Agenda and draft minutes

To receive any apologies for absence.

There were no apologies for absence.

To receive details of any changes in membership.

There were no changes in membership.

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 made on this occasion.

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 be not excluded during consideration of any items on the agenda today.

To consider the minutes of the previous meeting held on 19 January 2024 (copy enclosed).

Cllr Hanley, although not proposing any amendments to the minutes commented that he felt that many of the comments made by members at the meeting were missing.  Whilst accepting that the minutes were not a verbatim record of the meeting he asked if, in future, the minutes could reflect the key points raised by members.

RESOLVED,     that the minutes of the previous meeting be agreed, with the following amendment:

In the Present section of the minutes that Mr E Tallis and Mr D Blacklock be moved from the members listed into the officers in attendance section.

To review the delivery plan for the Smoke Free by 2030 objective.

Members had before them a report from the Director of Public Health and presented by the Interim Public Health Manager which informed them that the national Khan Review had recommended that all areas achieve Smoke Free status by 2030.

The report outlined the current focus of work and interventions being developed and the work currently being undertaken to support a Smokefree Westmorland and Furness by 2030. 

11.1% of the adult population (approximately 20,000 residents) of Westmorland and Furness were current smokers. Smoking at time of delivery (SATOD) maternity data showed that approximately 10% of mothers were still smokers when pregnant. 

In April 2023 Cabinet approved investment of £441,000 from the Public Health Grant from 1 April 2023 to 31 March 2026 to provide enhanced stop smoking interventions including:

•      Recruit 1 full time Community Outreach Tobacco Dependence post to support people from the 20% most deprived communities,  with severe mental illness, have alcohol/drug addictions and who are homeless to quit smoking.

•      Recruit 1 full time Pharmacy In reach Tobacco Dependence post to support people on respiratory health pathways,  receiving enhanced health checks, and providing additional capacity to pharmacies delivering the local authority stop smoking service operating in Westmorland in Furness.

•      Provision of aids to support quit attempts, including Nicotine Replacement Therapy (NRT) and e-cigarettes.

Cabinet also agreed to test new interventions to support populations at high risk and deliver a co-ordinated programme of prevention activity.  To include:

•        Procure and pilot a service within primary care and community services to increase capacity to support people on NHS clinical pathways. 

·           Recruit 1 x 12-month fixed term full time Smoke Free Co-ordinator to implement a system wide approach to training

·           Provide incentives via the provision of shopping vouchers to up to 80 pregnant women to quit smoking, targeting those for whom giving up smoking may be more difficult.

Westmorland and Furness Council was currently recruiting two Smoking Cessation Behaviour Change Coaches and also an Addictions Public Health Project Officer.  The initial focus of this post would be coordinating, and commissioning interventions and services and implementing programmes of work around tobacco control and nicotine dependency and smokefree 2030.

In January the community pharmacy service was enhanced to bring provision into line with national guidance. The service would now assessed suitability for stop smoking support, provide 12 weeks NRT and motivational support to smokers wishing to quit.

Working with Cumberland Council, Westmorland and Furness Council had received funding from the government’s ‘Swap to Stop’ scheme.  This was a harm reduction scheme to encourage people to stop smoking and use vaping as an aid to quit. 

In 2023 a pilot of the Allen Carr Easyway was commissioned targeting Furness due to its high smoking prevalence.  Allen Carr was an online drug free method of stopping smoking based on cognitive behavioural therapy.  The pilot showed positive results and after 4 weeks over 50% of the group were no longer smoking, and 40% were still not smoking at 12 weeks. 

In November 2023 a Vaping  ...  view the full minutes text for item 45.

To receive a report outlining the development of the Joint Strategic Needs Assessment.

The Committee received a presentation from the Public Health Registrar about the Westmorland and Furness Joint Local Health and Wellbeing Strategy (JLHWS) 2024-2034.  The presentation included details on:

·           The approach to developing the themes and priorities

·           The building blocks of good health and wellbeing

·           What shape is our health and wellbeing

·           Health outcomes in Westmorland and Furness

·           Differences in life expectancy

·           Health inequalities in Westmorland and Furness

·           A summary of the JSNA findings and the suggested themes and ambitions of the strategy

·           Next steps

Members thanked the Public Health Registrar for her very informative presentation.

The Consultant in Public Health apologised that members had not received the presentation in advance and confirmed that it would be circulated after the meeting.  She then took members through the report.

As previously mentioned in the presentation a steering group was overseeing a partnership approach to the development of the JLHWS, and this had representation from all Health and Wellbeing Board partners. The Health and Wellbeing Board would be asked to adopt the final JLHWS in July 2024.

The most recent Cumbria JLHWS was published in 2019 by the Cumbria Health and Wellbeing Board and had a ten-year lifespan. However, since 2019, both the national and local health and social care landscape had changed significantly.

The Westmorland and Furness Health and Wellbeing Board had been newly established following local governmental reorganisation. There had also been very significant health, social and economic impacts on the community following the Covid-19 pandemic. Furthermore, the Health and Care Act 2022 resulted in significant changes to the health and care system architecture with the establishment of Integrated Care Systems (ICSs).

