Agenda and minutes

Councillor Sajid Mohammed  -  unwell

Sabrina Taylor  -  Healthwatch Nottingham and Nottinghamshire

None

Minutes of the meeting held on 20 March 2025, for confirmation

The Committee confirmed the Minutes of the meeting held on 20 March 2025 as a correct record and they were signed by the Chair.

Report of the Statutory Scrutiny Officer

Simon Castle, Deputy Director of Cancer, Diagnostics and End of Life Care at the NHS Nottingham and Nottinghamshire Integrated Care Board (ICB), and Duncan Hounslow, Programme Director for Reconfiguration at the Nottingham University Hospitals NHS Trust (NUH), presented a report on the progress to establish a new Community Diagnostics Centre (CDC) in Nottingham.

a)  There were significant backlogs in elective diagnostic testing following the Covid-19 pandemic, which led to longer waiting times on a national level. Substantial progress has been made to reduce these waiting times through a number of initiatives, including creating additional capacity within Primary Care and through the use of outsourcing. In 2019, a review of diagnostics services was undertaken nationally across the NHS and concluded that more diagnostics testing facilities should be located away from hospital sites and closer to communities, such as on high streets, to enable easier access to same-day tests and other elective diagnostics services. As a result, a range of new CDCs aim to improve accessibility, increase capacity and help to futureproof services going forward.

b)  The ICB is developing two CDCs in Nottinghamshire, with one in Nottingham near the Broad Marsh redevelopment and one in Mansfield. Both CDCs will be able to run a wide range of diagnostics tests and their locations have been chosen strategically to ensure easy access to public transport links and car parking, particularly for people living in the most deprived areas. A bid for additional funding has been submitted to increase the number of MRI machines at the Nottingham CDC, significantly increasing potential capacity for diagnostic tests once it is open and running.

c)  The Nottingham CDC was originally intended to open in Spring 2025, but this has now been delayed to Summer 2026 due to a number of factors including issues revealed following initial assessment of the site. Various works licences are pending from the new landowner and, once obtained, work can begin on site.

The Committee raised the following points in discussion:

d)  The Committee asked what the main causes of delay to the project had been, and what measures were in place to ensure that further delays were mitigated. It was explained that the key points that had caused delay focused around difficult ground conditions at the site, access to the site and the discovery and removal of asbestos. Now that these have been resolved, NUH is in negotiation with Homes England (as the new the site owner) around starting work. A high-level design is in place and there is a better understand of the site’s complexity, so timings have been forecast accordingly. As the CDC is being created by refurbishing and adapting the current building on the site, there are unlikely to be arising archaeological issues that might slow down the work. However, the relevant surveys have been carried out and mitigations and a contingency sum have been established to cover any additional works, if necessary. A robust governance structure is in place for the management of the project, with monitoring by NHS England.

e)  The Committee asked how diagnostics appointments were being delivered in the interim, so that backlogs did not increase pending the opening of the CDC. It was report that there are a number of ways in which current diagnostics capacity is being supported, including the continuation of funding for additional provision at the NEMS Platform One Practice, and by bringing in external capacity. The mobile MRI in Hyson Green will also remain in operation. These actions combined will bridge most of the gap created by the delay and will also ensure that the backlog in diagnostics appointments continues to be reduced.

f)  The Committee asked how the CDC would be integrated effectively into other NHS systems to ensure that results are communicated effectively to the right place. It was set out that the IT systems at the CDC will be fully integrated with NUH’s wider systems to ensure that test results are available on patients’ records within the same timeframe as test results carried out at the hospital sites. Work is focusing on developing effective pathways of access to elective diagnostics, coordinating efficient testing and feedback back to the patient in a timely way. All emergency diagnostics will remain on the hospital sites, which will also retain capacity to undertake elective diagnostics.

g)  The Committee asked how NUH would ensure that there would be sufficient staff at the new CDC to deliver the needed appointments. It was explained that the development of a strategy for recruitment is already underway. A rotation system will be used, with staff spending time both at the CDC and at the NUH hospital sites, to ensure that all staff remain experienced in both emergency and elective settings so that their skills remain current. There are plans in place to extend the apprenticeship scheme for technician roles and to upskill existing staff members. NUH has a strong apprenticeship programme, particularly around diagnosis, and although recruitment to some roles can be challenging, this will be monitored and addressed throughout the programme.

h)  The Committee asked how it would be ensured that those patients with the greatest need were able to access diagnostics tests easily and in a timely way. It was reported that engagement has been carried out with a range of patient groups and the local Primary Care Networks, with close collaboration with commissioning partners on health promotion and prevention. Access to testing is being focused on the areas of greatest need, including for the most under-represented groups. The continued use of external healthcare capacity and maintaining additional capacity at the NEMS Platform One Practice will ensure that waiting times are reduced for diagnostic tests, with those in most need seen as a priority.

