Agenda and minutes

Apologies for absence were received from Councillor Cosgrove.

There were no declarations of interest.

There were no items of urgent business.

There were no public questions received.

The Minutes of the meeting of the Health Scrutiny Committee held on 26^th January 2021 are attached for approval.

RESOLVED that the minutes of the meeting of the Health Scrutiny Committee held on 26^th January 2021 be approved as a correct record.

To note the minutes of the meeting of the Joint Health Scrutiny Panel for Pennine Care NHS Trust held on 21^st January 2021.

RESOLVED that the minutes of the meeting of the Joint Health Scrutiny Panel for Pennine Care NHS Trust held on 26^th January 2021 be noted.

The Committee was provided with an update on the development of the early help offer for children and families in Oldham and the connections to other areas of activity, including place-based working. The update also highlighted linkages to a range of other work relating to prevention and early intervention in the Borough.

Work in relation to the development of the early help offer for children and families, moving in focus from Oldham Family Connect to the development of the multi-agency early help offer with a strong commitment across the Children’s safeguarding Partnership to make early help everyone’s business, was reported.  This development responded to the 2018 statutory guidance ‘Working together to safeguard children’ and included addressing parental issues such as poor mental health, drug and alcohol misuse and domestic abuse which impacted upon the lives of children in the family. “Working together…” highlighted the need for local organisations and agencies to work together to identify children and families who would benefit from early help; undertake an assessment of their need for early help; and provide targeted early help services to address the assessed needs of a child and their family which focuses on activity to promote outcomes for the child. There were three levels of need identified, and the measures to address these needs were outlined in the submitted report.

There had been an ongoing reorganisation of the internal targeted early help teams with the new structure going live on 1st April 2021. Key drivers for change had been strengthening the multi-agency effectiveness of early help; establishing integrated multi-agency working arrangements; preventing the needs of children and families from escalating; and reducing the need for children and families to be transferred between teams.  The reorganisation formed part of the wider multi-agency rollout of a district delivery model across Oldham, with many partners organising service delivery around the five districts.  Multi-agency district teams would be able to deliver better outcomes for children and families because of greater knowledge of local communities and closer working across agencies being developed.  Other developments and projects being progressed across the partnership were further reported and considered.

The demand for early help over the past year was considered.  A drop in demand following the onset of Covid-19 in March 2020 was noted, but numbers subsequently rose again. There had been clear peaks at the points children returned to school, reflecting the numbers of referrals for support made by schools.  It was anticipated that the return of children to school in March 2021 would result in a further increase in demand for early help support, reflecting the pressures on families during Covid-19. During this period early help teams had prioritised having regular face-to-face contact with families in order to ensure the visibility of vulnerable children, an approach adopted across all services supporting children and families.

Further to queries concerning the allocation of workers to districts, the Committee was advised that the allocation of workers was reflective of service demand, being driven by the number  ...  view the full minutes text for item 7.

The Committee was provided with an update on the transaction and future arrangements for Pennine Acute Trust (PAT) hospitals.

The key messages highlighted to the Committee were that:

·         the Trust was now technically ready to deliver the safe disaggregation (i.e. separation) of PAT sites and services on 1^st April 2021 as planned;

·         from 1^st April, Manchester University NHS Foundation Trust (MFT) would formally acquire and be responsible for North Manchester General Hospital (NMGH). The Northern Care Alliance (NCA) would continue to deliver some services on that site or jointly through a Service Level Agreement;

·         due to the pandemic and the complexity of the NCA’s part of the PAT transaction, NCA had asked for an extension by up to six months to formally complete their part of the legal transaction; and 

·         a two phased approach would therefore be enacted to complete the PAT Transaction and the final dissolution of PAT by no later than the end of September 2021.

Members were reminded that the NCA Group had made significant improvements across PAT services over the past five years, supported by a transaction programme preparing for the formal change in ownership of the Oldham, Rochdale and Bury hospital sites to Salford Royal NHS Foundation Trust to form the NCA: the transaction also involved the formal change in ownership of the NMGH to MFT.  Enormous effort had been invested into understanding and planning how to safely disaggregate PAT and its services, including work with NHS England/Improvement and MFT and with engagement and input from staff and clinical teams.  The process would be concluded in the timescales as outlined above, subject to approval by regulators and the Secretary of State for Health.

The NCA Group would progress with plans to recover from the pandemic and in continuing to develop new ways of working, mobilising services across the NCA, and integrating services and care within the localities across the NCA area.  Staff and patients would benefit from investments and developments being made across NCA sites, including at the Royal Oldham Hospital, a continued focus on research and innovation, and the progression of the Digital Control Centre.

