Agenda and minutes

The Chairman welcomed everyone to the meeting.

Councillor Sharon Ball sent her apologies and was substituted by Councillor Caroline Roberts.

Councillor Kate Simmons sent her apologies and was substituted by Councillor Bryan Simmons.

Councillor Simon Allen – Cabinet Member for Wellbeing, sent his apologies to the Panel.

At this point in the meeting declarations of interest are received from Members in any of the agenda items under consideration at the meeting. Members are asked to indicate:

(a) The agenda item number in which they have an interest to declare.

(b) The nature of their interest.

(c) Whether their interest is a disclosable pecuniary interest or an other interest,  (as defined in Part 2, A and B of the Code of Conduct and Rules for Registration of Interests)

Any Member who needs to clarify any matters relating to the declaration of interests is recommended to seek advice from the Council’s Monitoring Officer before the meeting to expedite dealing with the item during the meeting.

Councillor Eleanor Jackson declared an ‘other’ interest as a Council representative on Sirona Care and Health Community Interest Company.

Councillor Vic Pritchard declared an ‘other’ interest as a Council representative on Sirona Care and Health Community Interset Company.

Councillor Anthonty Clarke declared a ‘disclosable pecuniary interest’ in item 11 (Item 14 on the revised agenda) ‘THE ROYAL NATIONAL HOSPITAL FOR RHEUMATIC DISEASES IN BATH – UPDATE’. Councillor Clarke withdrew from the meeting for the duration of this item.

Councillor Caroline Roberts declared an ‘other’ interest in 11 (Item 14 on the revised agenda) ‘THE ROYAL NATIONAL HOSPITAL FOR RHEUMATIC DISEASES IN BATH – UPDATE’ as she is married to an employee of the Royal United Hospital.

1.  Mr Greg Hartley-Brewer made a statement to the Panel on the subject of ‘Non-Provision of Mandatory NHS Dental Treatments in B&NES Particularly ADP Oldfield Park and ADP Twerton Dental Practices’. A copy of the statement can be found on the Panel’s Minute Book.

The Panel asked the following factual questions:

Councillor Hall asked if there was evidence of the dental practices described being more widespread than Oldfield Park. Mr Hartley-Brewer stated that it could be happening elsewhere as there was no standard monitoring of Band 1 treatments. He stated that he could not say for certain.

2.  Ms Mary-Anne Darlow representing ‘Headway Bath’ made a statement to the Panel on the subject of the proposed closure of the specialist Neuro Rehabilitation Unit at the Royal National Hospital for Rheumatic Diseases (relating to item 11 on the agenda. Item 14 on the revised agenda). A copy of the statement can be found on the Panel’s Minute Book.

The Chairman thanked the members of the public for the statements. It was noted that the Panel wished to put an item on each of the above issues on it’s future work plan (‘Workplan’ Item 17).

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

Following some corrections, the Panel confirmed the minutes of the previous meeting as a true record and they were duly signed by the Chairman.

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

Jane Shayler – Programme Director for Non-Acute Health, Social Care and Housing read the update on behalf of Councillor Simon Allen – Cabinet Member for Wellbeing. The update (which is available in full on the Panel’s minute book) covered the following:

·  Winter Warmth Club – Stay warm this winter

·  Homelessness and Use of Temporary Accommodation

·  Response to ‘Winter Pressures’ Demand for Health and Social Care

·  Implementation of the National Resource Allocation System (RAS)

Panel members raised the following points and asked the following questions:

Councillor Pritchard asked if, in relation to the ‘Winter Pressures’, the “Section 256” funding was new money. The Director responded that it was an additional allocation and that the allocation for next year had also been confirmed. Councillor Pritchard stated that the Council would be in a difficult position if this funding stopped. The officer confirmed that the ‘Section 256’ funding was a one off payment which is confirmed on an annual basis which makes long term planning difficult.

Councillor Pritchard referred to the ‘Homelessness and Use of Temporary Accommodation’ item. He explained that he had asked about the current homelessness situation at a Cabinet meeting and that the Cabinet member was, by his own admission, vague in determination of homelessness. Councillor Pritchard stated that, considering the significant national increase in homelessness, he wanted a more detailed answer from the Cabinet Member. It was suggested that the Cabinet Member be invited to the next meeting of the Panel to answer some questions on this. Councillor Jackson added that it would be useful to also invite Graham Sabourn – Associate Director Housing. Councillor Brett added that she would like some information about B&NES approach to housing people with learning difficulties.