The Chair thanked the representatives from the ICB and NHT for attending the meeting to present the report and answer the Committee’s questions.

Resolved:

1)  To request that assurance is provided that any potential system costs arising from the delay in the opening of the Community Diagnostics Centre (CDC) from Spring 2025 to Summer/Autumn 2026 have been mitigated against, to protect the ongoing delivery of services.

2)  To request that assurance is provided that the governance structure for managing the delivery of the new CDC is robust, and that the appropriate learning has been taken from the causes of the delays experienced to date to ensure that the latest construction schedule proceeds as planned.

3)  To request that further information is provided on whether the current community-based MRI and CT scanning provision will continue in its existing locations following the opening of the CDC, or whether this provision is being delivered on a temporary basis and will ultimately be transferred to the new CDC.

4)  To request that data is provided on how the work to ensure equitable access to early diagnostics testing is being focused on the groups of highest need who are the most underrepresented in current early identification services.

5)  To request that further information is provided on the apprenticeship opportunities that have been developed by the Nottingham University Hospitals NHS Trust (NUH), particularly in the context of diagnostics services.

6)  To recommend that full consideration is given to how NUH could engage with the East Midlands Combined County Authority in the context of its remit to develop the economy and skills across the region, as part of enhancing recruitment into the NHS locally.

7)  To recommend that consideration is given to the establishment of a historical display within the completed CDC building on the development of the full-body MRI scanning machine in Nottingham.

Report of the Statutory Scrutiny Officer

Councillor Jay Hayes, Executive Member for Housing, Planning and Health, Helen Johnston, Consultant in Public Health, and David McDonald, Senior Public Health Manager, presented a report on the work being done to seek to reduce suicide and self-harm through proactively improving population mental health and wellbeing in Nottingham, and by responding to the known risks.

a)  In 2023, the Joint Strategic Needs Assessment for Suicide Prevention was undertaken, to consider services and unmet need in order to inform the Council’s strategy to tackle self-harm and suicide prevention moving forward. National data shows that of all people who take their own lives, three quarters were not accessing mental health services, so prevention work needs a broad approach going outside health services in order to reach those the most at risk groups. The new Nottingham and Nottinghamshire Self-Harm and Suicide Prevention Strategy has been developed in collaboration with people with direct service experience using a co-production group, whose members have gone on to join strategic steering groups to ensure continuity. There is also a stakeholders’ network that has had input into the development of the Strategy and accompanying Charter, representing a wide range of services and experiences.

b)  The Strategy sets out four ambitions, aiming to make Nottingham a place where wellbeing is promoted, and where families are treated with respect and have access to good quality resources. The ambitions are to promote a safe and stigma-free environment, promote wellbeing and reduce risk in at-risk groups, ensure that people get the right support at the right time and in the right place, and ensure that local data and direct experience informs and drives self-harm and suicide prevention work. The Strategy’s accompanying Charter was also developed in collaboration with people with direct experience and sets out how organisations should act and react, with a series of statements from the perspective of people with service experience. The Charter includes information and guidance for organisations, as well as links to additional resources. The Strategy has prompted the formation of a number of other groups in order to ensure its effectiveness, including a multi-agency steering group, a local education working group and a multi-agency real-time watching group, which monitors and addresses emerging trends in real-time.

c)  Since publication of the Strategy in December 2024, a number of organisations have made pledges through the Charter including Nottinghamshire Police, the Harmless Community Interest Company and the Aspire Primary Care Network, with a number of other partners with pledges in various stages of development. An external review of the Strategy commented that there is a strong local identity and context, with recognised resources, but it advised that increasing the reach of the campaign would be beneficial. Thirteen small grants have been awarded to voluntary organisations in order to support health and wellbeing activity, working with at-risk groups such as men, young people with autism, those bereaved by suicide and people in higher education. The aim of these small grants is to ensure resources are available so that people can access them at the right time.

d)  Over the next year, a co-produced self-harm prevention campaign will be developed to compliment the suicide prevention campaign. A service improvement plan will be developed and implemented to make work more effective and efficient, and additional materials will be developed and tailored to at-risk groups. A learning support e-module will be rolled out and made publicly available, along with a training pack and resources for Primary Care settings. There will also be enhanced data sharing with all of these elements developed in collaboration with people with direct experience.