The focus of the JLHWS remained on the delivery of activity at place and within local communities to improve health and wellbeing.

The production of a new JLHWS for Westmorland and Furness therefore provided a real opportunity to develop an evidence-based and partnership-driven strategic approach to improved health and wellbeing of the local population and reducing inequalities.

A community survey of the health and wellbeing priorities of Westmorland and Furness residents was conducted in November and December 2023 and received 701 responses.

The results of the summary JSNA and the community feedback had been used to develop a series of suggested themes and ambitions for the strategy. These were further developed at a full-day workshop in February 2024 with internal and external stakeholders including Health and Wellbeing Board partners.

Further stakeholder and community engagement was planned between now and July 2024, including workshops at the Eden, Furness and South Lakeland Community Health, Wellbeing and Equity Partnerships and South Cumbria Place-Based Partnership.

Cllr Chaffey asked for an update on where the council was with the process, including who had been involved so far and what would happen next.

The Public Health Registrar said officers had spent yesterday engaging with the Council’s Senior Leadership Team (SLT) and sessions were planned with all the Locality Boards in the near future.  A Member session was also planned and a large number of  ...  view the full minutes text for item 46.

To receive a report on the work being undertaken around recruitment and retention of the workforce by South Cumbria Place Based Partnership and the Lancashire and South Cumbria ICB.

Members considered a report which informed and assured them of the work being undertaken by South Cumbria Place Based Partnership and the Lancashire and South Cumbria ICB around the recruitment and retention of the workforce.

NHS workforce challenges were well documented, even before the impact of COVID19, there were staffing shortages and an aging workforce profile, which signalled a worrying prediction of unmanageable retirement numbers.

The Workforce Partnership Development Manager took members through a presentation which covered the following:

·           General Practice

·           GP recruitment numbers

·           GP partners and senior partners recruitment

·           GP workload pressures

·           Carlisle Healthcare Workload Snapchosy

·           Absence Rates

·           Turnover rates

·           New starters

·           Vacancy Rates

·           Sickness rates

·           Age demographics of staff

·           Ongoing Improvement Work

·           Barriers to Driving Improvement

The Chief Executive Officer from People First/Healthwatch was aware of the issue with staff satisfaction rates and wondered if the data presented also included data from the Health Trusts.

The Workforce Partnership Development Manager said the data from the Health Trusts was still awaited as it had not yet been released.  However, the Wellness Group had carried out a survey on staff satisfaction and staff from the Trusts had been involved in this.

The Chief Executive Officer from People Firs/Healthwatcht understood that figures on staff satisfaction in North Cumbria was particularly low and commented that this could affect staff in the Eden area. 

The Chair asked what ‘one workforce’ would look like, and the Workforce Partnership Development Manager responded that it was about how we could work better together and help staff to move within and across partnerships more easily.

The Chair asked about the vacancy rates of GPs across the ICB areas and the issue of how difficult it is to recruit doctors.

The officer said information was still awaited from the primary care partners on these vacancy rates.  However, she was aware that this was a national problem.

Cllr Edwards suggested speaking to youngsters on a regular basis to try to encourage them to consider careers in the health service.

Cllr Hanley gave members an update on the national recruitment figures for GPs which highlighted the national problem.  He said the UK was simply not training enough doctors to meet demand, and the situation with the recruitment of dentists was a similar story.

The Workforce Partnership Development Manager responded that one of the biggest challenges for trainee doctors was the fact that none of the current GP surgeries had facilities large enough to carry out effective training.

The Chair asked if this was about the size of the GP surgeries/buildings, and the officer confirmed that most GP surgeries were in small buildings that did not have the rooms/facilities needed for effective training.

The Director of Health and Care Integration informed members that the ICB had developed an Estates Strategy and part of this was looking for suitable locations for community health and GP practices.  However, this was a long term strategy and would not help in the short term.

Scrutiny Members commented that there was a lack of  ...  view the full minutes text for item 47.

To receive an update on the progress to prepare the organisation for Care Quality Commission (CQC) Assessment of Adult Social Care.

Members considered a report which provided an update on progress to prepare for the Care Quality Commission (CQC) Assessment of Adult Social Care.

The Council’s performance would be assessed against the new framework for how it delivered its duties under Part 1 of the Care Act 2014.

A Programme plan of work was now in place and was being led by Adult Social Care with oversight of progress being monitored and reporting into the Promoting Independence and Wellbeing Programme which was chaired by the Director of Adult Social Care (DASS).

The programme was structured around the requirements to respond to an assessment, and developing the plan for what the key areas of focus for improvement would be.

The Programme Manager explained that it was still unknown when Westmorland & Furness Council would receive notification from Care Quality Commission for assessment, however CQC had committed to assessing all local authorities within the first two years.

The CQC was still in a period of learning, so the assessment process was evolving as more assessments were undertaken and feedback was received about the process.   The Council was using this intelligence to inform its own planning and activity to ensure the council was as prepared as possible.

