Agenda item

The Committee considered a report of the Director of Public Health which provided assurance regarding the Council’s Clinical Governance processes since the last report to the Committee in November 2022.  The report also set out some of the key issues dealt with as part of the Council’s clinical governance arrangements, and role and responsibilities since October 2022.  A copy of the report marked ‘Agenda Item 7’ is filed with these minutes.

Arising from discussion the following points arose:

(i)               A Member commented that the information provided set out a high level overview of the governance arrangements in place but that further detail was needed for the Committee to challenge and test if this was adequate.  Members noted that the Standard Operating Guidance included the clinical governance processes to be followed in relation to serious incidents and safeguarding which had been summarised in the report.  However, this document was large and substantially detailed including the steps to be taken at an operational level.  The Director confirmed that a link to the full document could be provided to aid members understanding of the processes in place and undertook to include this in future reports.

(i)               Members noted that the services, which had once been provided by the NHS until the transfer of public health to the County Council, were provided by qualified doctors and nurses and therefore followed the same governance framework applied to other NHS clinical services.  Members were assured that these were robust but could be more clearly detailed in future reports.  It was suggested that the inclusion of some case examples that evidenced the clinical governance processes followed would be beneficial to understand how effectively these were working.

(ii)              A Member commented that the figures regarding serious incidents as detailed within the report were difficult to consider without more context.  It was suggested that some benchmarking data would be beneficial to understand whether the Council’s approach to these was working.

(iii)            A Member queried why NHS health checks were only provided up to the age of 74.  The Director advised that this was a national prevention scheme commissioned by Public Health from local GP’s which targeted those that might not be in regular contact with their GP but who might benefit from health advice and support (for example regarding diet or smoking). Members questioned the level of take up and noted that whilst this had fallen as a result of Covid, this was now improving.

(iv)            A Member raised concern that no bids had been received in respect of the Council’s re-procurement of sexual health services.  The Director reported that there were only a small number of providers and that this was therefore a challenging market. The current contractor was meeting requirements, but it was difficult for a new business to seek to take over from another organisation.  The Chairman suggested that this was a matter for the Health Overview and Scrutiny Committee to consider as it was not related to governance processes.

(v)             It was noted that the Council’s Health Overview and Scrutiny Committee monitored the performance of all clinical services and looked at these on an individual basis, particularly if issues had arisen.  Providers and stakeholders were invited to attend these meetings to answer questions.  Members noted that the Scrutiny Committee formed part of the clinical oversight provided but commented that this appeared to be ad hoc and suggested that a more consistent and regular reporting process might be better.  The Director undertook to consider this suggested approached.

(vi)            Members noted that an internal audit of Public Health Services had been undertaken in 2015 when this had been transferred from the NHS.  At that time, it was agreed that an annual report to the Committee would be appropriate given that clinical services sat outside the Council’s normal governance structures.  It was acknowledged that balancing the level of detail necessary to support the Committee’s understanding of the governance processes relating to these services, whilst not including unnecessary operational detail, was difficult.  It was suggested that a further internal audit might be timely and that this consider how best to report on such matters in the future. 

(vii)          Whilst Members supported the proposed internal audit, it was suggested that a further update to this Committee which focused on clinical governance processes and structures would be beneficial.  It was suggested that this would be best covered by way of a presentation to the May 2024 meeting.

RESOLVED:

(a)  That the update now provided regarding the Council’s clinical governance processes be noted;

(b)  That a further update be provide to the Committee in May 2024 providing less clinical detail but more information regarding governance processes adopted and that this be provided by way of a presentation;

(c)   That the Director be requested to consider a more regular and structured approach to reporting to the Health Overview and Scrutiny Committee on safeguarding and serious incidents;

(d)   That the Head of Internal Audit Service be requested to undertake a light touch audit of the Council’s approach to clinical governance and to consider how to improve future reporting to this Committee.