Agenda and minutes

Councillor Mrs Kay Cutts MBE

Councillor Colleen Harwood

Councillor Anne Peach

Councillor Jacky Williams

Martin Gately

Martin Gawith

Pete McGavin

None.

The minutes of the meeting held on 10 November 2015 were confirmed and signed by the chair.

Amanda Kemp, Deputy Director of Local Services at Nottinghamshire Healthcare Trust (NHT) provided an update on progression of proposed service redesign projects within the Adult Mental Health Directorate in 2015/16.  The following points were highlighted:

(a)  feedback from a diverse range of stakeholders has shown that services are quite difficult to navigate, with too many internal barriers. 

Further feedback has suggested that it is quite difficult for GP’s to call up and speak to senior nursing colleagues.  This can mean that patients have to have repeated assessments;

(b)  NHT are looking to set up a much more locality based focus on services, bringing together skills of specialist teams.  This will aid seeing patients more quickly.  With a much stronger multidisciplinary team approach, staff from different medical teams can work together more closely;

(c)  in Nottingham City there are approximately ten teams operating.  NHT have proposed a single point of access for the three localities;

(d)  following formal consultation, there was strong support for the development of a Community Rehabilitation team in the Mansfield area;

(e)  questions were raised around whether enough money was being reinvested.  Programmes such as outreach at Broomhill House were really valued and important to service users and families.  Data on this topic will continue to be reviewed;

(f)  service users from homes that have previously shut down, such as Enright Close in Newark, have been tracked and some have had very positive outcomes, including being discharged from the service;

(g)  eCRHT (Enhanced Crisis Resolution and Home Treatment Team) has reduced the need for admission to hospital by supporting people in crisis;

(h)  the Mental health 111 service commenced in February 2015 and is funded by NHS England for one year as a pilot study.  Of the services users who contacted 111, 90% were diverted from the Emergency Department;

(i)  the eight week period from the start of September 2015 up until the start of November 2015 was exceptionally challenging for staff.  This was part of a national trend.  NHT was able to secure private beds in Nottingham for people requiring acute admission. Some out of county beds were also used.

  The picture has stabilised over the past six weeks, with only four out of area beds being used from week beginning 23 November.  Previously, this figure was higher;

(j)  NHT will review their bed capacity, and examine whether step-down beds are needed.  A high number of delayed transfers of care had a big impact on the number of beds used;

(k)  a review of patients with personality disorder is underway to see if community provision could reduce admissions to hospital.  There is NICE (National Institute for Health and Care Excellence) guidance that can help with managing this.

After questions from Councillors, the following information was provided:

(l)  historically, services have been delivered from a centralised point; this can lead to services in the north of the County looking different to service provided in Nottingham City.  The City does provide services that can  ...  view the full minutes text for item 44.

Marie Hannah, Regional Officer (Nottinghamshire) at the Royal College of Nursing (RCN) provided an update to the Committee regarding the issues currently faced by nurses.  The following information was provided:

(a)  staffing shortages and vacancy levels are barriers to recruiting new nurses as newly qualified nurses are aware of the challenges of working on understaffed wards from the placement experience;

(b)  RCN is concerned about staffing shortages across the NHS, particularly within acute care for Emergency and elderly cases.

  Further concerns including care homes and acute beds facing closure; these all impact on workloads;

(c)  acute hospitals in England have had an issue with their staffing levels.  Trusts are in competition with one another.  An NUH staff survey shows a reduction in the proportion of staff that recommends the trust as a place to work;

(d)  the government is planning to replace student nurse bursaries with loans.  This could affect the number of young people from applying as they do not want to take on significant debt with limited earning capacity and also older people who may have applied as a significant proportion of them carry existing debts, and may be unlikely to want to take on additional debt.

  The bursary funds a lot of travel expenses, and funds the educational package.  The starting salary for a nurse is comparably low, so they will struggle to pay the loan off.  Trainee Midwives will also be affected by the withdrawal of the bursary;

(e)  members of the nursing workforce are often patients or carers themselves, and can endure mental health problems; there have been examples of lack of support for this from managers.  There is also a growing concern for nurses that fall foul of policies such as sickness absence; RCN is seeing a large number of nurses exiting trusts as they cannot meet the targets they have been set.  In addition, members are reporting being overworked and undervalued;

(f)  RCN Council revalidation process starts next year, involving a lot of work with organisations around the meaning of the workforce and the employer;

(g)  NUH use staff from Europe, but as yet, there has been any recruitment from outside of this area.  Traditionally, some of the cultural difficulties of settling combined with delays in gaining registration can prevent nurses coming from abroad;

(h)  work continues with Health Education East Midlands on targeting nurses from further education, however the uncertainty around bursaries can make it difficult to recruit.  There are also career talks in schools through the RCN, but with a small team, this is becoming increasingly hard to do, and might be more suitable for organisations such as Health Education England;

(i)  one of the difficulties with the career pathway in nursing is the transition from support worker to nurse.  Another route to becoming a nurse can be through the Open University (OU) – degrees through the OU can be fully funded by the RCN but there will be a duty to the RCN as a result;

(j)  degree  ...  view the full minutes text for item 45.

The Committee considered the report of the Head of Democratic Services regarding the Committee’s work programme for 2015/16.

Resolved to note the work currently planned.