Councillor Hall referred to the ‘Winter Warmth/Fuel Poverty’ item. She explained that social media and the press was used by Sirona to give advice during the recent cold snap and asked how successful this had been. The Director said she would find out and come back at a later date with the response.

Councillor Jackson explained that she had been stuck on a bus during the cold snap and another passenger with a computer could not get any response from B&NES. She explained that there had to be other ways to contact people other than Twitter as not everyone had access. Councillor Jackson went on to explain that she had found rough sleepers and that Julian House was unable to help until the next morning. Councillor Jackson stated that the Council should think about employing a detached worker. She added that there were 22 young people ‘sofa surfing’ in her ward and that the problem should not be underestimated.

Councillor Brett stated that the RUH saw 250 fractures in a single week related to the snow and ice and asked if there was a case for gritting pavements. Tracy Cox – B&NES PCT (Primary Care Trust) stated that a case could be made for this.

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

Jayne Pye from Bath and North East Somerset Local Involvement Network (Link) updated the Panel making the following points (a copy of the full update is available on the minute book):

·  “On the 30th November the Care Forum were appointed as hosts of Link until the 31st March when Healthwatch comes into being. Link meetings will take place on the 12th February and 26th March. There will be a stakeholder event looking at the work that Link has undertaken and the legacy that will be passed on to Healthwatch. The Care Forum is administering e-bulletins monthly. An annual report will also be produced.

·  Work continues in the following areas – work with the National Autistic Society; visits to two care homes; representation on various groups such as AWP stakeholder group, Health and Wellbeing Board, Strategy Group for Transition, Dignity Group at the RUH etc.

·  On the 20th December the Royal Mineral Hospital Board voted to close the Neuro Rehabilitation ward for financial reasons. There is an intention for the ward to be closed on the 31st March 2013.  Link was not involved in the consultation.  There are concerns for patients past present and future. Link wished to understand how the consultation process had been undertaken and is awaiting dates for a meeting with Kirsty Matthews – Chief Executive, on this. A meeting between specialist commissioning, the CCG (Clinical Commissioning Group) and Link regarding what happens to the patients needing this service and consultation arrangements is being organised.

·  The Re-ablement  and Post Discharge Support Project has had positive outcomes. I will be visiting a number of those who have received this service and talk to them about how they see the service, could we have done things differently, are there changes to make before a commissioned service specification is defined.

·  We continue to meet with CQC (Care Quality Commission) and the CCG  and have invited Dr Ian Orpen to share their patient and public involvement strategy on the 26th March at the Link legacy conference."

The Chairman noted that much of the content of this presentation (on the Neuro-Rehab unit at the RNHRD) would be debated at item 11 (revised agenda item14).

The Chairman thanked Jayne Pye for her contribution. Councillor Jackson added that Janye had made a huge contribution to meetings of the Panel and had enhanced the Panel understanding of the patient experience.

The Panel are asked to consider the presentation from Karen Taylor (CQC Compliance Manager, South Region - Bath and North East Somerset and Wiltshire).

The CQC guidance document on the role and relationship between the CQC and Scrutiny is included as the agenda item 15.

Karen Taylor – Compliance Manager, Care Quality Commission (CQC) made a presentation to the Panel and covered the following points:

·  The Local B&NES Team

·  Protecting people from poor care

·  Scale of CQC regulated care

·  Roles and responsibilities – CQC’s place in the system

·  PDS Panel and CQC local relationship

·  Approach to inspections

·  CQC – what CQC does and does not do

·  We are reviewing our strategy

·  What external scrutiny told us

·  Contacts

Panel members raised the following points and asked the following questions:

Councillor Pritchard asked about the Panel’s relationship with the CQC. Karen Taylor stated that she wished to establish this as it may not always be appropriate to report to full Panel. She asked that Panel members pass on any concerns about the way local services are being provided.

Councillor Pritchard asked what kind of penalty there is for inappropriate service. Karen Taylor explained that the Local Authority has the responsibility for safeguarding, the CQC are concerned with the way services are provided. She further explained that the CQC liaise with providers and if failings are found, a compliance obligation is issued and published. This is usually very effective. Penalty notices and fines can also be issued.

It was RESOLVED that:

·  The Chair/Panel receive a programme of planned reviews; and

·  The Panel are sent a link to the revised strategy; and

·  Karen Taylor and the Democratic Services Officer for the Panel (Jack Latkovic) speak about ways the CQC can feed into the work of the Panel.

