Agenda and minutes

The Chair opened the meeting and welcomed everyone to the January meeting of the Scrutiny Board (Health and Well-Being and Adult Social Care), the first of the new calendar year. 

The Chair reminded all those in attendance of the Council’s Third Party Recording code of practice, copies of which were available at the meeting. 

To identify items which have been admitted to the agenda by the Chair for consideration.

(The special circumstances shall be specified in the minutes.)

The following items were submitted and accepted as late items to the meeting:

Leeds and York Partnership NHS Foundation Trust: Care Quality Commission Inspection and Associated Action Plans.

·  Care Quality Commission press release

·  Care Quality Commission: Inspection Report (summary)

·  Leeds and York Partnership NHS Foundation Trust: Stakeholders Briefing Pack

(minute 61 refers)

Developing a Maternity Services Strategy for Leeds

·  Additional Information in relation to Leeds Maternity Health Needs Assessment

·  Presentation slides

(minute 63 refers)

Leeds Teaching Hospitals NHS Trust: Care Quality Commission Inspection and Identified Improvements – Update

·  Additional assurance information from Leeds’ Clinical Commissioning Groups (CCGs) and NHS Trust Development Authority (NTDA)

(minute 64 refers)

To disclose or draw attention to any disclosable pecuniary interests for the purposes of Section 31 of the Localism Act 2011 and paragraphs 13-16 of the Members’ Code of Conduct.

There were no disclosable pecuniary interests declared to the meeting. 

To receive any apologies for absence and notification of substitutes.

Apologies for absence were received as follows:

·  Councillor E Taylor

·  J Beal (HealthWatch Leeds) – non-voting co-opted member:

No substitute members were in attendance. 

To confirm as a correct record, the minutes of the meeting held on 16 December 2014.

RESOLVED – The minutes from the meeting held on 16 December 2014 were agreed as a correct record. 

To receive a report from the Head of Scrutiny and Member Development providing an update on some areas of work and activity of the Chair of the Scrutiny Board since the Scrutiny Board meeting in December 2014.

The Head of Scrutiny and Member Development submitted a report that provided an outline of the Chair’s activity since the Board’s meeting in November 2014. 

The Chair provided a verbal update at the meeting, drawing particular attention to the discussions and activity around the following matters:

·  The work of the Scrutiny Board (Sustainable Economy and Culture) and the ‘Leeds Let’s Get Active’ campaign/ programme of work. 

o  There was particular discussion around the potential for extending the times when service users could access to the Council’s sports centres as part of the programme.  The Chair agreed to highlight the issues raised by the Scrutiny Board with the Chair of the Scrutiny Board (Sustainable Economy and Culture).

·  The timely release of deceased relatives for the purpose of religious ceremonies and burials.

·  Regular discussions with Leeds Local Medical Committee (LMC)

o  There was particular discussion in relation to the success around bringing together representatives from the Council’s Strategic Housing Team and the LMC – to provide clarity around the role of GPs in providing medical evidence as part of the Council’s Choice based lettings scheme.

o  The Chair also invited other members of the Scrutiny Board to identify any particular matters that might warrant further discussion with Leeds LMC. 

Members discussed and commented on the information and update provided at the meeting.  Members thanked the Chair for the update and agreed to maintain an overview on the issues raised.

RESOLVED –

(a)  To note the report and update provided at the meeting.

(b)  To maintain an overview of the issues highlighted in the report and discussed at the meeting.

To receive a report from the Head of Scrutiny and Member Development introducing the Care Quality Commission’s inspection reports and ratings for Leeds and York Partnership NHS Foundation Trust, along with the Trust’s initial response and proposed improvement activity. (Cover report only attached.  CQC reports not yet published)

The Head of Scrutiny and Member Development submitted a report introducing the Care Quality Commission’s inspection reports and ratings for Leeds and York Partnership NHS Foundation Trust, along with the Trust’s initial response and proposed improvement activity. 

Additional information by way of the Care Quality Commission (CQC) press release and Inspection Report (summary) and Leeds and York Partnership NHS Foundation Trust: Stakeholders Briefing Pack were submitted to the meeting for consideration (minute 56 refers).

The following representatives were in attendance:

·  Chris Butler (Chief Executive – Leeds and York Partnership NHS Foundation Trust)

·  Anthony Deery (Interim Director of Nursing and Quality – Leeds and York Partnership NHS Foundation Trust)

·  Nigel Gray (Chief Officer) – NHS Leeds North CCG

·  Lianne Langdon (Director of Commissioning and Strategy) – NHS Leeds North CCG

Members were advised that representatives from the CQC had been invited to the meeting but were unable to attend. 

The Chief Executive of Leeds and York Partnership NHS Foundation Trust addressed the meeting and thanked the Scrutiny Board for the opportunity to discuss the outcome of the recent CQC inspection of the Trust. In his opening address, the Chief Executive highlighted a number of matters including the following:

·  The context of the Trust’s operating arrangements and experience of the inspection.

·  The Trust had been assessed as ‘Good at Caring’ across the organisation.

