Agenda and minutes

Councillor Bryan Organ sent his apology.  Councillor Michael Evans was his substitute for the meeting.

Councillor Sharon Ball sent her apology.  Councillor Gerry Curran was her substitute for the meeting.

Councillor Loraine Morgan-Brinkhurst sent her apology (no substitute present).

Councillor Simon Allen (Cabinet Member for Wellbeing) sent his apology.

Ashley Ayre (Strategic Director for People and Communities) also sent his apology.

Councillor Eleanor Jackson declared personal and non- prejudicial interest on the agenda item ‘Cabinet Member update’ as she is Council’s representative on Sirona Care & Health Community Interest Company.

Councillor Vic Pritchard declared personal and non-prejudicial interest on the agenda item ‘Cabinet Member update’ as he is Council’s representative on Sirona Care & Health Community Interest Company.

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Mr Greg Hartley-Brewer will address the Panel with his statement under item 11 on the agenda (Dental Access Update).

Mr Greg Hartley-Brewer also asked the following question to the Panel:

‘Bath and North East Somerset Clinical Commissioning Group already appears to have a perception of a conflict of interest and hasn’t even started its work.  How are the concerns raised in the Guardian article of 27 March 2012 to be addressed?’

The Democratic Services Officer read out the answer on behalf of the Panel.

‘The Panel has a specific remit which is a discharge of Health functions.  Once the Clinical Commissioning Group (CCG) is formally set up and once the specific guidance on future Health Scrutiny is available, the Panel will be monitoring how the CCG operates as commissioner and provider of health care’.

To confirm the minutes of the above meeting as a correct record.

The Panel confirmed the minutes of the previous meeting as a true record and they were duly signed by the Chairman subject to the following amendment:

·  Page 9, Para 7, third sentence should read: ‘The Chairman commented that this may exacerbate problems of homelessness…’

The Panel will have an opportunity to ask questions to the Cabinet Member and to receive an update on any current issues.

The Chairman invited Jane Shayler (Programme Director for Non-Acute Health, Social Care and Housing) to give an update in the absence of Councillor Simon Allen (Cabinet Member for Wellbeing).

Jane Shayler took the Panel through the update (attached as Appendix 1 to these minutes).  In addition to the update Jane Shayler brought to the Panel some changes in governance arrangements within Avon and Wiltshire Partnership Mental Health Trust (AWP) which were covered in local news.  The Chair of the AWP stepped down and was replaced with the deputy Chair whilst the Chief Executive is on a period of leave and has been replaced on interim basis by the Deputy Chief Executive.  The Council will be watching the developments in the governance of the AWP.

The Panel made the following points:

The Chairman said that the commitment for the Carers Week is excellent and congratulated the Carers Week initiative.  The Chairman also said that he was impressed with the quality account from the AWP which highlights the initiatives for carers and the Council should pick up on it.

Councillor Jackson expressed her concern that the cuts are already affecting respite care.  Councillor Jackson asked if there was any information how widespread this is.

Jane Shayler said that initiatives for carers in AWP quality accounts are not just Wiltshire based but they are for BANES as well.  In terms of the concerns on cuts in respite – the reverse is true.  There has been further investment from some of the money transferred from the PCT to Local Authority under Section 256 Agreement.  Some of that money was invested to support respite care, additional carer support and additional domiciliary care support.  Jane Shayler confirmed that there were no cuts in respite care.  What may be the case is that respite care was being accessed frequently by a relatively small number of people, meaning that some other people were not able to access respite at all.  There has been additional investment and, also, a redistribution, which has helped to address a potential inequity.  Jane Shayler accepted that for some people, this may mean they are not able to access respite quite as often as they have been used to.

Councillor Jackson said that this message is not getting out and it should be somewhere explaining this to clients.  Councillor Jackson asked what can be done on passing this message to clients.

Jane Shayler said that she will raise this with the carers centre and Council/PCT joint carers lead so they can continue to work on raising the awareness.

The Chairman suggested that simple explanation to those clients who felt that they would be affected by cuts should be most appropriate way to do it.

Councillor Jackson said that 16,000 carers is the figure that we have and asked if that was under-estimate of how many carers we have, given the demography of Bath.  Councillor Jackson also asked what we do about children carers supporting their parents.

Jane Shayler said that 16,000 carers may be  ...  view the full minutes text for item 8.

The Panel will receive an update from the NHS and Clinical Commissioning Group (CCG) on current issues.

