Agenda and minutes

The Democratic Services Officer will draw attention to the emergency evacuation procedure as set out under Note 6.

The Democratic Services Officer drew attention to the emergency evacuation procedure.

Councillor Cherry Beath had sent her 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 Interest Company.

Councillor Anthony Clarke declared a ‘disclosable pecuniary interest’ in item 12 on the agenda ‘Royal National Hospital for Rheumatic Diseases NHS FT – organisational update’. Councillor Clarke withdrew from the meeting for the duration of this item.

There were none..

The Panel confirmed the minutes of the previous meeting as a true record with the following stylistic corrections:

·  Page 5, minute 41, paragraphs 2 and 3 should read:

The Chairman commented that under the operational procedures, as described in the report on page 135, it is, in his view, not having a dedicated transitions team or specific transitions social workers is a much better approach.  Instead, case management can be accepted by any qualified social worker within the disability teams.  It is far less likely to cause the young people anxiety as they transition to adult social care services; particularly as people develop a special bond with their social worker.

Mike MacCallam replied that the aim is to develop the expertise in all teams.  Rather than having dedicated transitions workers in the teams there are people who primarily take transitions lead.  A few years ago there was an attempt to have dedicated transitions workers and that didn’t work well.  Transitions cases are now brought to the adult teams earlier so that there can be good planning between children’s services and adult services to ensure the best possible transition for each individual.

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The Cabinet Member will update the Panel on any relevant issues. Panel Members may ask questions.

The Chairman invited Councillor Simon Allen (Cabinet Member for Wellbeing) to give an update to the Panel (attached as Appendix 1 to these minutes).

The Panel made the following points:

Councillor Eleanor Jackson asked if the Council looked at the data provided in the table under the ‘Care Quality Commission Data’ update and also if the Council is sure that there is no cross-subsidy of clients in care homes.

Councillor Allen replied that the Council cannot tell external providers how much they charge individuals as this is a private arrangement.  The Council has fee levels, which, benchmarked against other neighbouring local authority’s fee levels, are in line with the benchmark.

Jane Shayler (Deputy Director for Adult Care, Health and Housing Strategy and Commissioning) added that fee levels  are beyond the scope of the CQC's regulatory inspection role.  Jane Shayler went on to say that whilst the Council does have indicative fee levels to ensure best use of public resources, if necessary in order to secure a placement to meet assessed, eligible care needs, a “market supplement” may be agreed.

The Chairman asked what would happen if the CQC did not get the satisfactory action in relation to compliance with the twenty eight quality standards, known as the ‘essential standards’.

Councillor Allen replied that the CQC and Council officers would monitor the service delivery.  The Council’s contracts cover more than the essential standards and the regulatory requirements that the CQC inspects against.

Jane Shayler added that if any regulated provider did not meet standards then they would be required by the CQC to put in place an action plan.  The CQC and Council's Contracts and Commissioning Team would take an overview of the action plan implementation.  The Contracts and Commissioning Team also works closely with the Adult Safeguarding & Quality Assurance Team, looking at the Care Home's shortcomings and considering whether or not, with the CQC, the fall in standards represent any specific risk of harm to service users.  If there is a significant level of concern then a “whole home” review of the care home would be undertaken by appropriately qualified staff, which might include health staff.  This would lead towards making a judgement about whether to temporarily suspend the placement of people in that home and in extreme circumstances move people away from that home.  Jane Shayler concluded that these situations are very rare.

The Chairman thanked Councillor Allen for an update.

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

The Chairman invited Dr Ian Orpen (Clinical Commissioning Group – CCG) to give an update to the Panel.

 Dr Orpen updated the Panel with current key issues within BANES CCG (attached as Appendix 2 to these minutes). 

The Panel made the following points:

Councillor Jackson commented that robust arrangements mentioned in the update on Urgent Care included great improvements in fall prevention and stroke mitigation.

Dr Ian Orpen responded that a lot of changes took place to improve the flow of patients, which involved organisations such as Sirona Health & Care, Clinical Commissioning Group (CCG), the RUH, etc.

The Chairman asked Dr Orpen if he is confident how the NHS 111 is developing now.

Dr Orpen responded that the CCG are confident with the current development but not completely relaxed.

The Chairman thanked Dr Orpen for an update.

The Panel will receive an update from Pat Foster on the Healthwatch Bath & North East Somerset.

The Chairman invited Pat Foster (Healthwatch representative) to introduce the report.

