Agenda and minutes

To receive the Minutes of the meeting of the Health Scrutiny Panel held on 22 September 2020

The minutes of the Health Scrutiny Panel meeting held on 22 September 2020 were submitted and approved as a correct record.

Mark Adams, Director of Public Heath (South Tees) (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 to provide the panel with an update in respect of COVID-19 and the local Public Health and NHS response. The Director advised that at the last Health Scrutiny Panel meeting, as held on 22 September 2020, the 7 day rolling average figure for the COVID-19 infection rate in Middlesbrough was 42.6 per 100,000 (19 September 2020). Today that rate had climbed to 268.8 per 100,000 (11 October 2020).

In terms of analysis by age the figures showed that the prevalence of COVID-19 was highest amongst the age range 23-34 (data extracted on 12 October), which was older than the main student body and was probably why the infection rate was proliferating. The panel was provided with a graphical representation showing COVID cases over the previous 14 day by LSOA area. The graph highlighted that there were positive COVID cases spread through all areas of the town and there had been a total of 625 positive cases in the previous 14 days.

It was acknowledged that the Government had placed Middlesbrough and Hartlepool in Tier 2 'high' restrictions from 3 October 2020 and it was explained to the Panel that this meant that:-

• People must not socialise with anybody outside of their household or support bubble in any indoor setting, whether at home or in a public place.
• People must not socialise in a group of more than 6 outside, including in a garden or other spaces like beaches or parks (other than where specific exemptions apply in law).
• Businesses and venues can continue to operate, in a COVID-Secure manner, other than those which remain closed in law.
• Certain businesses selling food or drink on their premises are required to close between 10pm and 5am. Businesses and venues selling food for consumption off the premises, can continue to do so after 10pm as long as this is through delivery service, click-and-collect or drive-thru.
• Schools, universities and places of worship remain open
• Weddings and funerals can go ahead with restrictions on the number of attendees
• Exercise classes and organised sport can continue to take place outdoors. These will only be permitted indoors if it is possible for people to avoid mixing with people they do not live with (or share a support bubble with)
• People can continue to travel to venues or amenities which are open, for work or to access education, but should look to reduce the number of journeys they make where possible

In response to the restrictions the Local Authority had put forward a number of asks from Government. This included an:-

• An exit strategy from the current restrictions
• Testing & Extended Tracing
• Communications
• Support for Care Homes
• Education & Enforcement
• Support for Vulnerable People (Help Boro Support)
• Support for businesses
• Increased uptake of Flu Vaccine
• Support for Homelessness and Asylum Seekers
• Local Council Tax Subsidy (LCTS) grants
• Early access to the approved Towns Fund and Future High Streets Fund

In response to the information provided the Panel was afforded the  ...  view the full minutes text for item 20/13

The following expert witnesses will be in attendance:-

Dominic Gardner - Director of Operations - Teesside

Dr. Baxi Sinha - Clinical Director Adult Mental Health - Teesside

Recommendation: - That the information presented at the meeting be considered in the context of the Scrutiny Panel's review.

The Chair welcomed representatives from Tees, Esk and Wear Valley (TEWV) NHS Foundation Trust and Public Health (South Tees) to the meeting. The Director of Operations at TEWV advised that the presentation had been compiled collectively and sought to present a system perspective on the way in which services were currently delivered. In preparation for the meeting the Panel had requested that information be provided on the following areas:-

• The level of resource currently invested by TEWV in reducing opioid dependency / supporting people in Middlesbrough with dual diagnosis.
• TEWV’s experience of working with those addicted to prescribed opioids,
• Relevant TEWV initiatives in place to address it.
• TEWV’s view on the impact opioid dependency is having on children and young people in Middlesbrough.
• TEWV’s view on what interventions are needed to better support people in their recovery from opioid dependency over the next 5 years.

The panel was advised that in terms of the services offered by TEWV in Middlesbrough, TEWV was a provider of Mental Health and Learning Disability Services and was not commissioned to provide Substance Misuse Services or services related to primary Opiate dependence. In the course of providing Mental Health and Learning Disability Services help was offered to persons with dual diagnosis. The definition of dual diagnosis was a co-existing mental health and alcohol and/or drug misuse problems.

In respect of the level of resources invested in dual diagnosis it was advised that regular mandatory training was provided to staff, a dedicated dual diagnosis lead had been appointed within the Trust, dual diagnosis link clinicians and dual diagnosis link champions also worked across a number of teams. In addition these practitioners worked in partnership with the locally commissioned substance misuse services. There was also a Mental Health and Substance Misuse network in place in Teesside and inpatient services/wards often needed to provide detox for patients.

The Clinical Director at TEWV advised that in terms of TEWV’s experience of working with those addicted to opioids it was felt that difficulties were increasing (anecdotal reports) and getting the right help at the right time (in terms of helping an individual addicted to opioids) could be challenging. There was also an association with adverse outcomes including fatalities and the individual often faced a number of difficulties in addition to mental health and substance misuse including issues relating to finance, housing and physical medical conditions.

In terms of the initiatives undertaken by TEWV that were relevant to this field it was explained that a series of Rapid Process Improvement Workshops (RPIW) involving partner organisations in four localities had been held. This had involved Change, Grow, Live in Middlesbrough and TEWV had also initiated the Mental Health / Substance Misuse Network with other stakeholders. The crisis assessment suite at Roseberry Park also received support from the Substance Misuse services and joined up care was provided. Training of inpatient staff in the use and distribution of Naloxone kits would also hopefully lead to a reduction in deaths linked to opiates.

With regard  ...  view the full minutes text for item 20/14

The Chair will provide a verbal update in relation to matters considered by the Overview and Scrutiny Board on 1 October 2020.

The Chair provided a verbal update in relation to the business conducted at the Overview and Scrutiny Board meeting held on 1 October 2020, namely:-

• An update from the Mayor in relation Covid and the Council’s finances
• Executive forward work programme
• Middlesbrough Council Covid-19 update - Chief Executive / Director of Public Health
• Executive Member of Finance & Governance update 
• Scrutiny Chairs’ updates

AGREED that the information provided be noted.