The financial position of the Trust was queried, given the deficit position that had existed for a period of time. Clarification was also sought as to the treatment of the balance outstanding on liabilities, how these would be applied to the NCA and MFT, and how they would be addressed going forward.  The historic PAT debt was acknowledged and the Committee advised that the transaction included a medium term financial plan to see delivery of a programme of improvements to productivity while achieving 4% efficiency savings to get the NCA into a sustainable, breakeven position.  It was confirmed that capital improvements at NMGH from 1^st April 2021 would be the responsibility of the MFT.

The implications of the six month delay on staffing vacancies and capital works was queried.  Members were advised that a business as usual approach was being adopted, with all necessary posts  ...  view the full minutes text for item 8.

To receive a presentation setting out ongoing developments and planning for 2021/22.

The Committee received a presentation that advised the Committee of NHS developments over the coming months.

Considering the final quarter of 2020/21, the Covid second wave meant that the winter period had been another challenging time for the NHS and presented five key tasks of responding to Covid-19 demand; implementing the Covid-19 vaccination programme; maximising capacity in all settings to treat non-Covid-19 patients; responding to other emergency demand and managing winter pressures; and supporting the health and wellbeing of the workforce.  Activities and programmes supporting each of these key tasks were advised. 

Looking to 2021/22, whilst full guidance had not been provided, it was known that national themes would be around recovery from Covid, especially focused on elective care and waiting lists; primary and community care; health inequalities; people and workforce; mental health; and integrating care.  Locally, Oldham’s health and care phase 3 recovery assessment had been established and a six month plan with eight priorities of cancer; elective; workforce; mental health and learning disabilities; health inequalities; primary care; winter; and integrated care determined. Actions underway and planned to further address these priorities were outlined in the presentation. 

A process for the transition to an integrated system model for health and social care during 2021/22 was advised, with a view to shadow running from September 2021.  The presentation considered the vision and principles behind this development and the issues being considered in the development of new systems and arrangements.  It was ,however, noted that the recent NHS White Paper pointed to a further period of change in the NHS and an offer was made to report further to the Committee on the developments and local implications that would follow.

Members of the Committee recognised the work undertaken over the past 12 months and expressed their appreciation of all the NHS staff who had worked hard in order to keep services up and running in difficult circumstances.  While Covid remained an issue, the major challenge of tackling waiting lists was recognised and the planning and prioritisations around addressing this was queried, with the managing of patients with cancer and other long term conditions being particularly highlighted.  The Committee was advised that work on clinical prioritisation had been undertaken nationally and across Greater Manchester looking to prioritise those in most clinical need: this could mean that conditions which might be painful but not life-threatening would be of lower priority.  The next stage would be to match up that demand with available resources, noting that capacity was reduced due to, for example, beds having to now be further apart and there being the same number of doctors etc., for which planning considerations were underway.

The reported preparation of a new equality strategy for Oldham was noted, with a comment being made that health inequalities had been recognised for decades and had been the subject of many previous reports and strategies.  There was a concern that this would just be another Strategy document and that concrete actions needed to be put in  ...  view the full minutes text for item 9.

To receive an update relating to local Covid vaccinations.

The Committee was provided with an update on the Oldham Covid Vaccination Programme, a presentation being received which considered -

·         the number of vaccinations delivered to the Oldham registered population within each of the priority Cohorts identified by the Joint Committee on Vaccination and Immunisation (JCVI);

·         the progress made in each of the Oldham Primary Care Network areas in respect of JCVI Cohorts 1-6;

·         vaccinations delivered by ethnicity across the Oldham registered population;

·         vaccination uptake by Ward across the Borough generally, and by JCVI Cohorts 1-6 specifically;

·         vaccine uptake across ethnicity and the Index of Multiple Deprivation;

·         vaccination of the Oldham population by site/location of vaccination centre;

·         comparison with other Greater Manchester CCG vaccination programmes; and

·         staffing vaccinations rates across health and care sectors in Oldham.

The Committee was advised that over 90,000 people had been vaccinated since 14^th December 2020, the majority being first doses but with the number of second doses now increasing.  The vaccination programme had followed the government priority of protecting life and so had worked through the nationally identified priority Cohorts in order.  There had been a very high take up among the Cohort 1-4 group and Oldham stood well in benchmarked performance.  Responding to issues highlighted by the vaccination by ethnicity data, a number of pop-up clinics had been held which had delivered good results in certain hard to reach areas.  The consideration of ethnicity and deprivation demonstrated the need for work with the voluntary sector, a need to understand the needs of communities, and the need to develop solutions to deliver vaccinations in tailored ways.

A Member considered that the good attendance at local clinics was a sign that accessibility and communications were key issues to get engagement with the vaccination programme.  The Committee was advised that government requirements for vaccination centres had been intensive but that local work had been undertaken to find a way to deliver local provision, the effectiveness of which was being demonstrated by the data.  The need to consider women only events and targeted communications was suggested and would be further considered, the issue also highlighting the need to give a broader consideration as to who might be regarded as a potential target group.

