An apology for absence was received from Pat Harris, Healthwatch Torbay.

To confirm as a correct record the minutes of the meeting of the Adult Social Care and Health Overview and Scrutiny Sub-Board held on 5 September 2024.

The minutes of the meeting of the Sub-Board held on 5 September 2024 were confirmed as a correct record and signed by the Chairwoman.

To review the Quality Account for 2024 and provide feedback to the Trust.

(Note: presented by Liz Davenport, Chief Executive , Torbay and South Devon NHS Foundation Trust and Nicola McMinn, Chief Nurse, Torbay and South Devon NHS Foundation Trust).

The Chief Executive and Chief Nurse from Torbay and South Devon NHS Foundation Trust presented the Torbay and South Devon NHS Trust Quality Account for 2023/2024 as set out in the submitted papers.  A Quality Account was an annual report to inform the public of the quality of services and improvements offered by an NHS healthcare provider.  The report included progress against the priority areas identified in 2023/2024 as well as setting out the quality areas for 2024/2025.

The priorities for 2023/2024 were:

• zero avoidable deaths;
• continuously seek out and reduce harm:
• falls prevention;
• improved identification of the deteriorating patient; and
• improved experience on discharge.

Members noted that following feedback the goals and priorities for 2024/2025 were:

• reduce health inequalities (changed from zero avoidable deaths);
• continuously seek to reduce harm;
• deliver what matters most to our people; and
• excellence in clinical outcomes.

Members heard representations from Robert Loxton (member of the public) in respect of vaping.  It was agreed that a written response would be provided if pre-operation questions included asking if people vaped.

Members asked questions in relation to changes to monitoring of patients and if monitoring ceased when other priorities were introduced; what action was being taken to address bullying in the workplace; a lot of good work was being undertaken to support people with cancer with 119 extra referrals per month from GPs, what was classed as planned care and what should people do when they were waiting for diagnosis but needed to seek help sooner due to deterioration; how were goals set in 2023/2024 for the number of inpatient falls resulting in harm (moderate, severe and death) monitored in the future to ensure that they were being met; what action was taken to promote the successes of the Torbay and South Devon NHS Foundation Trust; was the statistics table for the Emergency Department etc. attendance analysis the time for someone waiting for an assessment; was the data about deaths in an ambulance all deaths; and what was the reason for missing data on pages 59 and 60 of the annual report.

In response to questions, Members were informed that reporting on vaping was currently not required under national monitoring, however midwives did talk to mothers about smoking and tobacco use and record if they are vaping at their first booking meeting.  Public Health also provided guidance and advice on smoking and vaping to expectant mothers.

Members were advised that monitoring activity was carried out in accordance with National Guidance and advice.  Changes had been made to early warning score trigger systems, using electronic scoring based on patient monitoring which then determined the actions to take.  The score would then dictate how long it would take for a doctor to respond and for them to remain on the ward, also taking into account if the patient became more unwell during that time.

Members noted the work being undertaken by the Trust to address bullying including the introduction of a Speak Up Guardian as well as two people  ...  view the full minutes text for item 14.

To receive an update from the South Devon NHS Foundation Trust on the performance of the diagnostic unit together with the performance against diagnostic targets versus actual targets.

(Note: to be presented by Caroline Cozens, Director of Capital Developments, New Hospital Programme Director, Torbay and South Devon NHS Foundation Trust).

The Director of Capital Developments and Head of Communications and Engagement from Torbay and South Devon NHS Foundation Trust gave a presentation, as circulated prior to the meeting, on the latest position regarding the Building a Brighter Future (Torbay Hospital) Programme and the new Community Diagnostic Centre in Market Street.

Torbay was one of 46 hospitals included in the Government’s Programme, 40 original plus six who had been added following the Reinforced Autoclaved Aerated Concrete (RAAC) problems.  The Government was reviewing the Programmes, taking into account Lord Darzi’s independent investigation into the NHS and the NHS 10-year plan and was expected to confirm the details as part of the Autum Budget on 30 October 2024.  Work had continued on the Programme to ensure that it was ready to proceed to the next stage once the Government had confirmed the future.

The new Community Diagnostic Centre in Market Street, Torquay was established in partnership with InHealth and opened on 2 September 2024. It was offering echocardiography, lung function tests, ECGs, phlebotomy and ultrasound.  CT, MRI and X-ray were expected to open at the end of October 2024.  The project was on track and committed to deliver the agreed outcomes.

Members asked questions around did GPs still refer patients in the same way and could hospital consultants refer patients to the new Community Diagnostic Centre; had more staff been employed and had this impacted on existing hospital staff; was the tower at Torbay Hospital going to be demolished; why was progress on the Building a Brighter Future Programme so slow; and when was Torbay going to get a walk in centre.

