Agenda and minutes

Apologies for absence are listed above.

Members of Health Scrutiny Committee are asked to consider whether they have an interest in any of the matters on the agenda and if so, to formally declare that interest.

Councillor Taiq declared an interest due to being the Manager at Healthwatch in Oldham.

Councillor Grimshaw declared an interest due to a family member working at the Greater Manchester Combined Authority.

The minutes from the meeting held on 09^th November 2022 are attached for approval.

The minutes of the meeting held on 09^th November 2022 were agreed as an accurate record subject to the following clarification; the Edenfield item is reflected to demonstrate it will not be reviewed by GMCA until police investigations conclude.

There were the following matters arising:

Councillor Brown requested follow up to questions previously submitted regarding hospitals and pharmacies communication.

Questions are invited from members of the public present at the meeting on any matters for which this Committee is responsible.

Notice had been received of 1 question.

In addition, one member of the public attended and asked one question.

Mr Rubinstein asked what plans are in place to help get people out of hospital and what more is needed to get the Government to help with this.

Adrian Crook, Director of Adult Social Care explained that the answer to this question will be addressed under the Winter Pressures update on the agenda this evening and asked to cover the response under this item.

A period of up to 15 minutes will be allocated for questions and supplementary questions from members of the Council who are not members of the committee. This period may be varied at the discretion of the chair.

Notice had been received of 1 question.

Verbal update from Will Blandamer, Executive Director Health and Adult Care, Adrian Crook, Director of Community Commissioning and Councillor Tariq Cabinet Member for Health and Wellbeing.

Will Blandamer, Executive Director, Health and Adult Care provided a verbal update on the operation of the urgent care system over the recent winter period. The Committee is sited on the current pressures which include, ambulance waiting times, access to emergency services, and recognising that the number of NHS patients across the country declared critical incidents. As background, Bury will have further information provided in the March Health Scrutiny, however, the operation and transformation of our urgent care system is overseen by an urgent care Board Chaired by Dr Kiran Patel with all partners attending. In addition operationally, there is a daily system wide bronze command meeting at 8:30am and all relevant agencies and departments are connected to this.

Overall Bury’s position as viewed by the emergency department and colleagues from the Northern Care Alliance there has been a continued reduction of levels of attendances of admissions at Fairfield General Hospital compared to historic trends which is believed to be attributed to the operation of neighbourhood team working, urgent treatment centre at the hospital and frailty arrangements offering same day emergency care. This demonstrated our attendance avoidance schemes are working well, however, at times Fairfield General Hospital were stretched and resulted in beds on corridors and ambulances waiting outside however, emergency beds were planned and used. Ambulance turn-around times at Fairfield General Hospital are consistently good and are some of the best in Greater Manchester as is colleagues tremendous effort in the emergency department at Fairfield on the percentage waiting in Accident and Emergency.

There is a current focus on the no reason to reside numbers or those who are medically fit in hospital and are waiting discharge. We have a relatively good average length of stay and have been able to move patients along appropriately and quickly, but there is still more work to be done.

Whilst there has been and continues to be challenges Will Blandamer was pleased to report that Fairfield General Hospital was never at an opal 4 level (agreed emergency level) over the Christmas period.

Bury continues to work with Greater Manchester to support demand and Will wished to thank the work of the Northern Care Alliance have done in the Emergency Department and across the Hospital to support the quality of the services available. In Bury the greatest pressures were felt across the community, and specifically in primary care.  To mitigate the worst effect of this we stood up an acute visiting service working across both groups of primary networks to provide additional support to colleagues and a paediatric respiratory clinic was also stood up seeing up to 90 patients a day and has more recently been extended to all patients. Bury also accessed some Greater Manchester wide surge monies to increase primary care capacity in the Borough.

Finally Will Blandamer wanted to recognise that Fairfield Hospital is not the only Hospital that supports Bury residents, we have connections with North Manchester and Manchester MFT and work with them to discharge to Bury appropriately.  ...  view the full minutes text for item HSC.7

Report from Moneeza Iqbal Director of Strategy attached.