The Chairman invited Ian Orpen (Clinical Commissioning Group - CCG) to give an update.

Ian Orpen took the Panel through the update (attached as Appendix 2 to these minutes) and added that the CCG had produced a draft Standard Business Conduct Policy which will incorporate conflict of interest, hospitality gifts, etc.

The Panel made the following points:

Councillor Hall said that she was very glad that the CCG will be having Standard Business Conduct Policy and asked if the document will be public once finished.

Ian Orpen replied that the Policy will be public once it is finished.  The CCG will be also looking, in near future, to have their meetings in public and have the public involved in the process.

Councillor Brett suggested that the CCG should be looking in web based forums for discussion.

Ian Orpen replied that the CCG will be looking in all sort of ways to engage public (i.e. the way Council Connect does it).

Ian Orpen added that BANES CCG met with Wiltshire CCG (which is now single CCG) and the discussion was about the work with the RUH.  The RUH is also keen on having single discussion with CCG.  Also, on 31st May there will be a meeting between the Council, CCG, LINk, etc to look at broadly commissioning intentions and policies for the next three years.  Very much linked to the Joint Strategic Needs Assessment (JSNA).

Councillor Brett asked if the CCG board will have representatives from the RUH.

Ian Orpen replied they will not be because it would be difficult to draw the line on how widespread the board could and should be.  The RUH will be the essential part of the discussion though.

Ian Orpen explained that there is a process for appointment of co-opted/lay members of the board as per national guidance.

The Chairman said that it would be inappropriate to include providers in the commissioning group.

Ian Orpen added that the CCG group sent letters to all providers explaining on what is happening so they are up to speed.

It was RESOLVED to note the update.

The Panel are asked to consider an update from the BANES Local Involvement Network.

The Chairman invited Diana Hall Hall and Mike Vousden to introduce the update from BANES Local Involvement Network (LINk).

Diana Hall Hall took the Panel through the update as included in the agenda and informed the Panel that is Mike Vousden’s last meeting and thanked him for his work and help during the last three or so years.

The Chairman said that the Panel appreciated Mike Vousden’s input and that he will be missed.

It was RESOLVED to note the update.

The Wellbeing Policy Development and Scrutiny Panel will receive an update on how Access to Primary Care Dental Services has improved in B&NES.

The Panel are asked to note the update.

The Chairman invited Greg Hartley-Brewer to read his statement.

Greg Hartley-Brewer read out his statement where he highlighted that he had difficulty in finding an NHS dentist when he moved to Bath.  He also said that he received poor treatment on number of occasions with ADP Oldfield Park Dental Practice.  When he moved to another practice (1a Queen Square) he was asked to pay £35 for hygienist service which he felt he should not pay as NHS patient.  Mr Hartley-Brewer acknowledged that the Panel had a review on access to dental services which did not include quality of service from the NHS dentists and asked the Panel to take an investigation into the NHS/private relationship in Bath and North East Somerset and set up a system to monitor the type and number of treatments using the General Clinical Data Set to make sure all treatments are being provided close to national averages.

A full copy of the statement from Greg Hartley-Brewer is available on the minute book in Democratic Services.

Members of the Panel said that although they did not agree with everything that was mentioned in the statement, they felt that Mr Hartley-Brewer highlighted some really serious and important issues in relation with the quality of service provided by the NHS dentists.

The Chairman invited Julia Griffith (NHS BANES) to introduce the report.

The Panel made the following points:

The Panel asked about over-providing the service and is that the case that some areas might be saturated with service while there is a deficit in the others.

Julia Griffith responded that when the NHS dental service was commissioned, the NHS looked at the areas of deprivation, by using health needs assessment. In the main there might be some areas where there is more demand than supply but across the whole area there are practices still with capacity to take on new patients.

The Panel commented that people do stay with their dentists, even if they become private, mainly because of the comfort that they feel with their current dentists.

Some Members of the Panel said that in their Wards, such as Keynsham Wards, there is a perception that there are no NHS dentists.

Julia Griffith took that on board and said that the NHS could use particular publications, which people read, where a number for dentists could be included.

The Panel asked about the implication from Mr Hartley-Brewer that the NHS dentistry is inferior to private care.

Julia Griffith responded that the NHS does monitor commissioning of dental care and also quality of services.  Organisations like Care Quality Commission (CQC) inspect both, the NHS and private.  Julia Griffith said she will write a response to the issues raised in Mr Hartley-Brewer statement.