In response to questions about the Community Diagnostic Centre (CDC), Members were advised that GPs and hospital consultants would continue to refer patients in the same way, but the patients would have the option to choose the CDC or Torbay Hospital.  The CDC was provided by InHealth and they were responsible for recruiting staff and a previous Manager from the Trust had been supporting them.  The aim was to grow the workforce rather than move staff from the Hospital.

Members were advised that the Building a Brighter Future Programme was a national programme and the pace was dictated by the Government.  The Chief Executive of the Trust welcomed the current review of the Programme which she felt confident would continue to be delivered, once funding had been confirmed in October.  The Trust had been successful in some new developments e.g. the new endoscopy unit and was working with contractors and carrying out all appropriate preparations including the third outline business case so that it aligned with the Hospital 2.0 Blueprints.  They would have wished to move faster but funding was released in tranches.  It was confirmed that although money had been spent on the tower at the Hospital to make it safe it would be demolished towards the end of the project as part of the replacement of all inpatient ward beds.

The Sub-Board was advised that there was no immediate  ...  view the full minutes text for item 15.

To note the report and to support efforts to tackle the spread of infection and antimicrobial resistance.

(Note: presented by Dr Lincoln Sargeant, Director of Public Health, Julia Chisnell, Consultant in Public Health and Mandy Guy, Health Protection Specialist).

The Consultant in Public Health and the Public Health Specialist provided an update on infection prevention, anti-microbial resistance and the Winter vaccination programmes as set out in the submitted report and presentation.

Infection prevention was important because it:

·                 Prevents disease;

·                 Prevents or limits spread;

·                 Saves lives;

·                 Protects the vulnerable;

·                 Saves time and money; and

·                 Keeps the NHS and Care system moving.

Combating ant-microbial resistance was important as there were approximately 1.27 million deaths globally in 2019, expected to increase to 10 million a year by 2050.  Infections last longer and were more difficult to treat and people rely on antibiotics for so many treatments.  There is a five-year rolling national action plan to help address this as well as work taking place across the region through the South West Infection Prevention and Management Strategy 2024-29.  Locally the Public Health Team are working with NHS, Environmental Health, food businesses, schools (encouraging children to be ambassadors), and also through World Anti-Microbial Resistance Awareness week 18 to 24 November 2024.

Members noted the Winter vaccination programme included the following:

·                 Flu for 65+, pregnancy, children aged 2 to 16, clinical risk groups, carers and health and care workers;

·                 Covid-19 for 65+, older care homes, health and care workers, clinical risk groups and pregnancy; and

·                 RSV (respiratory syncytial virus – this was not a live vaccine) for 75-80 years and pregnancy (28 weeks).

Members were encouraged to:

·                 recognise the importance of infection prevention, vaccines and AMR;

·                 be an ambassador with their family, friends and neighbours;

·                 become an antibiotic guardian; and

·                 promote World AMR Awareness Week.

Members heard representations from Robert Loxton (member of the public) in respect of how safe and effective the Covid-19 vaccination was and how was this communicated and promoted.

The Sub-Board asked whether the offer of free Flu vaccinations could be extended to people working in the community and voluntary sector (it was agreed that a written response would be provided on this question); how could it be made easier for the community to have vaccinations where they carry out their day to day activities; did community venues show up on the NHS App; what could be done to raise awareness about people with colds, Flu or Covid-19 not meeting vulnerable people and trying to prevent spread through contacts; and what happens to children in schools whose parents do not consent to vaccination and was there an age when a child could give consent themselves.

It was noted that the online booking system for Covid-19 was not advising that patients could book both Covid-19 and Flu at the same appointment.  The Consultant in Public Health agreed to advise the NHS of this and to request clearer messaging that you could have both vaccinations together.

In response to questions, Members were advised that there was a reducing take up of vaccinations such as Flu and Covid-19, nationally and locally, but vaccinations remained the best defence against infectious diseases.  Although a vaccination may not prevent 100% of cases, vaccinations such as Flu and  ...  view the full minutes text for item 16.

To receive an update on the implementation of the actions of the Sub-Board and consider any further actions required (as set out in the submitted action tracker).

The Sub-Board noted the submitted action tracker.  The Chairwoman advised of the positive launch event for the Public Health Annual Report – Women’s Health held at the Palace Theatre which had been well attended and included informative presentations on what had been happening across Torbay.  Members suggested that it would be good to do some work around Women’s Health in light of the Report and agreed to review this as part of their Work Programme meeting in the New Year.

Councillor Brook confirmed that he had his follow up meeting with Tara Harris on homelessness and rough sleeping to review how the headline figures were collected into one document to make it easier to track and monitor.  Councillor Brook agreed to share this format once it had been finalised. 

Members noted that the Homelessness Strategy was still going through the governance process following which an action plan would be developed.  Members requested sight of the Homeless Action Plan once it had been drafted for their input.