Will Blandamer introduced the report which covers the disaggregation of clinical services from the previous Pennine Acute Hospitals Trust footprint

Moneeza Iqbal, Director of strategy advised that in 2021, Manchester Foundation Trust acquired the North Manchester General Hospital (NMGH) site, and Salford Royal Foundation Trust (SRFT) acquired the remaining sites of Pennine Acute Hospitals Trust, creating the Northern Care Alliance. Since then, due to the way in which digital systems and clinical rotas operate, there are some services which operate across the two providers which have not yet been ‘disaggregated’. This means that the services still need to be split between the two organisations using an agreed set of principles: including splitting of the workforce, budget and waiting lists.

Questions took place regarding hospital preference for Bury residents. Members were informed this is a conversation with your general practitioner, the consideration of patient preference, waiting times at local hospitals for the treatment required and distance.

Councillor Hussain asked a question regarding the medical certificate for cause of death (MCCD). He reported a large number of people who have passed away in hospital and hospital doctors being reluctant to issue a medical certificate for cause of death because of lack of information or connectivity with hospital doctors and General Practitioners and has caused problem in the Christian, Muslim and Jewish community. This is because it is a religious duty for all faiths to bury the deceased as soon as possible. Moneeza Iqbal, Director of Strategy asked if this discussion can take place following the meeting. In addition, Heather Caudle, Chief Nursing Officer from the Northern Care Alliance added one of her main duties is servicing is user and patient experience and the end of life and palliative care team. She advised there have been reasonable adjustments to the processes described to expedite burials in line with patients’ cultural norms. Heather Caudle advised that she will be involved in these discussions and work can be done to make the cultural adjustments stronger to ensure a difference experience. Councillor Hussain outlined he would like to meet with officers and the Jewish community to discuss this further.

Councillor Moss advised he has reports of Prestwich residents being referred to an outpatient clinic in Radcliffe but suggested it may just be for dermatology. Councillor Moss advised he has reports of Prestwich residents being referred to an outpatient clinic in Radcliffe but suggested it may just be for dermatology. Moneeza Iqbal, Director of Strategy advised Dermatology is a Salford Royal service and arrangements have been put in place, so patients do not have to travel to Salford for an appointment.

Councillor Hayes, asked about the consultation process especially the patient surveys and opportunities of a wider consultation. In response Moneeza Iqbal, Director of Strategy advised currently patient feedback and other options and clinical team views. Following this it will be pulled into a substantial variation document and considered by the integrate care system.

Councillor FitzGerald thanked Moneeza Iqbal for her attendance and update to the Committee.  ...  view the full minutes text for item HSC.8

Report from Heather Caudle, Chief Nurse Northern Care Alliance attached.

Dr Heather Caudle, Chief Nurse Northern Care Alliance provided an overview of the CQC Report. It was reported that an unannounced inspection commenced on 8th August 2022 and concluded following the well led element of the inspection on 26th September 2022.

Prior to the inspection in July 2022, the Northern Care Alliance had carried out a detailed self-assessment against the key lines of enquiry and had rated ourselves as requires improvement. The CQC Inspection was carried out using a risk-based approach based on data and intelligence gathered. Areas of concerns had flagged with CQC based on information from external reporting (STEIS, waiting times, quality and performance indicators), enquiries they had received from the public and staff, and from themes they had become aware of through Incidents, complaints and RCAs.  In particular a focus of the inspection in Fairfield General was the treatment and care of people with disordered eating, following a PFD order issued to the organisation in November 2021.

Members were informed that under regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, CQC have asked for a written report of the action we are going to take to meet the associated regulations and any other legislation. This is currently in development and due for submission with the CQC by 31st January 2023.

Discussions took place regarding the report and members expressed shock following the rating. Helen Caudle, reciprocated the shock and advised of the various barriers faced and advised the nurse accreditation scheme has been stood up again to look at key lines of enquire in line with the CQC.

Councillor Rizvi asked what elements of the must and should do sections of the report have been addressed. In clarification Heather Caudle advised the action plan must be submitted by 31^st January. In terms of the actions work is already happening.