It was important that the Council was self-aware of what it does well and what needs improvement, being clear about plans and timescales for delivery.

The assessment process would consist of an information gathering stage where the local authority would receive a request for the information needed and submit this within the time frame, usually 3 weeks. The Council would be notified of this with 6-8 weeks' notice.

The team would conduct interviews and undertake focus group type activities to receive feedback from officers, practitioner's users of the services including families and carers, partners, and providers.

The authority would be awarded a rating from the 4-point ratings scale:

·           Outstanding

·           Good

·           Requires improvement, or

·           Inadequate

A self-assessment was carried out in November 2022 using the Local Government Association (LGA) provided tool, and this had been reviewed in January 2024.  This was attached as Appendix 3 to the report.

The Programme activity was structured initially around preparation and readiness for the first CQC assessment, which then transferred into a plan for continuous improvement delivered as part of business-as-usual activity.

To ensure the council was as prepared as it could be it was linking in with national and regional networks via ADASS and the LGA to take on board the learning from those pilot local authorities, and subsequently assessed authorities as learning emerges.

The Chair asked if there was any further work the Council needed to do to prepare for the inspection, other than that outlined in Appendix 3 of the report.

The officer responded to say that the self-assessment was initially carried out in January but that the Council was currently reviewing the activities within it. 

The Interim Assistant Director – Quality, Resources and Transformation said there were still a number of issues to be worked through, the self-assessment was  ...  view the full minutes text for item 48.

To receive a report regarding recruitment and retention of the Adult Social Care Workforce of Westmorland and Furness Council.

The Director of Adult Social Care presented a report which set out the recruitment and retention challenges facing the Adult Social Care workforce of Westmorland and Furness Council.

The report outlined the underlying factors which contributed to persistent staffing gaps, both nationally and locally, before outlining the approach being taken to ensure that Westmorland and Furness council was able to recruit and retain an Adult Social Care workforce with the right skills and capacity to deliver the best outcomes for residents.

Some progress had already been made, particularly in care services where vacancy rates and agency use had both decreased since vesting day.

An Adult Social Care Workforce Plan was under development and working groups had been set up to drive improvement in workforce data, recruitment, Adult Social Care careers and culture.

The Director then asked the People Management Advisor for Adult Social Care to take members through the rest of the report.

He then outlined the following for members:

·           Vacancy Rates

·           Key issues contributing to the national staffing shortage

Ø  Aging workforce

Ø  Increasing

Ø  Perceptions of the Care Sector

Ø  Low Pay

·           Rurality

·           Housing

·           Transport

·           Brain Drain and Shrinking Labour Market

·           Competition from high paying employers

·           Inherited issues following LGR

A dedicated recruitment and onboarding team had been established to support recruitment in care services. Over the past year the recruitment process had been streamlined, engagement with candidates who are going through recruitment had improved, and the applications process for Support Worker roles had been simplified.

A market supplement for Care Services Support Worker roles had been amended on a trial basis. Westmorland and Furness inherited a flat rate market supplement from Cumbria County Council, which enhanced Support Worker pay by £0.72 per hour. However, following a review of agency use, vacancy data and competitor rates, the supplement had been amended to focus incentives on hard to fill shifts, now only weekends and nights are enhanced, but at a more substantial rate of time plus 30%.

These interventions had coincided with a significant improvement in the vacancy position in Care Services, which has reduced by over 40% between August 2023 and February 2024.

The Principle Social Work APL team had developed and implemented a new practice educator training package, increasing the service’s capacity to support student placement. As a result 6 new social work degree students had commenced their final placements at Westmorland and Furness Council in 2024. It was hoped a number of these students could be encouraged to apply for social work posts with the Council on completion of their training.

The strategic priorities set out in the Adult Social Care Workforce plan would feed into service thinking as part of any upcoming reshaping activities. This would be an opportunity to use management structures and the design of job roles to support workforce development.

Integration with system partners. Health and care integration presented opportunities for Adult Social Care to come together with system partners to work together on workforce priorities. Opportunities include shared approaches to recruitment  ...  view the full minutes text for item 49.

To receive a report from the Strategic Policy and Scrutiny Advisor.

The Strategic Policy and Scrutiny Advisor presented the Forward Plan and Draft Work Programme.

He reported that the relevant items from the current Forward Plan of Key Decisions, 1 March 2024 – 30 June 2024 had been attached as an appendix to the report.

Members were 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.

Members asked that the following items be added to the work programme:

·           Joint Strategic needs Assessment/Health and Wellbeing Strategy (prior to it going to the Health and Wellbeing Board in July)

·           An update on the  Smoke Free by 20230 Scheme in 12 months

The Strategic Policy and Scrutiny Advisor asked members to let him know if there were any other items to be added.

The Chair informed members that a review would be taking place in the near future on the meeting process for the Health and Adults Scrutiny Committee, including the timing of meetings.

RESOLVED,       that the report be received and noted.