Agenda and minutes

There were no apologies for absence.

There were no declarations of interest received.

There were no items of urgent business received.

There were no public questions received.

The Minutes of the meeting of the Health Scrutiny Committee held on 3^rd September 2019 are attached for approval.

RESOLVED that the minutes of the meeting of the Health Scrutiny Committee held on 3^rd September 2019 be approved as a correct record.

The Minutes of the meeting of the Joint Scrutiny Panel for Pennine Care (Mental Health) Trust held on 15^th October 2019 are attached for noting.

RESOLVED that the minutes of the meeting of the Joint Scrutiny Panel for Pennine Care (Mental Health) Trust held on 15^th October 2019 be noted.

The Minutes of the meeting of the Joint Scrutiny Panel for Pennine Acute Hospitals NHS Trust held on 18^th July 2019 are attached for noting.

RESOLVED that the minutes of the meeting of the Joint Scrutiny Panel for Pennine Acute Hospitals Trust held on 18^th July 2019 be noted.

The minutes of the meetings of the Greater Manchester Joint Health Scrutiny Committee held on 10^th July and 11^th September 2019 are attached for noting.

RESOLVED that the minutes of the meetings of the Greater Manchester Joint Health Scrutiny Committee held on 10^th July and 11^th September 2019 be noted.

The minutes of the meeting of the Health and Wellbeing Board held on 24^th September 2019 are attached for noting.

RESOLVED that the minutes of the meeting of the Health and Wellbeing Board held on 24^th September 2019 be noted.

The Committee received a report presenting an update on delivery in Oldham of the NHS Health Checks programme, a national health risk assessment programme looking to help prevent vascular disease, including heart disease, stroke, diabetes and kidney disease. Patients aged 40 to 74 years not already diagnosed with one of these conditions or not in receipt of certain prescriptions (the ‘eligible population’) are invited every five years to have a health check to assess their risk of developing one or more of these conditions.  The Health Check gave a personalised risk of developing a heart or circulation problem in the next 10 years and provided tailored advice and management plans to lower the risk, which may include improving physical activity levels, dietary advice, prescribed medicines for cholesterol or blood pressure, and support to stop smoking.  Introduced in 2013, the programme was now to run to 2023 and the Committee was advised of research indicating national outcomes of the programme.

Locally, on completion of a health check risk assessment, feedback and advice on achieving and maintaining healthy behaviours is given. If necessary, the individual is directed to either a health improvement intervention, referred to their GP for clinical follow up, or referred to secondary care.  Those at high risk of cardiovascular disease are placed on disease registers and clinically managed through their GP practice.  During the first five year programme Oldham had moved from one of the lowest performing local authorities to being an example of good practice, and between 2014/15 and 2018/19, 45.4% of Oldham’s eligible population had taken up the offer of a health check.  While slightly below the England average, this was one of the top performances by a Greater Manchester authority.  Performance had dipped in 2018/19 due to GDPR and a new provider being required in-year, but 2019/20 figures were expected to be representative of Health Check performance when these became available.

Local outcomes of the Health Check Programme were reported, and it was advised that 348 cases of diabetes, chronic kidney disease, hypertension, coronary heart disease or atrial fibrillation, or as being morbidly or super-morbidly obese which could now be managed through primary care and/or health improvement services had been identified over five years. 

Going forward, the key focus would be on improving the outcomes from the programme, including higher numbers of appropriate patients put onto care pathways for diagnosed conditions and better and earlier condition management.  Other activities would include work to increase referrals to support services, including social prescribing and to health improvement services such as smoking cessation, weight management and alcohol support, and to also identify common mental health conditions to support timely referrals.  The submitted report also reflected on wider public health work undertaken with primary care and work progressing in this area.

Members sought clarification on data presented, asking whether the data available extended to indicate measures such as male/female, age profiles, by ethnic group etc that might enable specific targeting; whether there was data as to how many individuals took  ...  view the full minutes text for item 10.

The Committee received a report presenting an update on the integration of community health and adult social care services delivered by the Community Health and Adult Social Care Service (Community Service) which held the commissioning responsibilities for all the statutory adult social services ensuring all requirements of the Local Authority including safeguarding, are enforced and also provided leadership for and operation of all the adult community health and statutory social care services operating in the Borough delivered through an alliance of several employers.  The Community Service was a critical mechanism to realising the shared vision for the wider health and social care economy and it was therefore essential that the service is focussed on wellbeing and prevention, enabling people to regain independence whilst targeting long-term support at those people with the most complex needs.

The emphasis for Phase 2 of integrating community services has therefore been focused on design and implementation of an integrated community service that would enable practitioners to focus on supporting people in their communities, avoid acute interventions and long-term community service dependency, reinforce a new culture of self-care, place and strength-based support, drive financial and demand efficiencies, and deliver better outcomes for residents and the economy as a whole.  The high level care and support pathway that it was envisaged would deliver this vision was illustrated, and support to provide a clear understanding of where the organisation needed to be to deliver this vision was being sought.

Alongside this work, the following were key areas of development –

·         Community enablement – to design and deliver an enablement model that building on the partially integrated crisis enablement team and further improve the referral pathway into enablement services;

·         Embedding integration – developing and embedding standard operating procedures for the integrated neighbourhood community teams;

·         Adults Targeted Model – designing and implementing a model for prevention and resident engagement to support people to self-care;

·         Streamlining governance and decision-making – while ensuring that the governance arrangements and requirements of each of the organisations involved were still met; and

·         Operational reform of services with known high risk concerns to ensure that we have strong and stable services are in operation ahead of transforming them to meet the refocused vision.