Councillor FitzGerald thanked Heather Caudle for her attendance and update and welcomed a further update as work progresses.

Will Blandamer, Executive Director, Health and Adult Care - Bury Council, Adrian Crook Director of Community Commissioning, Sian Wimbury (Programme Director) and Andrew Maloney (Deputy CEO and Exec lead for the programme) will present.

Andrew Maloney, Deputy Chief Executive and Sian Wimbury Programme Director provided a presentation to the Committee which gave an overview of work since Greater Manchester Mental Health declared a critical incident on 12^th September 2023 following serious concerns raised regarding care and treatment at the Edenfield Centre, Prestwich.  A copy of the presentation delivered can be found in the agenda papers.

Members sought reassurances on what work has now taken place since the findings and why it did not flag sooner for an in-depth review. Andrew Maloney, Deputy Chief Executive advised that ensuring patient and staff voice is at the heart of any governance within the organisation is crucial to ensuring this cannot happen again. Culture and staffing is also seen as how they will improve the environment for staff and patients.

Councillor Walsh asked for clarification as to what areas of the trust the update report covered. In clarification, members were informed the report relating to Edenfield is the CQC Well Led report published in November. An inspection was done over the whole of June - July which included Edenfield and other parts and ahead of that the CQC raised concerns around different parts of the organisation which started in April last year which started with community-based services in Manchester the issues in relation to fire and ligature safety, in patient services, safe staffing and Governance which ranges across all the trust. The trust has now been moved into Segment 4 as it is not just Edenfield it is about the wider organisation, but work is ongoing to embed these improvements trust wide.

Councillor Tariq, Cabinet Member for Health and Wellbeing thanked officers for the regular dialogue and discussion that has been maintained with the Local Authority. Councillor Tariq asked what quality assurance mechanisms are in place to monitor the improvement plan. In response Andrew Maloney, Deputy Chief Executive advised there are plans for accreditation of services, models of care and setting clinical standards that will be built in. In addition, there are clinical related actions that will have a bespoke level of assurance too.

It was agreed:

1.    Members note the report

2.    Members thanked Andrew Maloney, Deputy Chief Executive and Sian Wimbury Programme Director for their update.

Report attached from Caroline Beirne - Assistant Director of Workforce, IDC.

Lindsey Darley, Director of Transformation and Delivery and Caroline Beirne, Assistant Director of Workforce provided an overview of the system wide workforce wellbeing and retention.

Health Scrutiny made a request for an update on Workforce Wellbeing and Retention programs currently system wide. All partners in the health and care system in Bury recognise the pressures on workforce wellbeing currently, following Covid and with enormous demand pressures in the system.

The Strategic Workforce group brings together workforce leads from health and care organisations to address issues of common concern. There is a newly developed People and Culture Strategy which is due to be launched in March 2023.

Workforce wellbeing is a Greater Manchester and shared Bury systemwide workforce strategic priority. It was agreed with workforce colleagues at the system wide workforce group to hold workshops on wellbeing to assist and develop a shared understanding of what our current position is and start to consider how value can be added, address any gaps and work through the challenges by working together.

Councillor Birchmore asked if there are statistics of staff leaving for comparisons and trends.  Lindsey Darley, Director of Transformation and Delivery advised different organisations hold different policies and data and they are using different statistics. We are awaiting a date for Greater Manchester to participate in a new system called ‘VWis’ Virtual workforce information systems to centralise this data. Manchester and Bolton are currently involved in this and Bury hopes to join soon and is part of the strategy going forward.

Councillor Rizvi asked about training and progression; Lindsey Darley, Director of Transformation and Delivery advised there is lots of work needed. The Care sector has now made links with Bury College and Job Centre Plus to look at employment, training, and development.

Further discussions took place regarding offers wider than training and getting people into jobs to improve retention, an example of which is affordable car parking for staff.

It was agreed:

1.   that members note the report; and

2.   a further update be brought back to the committee on all wellbeing and retention offers in the new municipal year.