The purpose of the report is to provide the Wellbeing PDS Panel with an update following the publication in December 2012 of the Department of Health Review; Final Report – Transforming care: A national response to Winterbourne View Hospital.

The Wellbeing PDS Panel is asked to:

·  Note the content of the report; and

·  To receive a further update on actions taken to address the recommendations and findings in one year’s time.

Jane Shayler – Programme Director for Non-Acute Health, Social Care and Housing introduced the report. She explained that she had received some written questions from Councillor Brett and that the Panel would be sent a brief written response. Jayne Pye of LINK asked if she could be copied in on this briefing note.

Panel members raised the following points and asked the following questions:

Councillor Pritchard noted that B&NES did not have anyone at ‘Winterbourne View’ at the time that the review is concerned with. The Director reported that this authority does not use residential care very often. She explained that follow up reviews had been done with people who had been with Castle Beck (the provider). The Director explained that she is not complacent and that lessons can always be learned from cases such as this.

Councillor Pritchard stated that during the period of his involvement there had initially been an assumed level of comfort regarding safeguarding that could have perhaps been challenged. Since B&NES has applied the new national discipline on safeguarding, the authority has a new and warranted confidence. We were very fortunate to not have had any involvement in Winterbourne View but appreciate the opportunity to learn lessons.

This report covers a summary of data held in the Joint Strategic Needs Assessment on the subject of social and economic inequality. This is following an explicit request from the Panel to keep the JSNA as a standing agenda item on a subject-by-subject basis.

The Wellbeing Policy Development & Scrutiny Committee is asked to:

·  Note the findings of the briefing

·  Consider the broader implications/impacts of these findings on the work of the Panel.

Jon Poole and Helen Tapson made a presentation to the Panel covering the following (a full copy of the slide presentation is available on the minute book):

·  Background – what is the Joint Strategic Needs Assessment

·  The Local Picture

·  What are socio-economic inequalities

·  Life Course

·  Life Expectancy

·  Community Voice

·  What is being done?

·  Recommendations

Panel members raised the following points and asked the following questions:

Councillor Eleanor Jackson stated that the information was useful but that one of the greatest causes of poverty in her ward was due to the breadwinner becoming ill. Councillor Organ agreed that the information is too generalized. Councillor Pritchard stated that this kind of information provides a useful starting point with which to target resources. Councillor Brett asked if the findings could be circulated to all ‘not for profit’ organisations in the area and Policy and Partnerships.

Councillor Simmonds asked the age of the data. Jon Poole explained that the life expectancy data was from 2009/10 and the hospital admissions data was from 2012.

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

Dr Ian Orpen, Chair of the Clinical Commissioning Group, introduced the update paper to the Panel. A full copy of the update report is available on the minute book. The Update report covered the following:

·  Appointments to the CCG’s governing body

·  Authorisation

·  Commissioning Support Service

·  Commissioning Intentions

·  Urgent Care

·  NHS 111

·  Winter Pressures

·  Specialised Services – Review of Vascular Provsion

Panel members raised the following points and asked the following questions:

Councillor Pritchard asked about the transition to 111. Dr Orphen explained that he was confident that new providers are in place. He explained that during the bedding in period, there was likely to be some extra workload. He explained that the national campaign would be rolled out in October 2013.

Councillor Pritchard asked about the Vascular Review, he said that this concerned a small number of patients but could be a significant imposition if people from rural areas were being asked to travel to the BRI (Bristol). Dr Orpen explained that a B&NES patient would go to the BRI or North Bristol Trust and be transferred back to the RUH once the operation is done. How the patient got to the hospital in Bristol would depend on the way they entered the system eg. as an emergency case, they would be taken in the ambulance.

Councillor Brett asked for an update on Urgent Care in terms of outreach, homelessness. She also asked if the CCG would be financially disadvantaging the RUH in any way. Dr Orphen answered that this would only happen if a service was no longer based at the RUH.

Councillor Brett asked what the CCG are going to do to mitigate the risk of the 250 fractures happening in future years. Dr Orphen replied that this is a wider debate but that the CCG would back any move to mitigate the problem.

Councillor Clarke asked if the Panel should have access to the impact assessment regarding B&NES patients going to Bristol for services. Tracy Cox explained that the review process is about to start and an impact assessment would be brought back to the Panel.

Councillor Jackson had some concerns about Harmoni. Dr Orphen assured the Panel that there had been communication with the Department of Health and Harmoni and this had been positive.