The Panel asked about the initiatives to encourage parents to take their children to dentist regularly (as a result of junk food, etc).

Julia Griffith replied that there are a number of initiatives commissioned by the NHS.  Health Promotion Team goes to schools etc and raise  ...  view the full minutes text for item 11.

The Wellbeing PDS Panel is asked to note the current Quality Assurance Framework (QAF) for care services and engage with the further development of the QAF, including a clear articulation of the role of the Panel.

The Chairman invited Jane Shayler to introduce the report.

Jane Shayler suggested presenting this and the next report (The Effects of Delivering Adult Social Care Savings Targets on the Market – item 13) at the same time as there is direct link to those two reports.  The Panel agreed with this suggestion.

Jane Shayler took the Panel through both reports.  Jane Shayler highlighted that the findings of the Winterbourne View case will be published in August or September this year and she advised the Panel to schedule a report on that subject following the publication of findings and as part of that that the Panel receive an advice from Jane Shayler on how the findings could be incorporated in a further development of the Quality Assurance Framework as there is a direct link to it. 

The Panel made the following points:

The Panel agreed with the suggestion from Jane Shayler to have a report on findings from Winterbourne View case.

Jane Shayler said that the CQC became much more rigorous since the Winterbourne View incident and they are paying closer attention on all care homes.  CQC is now releasing very strong press releases in respect on any of findings and very proactively raising any concerns on such issues.  The Strategic Health Authority is also paying very close attention.  Self-assessment process for learning difficulties is very detailed.  It will not only put a pressure on commissioners but also on all providers, including non-specialist providers, to complete the self-assessment and show how the needs of all patients are met.

The Panel asked about budgetary considerations, in particular about saving of £1.2m on care placements.

Jane Shayler replied that she had consistently  advised that the 3 year efficiency programme (i.e. reducing the costs of placements) was just that and could not be extended to a fourth year.  The 3-year programme, which ends at the end of this financial year was evidence-based, including benchmarking fee-levels with other Local Authority areas and, also asking providers for detailed cost-breakdowns, showing how fees are made up, what element is profit, what element funds “hotel” – type costs and what proportion is spent directly on care provision to negotiate efficiency savings with providers, well informed evidence based programme with the fee breakdown of costs (how the costs are made up, how much profit they are taking, how much is spent on care provision, etc). It was evidence-based, including benchmarking fee-levels with other Local Authority areas and, also asking providers for detailed cost-breakdowns, showing how fees are made up, what element is profit, what element funds “hotel” – type costs and what proportion is spent directly on care provision The 3 year programme ends this financial year.  It will not be going for fourth year as a fourth year of seeking efficiency savings does run a risk of seriously compromising the quality and safety of that provision.  So we would need to seek savings through other means.  There is a link to commissioning capacity as there is a  ...  view the full minutes text for item 12.

The Adult Social Care & Housing Medium Term Service & Resource Plan (MTSRP) for 2012/13 includes a significant savings target to be delivered from efficiencies in purchasing residential and nursing care placements.  This report provides an overview for the Wellbeing PDS Panel of the approach to delivering this savings target, the potential impacts on the market and associated mitigations.

The Wellbeing PDS Panel is asked to note the content of this report and use the contents of this report to inform their scrutiny of the performance of the health and social care system.

This report was covered together with the Care Services Quality Assurance report (item 12). 

The purpose of the report is to provide the Wellbeing PDS Panel with an overview of the current provision of talking therapies in Bath & North East Somerset and development in 2012-13.

The Wellbeing PDS Panel is asked to note the current Talking Therapies services and engage with any further developments as necessary.

The Chairman invited Andrea Morland (Associate Director Mental Health and Substance Misuse Commissioning) to introduce the report.

The Panel made the following points:

The Panel expressed slight concern on finding out that provision will be moving away from GP practices and asked for assurance that variety will be kept.  The panel also asked about the size of the team.

Andrea Morland said that she was also slightly concerned about that issue but it needs to be clear that in certain clinical conditions, such as anxiety, Cognitive Behavioural Therapy (CBT) is the most effective form of therapy.  In depression it is a mix of counselling and CBT.  Andrea Morland said that her aim in terms of talking therapies is to expand the choice with variety of appropriate services and absolutely not to remove provision at GP practices.

Andrea Morland also said that nobody really knew what the team, in its size, will look like.  It was invested up to certain level with total investment of nearly £1m.  There is a strong business case to continue the service.

The Panel asked how self-referral works.

