Agenda and minutes

There were no declarations of interest at this point in the meeting.

The minutes of the Tees Valley Joint Health Scrutiny Committee held on 24 September 2021 were approved as a correct record.

The minutes of the Tees Valley Joint Health Scrutiny Committee held on 10 December 2021 were approved as a correct record.

The Chief Executive at Tees, Esk and Wear Valley NHS Foundation Trust (TEWV) and Lead Inspector from the Care Quality Commission (CQC) will be in attendance to provide an update in respect of the CQC’s recent inspection report findings.

The Chief Executive at Tees, Esk and Wear Valley NHS Foundation Trust (TEWV), the Chair at TEWV NHS Foundation Trust and the Lead Inspector from the Care Quality Commission (CQC) were in attendance to provide an update in respect of the CQC’s recent inspection report findings.

The Chief Executive thanked the Committee for providing the opportunity to update Members on the action that had been taken by the Trust in response to the CQC’s recent report. In terms of the presentation, a copy of which had been provided to the Committee in advance of the meeting, it was advised that information on the following would be covered at today’s meeting:-

• Our Journey To Change and key improvements.

• An overview of our recent Care Quality Commission (CQC) core service inspection (Jul-Aug 2021).

• An update on our secure inpatient service – key actions, improvements and impact. • An update on our community child and adolescent mental health services – key actions, improvements and impact.

• Other services inspected and the feedback from the CQC.

• Adult mental health and psychiatric intensive care unit (PICU) follow up inspection progress. • Wider challenges and how we're addressing them.

• Continuing Our Journey To Change.

In terms of the Trust’s Journey to Change it was noted that a number of improvements had been made following the CQC inspection including; an organisational restructure, the introduction of improved governance arrangements, an increased leadership capacity - including the appointment of two lived experience directors, additional Board development work, increased oversight of the work of the Board and its sub-groups, the introduction of revised risk management arrangements, numerous recruitment and retention initiatives – resulting in a 5 per cent increase in FTE equivalents in the Trust’s overall headcount, the implementation of enhanced quality assurance programmes, the development of an improved organisational learning infrastructure – development of a learning library and an increase in compliance with statutory and mandatory training.

With regard to the report itself, the CQC inspection had been held between June and August 2021 and the report had been published in December 2021. An action plan, as produced by the Trust was submitted to the CQC in January 2022 and the Trust had been working collaboratively with the CQC, colleagues in NHSEI, the CCG’s, staff, patients and carers to bring about improvements. The improvement plan submitted to the CQC was co-created and frontline staff and patients were directly involved in its development. The Chief Executive stated that the Trust was confident in the approach it had adopted to bring about improvements. In terms of its CQC overall rating the Trust remained at requires improvement. The Trust had been rated as being good for caring and effective and required improvement for being well-led, responsive and safe. The Chief Executive advised that since the CQC inspection significant progress had been made and that the focus now was on embedding and sustaining those changes.

The Chief Executive advised that he wished to focus specifically on the delivery  ...  view the full minutes text for item 23.

Representatives from Tees Valley Clinical Commissioning Group (TV CCG) and the Director of Public Health (DPH) for South Tees will be in attendance to provide an update in respect of the local NHS / Public Health response to COVID-19.

The Director of Health was unable to attend the meeting and the Chair requested that in his absence this item be deferred for consideration at the next meeting of the Tees Valley Joint Health Scrutiny Committee.

AGREED that the item be deferred.

The Assistant Director of Communications at the North East Ambulance Service (NEAS) will be in attendance to provide a performance update to the Committee.

The Chief Executive and the Assistant Director of Communications at the North East Ambulance Service (NEAS) were in attendance to provide a performance update to the Committee.

In terms of 111 call handling it was advised that the call volumes coming into the service had spiked dramatically at the start of the Covid-19 pandemic. In respect of the calls received at that time, the average time to answer was within usual boundaries until April 2021. At that time call response times began to deteriorate and the service was impacted by waves of Covid-19 on the NEAS’s workforce. There was a very large scale recruitment campaign, which was current at the moment to recruit 152 health advisors into the 111 and 999 service. NEAS was on target to meet demand and this month alone the service had welcome 53 new health advisors into the control room. A third call handling site was also opening on Teesside and the centre would handle both 111 and 999 calls. In particular there had been a large increase in the number of patients contacting the 111 service looking for dental help and NEAS had been working hard with NHS England to double the number of dental appointments the service was able to offer to patients each week, where they had an urgent dental concern.

