Agenda and draft minutes

Councillors Clarke, Organ, Hall and Kate Simons had sent their apologies for this meeting.

Councillors Tim Warren, Sally Davis, Douglas Nicol and Brian Simmons were their substitutes respectively.

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 Officeror a member of his staff before the meeting to expedite dealing with the item during the meeting.

Councillor Vic Pritchard declared an “other” interest as a representative of the Council on Sirona Care & Health Community Interest Company.

Councillor Sally Davis declared an “other” interest as a representative of the Council on Sirona Care & Health Community Interest Company.

Councillor Eleanor Jackson declared an “other” interest as a representative of the Council on Sirona Care & Health Community Interest Company.

Councillor Simon Allen (Cabinet Member for Wellbeing) declared an “other” interest as an employee of Sirona Care & Health Community Interest Company.

The Chairman had invited the Panel to confirm the nominations for the AWP Task and Finish group (looking into AWP response to the CQC inspection results from Sep 2014). 

The Chairman had informed the Panel that nominated Panel Members were Councillor Eleanor Jackson and the Chairman himself.

The Chairman also informed the Panel that the above Task and Finish group meetings had been scheduled for the 20th March and the 7th April.

The Panel unanimously AGREED with Chairman’s proposal.

There were none.

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 (attached to these minutes).

Members of the Panel paid a tribute to Councillor Allen and all officers for their work in the past four years. 

The Chairman had commented that the Panel, and the Council, should be proud of achievements made in the last four years.  The Chairman had highlighted great working relationship with Clinical Commissioning Group and other NHS bodies in the area. 

The Chairman suggested that the update from Councillor Allen had summed up what had been happening in the last four years and suggested to the Panel that briefing paper should be sent to the Communications and Marketing team with request that the document should be included in the next edition of Council Connect as well as all other relevant press and media means in the Council.

It was RESOLVED to:

1.  Note the update from Councillor Allen;

2.  Congratulate Councillor Allen and team of officers, including external partners, for the achievements made over the last four years;

3.  Request that Communications and Marketing publish the update from Councillor Allen in next edition of Council Connect as well as all other relevant press and media means in the Council.

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

The Chairman invited Dr Ian Orpen to give an update (attached to these minutes).

Members of the Panel had expressed their concerns on the provision of Independent Sector Treatment Centres (ISTCs), especially on those centres where patients have to travel long distance.

Dr Orpen had commented that he had understood concerns made by the Panel though the CCG has a duty not to discriminate against or in favour of any particular sector or provider and this duty is contained in legislation which governs how we conduct our procurement. For example, excluding private sector organisations, solely on the basis of their ownership, is contrary to The National Health Service (Procurement, Patient Choice and Competition) Regulations 2013.

Councillor Jackson had asked if the CCG would be commissioning GP services in future.

Dr Orpen had responded that this would be looked at possibly after May 2015 elections.

The Chairman concluded the debate by thanking Dr Orpen and the team for their work over the last four years.  The Chairman also highlighted that partnership between the Council and the CCG had been nationally recognised.

It was RESOLVED to:

1.  Note the update from Dr Orpen;

2.  Congratulate Dr Orpen and his team for the achievements made over the last four years.

The Healthwatch representative will update the Panel on any relevant issues. Panel members may ask questions.

The Chairman invited Helen Francis (Healthwatch representative) to introduce the update (attached to these minutes).

The Chairman has asked about the responses in table 2 of the document, in particular why there were no responses to date from Bath and North East Somerset Council.

Helen Francis had said that the Health would not expect to receive responses on those issues, though this would be something that the Healthwatch would continue to follow up.

The Chairman had said that Healthwatch B&NES had had ‘shaky’ start in the way how they conducted their role and also how they have reported to the Panel.  However, for some time now the Healthwatch had been proactive and provided clear and concise information to the Panel and public.

The Panel congratulated the Healthwatch on the achievements so far and wished that the same level of service and standards continue.

It was RESOLVED to:

1.  Note the update from Helen Francis;

2.   Congratulate the Healthwatch for the achievements and good work so far.

The Panel are asked to consider a presentation from the Care Quality Commission Inspection Manager for North Somerset & BANES and Swindon Wiltshire Region.

The Chairman invited Justine Button (Care Quality Commission Inspection Manager for North Somerset & BANES and Swindon Wiltshire Region) to give a presentation, as per report.

The Chairman has asked about the new regulations, and what those would be in comparison to old ones.

Justine Button had explained that the new regulations on fundamental standards means that all registered providers must demonstrate that they would be meeting regulatory requirements in order to register with CQC and then continue to deliver regulated services.

