Apologies for absence were received from Mr Graham Hodkinson, Director for (Adult) Care and Health – Mr Jason Oxley, Assistant Director Health and Care Outcomes attended as deputy.

Members of the Committee were requested to declare whether they had any disclosable pecuniary interests and/or any other relevant interest in the item on this agenda and, if so, to declare it and state the nature of such interest.

Members were reminded that they should also declare whether they were subject to a party whip in connection with any item(s) to be considered and, if so, to declare it and state the nature of the whipping arrangement.

The following declarations were made.

The Chair invited nominations from the Committee in respect of the appointment of a Vice-Chair for the remainder of the Municipal Year 2019/20.

It was proposed by Councillor Moira McLaughlin and seconded by Councillor Mary Jordan that Councillor Phil Gilchrist be appointed Vice-Chair of the Adult Care and Health Overview and Scrutiny Committee.

Resolved – That Councillor Phil Gilchrist be appointed Vice-Chair of the Adult Care and Health Overview and Scrutiny Committee for the remainder of the Municipal Year 2019/20.

To approve the accuracy of the minutes of the Adult Care and Health Overview and Scrutiny Committee meeting held on 19 March 2019.

To receive the draft minutes of the Wirral and Cheshire West and Chester Joint Overview and Scrutiny Committee meeting held on 18 December 2018.

The Committee was requested to approve the accuracy of the minutes of the meeting of 19 March 2019.

The Committee was also requested to note the content of the draft minutes of the Wirral & Cheshire West and Chester Joint Health Scrutiny Committee of 18 December 2018.

Resolved – That

1)  the minutes of the meeting of 19 March 2019, be approved; and

2)  the minutes of the Wirral & Cheshire West and Chester Joint Health Scrutiny Committee meeting of 19 March 2019 be noted.

The Committee is requested to provide nominations and confirm the appointment of 3 members (2 Labour : 1 Conservative) to the Wirral & Cheshire West and Chester Joint Health Scrutiny Committee.

The Chair invited the Adult Care and Health Overview and Scrutiny Committee to provide and confirm nominations for 3 Members to be appointed to the Wirral & Cheshire West and Chester Joint Health Scrutiny Committee for 2019/20, on a proportionality ratio of 2 Labour Members: 1 Conservative Member.

The Chair informed that a meeting of the Joint Committee had been scheduled for Monday 1 July 2019 at Wallasey Town Hall.

The following nominations were proposed and seconded - Councillor Yvonne Nolan (Labour), Councillor Tony Norbury (Labour), Councillor Mary Jordan (Conservative).

Members further agreed that invitations be extended to Eastham Ward Councillors and the Chair of the Adult Care and Health Overview and Scrutiny Committee to observe proceedings and act as witnesses if appropriate (non-voting role).

Resolved – That Wirral representation on the Wirral & Cheshire West and Chester Joint Health Scrutiny Committee comprise:

Councillor Yvonne Nolan (Labour)

Councillor Tony Norbury (Labour)

Councillor Mary Jordan (Conservative)

Verbal update.

CQC Inspection documentation may be found here.

Paul Moore, Director of Quality and Assurance at Wirral University Teaching Hospital (WUTH) provided a verbal update on tha actions arising following the Care Quality Commission (CQC) inspection of urgent and emergency services at WUTH Arrowe Park in March 2019. Services had been rated as ‘Required Improvement’.

Mr Moore informed that it had been helpful to receive the CQC inspection in March which had followed on from and earlier inspection in May 2018. He further informed that there had been positive movements in some service areas and others had demonstrated outstanding practice. He concurred that of a number of issues identified, concerns remained e.g. responsiveness to initial assessment and triage where a combination of high occupancy, demand, patient flow i.e. nowhere to go, had resulted in unacceptable waiting times for both assessment and triage.