Pat Foster took the Panel through the report and highlighted the impact that social media (twitter, Facebook, etc.) had recently on the promotion of Healthwatch B&NES.

Members of the Panel welcomed the report, in particular the role of volunteers.  The Panel asked if all 8 volunteers are covering every area in Bath and North East Somerset.

Pat Foster replied that some pockets of the area are not yet covered though the expectation is that this will be achieved with the new group of volunteers.

It was RESOLVED to note the update.

The Adult Social Care & Housing Medium Term Service & Resource Plan (MTSRP) Update is presented for consideration by the Panel:

(1)  To ensure all members of the Panel are aware of the context for Service Action Planning

(2)  To enable comment on the strategic choices inherent in the medium term plan

(3)  To enable issues to be referred to the relevant Portfolio holder at an early stage in the service planning and budget process.

The Panel is asked to:

(1)  Comment on the update to the medium term plan for Adult Social Care & Housing 

(2)  Identify any issues requiring further consideration and highlighting as part of the budget process for 2014/15

(3)  Identify any issues arising from the draft plan it wishes to refer to the relevant portfolio holder for further consideration.

The Chairman invited Jane Shayler to introduce the report.

Jane Shayler took the Panel through the report by outlining that the first part of the report is the same to all Medium Term Plans presented to PDS Panels.  The whole Council is required to make additional savings of £4m in 2014/15 in order to balance the books.

Appendix 1 of the report sets out the additional Adult Social Care and Housing savings details for 2014/15.  Page 51 of the report shows the additional savings of £500k and £280k.  Jane Shayler gave, as per the report, an update on the additional savings.

The Panel made the following points:

The Chairman pointed to page 44, and the bullet point about Integration Transformation Fund (ITF) and asked if £9.8m is all that this Council will get from the government.

Jane Shayler responded that those figures were not confirmed yet.  The ITF detailed guidance, by the Department of Health, is expected to be available mid- December this year.  The finance officers have made some reasonable assumptions on the amount that is likely to be allocated to this area.  That is based on the experience of how the national allocation usually converts to local allocation for B&NES.  It is an informed estimate though the Council and Clinical Commissioning Group cannot be absolutely certain until the the funding allocations and detailed guidance are issued. Jane Shayler reminded the Panel that the ITF does not come into effect until 2015/16.  The challenge is that every area has to agree plans for the investment of that fund by the end of this financial year.  There is a process to navigate those plans through – the plans do need to be signed by the Clinical Commissioning Group, the Council, NHS England  area team and the Health and Wellbeing Board.

Jane Shayler said that the figure of £9.8m is the best estimate of how much will be available locally as is the maximum of £1.2m which represents new money into the local health and social care system.

The Council is already receiving funding in support of demand pressures in the health and social care system, which is usually referred to as “Section 256” money.  The Section 256 money is already invested in services, such as re-ablement services, 7-day social work services, and some therapy services in the hospital and similar.

Jane Shayler informed the Panel that one of the significant differences in the ITF is that it will go into a pooled budget is likely to be administered by the local authority.

The Chairman read out Risk & Opportunities section on page 45 and said that the section should be more focused on B&NES than London though it is a measure on what might happen in this Council.

Jane Shayler reminded the Panel that an update on the Care and Support Bill is scheduled for January 2014 meeting of the Panel.  On national level, most local authorities are saying that although they welcome the changes in the Bill/Act  ...  view the full minutes text for item 58.

This paper is an organisational update from the Royal National Hospital for Rheumatic Diseases NHS Foundation Trust (RNHRD) to the B&NES Wellbeing Policy and Development Scrutiny Panel.

The Chairman invited Kirsty Matthews (Chief Executive of the RNHRD) to introduce the report.

Kirsty Matthews took the Panel through the report and introduced Eugene Sullivan as the new Chair of the RNHRD and the Council of Governors.

The Chairman commented that the hospital was able, in very short time, to reduce their forecast deficit from £3.7m to £2.6m.  The Chairman said that this was extremely positive and asked if they could continue to reduce the deficit.