The new regulations would strengthen CQC’s approach to assessing applications for registration with CQC and the registration process.

In comprehensive inspections (which lead to ratings of individual services and of the provider overall), CQC would primarily look for good care, rather than checking compliance with regulations.

CQC would consider whether a regulation has been breached. CQC would take this guidance into account to determine whether a provider has been meeting the new regulations. This then would lead to what enforcement action CQC would take to address breaches of regulations.

Justine Button had also said that the previous 16 regulations (also known as the ‘essential standards’) had been replaced by 11 regulations that set out the fundamental standards of quality and safety. These regulations would be clearer statements of the standards of care below which care should never fall. There would be two new regulations, on fit and proper person requirements for directors and on a statutory duty of candour.

CQC had consulted on guidance for providers about fundamental standards and the final guidance is available on their website.

Justine Button concluded that the new guidance would entirety replace, from April 2015, CQC’s current Guidance about compliance: Essential standards of quality and safety and current enforcement policy.

CQC’s inspections would focus on rating providers on the five key questions for identifying good care.  However, where CQC identify poor care, this guidance would help them to also determine whether there had been a breach of regulations and, if so what action to take.

The Chairman thanked Justine Button for a presentation.

It was RESOLVED to note the presentation.

Improving the quality of life for people with dementia is a priority for the Health and Wellbeing Board and the dementia work programme links to two of the CCG’s strategic priorities for the next 5 years: ‘Long Term Condition Management’ and ‘Safe, compassionate care for frail older people’. The purpose of this paper is to update the Wellbeing Policy Development and Scrutiny Panel on the dementia work programme.

The Panel is asked to note the work undertaken to date and support the delivery of the work programme.

The Chairman invited Laura Marsh (CCG) to introduce the report.

The Chairman had asked why is that, as of January 2015, the diagnosis rate in BaNES has been 57.3% compared to 54.02% in the South of England.

Laura Marsh responded that only one of the 50 CCG’s in the South of England had achieved the 67% target and locally, despite best efforts to improve the diagnosis rate, there were three key reasons why the 67% target was unlikely to be achieved.

Firstly, the estimated prevalence may not be accurate. The number of people who have been expected to have dementia has been based on the 2007 Alzheimer’s Society Dementia UK report which had used the Expert Delphi Consensus approach based on studies from 1986-1993 in a limited number of areas in the UK and not including any sites in the South West.  No allowance has been made for the type of area (e.g. inner city, rural, small town) or any other health factors.

Secondly, most of the diagnosis rate increase over the last six months has been due to coding corrections and not new people diagnosed with the disease.

And, thirdly, there has been a considerable increase in referrals to RICE over the past few years. This indicates a greater awareness of dementia but the number of new diagnoses has not been increasing at the same rate as referrals.  This was because over the last decade the patients presenting were older but their memory problems are considered milder as judged by the Mini Mental Score Examination and therefore they were not being diagnosed as having dementia.

The Panel had made a few comments by saying that dementia and depression had been seen as the same issue; training for social workers on how to deal with dementia; and work with care providers.

Laura Marsh had responded that the CCG would be looking into provision of awareness training to all those who would be in contact with people with dementia.

It was RESOLVED to note the report.

Panel members received two briefings on the performance of the NHS 111 Service in the Bath & North East Somerset area in 2014. The last briefing reported on progress to improve performance, as well as a range of proposed developments. This briefing paper describes progress made, performance over the winter and how service performance continues to be monitored closely to ensure that it meets the needs of local people.

Panel Members are asked to note the latest performance of the NHS 111 service.

The Chairman invited Catherine Phillips (CCG) to introduce the report.

The Chairman had commented that the NHS 111 service had improved a lot since its launch.  The Chairman also said that feedback from the Health on the NHS 111 had been positive.

The Panel suggested that regular updates on the NHS 111 services should be provided to future Scrutiny Panel.

It was RESOLVED to note the report and to put NHS 111 services update in the forward plan for future Scrutiny meetings.

Panel members received briefings on the performance of the Non-Emergency Patient Transport Service in the Bath & North East Somerset area in March 2014, July 2014 and September 2014. The first set of reports set out the challenges being experienced during the mobilisation of the new single provider of this service within the first year of the contract. This briefing explains the progress being made with the service delivery of this contract and explains the actions being introduced within the contract to ensure this service meets the needs of the patients of BaNES.

Panel Members are asked to note the agreed actions and the latest performance of the Non-Emergency Patient Transport Service.