The Adult Care and Health Overview and Scrutiny Committee were apprised that at time of inspection this was the case, and this operational dilemma was being addressed i.e. where to place people. He added that it was clear that in order to reduce risk to patients, centralisation of Urgent Care in and around A&E where a variety of professional care services were available would provide the most appropriate solution. He agreed that even if used for shortest possible time, ‘corridor care’ was not compliant care or acceptable practice.

Mr Moore explained that as a result of the CQC inspection procedures for escalation measures had been made clear to all staff.

Members were informed that the WUTH did not agree with the CQC’s comment regarding paediatric staffing levels and inter collegiate guidelines. He informed that it was not clear if this comment was accepted by NHS as a whole, believing the recommendation regarding staffing levels may not be achievable, given there was an insufficient number of registered child nurses available in the country. The WUTH had accepted the advice but had asked for comment on the guidelines.

Mr Moore provided reassurance on the control of infection – particularly clostridium difficile – an extremely difficult infection to eradicate. He stated that WUTH was making progress in this regard and doing everything possible to address this bacterial infection, generally only using antibiotics where absolutely necessary.

Members questioned the Director of Quality and Assurance WUTH on a number of points relating to his verbal report and matters raised as a result of the CQC inspection. These included:

·  Staffing Levels;

·  WUTH leadership style;

·  Number of people held awaiting treatment, or being treated on trolleys (max 12);

·  Cost of temporary workforce (£60k per month);

·  Time patients to spend in A&E (no recorded data, but no more than 12hours); and

·  Current time taken for triage (15 minutes, down from 23 minutes).

Members stated that all future reports should be submitted in written format, noting that although verbal reports were helpful, it was not good practice.

Mr Moore provided explanation of a CQC comment that staff could not demonstrate what to do in the case of a fire and although this was  ...  view the full minutes text for item 6.

Jean Stephens (Managing Director) and Mike Naden (Chairman) introduced their report that provided an update for Members on the priorities and future direction of Wirral Evolutions Ltd.  The report centred on the organisations guiding principles to ensure:

·  People supported were at the heart of everything the organisation does;

·  Service delivery was of the highest quality, enabling greater outcomes and benefits for the people supported;

·  Strong engagement and partnership working with the people supported, families, carers, stakeholders and communities;

·  The business operated in an efficient and effective manner raising standards; and

·  Governance Standards and Principles were maintained and adhered to the highest level.

The report informed that Wirral Evolution’s Strategic Framework was aligned to Wirral Council 2020/30 Pledges and Healthy Wirral Plan that set out a series of 20 pledges whereby the Council and its partners would work to achieve by 2020, focusing on three key themes:

·  Protecting the most vulnerable

·  Driving economic growth

·  Improving the local environment

The report further informed that Wirral Evolutions Ltd was established in May 2015 as a private company limited by shares, trading as a Local Authority Trading Company (LATCo) providing support services for 407 adults with a wide range of learning and physical disabilities. The size of the adult population in Wirral with a learning disability aged 18 and over was estimated at 5,914 (2016) with a slight predicted increase to 6042 by 2030.

Ms Stephens welcomed the opportunity to share the Company’s plans for the future, and updated Members on the future direction of services, working to deliver against the organisation’s vision 'to enable the people supported had choice and exercised control of their own lives'. Ms Stephen’s cited examples of how people were now travelling independently, growing in confidence and informed on other areas of work that focused on:

·  The need to work in partnership with other organisations. Co-developing of products and services to meet needs.

·  Working with self-advocacy service – who provided great help and support to service users.

·  ‘Making it real’ – involvement in future direction of service.

·  Significant investment on facilities, driving up standards.

·  Focus on outputs – activities, health and wellbeing, and skills.

Jean Stephens (Managing Director) and Mike Naden (Chairman) invited comments/questions from Members of the Committee.

The Chair thanked the Ms Stephens and Mr Nader noting that it was good to hear about the organisations intentions and requested further information about what the organisation had done in the form of scorecard and evidence of outputs.