Councillor Jackson referred to a Guardian article about Familial hypercholesterolaemia (FH) screening. Dr Orphen explained that there were no immediate plans for this but that he was always horizon scanning.

It was RESOLVED that the Impact Assessment regarding the Vascular Review be submitted to the panel as soon as it becomes available.

The Panel are asked to consider the presentation on the Royal National Hospital for Rheumatic Diseases in Bath.

(Note: Councillor Anthony Clarke withdrew from the meeting for this item having declared a disposable pecuniary interest)

Kirsty Matthews – Chief Executive RNHRD, made a presentation to the Panel covering the following (a full copy of the slide presentation is available on the minute book):

·  Our position as a foundation trust

·  Money not services

·  Finding a solution?

·  The decision – we expect to join with the RUH

·  How will this happen?

·  Transition process – progress to date

·  Risks and opportunities

·  Shape of the services 2013

·  Successes at the Min

·  Communication and information

·  Coming together – Vision for the future

The Panel noted that they had been sent a statement on the concerns of the RNHRD Governors’ for the future of the Neuro-Rehabilitation patients.

Panel members raised the following points and asked the following questions:

Councillor Pritchard asked about the nature of ‘acquisition’ as opposed to ‘merger’. He stated that if it is an acquisition, the RUH might want to lose elements of the Min (RNHRD) because of the business considerations of the hospital. Councillor Pritchard noted that he had never heard a criticism of the Min and that people go out of their way to praise its valuable service. Councillor Pritchard stated that, regarding public perception, the fact that the Neuro-Rehab unit could close so early in the process of acquisition, it may similarly lead to concerns of the possible loss of other services. Kirsty Matthews – RNHRD Chief Executive explained that, due to the size of the Min compared to the RUH, it was not the classic definition of a merger and the legal term ‘acquisition’ was more appropriate. She explained that the working relationship with the RUH was good.

Councillor Pritchard asked about the public perception of the acquisition, he asked if there would be two sites or would the buildings be merged. He stated that he felt that the Min should retain its individual identity. Councillor Hall stated that she felt it was the continuation of the service that was most important, rather than the badge. James Scott – Chief Executive RUH explained that the Min and RUH are currently separate legal entities. He explained that the question regarding the future identity of the hospitals was many steps ahead of the process at the present time and for the acquisition to go ahead, the RUH had to become a Foundation Trust and this would not happen until early summer.

Councillor Brett asked what the business case for the RUH was in going forwards with the acquisition. James Scott explained that the RUH do not have a rheumatology section and that in terms of research and development, it was not a university hospital although it was research active. He stated that the acquisition would address these points. He further explained that the acquisition was in the final phase and the outcome should be clear in 6-8 weeks.

Councillor Nicol asked why the current budget situation was not foreseen. Kirsty Matthews – RNHRD Chief Executive explained that  ...  view the full minutes text for item 85.

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

·  Services in place to support substance misusers to overcome their dependence; to obtain/maintain their tenancy; and to support their families.

·  Criminal Justice Services in place to support substance misusers to reduce re-offending.

·  Progress being made to support ketamine misusers in B&NES.

·  Progress being made in re-commissioning substance misuse services.

Jane Shayler – Programme Director for Non-Acute Health, Social Care and Housing and Carol Stanaway – Substance Misuse Commissioning Manager introduced the report.

Panel members raised the following points and asked the following questions:

Councillor Pritchard stated that it was an excellent report. He asked how outreach workers persuaded users to come in to the service. Carol Stanaway said there were lots of ways and that they had distributed cards with harm reduction messages, they used Project 28 and the use of peer advocates was effective.

Councillor Brett asked how the probation service was getting involved. The officer explained that she worked well with them and they helped to support offenders. She explained that there had been some significant success with alcohol treatment processes which had also proved cost effective.

Councillor Jackson asked if the work was cross border. The officer explained that people would not be turned away.

Councillor Pritchard congratulated Carol Stanaway and the service and also Project 28.

This report presents the latest workplan for the Panel.

Following the additions shown below, they Panel noted the future workplan:

·  Sexual Health (Councillor Clarke)

·  RNHRD – Update on the Acquisition

·  Temporary Accommodation and Homelessness – invitation to the Cabinet Member for Homes and Planning (Councillor Tim Ball)

·  Dentistry

·  Extra meeting – Neuro-Rehab Unit (RNHRD)

·  Vascular Review – Impact Assessment