The 111 outcomes chart (December 2021) showed that almost half of the calls (46 per cent) received by the service were referred back into Primary Care services (including the patient’s own GP). Dental calls made up approximately 10 per cent of all calls to the 111 service. It was noted that although the outcome figure for calls to the 111 service where an ambulance was required indicated 17 per cent it was explained that the actual ambulance response figure was closer to 7 or 8 per cent. The reason for the difference was that these calls were revalidated by clinicians, which included a call back, to check on the level of need. The remaining specialist services included, for example, eye services, children’s A&E and maternity suite referrals.

In respect of the 999 calls there had been a significant increase in the call volumes. Before the Covid-19 pandemic call volumes were quite high. During the first lock down in 2020 999 calls actually eased off a little bit. Over the last year or so the volume of 999 calls had started to increase again. A key mechanism to monitor the number of patients being handed over to A&E services was the hear and treat rates. These were patients that were either treated on the phone or passed onto an alternative service. The hear and treat rates both for the ambulance service as a whole and for the Tees Valley were almost identical. The rates had increased significantly over the last year.

Where an ambulance response was required it was noted that the service was measured against four different categories. The first category was average response standards to life threatening calls  ...  view the full minutes text for item 25.

Representatives from TVCCG will be in attendance to provide an update to the Committee in respect of the following:-

- The development of the North East and North Cumbria Integrated Care System (NECS ICS), the Integrated Care Board (ICB) and the proposed sub-regional Integrated Care Partnership’s (ICP’s)

- Opioid prescribing rates across the Tees Valley and actions taken to reduce overprescribing

- Learning Disabilities Respite Review

Representatives from TVCCG were in attendance at the meeting to provide an update to the Committee in respect of a number of items. The first of which was the development of the North East and North Cumbria Integrated Care System (NECS ICS), the Integrated Care Board (ICB) and the proposed sub-regional Integrated Care Partnership’s (ICP’s). The Chief Executive of the Tees Valley CCG and the Executive Director at NENC ICS were in attendance to provide this aspect of the update.

The Chief Executive of the Tees Valley CCG advised that Samantha Allen, the Chief Executive Designate of the NENC ICS, would welcome the opportunity to attend a future meeting of the Committee to discuss its establishment in more detail. It was advised that recruitment to the ICB had commenced and work was underway to describe the operating model of the ICB. Feedback had been sought, particularly from CCG staff who were affected by the change, as the CCG’s morphed into the ICB, as well as a range of partners and stakeholders. A number of issues were being considered particularly in terms of what would happen at what level. For example, there would be issues that would be addressed at ICB level, either because it was high level commissioning i.e. the North East Ambulance Service, which worked across the whole of the North East but not the North East and Cumbria but also the annual report and annual accounts, which again would be produced at an ICB level.

A new organisational structure was being drawn up for discussion with staff, as the ICB would take over formally from the CCGs on 1 July 2022. Consideration was currently being given to a number of issues including whether all the functions presently undertaken by the CCG’s would continue to be delivered by the ICB, were there any issues of concern around safety, was there anything specific that needed to be considered in terms of the committee structure and what aspects of work would be undertaken more locally and fed into the ICB?

Reference was made to the white paper on integration and it was advised that efforts were being made to pick up on the links in that white paper to ensure these were implemented as part of the establishment of the ICB. The good news was that the overriding proposal in the white paper was for there to be a focus on place (13 upper tier local authorities in the NENC ICS). In the new ICB proposed organisational structure place was key and having leadership of place was included, along with oversite of budgets and working with existing Health and Well-Being Boards were also included.

The Executive Director advised that she was really keen to work with the Chair of the TVJHSC and Scrutiny Officer to consider the Committee’s forward work programme and how the ICB’s attendance at future meetings would be really helpful from a system perspective.

The second element of the update focussed on the opioid prescribing rates across  ...  view the full minutes text for item 26.