Further questions followed on a range of subjects that included:

·  Councillor’s attendance at the organisation’s monthly meetings, and why this has been stopped.

·  What plans were in place for refurbishment and upgrading of Wirral Evolution’s buildings to become pleasant welcoming venues.

Jean Stephens (Managing Director) confirmed that part of the organisation’s five-year business plan would be looking at co-location e.g. sports centres, and moving away from 70’s institutional type feel, was included in an asset review. Investigation would take place as to why Councillors had not been invited to meetings.

Chair  ...  view the full minutes text for item 7.

Jacqui Evans, Assistant Director, Unplanned Care and Community Care Market commissioning introduced her report that outlined the developments in NHS 111, a telephone service that patients can use to access urgent care. Sara Sheikh, Lead Officer for NHS 111 and Paula Cowan, Chair Wirral CCG also attended to respond to questions from the Committee.

Sara Sheikh, Lead Officer for NHS 111 provided Members with an overview of the 111 service that included information on:

·  Activity and Outcomes

·  Performance

·  Patient Feedback

·  Compliments and Complaints

·  Developments

The Chair then invited comments/questions from Members of the Committee.

Members sought reassurance that transfers between the service and relationships with GPs could ensure prescriptions were managed and handled properly, particularly during peak times. The Committee was apprised that ongoing initiatives were looking as this, but the 111 service did not interfere with normal prescribing, only prescribing over the weekend or out of hours, with information being fed back to GPs. Repeat requests were also followed up.

A Member asked what arrangements were in place for the 111 service to access medical records, particularly in relation to deal with clinical advice for children. Members were informed that 6 weeks training was in place for staff, and more nurses were becoming available to work in the 111 service. Dr Cowan advised that the 111 service did not currently have access to Wirral records, but this is being investigated at a more senior NHS management level and across a wider geographical area.

Members were informed that there was a key focus on recruitment and retention of staff with a new centre opening in Liverpool, providing flexible working arrangements and more full time posts.

Sara Sheikh, Lead Officer for NHS 111 informed that many residents / patients who had used the system found it quicker and helpful. She further informed that the system was continually being reviewed and developed.

Resolved – That the report be noted.

Dr Paula Cowan Chair, Wirral CCG introduced the report of Wirral Health and Care Commissioning, Nesta Hawker, Director of Commissioning and Transformation. A presentation also accompanied the report.

The report outlined the current position of urgent care transformation work and focused on consultation and engagement feedback.

The Chair advised the Adult Care and Health Overview and Scrutiny Committee that the report did not cover the CCG decision regarding the Urgent Care Review (UCR), and that this specific information was scheduled for publication on the Council’s website on Friday 28 June, for consideration by the Joint Strategic Commissioning Board (JSCB) at its meeting to be held on 9 July 2019.

A special meeting of the Wirral Adult Care and Health Overview and Scrutiny Committee (OSC) had been scheduled for 24 July 2019.

Members were made aware that the OSC was requested to provide its final recommendations or comment on the consultation by 5pm, Friday 5 July 2019, to provide feedback for commissioners when they consider the final recommendations prior to decision by the CCG Governing Body on 9 July 2019.

Dr Paula Cowan Chair, Wirral CCG introduced her presentation and summary of the clinical senate report findings. She informed of the variety of consultation methods undertaken between September and December 2018 that had generated a great deal of public interest.

Dr Cowan informed that an independent organisation had been employed to assess feedback on the 2 options consulted upon (including urgent treatment in the community), Walk-In Centres and arrangements for treatments for children.

Dr Cowan apprised the Committee of details relating to the statistical feedback that favoured option one, with an overall preference rating of 66.5%.

Areas covered within the presentation included information on bookable appointments and the (disliked) closures to minor injury and illness and walk-in centres in local communities.