·  70% of services were assessed as good; 25% of services ‘required improvement’ and 5% of services had been assessed as ‘inadequate’.

·  The inspection outcome could be considered as providing a ‘tale of two cities’ – with services in Leeds generally receiving a more favourable assessment when compared to some services in York.

·  It was believed that a number of issues identified in York were a result of historic underfunding, with the Trust only taking control of services in York in the previous 3 years.

Representatives from NHS Leeds North CCG addressed the meeting and highlighted a number of matters, including the following:

·  Commissioners had been fully involved in the inspection process and welcomed the report.

·  The inspection clearly identified some areas for improvement, but also highlighted some examples of good practice.

·  The Mental Health Partnership Board would be taking a commissioner/ provider approach in looking to address some of the areas for improvement.

·  The CQC’s inspection methodology had recently changed (moving from a place based assessment to a whole service assessment) and the Trust was part of the first wave to be inspected under the new arrangements/ approach.  Some learning about the inspection process had emerged.

The Scrutiny Board considered the information submitted to the meeting and the verbal introductions provided.  Members raised and discussed a number of matters, including:

·  The relationship between service commissioners in Leeds and York.

·  The experience of patients accessing services.

·  The need to differentiate improvement actions to services across Leeds and York i.e. being clear about which services needed to improve and where – Leeds, York or both.

·  Concerns regarding the ‘ligature points’ identified during the inspection.

·  Delivery of a ‘place of safety’ and  ...  view the full minutes text for item 61.

To receive a report from the Head of Scrutiny and Member Development presenting the initial 2015/16 budget proposals relevant to the Scrutiny Board’s portfolio.

The Head of Scrutiny and Member Development submitted a report presenting the initial 2015/16 budget proposals relevant to the Scrutiny Board’s portfolio areas.

The following representatives were in attendance:

·  Councillor Lisa Mulherin (Executive Board Member for Health and Wellbeing – Leeds City Council)

·  Lynne Hellewell (Public Health Business and Health Protection Manager – Leeds City Council)

·  Ann Hill (Head of Finance (Adult Social Care) – Leeds City Council)

The Scrutiny Board was advised that Cllr Ogilvie (Executive Board Member for Adult Social Services) had sent his apologies as he was unable to attend the meeting.

The Executive Board Member for Health and Wellbeing addressed the meeting and thanked the Scrutiny Board for the opportunity to discuss the initial 2015/16 budget proposals for Public Health and Adult Social Services.  It was noted that the proposals had been set out in the context of a very challenging budget position and unprecedented cuts in local government grants. 

The Scrutiny Board went on to consider the budget proposals for Public Health and Adult Social Services in turn.  The following provides a summary of the issues highlighted and discussed.

Public Health

·  Historically underfunded in Leeds (£6M below target budget) with no increase in grant funding for 2015/16.

·  Work undertaken in 2014/15 included re-commissioning of Drugs and Alcohol services and Sexual Health services.  The commissioning arrangements in each area would see improved services at reduced cost. 

·  Linking into City-wide strategies and contributions to other parts of the Council

·  Proposals for 2015/16 included some funding for:

o  Neighbourhood Networks – contributing to tackling social isolation

o  Children’s centres – contributing to providing children with the ‘Best Start’

·  Delivery of the Better Care Fund Programme.

·  The Return on Investment across Public Health expenditure.

Adult Social Services

·  In addition to the challenging financial position facing the Council, there were also significant demographic pressures (around £20M) in Adult Social Services.  Broadly. these arose due to a rise in demand (circa £14M) and inflation (circa £6M).

·  Particular demand pressures arising from increased numbers of service users across Learning Disabilities Services.

·  An additional pressure resulting from a Supreme Court ruling in relation to assessments of mental capacity.

·  The sharing of risks with health partners (i.e. Clinical Commissioning Groups) across the City.

·  The rate of inflation and the impact on contractual commitments.

In its deliberations, the Scrutiny Board particularly welcomed the joint working and Public Health support for programmes of work that underpin some of the wider determinants of health.

RESOLVED –

(a)  To note the report and the information presented and discussed at the meeting.

(b)  To note the extremely challenging financial environment facing the Council and welcome the joint working and Public Health support for programmes of work that underpin some of the wider determinants of health.

(c)  To report to Executive Board the outcome of the Board’s deliberations, as summarised in (b) above. 

On conclusion of the discussion, the Chair thanked those in attendance for their contribution to the discussion. 

To receive a report from the Head of Scrutiny and Member Development providing an update on the development of a Maternity Services Strategy for Leeds.

The Head of Scrutiny and Member Development submitted a report providing an update on the development of a Maternity Services Strategy for Leeds.

Additional information in relation to Leeds Maternity Health Needs Assessment and a set of presentation slides were submitted to the meeting for consideration (minute 56 refers).

The following representatives were in attendance:

·  Jane Mischenko (Commissioning Lead – Children and Maternity Services) – NHS Leeds CCGs

·  Dr Sharon Yellin (Consultant in Public Health Medicine – Leeds City Council)

·  Sarah Erskine (Advanced Health Improvement Specialist (Maternity and Infants) – Leeds City Council)

·  Susanne Cox – Senior Associate, NHS Yorkshire and Humber Commissioning Support Unit

The Commissioning Lead for Children and Maternity Services addressed the meeting and provided some of the context for developing a 5-year Maternity Services Strategy for Leeds – that will inform future commissioning plans and decisions. 

