CCG carried out targeted work with partners and work included protective characteristic groups as well as those  ...  view the full minutes text for item 37.

Report of the Staffordshire and Stoke-on-Trent Integrated Care System - Together We’re Better

The Accountable Officer of the 6 Staffordshire and Stoke on Trent CCGs and Director and Programme Director presented information relating to performance overview and dashboard. The report detailed referral times, diagnostic timelines and metrics, and information relating to UEC and winter pressures. It was highlighted that the ongoing pandemic and with case rates rising, the NHS was facing probably the most difficult winter ever ahead and the pressures were reflected in the dashboard submitted.

The following comments and responses to members questions were noted:

·       The indicators and red amber and green RAG rated dashboards gave a view to how indicators would progress over time.Next year the Integrated Care System ICS would move to one dashboard rather than the 6 CCG dashboards.

·       Health care acquired indicators detailed expected levels over 12 months April to March. It was considered that the infection control and lack of visitors during the pandemic had an impact on the indicators, but they did provide an indication of protection and cleanliness.

·       ICS to produce quarterly data and to report progress positive or negative movement from the last quarter.From a transformation and restoration perspectiveit was also important to compare current data with pre pandemic levels, pre-pandemic there were no waiting periods to access most services, which was considerably different now.

·       It was suggested that a financial dashboard could be added to sense check financial position moving forward.

·       More information was given on the breast cancer symptom indicator. CCG advised that this was an issue across the region and that work was taking place to set up different pathways for people to be seen, looking at new and innovative means to get women through this pathway.

·       The Chairman welcomed seeing GP Access data which was of importance to all residents

ICS was working across the system to get better integrated performance data and to use the data to ask questions to see how to improve and what can be done differently. In the new system the oversight indicators may change and links between old data and new would be looked at, it was considered that the information would be useful to people to help understand what was happening and to make change happen.

The Chairman welcomed the report which helped to build towards an overall dashboard of health across the County to see progression. It also could be rolled down into District and Borough Councils to consider what they are doing individually to improve the Health of residents.

Resolved:

That the performance overview for the Staffordshire and Stoke-on-Trent Integrated Care System (ICS) population was noted

Reports of the Director of Health and Care and UK Health Security Agency

Representatives from Staffordshire Public Health, the Environment Agency and UK Security Agency provided updates to highlight findings from four surveys that had been undertaken to measure odour and symptoms experienced by residents living close to Walley’s Quarry, and to report on the Health Risk Assessment of air quality monitoring and measures taken to reduce the off-site odours from the landfill site, since July’s meeting.

Committee considered the latest community figures from the surveys covering the period between 18 May 2021 and 13 October 2021. The residents self-reported odours and symptoms which indicated that that the air pollution continued to have a detrimental effect but that there had been an increase in the number of mental health symptoms reported due to the length of time residents were impacted by levels of Hydrogen Sulphate H2S.

The EA Project Executive provided a brief update on the strategy and plan to contain, capture and destroy H2S gas including the successful deployment of the posi-shell on 70% of the site. With the temporary capping in place to contain the gas, progress had also been made to drill 20 of the 28 wells and 50% more gas was being captured and destroyed as at same time last year.  The data showed a consistent reduction in H2S levels, that measures were having the impact expected and strong regulatory approach was being taken to encourage compliance by the operator.  There had been 2 face to face consultation events over consecutive weeks with 160-180 residents attending.

The UK Security Agency UKSA (the successor body to Public Health England) provided an update on the Health Risk Assessment of air quality monitoring results from March to August 2021.  The report detailed that the Hydrogen Sulphide H2S data up to the end of August showed continuing exposure to the population around the site at decreased concentration levels compared to March-July 2021 and at 3 of the monitoring sites they were  below the long-term (lifetime) health based guidance levels. 

The following comments and assurances were noted in response to Members questions:

• Site MF9 had higher WHO annoyance levels than recommended. The impact of the odour on resident’s mental health and the uncertainty about safety and health of self and family should not be undermined even when the advice was that air pollution was unlikely to cause long-term physical health problems.
• Assurance was given that there was no pollution in the water course coming from the landfill. Site monitors would stay in place and would continue to monitor water.
• It was reported that gypsum had got into the landfill and had produced H2S. Work was ongoing to ensure no gypsum-based materials go into site. Checks were made by sampling and continuous monitoring, also EA was also looking at where the waste was coming from and if the waste, they were sending was suitable.
• There were further concerns raised about a reduction in people’s mental health highlighted in the symptom tracker. Concern was raised about the impact on families and that there were no questions  ...  view the full minutes text for item 39.

Verbal Update of the Director of Health and Care

The Interim Assistant Director Public Health and Prevention provided an update which detailed the current position in relation to management of Covid-19, case rates, hospitalisations, death rate and infection rates.

• Covid case rates remained high and above the National and West Midlands averages. School age children have the highest case rates however they were increasing across all groups.
• Hospitalisations were creeping up however deaths from all causes remained around the same as the 5-year average.
• Vaccination: 12-15 group had slowed due to delays and the highest infection rates, causing young people to isolate and not get the vaccine jab for 28 days.

Committee noted the following comments and responses to questions:

• Testing rates in Staffordshire were amongst the highest nationally. Some issues had been reported relating to test centres and would be looked at on a case by case basis.
• Concerns that people were disrupted in their daily life waiting for test results. No tests were sent to Wolverhampton test centre from Staffordshire these were sent to Keele and further north.
• 3rd dose booster vaccine was not rolling out as fast as anticipated.
• In Staffordshire flu vaccine roll out was on track and data would be included in future presentations.

Resolved:

1. That the update report be noted.

Reports of the District and Borough Representative

District and Borough representatives presented update reports and highlighted the following matters being considered at District and Borough meetings.

• Cannock Chase 14 September 2021 meeting established Enviro crime and waste and recycling. The Portfolio holder had written to CCG about MIU awaiting response.
• Working Groups had been set up at East Staffordshire DC relating to GP Access and the Impact Covid was having in East Staffordshire. Waste review and engaging communities’ reports would be considered at a meeting soon.
• Lichfield Council had set up Dual Recycling and Climate Change work groups.

The Chairman reminded District and Borough representatives that the GP Access was being considered at County Overview and Scrutiny Committee and that local scrutiny should relate to local matters and not duplicate the work of this Committee.

Resolved:

·       That the District and Borough Updates be noted.

Report of the Scrutiny and Support Officer

Committee received the work programme and noted the following:

• The meeting on 13 December 2021 would focus on WMAS and system pressures in Staffordshire, as well as an update on the GP Access action plan.
• The link to the Introduction to Mental Health session 21 October 2021 would be circulated to all Members.
• George Bryant Centre schedule February-March 2022.

The Chairman to move:-

That the public be excluded from the meeting for the following items of business which involve the likely disclosure of exempt information as defined in the paragraphs Part 1 of Schedule 12A Local Government Act 1972 (as amended) indicated below.