A Member noted that they had observed attendance at a vaccination clinic where those attending had appeared younger than might have been expected and requested a breakdown of the ethnicity vaccination data by age.  In response the Committee was advised that there was confidence that the right groups were being identified.  However, local GPs had no sight of the national vaccination programme meaning that at times some people may have two appointments which could result in other Cohorts being invited to local clinics to avoid wastage.  If calls for vaccination were not responded to, it was confirmed that these cases were followed up.

Comment was made as to issues with the receipt and follow up of invites received from GPs, of the national programme not providing local venues, and of GPs not being  ...  view the full minutes text for item 10.

The Committee was reminded that a Council Motion ‘Ban on Fast Food and Energy Drink Advertising’ had been referred to the Health Scrutiny Committee for consideration.  The Committee had subsequently made and referred recommendations for consideration to the Cabinet.  Members were advised of the response of the Cabinet to these recommendations and invited to consider the next step in their consideration.

A Motion to Council ‘Ban on Fast Food and Energy Drink Advertising’, referred from the Council meeting held on 11^th September 2019 to the Overview and Scrutiny Board for consideration, had read –

“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 publicly-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.”

The Motion had subsequently been referred to the Health Scrutiny Committee which gave consideration to the issues at meetings held on 7^th January, 7^th July and 1^st September 2020, the Committee resolving at the latter meeting such that -

1.     the Motion be referred to the Cabinet with a recommendation that the issues raised within the Motion relating to a Ban on Fast Food and Energy Drinks Advertising be progressed on a Greater Manchester-wide basis, that the matter be raised with the Leaders of the other Greater Manchester authorities, and that  ...  view the full minutes text for item 11.

The Committee was reminded that a Council Motion ‘Not Every Disability is Visible’ had been referred to the Health Scrutiny Committee for consideration.  The Committee had subsequently made and referred recommendations for consideration to the relevant Portfolio Holder and Officer.  Responses received to these referrals were reported and the Committee was invited to consider the next step in their consideration.

A Motion to Council ‘Not Every Disability is Visible’, referred from the Council meeting held on 9^th September 2020 to “Overview and Scrutiny” for consideration, had read –

““This Council notes that:

·           The charity Crohn’s and Colitis UK is encouraging venues providing accessible public toilets to install new signage.  This is to help stop stigma and discrimination towards people with ‘invisible illnesses’ such as Crohn’s Disease or ulcerative colitis.

·           There have been instances nationally where such individual using an accessible toilet have been accused by staff members of being ineligible to use them. 

·           These signs have two standing figures and a wheelchair user with the words Accessible Toilet and the logo ‘Not every disability is visible’. 

·           The Government has decided recently that large accessible toilets for severely disabled people – known as Changing Places – will be made compulsory for large new buildings, such as shopping centres, supermarkets, sports and arts venues, in England from 2021. 

Council resolves to: 

·           Ensure that accessible toilets on Council premises bear these signs. 

·           Ask town and district centre retailers and leisure outlets to do likewise with their accessible public toilets. 

·           Seek advice from the charity Crohn’s and Colitis UK on the information and training we should provide to Council staff members.  This is so they understand these illnesses and to prevent potential embarrassment for those who suffer with them

·           Ensure that any Changing Places toilets in our buildings are property signposted for visitors. 

·           Ensure that the requirement to provide new Changing Place toilets is included within the Council’s future plans for new public buildings in the borough.”

The Motion had subsequently been referred to the Health Scrutiny Committee which gave consideration to the issues at a meeting held on 8^th December 2020, the Committee resolving at the latter meeting such that –

1.     the issue of signage of accessible toilets as suggested by the Crohn’s and Colitis ‘Not every disability is visible’ campaign be forwarded to the relevant Cabinet Member and Officers to look at and cost up the necessary changes and to report further to this Committee to enable the Committee to prepare a report on this matter;

2.     the provision of a Changing Places toilet facility at the Spindles Shopping Centre be referred to the relevant Portfolio Holder and Officers to look at and cost up to consider whether this could be provided, to apply for relevant grants and progress if the funding is forthcoming, and to report back to this Committee. 

The Committee was advised that the Leader of the Council (as the relevant Cabinet Member) had given his support to the costing of proposals and that  ...  view the full minutes text for item 12.

The Committee gave consideration to the updated Health Scrutiny Committee Work Programme for 2020/21.  Members’ attention was drawn to the proposed implementation of the revised overview and scrutiny terms of reference, agreed by the Council in June 2020, with effect from the forthcoming Municipal Year.

The Committee was advised that the outcomes from the further meeting held to discuss Northern Care Alliance employment and training opportunities, as agreed by the Committee at the meeting held on 26^th January 2021 and which had been held on 8th March 2021, would be included in the outturn Committee work programme.

RESOLVED that the Health Scrutiny Committee Work Programme 2020/21, as presented, be noted.