The Committee raised the following points in discussion:

e)  The Committee asked how the voluntary organisations in receipt of small grants were supported in providing good quality preventative services. It was explained that the work delivered within the Strategy has been externally evaluated, including the voluntary organisations in receipt of grants. The Council also continues to engage with groups and communities using the services. There are two listening exercise due to take place this year, which are advertised and communicated through a range of partner organisations and access groups, and will be visible online when they are launched. The exercises will include elements for children and young people as well as for adults. Quality is assessed through the commissioning process, with quality assurance pathways built into contracts.

f)  The Committee asked to what extent people who had lost their life to suicide had previously tried to access mental health support services, but had been unable to. It was reported that the Strategy’s approach is to focus on early intervention and ensuring people have access to services at the right time to reduce risk. Work is underway to enhance data sharing between partners to create a better understanding of whether at-risk people have tried but have been unable to access support services.

g)  The Committee asked how information is shared to ensure a joined-up, partnership approach to prevention across the whole system. It was set out that partnership working is extremely important to the success of the Strategy. There are clear governance routes with NHS partners, who are represented at the overall strategy group, alongside a number of other important stakeholders to ensure that conversations and strategy are aligned across the city. The NHS and other partners have made a clear commitment to work together to seek to bring the numbers of self-harm incidents and suicide down, with engagement has also been carried out with the Police on ensuring the right pathways to safe spaces.

h)  The Committee asked how work was carried out with schools in relation to preventing self-harm and suicide. It was explained that there are a number of interventions and resources that are accessible to schools, and that the Council’s Public Health team can act as a point of liaison. Early intervention is vital to reducing the number of young people at risk of self-harm and suicide, and schools will usually have a specialist mental health lead in the school leadership team.

i)  The Committee asked how engagement with the most at-risk groups was carried out, and how impact was measured. It was reported that a wide range of evidence-based practice and interventions are used, with a particular focus on early intervention and reducing risk in public places. People from marginalised groups are at particular risk, so targeted and individualised approaches are taken in these areas. A great deal of case data arises from hospitals, but not everyone in crisis will go to an Emergency Department and very clear community engagement is required to understand the full range of needs. There is a growing number of young people (particularly young women) presenting to hospital Emergency Departments following self-harm, and work is underway to assess the underlying causes of these emerging trends. Strong real-time surveillance processes are in place, providing up-to-date information to partners.

j)  The Committee asked how the Council took the potential impacts on people at risk from self-harm and suicide into account when making service decisions. It was reported that Public Health colleagues are not consulted as a matter of course when Equality Impact Assessments are produced in relation to service decisions, but they are able to work with departments to assess and mitigate potential impacts in this area.

k)  The Committee noted that some reports from the Coroner’s Service on suicide cases set out elements of detail that could have a negative impact on other at-risk people, and considered that engagement from Public Health on best practice could be beneficial.

The Chair thanked the Executive Member for Housing, Planning and Health, the Consultant in Public Health and the Senior Public Health Manager for attending the meeting to present the report and answer the Committee’s questions.

Resolved:

1)  To request that further information is provided on the types of real-time surveillance data collected and how it is used to inform the delivery and development of the Self-Harm and Suicide Prevention Strategy in an evolving way.

2)  To request that further information is provided on how the outcomes of the Strategy will be measured, and what the key performance targets and milestones are during the lifetime of the Strategy.

3)  To recommend that full consideration is given to how to develop as much of an understanding as possible around the extent to which people who have acted on thoughts of self-harm or suicide had previously attempted to present to support services that could have delivered early intervention or prevention, but had been unable to access them.

4)  To recommend that full consideration is given to how the Council can engage with secondary schools as much as possible as part of delivering early intervention and prevention initiatives in relation to self-harm and suicide amongst young people.

5)  To recommend that the Council seeks to engage as closely as possible with the Coroner’s Service to offer advice on the current best practice around what should be redacted from published post-mortem reports in relation to suicide, in order to protect other vulnerable people who are at risk of suicide.

6)  To recommend that both Executive Members and officers work to give full consideration to how any decision to be taken by the Council could impact vulnerable people at risk of self-harm and suicide and that, where relevant, appropriate engagement is carried out with Public Health colleagues as part of informing the drafting of the associated Equality Impact Assessment.

To note the responses received to recommendations made to the Council’s Executive

The Chair presented the latest responses received from the Council’s Executive to recommendations made to it previously by the Committee.

The Committee noted the responses of the Executive to its recommendations.

Report of the Statutory Scrutiny Officer

The Chair presented the Committee’s completed Work Programme for the 2024/25 municipal year, and the potential priority topics identified by Committee members for consideration during the 2025/26 municipal year.

The Committee noted the completed Work Programme.