Agenda and minutes

To declare any personal / prejudicial interests for the purpose of Section 81 (3) of the Local Government Act 2000 and paragraphs 8 to 12 of the Members Code of Conduct.

No declarations of interest were made at this point, although a declaration was made later in the meeting (minute 50 refers)

To receive any apologies for absence and notification of substitutes.

Apologies for absence were received from:

Councillor Bruce who was substituted by Councillor Driver

Councillor Charlwood who was substituted by Councillor Walshaw

Councillor Hyde who was substituted by Councillor Robinson

Councillor Armitage

Sally Morgan – Equality Issues

Betty Smithson – Leeds LINk

The possibility of obtaining substitutes for Co-opted Members who had given their apologies was raised.  It was understood that the Council’s constitution precluded this, but it was agreed that this would be discussed with the Council’s Head of Scrutiny and Member Development

To confirm as a correct record, the minutes of the meeting held on 25^th November 2011.

RESOLVED -  That the minutes of the Scrutiny Board (Health and Well-being and Adult Social Care) meeting held on 25^th November 2011 be approved

To consider a report of the Head of Scrutiny and Member Development providing information on the plans for Yorkshire Ambulance Service NHS Trust to become a Foundation Trust and seeking the Board’s views on this

Further to minute 41 of the Board’s meeting held on 25^th November 2011, where Members received a report on the Yorkshire Ambulance Service (YAS) NHS Trust’s proposals to become a Foundation NHS Trust (FT), the Board considered a further report.  Appended to the report was a copy of the consultation document prepared by YAS; a list of issues/queries raised by the Board at the previous meeting with written responses provided by YAS together with a copy of the Board’s interim consultation response

Attending for this item and representing YAS were:

• David Whiting –Chief Executive – YAS
• Fiona Barr – Foundation Trust Programme Director – YAS
• Paul Mudd – Operations Manager – YAS

Members queried and commented on the following matters:

• funding for new ambulances, with the Board being informed that the A&E ambulances were a relatively young fleet but that some improvements were proposed to the Patient Transport Service fleet
• whether two Local Authority representatives were sufficient to properly represent such a large population which differed considerably in terms of geography, demographics, communities and needs.  On this matter, the Board was informed that the Foundation Trust legislation only required one Local Authority representative to be an Appointed Governor but that two places were being proposed; these being one representing rural areas which would be East Riding of Yorkshire Council and one representing cities, which would be Sheffield City Council.  It was the view of the YAS Executive that while trying to balance the diversity of the Yorkshire region, the Council of Governors should be manageable in number and be active and well developed.  Advice obtained from other FT Ambulance Services had highlighted the importance of a relatively small Council of Governors as a large Governing Body could become unwieldy
• details of the process which had been undertaken to select these two Local Authority representatives was requested.  Mr Whiting stated that this had been discussed at their Board level.  Concerns were raised by the Board that there had not been a democratic process carried out on this issue
• the process for electing Public Governors; the measures in place to ensure these would properly represent the region across all areas; how hard to reach groups would be represented; the need for equality and whether any positive discrimination would be applied.  Ms Barr informed the Board that links had been made with many groups and that early indications were that there was a good mix of people wishing to become governors.  YAS sought advice from Leeds City Council on how to ensure all groups were represented
• the importance of recruiting actively from under-represented areas.  On this matter, Members were informed that as part of the tests for FT status, YAS would need to demonstrate their membership was representative of its area.  The Board was also advised there would be a drive to encourage membership early in 2012
• the Government’s position on FTs and whether, given a choice, YAS would currently be seeking to become a FT.  Mr Whiting stated  ...  view the full minutes text for item 47.

To consider a report of the Assistant Chief Executive (Customer Access and Performance) presenting a summary of the quarter two performance data for 2011-12 which provides an update on progress in delivering the relevant priorities in the Council Business Plan 2011-15 and City Priority Plan 2011-15. 

Members considered a report of the Assistant Chief Executive (Customer Access and Performance) providing a summary of the quarter 2 performance data relevant to the Scrutiny Board (Health and Well-being and Adult Social Care), with two key issues being highlighted; the budget and health inequalities.  Appended to the report were detailed City Priority Plan performance reports in respect of the following priorities:

• Help protect people from the harmful effects of tobacco
• Support people to live safely in their own homes
• Give people choice and control over their health and social care services, and
• Make sure that people who are the poorest improve their health the fastest

The latest performance report from NHS Airedale, Bradford and Leeds was also provided, which gave an overview of performance against key performance indicators for the Leeds element of the NHS Airedale, Bradford and Leeds Cluster

  Attending for this item were:

·  Councillor Lucinda Yeadon – Executive Member (Adult Health and Social Care)

·  Heather Pinches – Performance Manager Planning, Policy and Improvement LCC

·  Dr Ian Cameron – Joint Director of Public Health – NHS Leeds and LCC

·  Sandie Keene – Director Adult Social Services LCC

·  Stuart Cameron-Strickland – Head of Policy, Performance and Improvement Adult Social Services – LCC

Considering the City Priority Performance Plan reports and the Adult Social Care Directorate Scorecard, the key areas of discussion were:

• Safeguarding referrals, the increased focus on safeguarding for adults in view of recent media coverage of incidents in other parts of the country; the multi-agency approach and the importance of Elected Members taking an interested view in Adult safeguarding
• Budgetary pressures; that the overspend was decreasing and that this could be attributed to the work being done to enable people to live in their homes for longer, thereby decreasing the amount of time people needed to spend in residential or nursing home care

Members raised concern that the print used to produce the report was especially small, which may lead to the document not being used to full effect due to the difficulties reading it

Considering the report provided by Airedale, Bradford and Leeds NHS

setting out performance for Leeds, the key areas of discussion were:

• Fractured neck of femur operated within 48 hours, with concerns being raised that performance had decreased and that delays could lead to fatalities
• 30 day readmission rates, following elective discharge and that these remained too high
• Emergency home visits and that waiting times of 1 and 2 hours were lengthy
• C.difficile rates
• Diabetes treatment
• Health visitor numbers
• Stroke care, with concerns that the information provided lacked clarity
• Alcohol related harm, particularly whether there was sufficient treatment slots available for those in need

Dr Cameron responded to the points raised by Members and provided

the following information:

• That the concerns raised were noted and that much work was being carried out to address the issues highlighted by the performance indicators and as a result it was hoped that an improving picture would be seen when this data was next presented
• There had  ...  view the full minutes text for item 48.

To consider a report of the Head of Scrutiny and Member Development on the Board’s Inquiry into Health Inequalities.

Following the initial meeting in November, the Director of Public Health will present a range of data contained within the Joint Strategic Needs Assessment (JSNA) to inform and support the inquiry.

A cover report will be provided and include presentation slides (to tell the story) supported by a number of data sets.  It is proposed that the presentation will focus on two specific themes, starting with Life Expectancy, specifically using premature mortality from cardio vascular disease (CVD) to illustrate the point.  It will explore some of the data sets that exist to illustrate factors that affect life expectancy, with the following data sets from the JSNA to support this:

·  CHD (coronary heart disease)

·  Active Lifestyles

·  Smoking and Tobacco

·   

The presentation will also focus on Poverty and explore the link between poverty, income and health – linking back to the life expectancy (as life expectancy is related to the level of deprivation).  This section will again examine some of the data sets that exist to illustrate the interplay between poverty, deprivation, health and ultimately life expectancy.  Four specific data sets from the JSNA will be presented  to support this.  These are:

·  Homes and Housing

·  Child Poverty

·  Deprivation

·  Incomes and Benefits

The presentation will then move to “A Tale of Two Medium Super Output Areas (MSOAs) which ties the presentation together by demonstrating the inequalities between two specific areas in the City (Gipton and Adel). 

Further to minute 39 of the meeting held on 25^th November 2011 which detailed the Board’s first session into its Inquiry on Health Inequalities, the Board undertook its second session

Following on from the Director of Public Health’s presentation on the JSNA at the meeting on 25^th November 2011, the Board considered some specific examples of the data sets which formed part of the JSNA refresh; these providing both statistical information and commentary.  Appended to the report were draft data sets in respect of the following:

• Coronary heart disease (CHD)
• Active lifestyles
• Smoking and tobacco

In the context of the Inquiry, premature mortality from CHD was

considered with the above data sets being explored as affecting life expectancy

The following people were present for this item

• Dr Ian Cameron – Joint Director of Public Health – NHS Leeds/LCC
• Lucy Jackson – Consultant in Public Health – NHS Airedale, Bradford and Leeds
• Nichola Stephens – Senior Information Manager – NHS Airedale, Bradford and Leeds

Dr Cameron provided information exploring the link between poverty, income and health and to assist the debate, the following draft data sets were also appended to the report:

• Homes and Housing
• Child Poverty
• Deprivation
• Incomes and Benefits

To highlight the health inequalities which existed within Leeds, information had been provided indicating health inequalities citywide as well as in deprived and non-deprived areas of Leeds.  Dr Cameron provided a slide presentation which brought the issues into sharp focus when considering data relating to two different areas of Leeds; Gipton South and Adel.  Details were also provided on the Leeds Observatory, a website which when completed would be the mechanism for accessing data, enabling links and searches to be made to provide both general and postcode specific profiles of a range of  health and wellbeing related data

