Agenda and minutes

To receive any apologies for absence.

An apology for absence had been received from Councillor Atkinson.

To receive details of any changes in membership.

Councillor Irving had attended a substitute for Councillor Atkinson for this meeting only.

To receive declarations of interest by members of any interests on respect of items on this agenda, and to consider any dispensations.

Members may however, also decide, in the interests of clarity and transparency, to declare at this point in the meeting, any such disclosable pecuniary interests which they have already declared in the Register, as well as any other registerable or other interests.  

There were no declarations of interest.

To consider whether the press and public should be excluded from the meeting during consideration of any item on the agenda.

RESOLVED: - That the press and public not be excluded during the consideration of any items on the agenda.

To consider the minutes of the previous meeting held on 1^st June, 2023 (copy enclosed).

RESOLVED: - that the minutes of the previous meeting held on 1 June 2023 be agreed with the following amendment:

On the attendance ‘Patricia Bell’ be changed to Councillor Bell.

To Consider a report from the Interim Assistant Director Quality, Resources and Transformation on the Adult Social Care update.

The Interim Assistant Director Quality, Resources and Transformation presented the Adult Social Care Update.

He stated that Westmorland and Furness, in common with most upper-tier authorities, had significant challenges in managing demand, demographic change, recruitment and resources in Adult Social Care, and with the recent formation of the new unitary council the time was right:

a) For a review of how Westmorland and Furness assessed, plans and provided support and care,

b) To engage other services across the new council in joint working to mitigate those issues and build community resilience

c) To work with providers to develop the market place, and

d) To review their in-house services to ensure that resources were directed to the most complex and difficult to source care services, and less towards the more routine.

Within the context of the overarching aims of the council’s Target Operating Model and its ambitions, there had been an opportunity to shift the model of care, to improve practice, improve effectiveness of services and exploit efficiencies of bringing housing policy and services together.

The government legislated last year, through the Health and Care Act 2022, to place a duty on the Care Quality Commission (CQC) to carry out and report on reviews of councils’ performance. The first of these ‘inspections’ nationally would take place from the end of 2023; it was made clear that the recent LGR councils would not be in the very first wave, but there had been no indication of the schedule after 2023 and so preparation had been required to be ready in the event of announcement from March 2024 onwards.

A programme of work was being brought together to bring new vision, direction and ambitions for services in Westmorland and Furness. The programme was to be called “Promoting Independence Programme” and reflected an ambition to create and nurture an environment where people were supported remain as independent as possible for as long as possible, and when the time came, that they had access to the right support, in the right place and the right time.

The briefing attached as an appendix to the report set out the headlines and context for that programme, as well as a summary of the preparation and readiness for the CQC assurance framework process.

He proposed that they provide the committee with a more detailed session on the CQC preparation.

A Councillor asked a question regarding the current workforce numbers and the recruitment process.

Cath Whalley responded stating recruitment and retention was critical and they were in the process of appointing a new Assistant Director. They still had some significant challenges with Social Workers, however going forward there was a greater piece of work in the Council on pay and grading.

RESOLVED: -

1.    To support the direction of travel and programme principles

2.    To agree to receive further briefings on the programme as it developed and CQC Assurance Framework readiness.

To Receive a report from the Chief Operating Officer – University Hospitals of Morecambe Bay NHS Foundation Trust on their pressures, priorities, challenges and winter plans.

The Chief Operating Officer – University Hospitals of Morecambe Bay NHS Foundation Trust presented a report on the Pressures, Priorities, Challenges and Winter Plans.

He stated that the provision of ‘High Quality, Safe Healthcare’ leading to good patient experience was a key Trust priority, however, operational and seasonal pressures could limit the ability of key areas to provide this effectively at all times. These challenges included:

1)    Recruitment (Speciality Medical Staff, Therapists and Social Care Staff in particular)

2)    NHS Industrial Action: Industrial Action (IA) had been ongoing since December 2022 initially by Nursing and Ambulance Service Staff initially, and now with Junior and Consultant Medical Staff. The impact of IA on patients was measured by the number of cancellations, however there was also a reduction in the numbers of patients booked during known strike dates which then impacted on the routine slots in the days after IA and increased the length of appointment waits for patients. It also took operational teams away from business as usual due to the extensive planning required for IA.

3)    Bed Capacity: Constraints continued due to challenges discharging patients to Social and Community Care (including EMI Regulated Care) with patients the Not Meeting medical Criteria to Reside (NMC2R) currently occupying 20% of the available general beds. Identifying care capacity with on-framework providers for those requiring long-term care continued to be problematic with delays transferring patients on from NHS Hospital Homecare and Re-ablement Services. This was even more problematic in rural areas in Westmorland & Furness (W&F) and resulted in poorer outcomes for people.

4)    Achievement of the current national target of 76% of patients attending the Emergency Department (ED) being admitted, transferred or discharged within 4-hours, due to the poor patient flow through the hospital, was incredibly challenging. The volume of patients attending ED with co-morbidities, patients attending with non-urgent conditions, and an ED estate not designed for the volume of patient attendances, were key drivers of this.

5)    Ambulance handover times in less than 15 minutes: congestion in the EDs due to reduced flow could result in queueing ambulances at acute hospitals. A target had been set for completing at least 90% of ambulance handovers within 30 minutes during Q3 and Q4 of 2023/24.

6)    Maintaining Elective Care capacity and not using elective beds to release pressure from ED as this resulted in cancellations of elective care and further delays patient treatments, impacting on health outcomes.

7)    Reducing Backlogs: impacted by recruitment challenges, estate challenges.

8)    Resourcing and finance.