Other work being undertaken was the review of community health contracts transferred from Pennine Care Foundation Trust to the Oldham Care Organisation following recognition that the specifications were out of date, and the implementation of a redesigned safeguarding adults system.

A Member queried how changes to service delivery are communicated to service users and what feedback was received.  It was accepted that more work on communication needed to be done, in part because information governance and data sharing issues needed to be resolved, and in part in developing an identity for the new structure which Phase 2 would seek to resolve.

The role that the North West Ambulance Service (NWAS) might play within this service model was queried.  Members were advised that early work seemed to be going well, NWAS being made aware  ...  view the full minutes text for item 11.

Further to Minute 13(2) of the meeting held on 3^rd September 2019, the Committee received a presentation providing the requested update, noting that the review now more broadly addresses the future of all of General Practice in Oldham, rather than just urgent primary care.  Work had commenced to develop a Primary Care Strategy that would identify priorities to address the known challenges in primary care which, despite those challenges, continues to improve and in the main was working as planned to reduce inequalities and improving health outcomes.  However, a new model of Primary Care is required to provide assurance as to the sustainability of the primary care offer, with a strong workforce who have manageable workloads that is able to meet the needs of the population and demands on the system. Work was also going progressing on a new assurance framework for General Practice in Oldham with a focus on both clinical quality and practice governance.

The presentation noted that the NHS Five Year Forward View set out the case for change in healthcare and that Oldham CCG aimed to enable general practice to play an even stronger role at the heart of more integrated out of hospital services.  Key themes considered were

·         addressing the increasing demands of an aging population and raised patient expectation and the service variations that arise due to the different contractors providing services;

·         sustaining a competent and motivated workforce and addressing the issue of a local aging workforce

·         the need for integrated approaches to address the complex contracting and funding arrangements within primary care;

·         the Walk-in Centre Review findings;

·         potential future services to deliver alternative urgent care services to deliver ambulatory care services and Long Term Condition management to support reductions in out-patient activity.

Work was also required to update and understand where each Primary Care Network (PCN) was against the PCN Maturity Matrix.  The Matrix was designed to support network leaders, working in collaboration with systems, places and other local leaders within neighbourhoods, to work together to develop individual Networks and support groups of Networks to collaborate in the planning and delivery of care across a number of roles.

Further to the presentation, the Committee was asked note that the health system was now in a similar position with regard to supply and demand that had existed at the time of the last review of GP contracts in 2014, and that the position of being able to offer people an appointment within two weeks had generally been lost.  While the situation was at saturation point nationally, Oldham did well on some metrics, a point not recognised by people.

A Member noted that the problem of people attending A&E unnecessarily continued, querying whether this was down to people not understanding a system which, while in transition, remained complex.  The issue, and the complexity of addressing it, was acknowledged, with it being clear that it took several years to educate people to access health care at the appropriate point.  The large numbers contacting practices  ...  view the full minutes text for item 12.

Members were advised of a Motion which had been referred from the Council meeting held on 11^th September 2019 to the Overview and Scrutiny Board which had, at a meeting held on 22^nd October 2019, further referred the Motion to this Committee.

The Motion read as follows –

“Ban on Fast Food and Energy Drinks Advertising

 “Council notes that:

·           Fast food contains high level of fats, salt and sugar and energy drinks often contain high levels of caffeine and sugar.

·           Excessive consumption of these products contributes to obesity, tooth decay, diabetes, gastro-intestinal problems, sleep deprivation and hyperactivity.

·           The Royal College of Paediatrics and Child Health predicts half of all children in the UK will be overweight or obese by 2020.

·           The Mayor of London banned all fast food advertising on publically-controlled advertising spaces across London’s entire transport network.

·           Sustain and Foodwatch recently published a report ‘Taking Down Junk Food Adverts’ which recommends that local authorities regulate adverts on public telephone boxes and that the Advertising Standards Authority should be able to regulate advertising outside nurseries, children’s centres, parks, family attractions and leisure centres.

As a local authority with a statutory responsibility for public health, Council believes that it should do all that is possible to discourage the consumption of fast food and energy drinks.

Council therefore resolves to:

·           Ask the Chief Executive to write to the Chief Executive of Transport for Greater Manchester asking TFGM to impose a ban on the advertising of fast food and energy drinks on publicly owned poster sites etc across the Greater Manchester transport network.

·           Ensure that fast food or energy are not advertised on any hoarding or within any building owned by this Council including large advertisements on bus stops. 

·           Ensure that such products are not sold to children or young people on any of our premises.

·           Ask our NHS, social housing, voluntary and private sector partners, including the Mayor of Greater Manchester, to make a similar undertaking.

·           Ask the Chief Executive to write to the relevant minister requesting the recommendations of the ‘Taking Down Junk Food Adverts’ report be adopted as government policy as soon as possible; copying in our local members of Parliament to seek their support.”

Members of the Committee were provided with a copy of the Sustain and Foodwatch report ‘Taking Down Junk Food Adverts’ that was referenced within the Motion.

RESOLVED - that a report be submitted to the next meeting of the Committee.

RESOLVED that the Health Scrutiny Work Programme for 2019/20 be noted.

The next meeting of the Health Scrutiny Committee will take place on Tuesday, 28^th January 2020 at 6.00 p.m.  This meeting will be a Development Session.

RESOLVED that the scheduled date and time of the next Health Scrutiny Committee meeting to be held on Tuesday, 28^th January 2020 at 6.00 pm be noted.  This meeting will be a Development Session.