As the issue of smoking and tobacco would be the subject of a discussion in January 2012, the Chair asked that Members wait until then to discuss any specific issues in this area

In summary, the key areas of discussion were:

• the focus of the Board and whether this should be on the key causes of premature mortality or to look wider and at areas which over the long-term could lead to improved health and less inequalities
• mortality rates and differences between men and women
• housing; the impact of poor housing on health
• the link between poverty and health and the likely negative impact of changes to the benefits system
• the introduction of the health premium with concerns this could lead to pressure being placed on health professionals to register data in a certain way
• the fluid nature of the population in some areas of Leeds and the distortion to the data caused by the large student population
• whether or not significant improvements/results could be achieved
• data quality and reporting rates among local GPs
• the range of data being collected; that winter deaths should be recorded and the importance of including details of residential properties in the  ...  view the full minutes text for item 49.

To consider a report of the Head of Scrutiny on Member Development on the Board’s inquiry into consultation.

Appended to the report will be two papers for the Board to consider:-

(a)  Input from Clinical Commissioning Groups (CCGs)  

(b)  Input from Leeds Involving People.

Further to minute 19 of the Board’s meeting held on 21^st September which detailed the Board’s first session on its Inquiry into Consultation, the Board undertook its second session

The Board considered a report of the Head of Scrutiny and Member Development and a report from NHS Airedale, Bradford and Leeds on consultation and patient involvement.  Appended to the reports was information from the Clinical Commissioning Groups (CCGs); Leeds Involving People – a user-led charity which championed the voice of service users and carers and an NHS Confederation discussion paper of October 2011 entitled Patient and public engagement in the new commissioning system

Attending for this item were the following:

• Matt Neligan – Executive Director Commissioning Development – NHS Airedale, Bradford and Leeds
• Dr Andy Harris – Leeds South and East CCG (Leodis)
• Dr Jason Broch – Leeds North CCG (Calibre)
• Dr Gordon Sinclair – Leeds West CCG (H3Plus)
• Barry Naylor – Chair Leeds Involving People
• Jagdeep Passan – Chief Executive – Leeds Involving People
• Tim McSharry – Management Committee – Leeds Involving People
• Joseph Alerdice – Involvement and Development Officer – Leeds Involving People

Joy Fisher declared a personal interest through being a member of the Alliance of Service Experts which was served by Leeds Involving People which were making a presentation to the Board and through knowing many of the people present for this item

The Board heard first from the Executive Director (Commissioning Development) and the CCG representatives, receiving information on:

• the changeover process for responsibilities shifting from the PCTs to the CCGs, including an outline of the authorisation process.  It was outlined that CCGs would become formal sub-committees of the PCT and that shadow arrangements would be in place from April 2012, in preparation for CCGs taking over responsibility from April 2013
• the three CCGs, the geographical areas covered, including population and number of GP practices
• the work undertaken by each of the CCGs in respect of patient and public involvement and the importance of this under the proposed NHS reforms
• the on-going feedback and dialogue that CCGs and the constituent GPs had through daily contact with patients.  The invaluable resource this provided was also discussed

The Board questioned the CCG representatives, with the key points of

discussion being:

• data quality
• the difficulties of setting up and maintaining community groups especially in deprived areas; that multi-issue consultation and engagement was encouraged and the need to work with partners to achieve this
• the importance of retaining and using existing resources, groups and networks
• that adequate time be allowed for consultation
• the variations between the CCGs priorities and the potential impact this may have across the City
• the importance of benchmarking and independently auditing consultations
• the timescales for achieving the required level of meaningful engagement with patients, carers and communities, as part of the authorisation process
• geography – including how cross-boundary issues would be addressed, with some parts of the city split geographically and where other areas bordered different local authority/  ...  view the full minutes text for item 50.

To consider a report of the Head of Scrutiny and Member Development setting out the work schedule for the Board for the current municipal year.

The Head of Scrutiny and Member Development submitted a report together with a copy of the Board’s current work programme.  Also appended to the report was the Council’s current Forward Plan – 1^st December 2011 to 31^st March 2012 relating to the Board’s portfolio and terms of reference

RESOLVED - To note the information provided and to agree the work schedule presented in Appendix 1

Wednesday 25^th January 2012 at 10.00am in the Civic Hall, Leeds (Pre-meeting for Board Members at 9.30am)

Wednesday 25^th January 2012 at 10.00am (pre-meeting for all Board Members at 9.30am)