Members noted that during consultation, the CCG engaged with the public at a range of events and roadshows (in excess of 80 individual events) across Wirral. These included focus groups, public meetings, stakeholder engagement meetings and visits to current urgent care locations. Local and regional media were utilised to highlight the consultation and a household postcard drop was also completed.  Engagement activity also included visits to shopping centres and social media posting on Facebook and Twitter

A Member commented that there was one troubling aspect i.e. that of no visit to one of the Walk-In sites, that at Eastham. He sought assurance that the lack of a visit would have had an adverse effect when the final decision was to be taken. Reassurance was given that it did not have a detrimental effect.

The Chair thanked the speakers, and pointed out in summary that since the consultation had been undertaken MerseyTravel and private bus operator Stagecoach had further reduced their services, adding to Members concerns about future access to the Urgent Care Treatment service.

Resolved – That

1)  The Adult Care and Health Overview and Scrutiny Committee thanks officers of the CCG for this report and notes that the consultation  ...  view the full minutes text for item 9.

Chair introduced a background summary to the item, informing that this matter had been an item of earlier report to this Committee.

Simon Banks (Chief Officer, Wirral CCG) introduced his report that detailed the proposed revised delivery models for the Community Phlebotomy Service from 22 member GP practices of Primary Care Wirral Federation scheduled to commence on 1 July 2019. The report informed that the Community Phlebotomy Service was designed to support the Healthy Wirral agenda as part of the Wirral Plan 2020, in turn helping Wirral residents to keep as healthy as possible and reduce health inequalities.

Mr Banks apprised the Committee that following ongoing issues and concerns raised by patients, PCW federated practices and other stakeholders regarding the delivery of the service, Wirral Health & Care Commissioning (WH&CC) intervened where the remaining 22 practices had not provided a service in line with requirement.  As a result a revised delivery model had been proposed by PCW Federation and WCFT in January 2019. This had been presented to an extraordinary Primary Care Co-Commissioning Committee on 22 January 2019. The proposed revised model was not approved by the Committee for the following reasons; specification requirements not met, lack of evidence of patient engagement, non-completion of impact assessments to support a significant reduction in provision from a number of locations, demand management concerns in regards to a significant increase in referrals for domiciliary visits not addressed and lastly it did not support equity of access for all patients across Wirral.

Subsequently this resulted in WCFT serving notice to all 22 GP practices, as they had been unable to provide a sufficiently high quality level of service for their patients, in meeting the service specification. These contracts ceased on 30 June 2019.

The report provided details of the revised delivery models for the Community Phlebotomy Service from 1 July 2019, namely:

Practices providing the service independently:

·  Marine Lake Medical Practice

·  Estuary Medical Practice (previously known as TG Medical Centre)

·  Heswall & Pensby Group Practice

·  The Warrens Medical Centre

·  Greasby Group Practice

·  Upton Group Practice

·  Paxton Medical Practice (includes Fender Way Health Centre)

·  Vittoria Medical Centre (K)

·  The Village Medical Centre

·  St Georges Medical Centre

·  The Manor Health Centre

·  Commonfield Road Surgery

Practices collaborating:

·  Riverside Surgery - Sunlight Group Practice will undertake domiciliary visits on their behalf

·  Somerville Medical Centre & Central Park Medical Centre – all drop-in sessions will be undertaken at Central Park Medical Practice. Phlebotomist staffing resources will be shared as and when required.

·  Healthier South Wirral consisting of; Allport Surgery, The Orchard Surgery, Spital Surgery, Eastham Group Practice, Civic Medical Centre and Sunlight Group Practice.  Patients will be able to utilise the appointment and drop-in sessions at all practices within this model. 

Practices sub-contracting with GP Wirral Federation to deliver the service on their behalf:

·  Vittoria Medical Centre (G)

·  Whetstone Medical Centre 

A Member thanked Mr Banks for the summary, noting that phlebotomy was a skilled role an expressed concern that a hybrid role may affect the quality of service and what  ...  view the full minutes text for item 10.

