Agenda and minutes

To receive any declarations of interest.

There were no declarations at this point in the meeting.

The minutes of the Health Scrutiny Panel meeting held on 21 July 2020 were approved as a correct record

Mark Adams, Director of Public Heath (South Tees) and Craig Blair, Director Of Commissioning, Strategy and Delivery at Tees Valley Clinical Commissioning Group (CCG) will be in attendance to provide an update on Covid-19 and the local Public Health / NHS response.

Recommendation: Panel notes the information provided.

The Director of Public Health (South Tees) was in attendance at the meeting to provide an update to the panel in respect of COVID-19 cases in Middlesbrough.

In respect of the number of positive COVID-19 cases in Middlesbrough the panel was advised that there had been a significant reduction in cases during May. A low number of cases during June and July before an increase at the beginning of August when the first new outbreak had been reported. The numbers had then continued to increase during September. For cases tested during the last 7 day period (13 - 19 September) there had been 60 positive cases in Middlesbrough. A rate of 42.6 per 100,000 population. This compared to 55 cases the previous week (6 - 12 September), a rate of 39.0 per 100,000 population. Middlesbrough had seen in a 9.1 per cent increase in cases over the last 7 days.

It was noted that over the previous 21 days the rolling 3 day average showed daily cases had remained steady before decreasing over the previous 4 days. It was advised, however, that a lag in cases being added could be the cause of the drop in the last few days. With regard to the pillar 2 testing rates (those carried out in the community, as oppose to in a hospital setting) showed that Middlesbrough ranked 44th highest nationally for rate of positive Covid-19 tests. The rates of tests per 100,000 population showed Middlesbrough was ranked 34th highest nationally. Information in respect of ethnicity data was presented, which showed the number of positive cases by ethnic group over the previous 6 weeks. It was noted that the proportion of cases affecting Asian residents in Middlesbrough had been high during the first half of August but this had since changed and the virus was now mostly affecting White British residents. It was emphasised that it was not the case that the BAME community was more at risk of contracting or transmitting Covid-19. However, the community was more risk of having a poor outcome.

In terms of the ages of those affected it was noted that cases in the most recent 14 days had affected young people and those in the 30-49 age group, with much fewer cases in the older age groups. However, the numbers affected in the older, more vulnerable age groups (70+) were starting to increase. A heat map showing the 66 positive COVID cases in the previous 7 days by ward and the count by Local Super Output A rea (LSOA) across Middlesbrough was shared. It was noted that the positive cases were spread throughout the town and there had not been any particular clustering identified.

In relation to contact tracing it was advised that this was being undertaken by Council staff in an effort to build local intelligence and develop a better understanding of where people had been in the presymptomatic period. Most of the younger group had advised that they had been 'out and about' and 80  ...  view the full minutes text for item 20/7

Representatives from ST NHS FT will be in attendance to discuss the key performance outcomes for 2019/20, as detailed in the Quality Account document.

In terms of background context the Medical Director at South Tees Hospitals NHS Foundation Trust (STH NHS FT) advised that in July 2019 the Trust had received its CQC inspection report, which had seen the Trust downgraded from a rating of good to required improvement. In September 2019 the Trust had given a presentation to the South Tees Health Scrutiny Panel outlining the areas for improvement and undertaken by the Trust to immediately address the concerns highlighted by the CQC. The Trust had again attended the South Tees Health Scrutiny Panel in November 2019 to update specifically on the changes that had been made to Critical Care Services since the CQC inspection.

The Medical Director explained that since the CQC inspection the Trust had been working to 'get back to our best' and a clinical policy group had been established. STH NHS FT was now a clinically led, as opposed to a managerial or operationally led, Trust and clinical priorities directed decision-making.

In response to COVID-19 the panel heard that an escalation process was put in place, which ensured that as much high level quality care could continue to be delivered across services, with the James Cook University Hospital (JCUH) site separated into COVID and NON-COVID areas. The same approach was adopted at the Friarage Hospital site to ensure that any mixing was minimised. Testing was also key in this approach. At the start of the pandemic the Trust built up capacity very quickly, from a position of conducting 30 tests per day the Trust now had capacity to conduct 1500 tests per day and those tests could be carried out 24 hours per day.

It was advised that throughout the pandemic the Trust had exceeded national emergency guidance requirements. On 12 March 2020 the Trust introduced COVID-19 testing for all admitted patients who met the national case definition (list of symptoms) and on 6 April that was extended to include all inpatients upon their arrival at hospital (irrespective of the case definition). On 16 April 2020 national COVID-19 guidance was published setting out requirements to test patients being discharged from NHS hospitals to a care home. On 21 August national guidance was published setting out the requirements for Hospital Discharge Service: Policy and Operating Model effective from 1 September 2020.

In terms of PPE availability and staff testing it was explained that PPE Marshalls had been introduced, as it was relatively easy for cross contamination to take place. Psychological support had been introduced and was available to staff and the Trust had seen lower staff sickness rates when compared to similar Trusts. At the height of the pandemic JCUH had 150 positive COVID-19 patients but the Trust’s resources team had ensured staff never ran out of PPE. A comprehensive risk-assessment process for all BAME colleagues had also been introduced, which was subsequently extended to all staff.

In respect of supporting patients and communities it was explained that staff had undertaken kindness calls and used ipads / technology to communicate  ...  view the full minutes text for item 20/8

The panel is requested to consider an update on the work recently undertaken by the regional Joint Health Scrutiny Committee:-

Tees Valley Joint Health Scrutiny Committee - 18 September 2020

Recommendation: That the update provided be noted.

The Democratic Services Officer provided an update in respect of the following regional meeting:-

-       Tees Valley Joint Health Scrutiny Committee hosted by Redcar & Cleveland Borough Council on 18 September 2020.

AGREED that the regional health scrutiny update be noted.

The Chair provided a verbal update in relation to the business conducted at the Overview and Scrutiny Board meeting held on 3 September 2020, namely:-

- Executive forward work programme.

- Covid-19 update - Education and skills.

- Scrutiny Work programme.

- Scrutiny Chairs' updates

AGREED that the information provided be noted.

The minutes of the Health Scrutiny Panel meeting held on 10 March 2020 were approved as a correct record.