Andrea Morland initially referrals were controlled through the GPs but now the service is more stable most people self-referred after getting a leaflet from their GP or from other community locations.  There is a lot of different ways that people can get support and some people prefer not to go via GPs but straight to the relevant service.

The Panel asked if the safeguards are in place that patients are getting appropriate response to their mental health needs.

Andrea Morland replied that the service is working with other health professionals.  The NHS has to spend money on services that meet NICE guidelines.  Andrea Moreland said that there is a role to play to open access to variety of services.  It is also important that we don’t mistake talking therapy for specialist mental health care.  Those with profound problems, in a need of specialist care, would go to the AWP. 

The Panel expressed their concerns that some GPs suggest to people who have mental health problems to ‘pull themselves together’ etc.  The Panel asked if there was any work with youth services.

Andrea Morland replied that her intention was to link with young people and she will be talking with Liz Price from Children Services and Youth Commissioning Team on the approach.

It was RESOLVED to note the report and to receive a further update on one of the future meetings.

The Refreshed Alcohol Harm Reduction Strategy for B&NES was adopted and key priorities agreed by Cabinet on 11th April 2012. Implementation of the Strategy is overseen by the Alcohol Harm Reduction Steering Group through an annual action plan on the key themes of health and treatment, community safety, crime and disorder, children and young people and partnership working. The Government’s new Alcohol Strategy was launched in March 2012 and it was agreed to review the local Strategy in light of the national strategy within 12 months. The involvement of the Wellbeing Policy, Development and Scrutiny Panel in this process is welcomed.

The Wellbeing Policy, Development and Scrutiny Panel is asked to:

·  Note the briefing report, the Action Plan for delivery of the Alcohol Harm Reduction Strategy and the intention to review this Strategy in light of the new National Strategy.

·  Consider nominating a representative to sit on the Alcohol Harm Reduction Steering Group.

·  Consider holding an enquiry day with relevant experts and stakeholders to formulate policy on approaches to key issues such as Early Morning Restriction Orders, late night levies and health bodies involvement in licensing decisions.

The Chairman invited Cathy McMahon (Public Health Development and Commissioning Manager) to introduce the report.

The Panel made the following points:

The Chairman informed the meeting that the Panel is not in the position to note the report due to the lack of clarity on Equality Impact Assessment (EIA) for this paper.  Cathy McMahon responded that the EIA had been conducted for the Strategy but not for this update.

The Panel asked whose fault is that children get alcohol at young age and how is that problem resolved.

Cathy McMahon responded that a lot of work is going on with students and young people on education in terms of alcohol and drinking,  and from face to face work lots of intelligence and information is picked up.

Cathy McMahon also said that there is a big issue with young people and binge drinking.  They don’t drink much but they drink it quite quickly.

Some Members of the Panel highlighted the work of the Community Alcohol Partnership (CAP).  Financed by supermarkets and the idea behind that partnership is to bring relevant partners (schools, Council, supermarkets, etc) to try to change drinking culture.

The Panel also expressed their concerns that people do not know how much units of alcohol is in different alcoholic drinks.  The report should also say more about gender differences in consumption patterns.

Some Members of the Panel welcomed that Health Authorities will be more involved on this issue and ask for a review of licensing laws but expressed their concern that huge amount of resource will be used into work that might be duplicated with the work that police, licensing, etc. are already doing.

Cathy McMahon said that Health Authorities are very keen to engage and there would not be massive impact on resources and it wouldn’t be duplication of work with police.

The Chairman summed up by saying that this is a very long term project.  It would be useful to have statistics from A&E related to alcohol abuse.  The big problem in Bath is 24 hour licensing laws.  The enforcement opportunity had never exercised and that has to be changed.  Some of the bigger off-licence chains employ youngsters who get easily intimidated by the other youngsters to supply alcohol.  We will also see the impact of alcohol price increase in Scotland.

It was RESOLVED to:

1.  Nominate Councillor Kate Simmons as Panel’s representative to sit on the Alcohol Harm Reduction Steering Group; and

2.  Hold an enquiry day with relevant experts and stakeholders to formulate policy on approaches to key issues such as Early Morning Restriction Orders, late night levies and health bodies’ involvement in licensing decisions.

This paper provides an update on the change of public health responsibilities from NHS B&NES to B&NES Council from April 2013. The accompanying Public Health Transition Assurance Plan outlines the processes being undertaken to manage this transition including the key tasks, milestones and governance arrangements.