Jason Oxley Assistant Director, Health and Care Outcomes introduced the report of the Director for Health & Care (DASS) that provided the 2018/19 Quarter 4 (January - March 2019) performance report for the Wirral Plan pledges under the remit of the Adult Care and Health Overview and Scrutiny Committee.

The report, included as Appendix 1 to the cover report, provided an overview of the progress in Quarter 4 and available data in relation to a range of outcome indicators and supporting measures.

The Year End closedown report was included as Appendix 2 and provided a summary analysis of performance against measures and Wirral Plan delivery of Pledge strategy actions at year end.

The report also included further performance information that had been requested by Members to enable effective scrutiny. The Adult Social Care and Health Performance Overview was included as Appendix 3 and had been developed following Member feedback to include key performance across health and social care.

Assistant Director, Health and Care Outcomes informed the Adult Care and Health Overview and Scrutiny Committee that in support of the Relevant Wirral Plan 20/20 pledge(s) i.e. Older People Live Well, People with Disabilities Live Independent Lives and Zero Tolerance to Domestic Violence a number of successful actions had been completed resulting in improved statistics. These included:

·  Good feedback on door knocks - 211 conversations, many resulting in service referrals.

·  126 people volunteering - above expected target

·  Employment for 50+ age group has risen

·  People with disability living independently – highest rate since plan started.

·  Domestic abuse – increased number of mentors

·  Family safety referrals increase 20%

Less positive news had been highlighted by the statistics, namely that the healthy life expectancy had fallen for women, however the reasons for this were being investigated.

The Chair thanked Mr Oxley for his report and requested that a report on domestic abuse, use of women’s refuges and finance be prepared for a future meeting of the Committee, or possibly as a subject of a Scrutiny Workshop session.

Resolved – That the report be noted.

The Chair will introduce the report on behalf of the former Chair of the Panel, Cllr Julie McManus.The report provided an overview of the Health and Care Performance Panel meeting held on 11 March 2019 and provided feedback to members of the Adult Care and Health Overview and Scrutiny Committee around key discussions and areas of interest resulting from the meeting.

The report included updates on the following key items, namely:

Wirral Community Trust – recording assurance that the Trust were making sufficient progress in developing quality improvement measures across the organisation following its CQC inspection;

Wirral University Teaching Hospital – update from the Director of Quality and Governance on progress made at the Trust relating to its CQC Improvement and Action Plan – an item also considered earlier in this Committee meeting (Minute 6 refers); and

Options for improving performance and contract compliance in Care Homes and review of Health and Care providers – a matter for consideration by the Committee under it’s work programme - in terms of a revisit of past recommendations.

A Member suggested that the Health and Care Panel also consider reviewing / revisiting plans to address ‘winter pressures’ on services. The Chair concurred, noting that Members hadn’t yet received an update on this, as had initially been promised when the issue had been raised before.

Resolved – That the contents of the report of the Health and Care Performance Panel.

The Chair introduced the report and request that Members agree to the formation of the working group of 7 Members (plus Healthwatch representation). The report suggested that Membership was made up of the following:

(Labour 3: Conservative 2: Green 1: Independent: 1)

Members were invited to confirm interest in joining the working group noting that Panel meetings were likely to take place during the day so availability at this time should be considered – meeting approximately every 8 weeks at 4:00pm

Resolved – That Committee agrees to establish a cross party Health and Care Performance Working Group for the current municipal year; and appoints members to the Working Group and that nominations be confirmed by the Chair and Party Spokespersons of the Adult Care and Health Overview & Scrutiny Committee at the earliest available opportunity.

The Chair introduced her report and notified Members that a Special Meeting of the Committee will be convened on Wednesday 24 July 2019 to consider the Urgent Care Review.

A Member requested that a repeat study in respect of transfer beds at Clatterbridge Hospital be considered at an appropriate time. The Chair agreed that this should be considered by Members of the Committee.

Resolved – That the report be noted.