Kirsty Matthews replied that the hospital had been able to improve the financial position in a year.  The hospital was able, during this financial year, to pull additional clinical activity in of around £250k.  Part of the plan to reduce the deficit was improvement with pain services – moving all Pain Services to Specialised Commissioning.  There is also an increase of 4.5% of outpatients in Rheumatology Services.  Kirsty Matthews also said that, at the beginning of the year, some money had been put in reserves for some unknown factors, such as non-clinical staff and corporate services.  These reserves (around £350k) were released back out as there was no need to spend that money.  The hospital was able to work through some cost improvement programmes which contributed to improve end of year position.  The hospital had to work with a very cautious budget.

The Chairman asked why the endoscopy referrals are reducing dramatically.

Kirsty Matthews responded that the reduction in referrals was more to do with the fact that it is a single handed consultant service, which always creates a risk.  When the consultant was unavailable for a number of reasons then it was very difficult for the hospital to get the right level of cover for that post.  The impact on the hospital was that they could not operate at optimum capacity.  There are also greater ranges of providers in the community and GPs have a greater level of choices where they can send their patients.

The Chairman commented that the endoscopy could be at risk in the same way as Neuro-rehab services were.

Kirsty Matthews responded that the hospital wanted to flag to the Panel that endoscopy referrals are significantly reduced.  The Board of the hospital is aware what the minimum number of referrals is in order to continue provision of endoscopy.  The hospital is also looking quite closely with the commissioners on what is the best plan for services in 2014/15.

Councillor Organ said that despite the deficit of £2.6m, the public are delighted with the services provided by the hospital.

Councillor Bevan said that the issues such as fall in referrals for endoscopy and/or rise in referrals for Pain Services often change in time and asked how flexible the hospital would be to deal with these issues.

Kirsty Matthews responded that the hospital saw an enormous degree of change in Pain Services.  The team at Pain Services had adapted in looking at different types of programmes and made adjustments in how they run their programme to meet those needs.  Kirsty  ...  view the full minutes text for item 59.

Purpose of the report is to update Bath and North East Somerset (B&NES) Wellbeing Policy Development and Scrutiny Panel on the provision of specialised Category A (Level 1 and 2a) Neurological Rehabilitation (neuro-rehabilitation and non-specialised neuro-rehabilitation services) following the Royal National Hospital for Rheumatic Diseases (RNHRD’s) decision to cease providing specialised neuro-rehabilitation at the end of March 2013.

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

• Patients needing this service have continued to be treated at the level of service that is most clinically appropriate for their needs;

• Service provision has increased as a result of the re-provision and is subject to further expansion and no patients from B&NES have had to be referred out of area;

• There have been no issues regarding access, quality or safety at any of the re-provided services;

• Very few (< 5) people from the B&NES area currently accessing any of these inpatient services;

• New rules requiring providers of neuro-rehabilitation to register with UKROC now provide independent quality assurance over and above NHS commissioning arrangements;

• Sirona Care & Health has now established service arrangements for the provision of non-specialised services;

• The CCG will extend the initial contract for non-specialised services with Sirona Care & Health to 31st March 2016.

The Chairman invited Tracey Cox (B&NES Clinical Commissioning Group), Steve Sylvester (NHS England Specialised Commissioning Team) and Carrie Wedgewood (Sirona Care & Health Rehabilitation Service) to introduce the report.

Members of the Panel welcomed the report, in particular the seamless transition of services for outpatients, which are now provided by Sirona Care & Health. 

The Panel asked if the same seamless transition of services happened to inpatients from B&NES who required Level 1 and Level 2a beds.

Steve Sylvester responded that all the patient feedback received from Frenchay’s Brain Injury Rehabilitation Centre was positive and there have been no complaints from Level 1 or 2a patients at any of the providers. 

It was RESOLVED to note the report.

Adopting the Draft Homelessness Strategy has been identified as a ‘Key Decision’ because of community impact and is scheduled for the Council Cabinet meeting on 4 December 2013.

The Wellbeing Policy Development & Scrutiny Panel are asked to agree that the revised approach contained in the Draft Homelessness Strategy 2014-2018 which not only continues a successful provision of early interventions to prevent homelessness but also focuses on achieving a nationally accredited Gold Standard and targeting ten new local priorities:

1)  Complies with agreed Council policies and plans.

2)  Will have a positive impact on vulnerable people and reduce inequalities.

The Chairman invited Sue Wordsworth (Planning and Partnership Manager) to introduce the report.

The Chairman read out paragraph 5.2 on page 80 of the report and asked from what figure the number of households in temporary accommodation was halved.