Seasonal Winter Plans

The Trust had been working closely with W&F Council and System Partners in the Winter Planning process and were currently working through planning detail. These plans may therefore be duplicated in the Council’s Promoting Independence Programme (PIP) report. Resilience over this period would only be achieved through taking a system approach with plans created and delivered in a collaborative manner, leveraging the strengths of their Integrated Care System as well as our local partners across the health and social care  ...  view the full minutes text for item 16.

To receive a report on the Lancashire and South Cumbria new Hospitals Programme Update.

The Chief Operating Officer – University Hospitals of Morecambe Bay NHS Foundation Trust presented an update on the Lancashire and South Cumbria New Hospitals Programme.

He stated that the Lancashire and South Cumbria New Hospitals Programme offered a once in a generation opportunity to develop cutting-edge facilities, offering the absolute best in modern healthcare and addressing significant problems with the current ageing hospital buildings in Lancaster (Royal Lancaster Infirmary) and Preston (Royal Preston Hospital). There was also a need to invest in Furness General Hospital’s infrastructure in the context of its strategic importance and geographically remote location.

This would provide patients with high-quality, next generation hospital facilities and technologies. Hospital buildings would be designed in a way to meet demand, while remaining flexible and sustainable for future generations. The aim was to support local communities, bringing jobs, skills and contracts to Lancashire and South Cumbria businesses and residents.

University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) and Lancashire Teaching Hospitals NHS Foundation Trust (LTHTr) had been working with local NHS partners to progress the case for investment in new hospital facilities as part of cohort 4 of the Government’s national New Hospital Programme.

In September 2022, the NHS in Lancashire and South Cumbria stated its preference for new hospitals on new sites for both Royal Lancaster Infirmary and Royal Preston Hospital, alongside alternative partial rebuild options. This followed a comprehensive assessment for deliverability, affordability, value for money, and viability, considering feedback from thousands of patients, local people and staff.

Following the Government statement on 25 May 2023, announcing a record investment of more than £20 billion ring-fenced for the next phase of the national New Hospital Programme, the local NHS was delighted to welcome the announcement of two new hospitals to replace Royal Lancaster Infirmary and Royal Preston Hospital as part of a rolling programme of national investment in capital infrastructure beyond 2030. This would also include investment in improvements to Furness General Hospital.

Further detailed work was underway to assess the viability of potential locations for new hospital builds for both Royal Lancaster Infirmary and Royal Preston Hospital and to develop the required business cases. There was still further work to be completed in this area and additional sites may emerge over the coming period.

A councillor stated that it was important that access to the new hospitals was being taking into consideration when planning their location.

RESOLVED: - To note the report.  

To receive a report from the Senior Manager Safeguarding Adults, Mental Health, Learning Disability, Transition and Autism Services.

The Senior Manager – Safeguarding Adults, Mental Health, Learning Disability, Transition and Autism Services provided an update on Safeguarding Adults.

He provided a presentation to; -

1)    Provide an update and analysis of adult safeguarding activity for the Quarter 1 2023/2024

2)    Brief members on progress against the key areas of performance relating to making Safeguarding personal.

3)    Describe the actions planned to strengthen and consolidate improvements in Adult Safeguarding in Westmorland and Furness.

The presentation included figures of the number of referrals received each month from June 2022 to June 2023. The committee were advised that there had been a significant increase in referrals compared to last year but they had kept a consistent approach in responding to this.

The number of cases coming in had increased however, this had not led to huge surge of enquiries being open.

A table showing the types of abuse being logged was included in the report but it was important to note that abuse type was open to some interpretation by the referrer e.g., such as in domestic abuse concerns where physical or emotional abuse can be indicated. For reference multiple abuse types could be made at the referral point such as in domestic.

 Further work was to be undertaken to support a more defined understanding of referral types when being referred into the Local Authority.

A councillor asked what they could do as a community to support.

Andrew Horrobin advised that over the last few years they had set up a specialist safeguarding training for councillors and they were currently in the process of setting this back up.

 RESOLVED: To note the report.

To receive a report from the Strategic and Scrutiny advisor on the forward plan and draft work programme.

David Stephens presented the Forward Plan and Draft Work Programme.

He reported that the relevant items from the current Forward Plan of Key Decisions, 1 October 2023 – 31 January 2023 had been attached as an appendix to the report.

Members had been asked to consider the excerpts from the Forward Plan identified as relevant for the Health & Adults Overview and Scrutiny Committee and decide whether they should be reflected in the Committee’s work programme.

Future iterations of the Forward Plan could be used to identify potential areas

for scrutiny activity or where further information sharing was required.

The committee discussed the Forward Plan.

The Work Programme had been attached as an appendix to the report. This was for consideration based on the topics for consideration discussed at the meeting of the Committee in June and further meetings between the Chair, Vice Chair and key officers, it was for this Committee to discuss and further develop.

The proposed Task & Finish Group Activity around Assistive Technology was in development and a scope would be brought to the Committee at its November meeting for consideration and approval.

The committee discussed the draft work programme and it was agreed that the follow issues be discussed at the next committee meeting in November:-

-       Public Health/ Population Health - To provide Scrutiny of the alignment of policies and procedures to streamline and improve provision throughout the area of public health and protection.

-       Development of the Health & Well Being Strategy - The Committee to have an opportunity to provide feedback on the development of the Strategy and hear how the JSNA and the response to the Health Equity report had been considered and reflected in the Strategy.

-       Mental Health Services in W&F - Mental Health Services provision across both systems in Westmorland & Furness.

-       Access to primary care - Review of dentistry and GP provision.

David Blacklock stated they has a Waiting for Wellness report which may be of interest to the Committee.

David Stephens added that an analysis of the review work from Adult Social Care Update report could be scheduled for January’s meeting.

RESOLVED: -

1.    To Note the Cabinet Forward Plan

2.    To Note the Work Programme