The Wellbeing Policy, Development and Scrutiny Panel is asked to note the information contained in the briefing and accompanying report and comment on any areas of concern or potential opportunity.

The Chairman invited Paul Scott (Assistant Director of Public Health) to introduce the report.

The Panel made the following points:

The Chairman asked about the level of finances for this matter.

Paul Scott said that the Local Authorities budgets for Public Health will be announced next year.  The expectations are that budgets should be the same for each authority.  The report is more flagging the potential risk.

The Panel asked about the governance structure.

Paul Scott replied that under current proposal the Director of Public Health will be one of Divisional Directors within People Directorate.  The Department of Health is suggesting that the Director of Public Health should be one of the Chief Officers.

The Panel asked about the intention to work with West of England and what influence the Government would have.

Paul Scott said that collaboration with the authorities within West of England region will continue.  The Government is setting the targets and it is up to Local Authority to set prioritisation on areas where they want to improve services.

The Chairman summed up by saying that on page 116 of the report (under 9.21) there was omission of homelessness.  The Panel agreed with this remark.

It was RESOLVED to note the report and include homelessness into 9.21 (Tackling Social Exclusion) of the Assurance Plan.

The Council is required to adopt and publish a housing renewal policy, referred to as The Home Health and Safety Policy in this report.  This policy is periodically reviewed and revised as required.  It sets out how Housing Services will provide assistance, including financial assistance, to help low-income, elderly, disabled and other vulnerable residents to undertake essential repairs and adaptations to their homes.  The policy supports the aims of the Housing and Wellbeing Strategy 2012 – 2015, particularly around improving health and wellbeing and reducing inequalities within our communities.

The Council Cabinet adopted a revised policy on the 13th of July 2011 which takes into account the financial constraints caused by the withdrawal of Private Sector Renewal funding by Government.  The Cabinet asked for the policy to be reviewed in 1 year.

This report to the Wellbeing Panel proposes some changes to the Home Health and Safety Policy adopted last year.

The Wellbeing Panel is asked to note and comment on the proposed policy.

The Chairman invited Chris Mordaunt (Housing Services manager) to introduce the report.

The Panel made the following points:

The Panel asked where the money comes from for the changes to the current policy.

Chris Mordaunt replied that money for:

·  disabled facilities grant – approximately 50% from Government and other 50% from Council’s revenue budget

·  home improvement loans – mixture of Housing Services revenue and Health and Social Services budget

·  empty properties – envisaged funding to come from two year pot money that was agreed by the current administration.

The Panel welcomed the paper and asked if the paper had been submitted to the Cabinet.

Chris Mordaunt replied that last year the revised policy had been submitted to the Cabinet who asked for the policy to be back in year time.  We plan to bring the policy back to the Cabinet this summer.

Jane Shayler said that Panel is asked to comment on proposed amendments.  All those comments will be submitted to the Cabinet Member who will consider those before the final report goes to the Cabinet.

The Chairman pointed to the page 191 of the report under bullet point 6 (Exceptional Cases) it should be Cabinet Member who should make a decision on exceptional cases and not Housing Service Manager. That would help the administration to be more transparent. 

The Panel heard from the officers that these exceptional cases happen 2-3 times per year.

The Panel agreed with the Chairman’s suggestion.

The Panel said that the Equality Impact Assessment (EIA) was very good but it underestimated  the needs of those with severe mental health illness.

Chris Mordaunt replied said that in practice there is reasonable allowance for these groups.  The Council also commission services from Care and Repair whose key role is to work with vulnerable people.  There are some procedures to deal with those issues but there is a scope to in the EIA.

Member of the Panel asked about ethnic minorities and how they are kept informed about services.

Chris Mordaunt replied that the service had been in contact with some communities recently and there is on-going work in that area.

It was RESOLVED to note the report and for the officers to take on board comments made by the Panel.

This report presents the latest workplan for the Panel.

It was RESOLVED to note the workplan with the following additions:

• Half Day open session on Joint Strategic Needs Assessment before autumn this year.
• Report on the Quality of Dental Service with NHS registered dentists (for July meeting)
• Winterbourne View findings – September 2012 (to be confirmed)
• Talking Therapies update – date to be confirmed

·  Scrutiny Inquiry Day with relevant experts and stakeholders to formulate policy on approaches to key issues such as Early Morning Restriction Orders, late night levies and health bodies’ involvement in licensing decisions (subject to the agreement from policy Development and Scrutiny Chairs and Vice Chairs).