The context included both national and local developments, including:

·  The NHS Mandate around Choice, Personalisation and mental Health Needs.

·  The Wave report around impacts on brain development.

·  Leeds Maternal Health Needs Assessment (and health inequalities)

·  Service user pre-consultation feedback.

·  The Commissioning Case for Change.

The Scrutiny Board discussed the information presented and a range of matters, including:

·  The assessment of existing arrangements and pathways.

·  The outcome of the Leeds Maternal Health Needs Assessment and specifically the health inequalities identified.

·  Mental Health pathways and support for mothers within maternity services.

·  Promoting choice and personalised services.

·  Home-birthing rates and support.

·  Behaviours in relation to breastfeeding, smoking during pregnancy and maternal obesity.

The Scrutiny Board also discussed the next steps in the development of the strategy and discussions with service providers, Children’s Trust Board and the Health and Wellbeing Board.

RESOLVED –

(a)  To note the report and the information presented and discussed at the meeting.

(b)  To consider the draft details of the strategy at the February meeting of the Scrutiny Board.  

On conclusion of the discussion, the Chair thanked those in attendance for their contribution to the discussion. 

To receive a report from the Head of Scrutiny and Member Development introducing an update from Leeds Teaching Hospitals NHS Trust in relation to its improvement actions following the Care Quality Commission inspection in March 2014.

The Head of Scrutiny and Member Development submitted a report introducing an update from Leeds Teaching Hospitals NHS Trust in relation to its improvement actions following the Care Quality Commission inspection in March 2014.

Additional assurance information from Leeds’ Clinical Commissioning Groups (CCGs) and NHS Trust Development Authority (NTDA) was submitted to the meeting for consideration (minute 56 refers).

The following representative was in attendance:

·  Craig Brigg (Director of Quality – Leeds Teaching Hospitals NHS Trust)

The Director of Quality addressed the Scrutiny Board and highlighted a number of matters, including:

·  Progress against the Trust’s Action Plan was overseen by the NHS Trust Development Authority (NTDA).

·  There was also monthly oversight of progress discussed with local commissioners (led by Leeds West CCG).

·  17 recommendations identified by the CQC related to specific regulations and were referred to as ‘must improve’ actions.

·  A further 39 recommendations were identified as ‘should improve’ actions. 

·  The Trust Board had last considered progress at its November 2014 meeting.

·  It had recently been agreed that to incorporate any outstanding matters into the Trust’s general improvement plans and not to monitor progress separately via a stand-alone action plan.

·  It was likely that there would be a return CQC visit within two years.

The Scrutiny Board discussed the information presented and a range of matters, including:

·  The need for a comprehensive assessment of the additional staff (across disciplines) identified as part of the CQC inspection and progress in successfully recruiting the required numbers.

·  Future workforce planning and the potential impact of future retirements – in particular across the nursing establishment.

·  Some concern around proposals for future monitoring of the Trust’s progress.

·  The need for a more forensic and detailed assessment from the local Clinical Commissioning Groups and the NTDA.

RESOLVED –

(a)  To note the report and the information presented and discussed at the meeting.

(b)  To use the information presented and discussed to inform the Board’s final inquiry report.

On conclusion of the discussion, the Chair the Director of Quality for his attendance and contribution to the discussion. 

NB Cllr Graham Latty left the meeting at 12:20pm during discussion of the above item.

To consider the Scrutiny Boards work schedule for the 2014/15 municipal year.

The Head of Scrutiny and Member Development submitted a report setting out the progress and ongoing development of the Scrutiny Board’s work schedule for the current municipal year.

Members discussed the issues presented in the report and the additional areas of work (i.e. requests for scrutiny) agreed earlier at the meeting.  Members also discussed the following additional work areas:

·  Consideration of the draft Best Start Plan through a joint working group meeting involving the Scrutiny Board (Children’s Services) – 29 January 2015.

·  Consideration of the performance of Yorkshire Ambulance Service – following the request for scrutiny in December 2014 – 28 January 2015.

·  Future working group meetings for Adult social care and the Health Service Developments Group.

RESOLVED –

(a)  To note the content of the report and the additional / continued activity discussed at the meeting.

(b)  To make any necessary amendments to the work schedule for the remainder of the current municipal year.

Wednesday, 28 January 2015 at 2:00pm in the Civic Hall, Leeds (Pre-meeting for all Board Members at 1:30pm).

To note the date and time of the next meeting as Wednesday, 28 January 2015 at 2:00pm (with a pre-meeting for members of the Scrutiny Board from 1:30pm).

It was noted this represented an additional meeting to allow the Scrutiny Board to consider the Request for Scrutiny in relation to Yorkshire Ambulance Service NHS Trust, agreed at the Board’s meeting in December 2014. 

(The meeting concluded at 12:30pm)