Sue Wordsworth responded that all Local Authorities received a target, from the government, to halve the use of temporary accommodation and this Council had achieved the target.  Sue Wordsworth also said that she could not specify when the Council was set the target but it had to happen within three years of setting the target and this was achieved.

The Chairman read out paragraph 5.3 on page 81 of the report and asked what evidence the Council has that welfare reform is having an adverse effect on households at risk of homelessness.

Sue Wordsworth responded that the number of people that are approaching the housing options team for debt advice is increasing.  The other aspect is an increase in rough sleepers in B&NES.  This is because of the change in the way that rough sleepers are counted, which is believed to be more realistic.  It may also be because some other local authorities have reduced the spend on provision for rough sleepers as a result of financial pressures. 

The Chairman said that he is fully in support of the strategy.  However, the ten priorities within the strategy present a considerable challenge with the present budgetary constraints. 

Councillor Bevan asked about the change of method in counting homeless people.

Sue Wordsworth replied that the government wanted everyone in the country to count homeless people in the same way and they produce the guidelines on how to do that.  Sue Wordsworth also said that the new way of counting homeless people is much more realistic.

Councillor Jackson expressed her concern that heavily pregnant women are counted as single and treated as such.  Councillor Jackson asked if there is still a facility to help vulnerable people get settled in private accommodations.

Sue Wordsworth said that the Council still have rent deposit schemes for support for people settling in private accommodations.  The intention is to retain the scheme despite the budget pressure.  The difference between the cost of social rented housing and private rented housing is reducing as a result in changes in the social rented sector, which may be helpful.

Sue Wordsworth also said that in homelessness legislation pregnant women, as well as parents with children, have a priority need for housing.

Councillor Jackson asked if there is evidence of the bedroom tax making people homeless.

Sue Wordsworth responded that there is limited evidence at the moment.  The number of people that were predicted to be affected with the bedroom tax has reduced dramatically.  A lot of people have found ways of coping with the bedroom tax. 

Sue Wordsworth also said that all registered providers are doing their best to limit the impact on tenants.  Sue Wordsworth repeated that the Council’s funding of the rent deposit scheme does help people to access private  ...  view the full minutes text for item 61.

The Wellbeing Policy Development & Scrutiny Panel are asked to:-

1)  Consider and make any further comments on the findings of the final Alcohol Harm Reduction Scrutiny Inquiry Day report; and to

2)  Consider the recommendations response table which will be received by the Cabinet Member for Wellbeing, Simon Allen; Cabinet Member for Sustainable Development, Ben Stevens; Cabinet Member for Neighbourhoods, David Dixon and the Cabinet Member for Early Years, Children & Youth, Dine Romero as detailed in the report.

The Chairman invited Emma Bagley (Policy Development and Scrutiny Project Officer) to introduce the report.

The Chairman thanked the officers who put a tremendous amount of work into the report and also for organising the scrutiny inquiry day to hear from different stakeholders.

The Chairman also welcomed Councillor Patrick Anketell-Jones as the Economic and Community Development PDS Panel representative.

The Chairman explained that the reason why the Panel is having this report before them is that the Policy Development and Scrutiny Chairs and Vice-Chairs decided that the Wellbeing PDS Panel would receive the final draft of the report and recommendations with invitation to other PDS Panels to participate in the debate.

The resource implications are not to be considered by the PDS Panels.  It is down to the relevant Cabinet Members to consider resources issues.

Members of the Panel, along with Councillor Anketell-Jones, focused on the subject of education of young people in order to prevent alcohol related deaths.

The Panel made couple of suggestions in terms of re-wording and priority of the recommendations which were noted by Emma Bagley.  Emma Bagley said that all suggestions from the Panel will be incorporated in the final version of the report.

It was RESOLVED to AGREE with the report and recommendations response table to the relevant Cabinet Members subject to ‘fine tuning’ of recommendations by Emma Bagley, namely with the following amendments:

Page 9 – should read 68 people including the parties mentioned rather than 68 councillors

Recommendation 1 (c) - add “over 65s” into the scope – suggested by Councillor Jackson

Recommendation 4 – add “and colleagues” regarding workplace health – suggested by Councillor Jackson

Recommendation 6 Move (f) regarding health to position (a) to reflect the importance of this factor – suggested by Councillors Clarke and Anketell-Jones.

This report presents the latest workplan for the Panel.

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

·  Home Care update for January 2014 meeting

·  Connecting Families – Health update (July 2014)

·  Sexual Health (HIV) – date to be confirmed