The Chairman invited Dominic Morgan (CCG) to introduce the report.

Councillor Jackson had commented that report appears to focus mostly on services in Bath area.  Councillor Jackson had said that residents in her Ward (Radstock) had been having issues in getting transport back from the hospital.  Councillor Jackson had asked if services had improved since the last update.

Dominic Morgan explained that during the first 14 months of the contract there had been a number of challenges involved in the provision of a Non-Emergency Patient Transport Service (NEPTS) to patients across four CCG areas; patients attending four acute trusts within the CCG boundaries and a number of significant patient flows to acute trusts outside the CCG boundaries. The contract had replaced a multitude of bespoke service arrangements that had developed over time within the different acute trusts. A significant challenge had been the misalignment of predicted versus actual activity and mobility profiles.

Dominic Morgan had responded that NEPTS services had significantly improved since its launch though there was still some room for improvement.

Currently the four CCGs who contract with Arriva Transport Solutions Ltd have been in the process of contract rebasing negotiations.  This would result in a re-based contract, which would enable the core service to better match known demand; and the cessation of non-recurrent monthly top-up funding, currently used to purchase additional third party resource.

Included within the rebasing were amended contract penalties and incentives for the Key Performance Indicators (KPIs).  This would reinforce the focus on the main KPIs which relate to the timeliness of service delivery for both inbound and outbound journeys and a particular focus on the longest-wait journeys.  Incentives would also apply to other patient experience measures.

The Chairman thanked Dominic Morgan for an update.

The Panel suggested that regular updates on Non Emergency Patient Transport Services should be provided to future Scrutiny Panel.

It was RESOLVED to note the report and to put Non Emergency Patient Transport Services update in the forward plan for future Scrutiny meetings.

The Panel are asked to approve the draft ‘Shaping Up’ strategy for further public consultation and that the draft ‘Shaping Up’ strategy to go to Health and Wellbeing Board for final consultation and approval.

The Chairman invited Jameelah Ingram (Public Health Development and Commissioning Manager) to give a presentation to the Panel.

The following points had been highlighted in the presentation:

·  Why is obesity an issue?

·  How obesity harms communities

·  Key facts – Healthy Weight

·  Vision for discussion

·  Aim

·  Objectives

·  3 Levels of Action

·  Prioritising Need

·  Monitoring Outcomes

·  Local Governance

·  Initial Consultation Plans

·  Next steps

A full copy of the presentation is available on the Minute Book in Democratic Services.

Members of the Panel had commented that new technology (such as electronic devices and video games) had increased fast food regime.

Councillor Jackson had commented that overweight could be genetic issue as well.  Councillor Jackson had asked why eating disorders had not been included in the strategy.

Jameelah Ingram had responded that eating disorders had been deliberately excluded from the strategy as they would fall within remits of other health services.

The Panel had requested that officers should specify in the strategy why eating disorders have not been included in the paper.

Jameelah Ingram had said that Public Health Team had been working closely with Sirona on finding out what people want and also on how to work with young people.

It was RESOLVED to support the Strategy and that should specify why eating disorders have not been included in the paper.  

The Chairman, Councillor Vic Pritchard, will use this opportunity to summarise the work that the Panel had done, or had been engaged in, in the last 4 years.

The Chairman had used this opportunity to summarise the work that the Panel have done, or have been engaged, in the last 4 years.

The Chairman had said that the Panel had been involved in the following:

• External
  • Neuro Rehab services at the Mineral Hospital
  • The Mineral Hospital acquisition by the RUH
  • Foundation Trust status to the RUH
  • Joint Scrutiny of South West Ambulance (Cllr Clarke’s involvement as the Chair of the Joint Panel considerable time)
  • Mortuary Services (at the RUH)
  • Non-Emergency Patient Transport Services
  • NHS 111
  • Mental Health services
  • Ongoing dialogue with the CQC and their presence at Panel meetings
  • Urgent care and Winter Pressures
  • Dementia
  • And many more
• Internal
  • Public Health (an excellent working relationship) – with that, Panel’s involvement in issues such as Teenage Pregnancy, Alcohol Strategy (Joint Scrutiny Inquiry Day), Sexual Health (national leaders in encountering problems with the HIV)
  • Homecare Review
  • Care Act 2014
  • Homelessness and rough sleepers
  • Loneliness
  • Connecting Families programme
  • And many more from our Council services

The Chairman thanked Panel Members for their contribution, Clinical Commissioning Group, other NHS bodies and special ‘thank you’ to people/staff who deliver health and social services to the community.