Agenda and minutes

The Chair welcomed everyone to the meeting.

The Chair drew attention to the emergency evacuation procedure.

Councillors Tim Ball and Bryan Organ had sent their apologies to the Select Committee. Councillor Dine Romero was present for the duration of the meeting as a substitute for Councillor Tim Ball.

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 Paul May declared an other interest as he is a non-executive Sirona board member.

There were none.

Councillor Eleanor Jackson advised the Democratic Services Officer that the word ‘practice’ had been incorrectly spelt within Minute 51 (Clinical Commissioning Group Update).

The Select Committee confirmed the minutes of the previous meeting with this amendment as a true record and they were duly signed by the Chair.

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

Dr Ruth Grabham addressed the Select Committee. A copy of the update can be found on their Minute Book and as an online appendix to these minutes, a summary of the update is set out below.

A&E performance

Local system performance against the A&E waiting time target (95 per cent of attendees to be seen within four hours) was 81.3 per cent in November against a trajectory of 90.5 per cent and 86 per cent for December against a target trajectory of 91 per cent.

The local health and care system maintained relatively good performance between the Christmas and New Year period delivering 86.3 per cent for week ending 1January 2017.  However since then there has been extremely high demand and this is putting local health and care services across the area under significant pressure.

Some non-urgent hospital appointments and operations have been rescheduled and extra staff have been deployed to the emergency department and hospital wards. Extra beds have also been made available in care homes so frail elderly patients can be discharged from hospital more quickly.  The maternity beds at Paulton Birthing Centre have also been temporarily closed to accommodate patients who have been discharged from the RUH but are not yet well enough to return home or to another care setting.

Sustainability and Transformation Plan update

The Bath and North East Somerset, Swindon and Wiltshire (BSW) ‘Emergent  Sustainability and Transformation Plan’ was published on 14 December 2016 setting out how health and care organisations across the ‘footprint’ plan to work together in new ways to improve our local population’s health and wellbeing, improve the quality of services and ensure financial sustainability.

There are plans for launching a period of engagement with patients, carers and other stakeholders to support the further development of STP proposals - this is due to begin in February.

2017/18 Operational Plan

The CCG submitted its two year operational plan for the period 2017/18- 2018-19 to NHS England on the 23December in line with the nationally set deadline. The CCG’s Operational Plan is a detailed document that assures NHS England of our delivery plans against the nationally mandated “nine must dos”.

Delegated Commissioning

The CCG submitted its application to take over responsibility for commissioning of primary care services from NHS England on 5 December 2016.  The decision was supported by our member practices with a 96 per cent turn out and 83 per cent of practices voting ‘yes’.  We will announce the outcome of our application very shortly.

Engagement on stopping two groups of over-the-counter medicines (OTC) and gluten-free prescribing

We undertook a period of engagement between 26 November – 21 December on our proposals to stop prescribing of gluten-free products and two groups of over-the-counter medicines to treat minor ailments (pain killers and anti-histamines).  The outcome of the engagement process will be presented to the CCG’s Joint Clinical Commissioning Committee on the 26 January 2017 for review and to agree next steps.

Mental Health Pathway Review

The Council and  ...  view the full minutes text for item 69.

The Cabinet Member will update the Select Committee on any relevant issues. Select Committee members may ask questions on the update provided.

Councillor Vic Pritchard, Cabinet Member for Adult Social Care & Health addressed the Select Committee. A copy of the update can be found on their Minute Book and as an online appendix to these minutes, a summary of the update is set out below.

Hospital to Care Home Learning Workshop

A Hospital to Care Home learning workshop was held on 21^st September and included over 40 colleagues from across the Council, Clinical Commissioning Group, RUH, Sirona, care homes and Healthwatch. The purpose of the event was to share issues between care homes and hospitals, to learn about each other’s roles and situations and understand how to improve discharges to care homes from hospital. 

Actions from the day are being taken forward by a new action group – the Hospital to Care Home Group, which includes representatives from the above organisations and a 6 month plan has been created.

Learning Disability Government Funding

The Council has been successful in bidding £456,800 of Government funding to improve independence for people with learning disabilities. In September, the Department of Health announced that funding would be made available to help people with learning disabilities to live independently by creating a range of housing and technology options.

The fund will enable us to develop the use of Assistive technology through a range of applications, predominantly electronic equipment, used to monitor or enable people with learning disabilities, thus increasing their independence and improving their quality of life.  

The funding will also support a number of people with learning disabilities to own their own homes using a unique Government approved shared ownership model known as HOLD (home ownership for people with long term disabilities).

The plans will be delivered in partnership with a range of bid partners, including West of England Care and Repair, Advance Housing and CURO.   

Your Care Your Way Update

The primary aim of this stage of the project is to ensure the safe transfer of community health and care services and have no disruption for people who use services. Significant progress has also been made towards finalising the Prime Provider Contract with Virgin Care and the final draft is expected to be available for signature by the end of February. 

The 3 year transformation project will begin in earnest after the first 100 days of the contract, however transformation plans that we have developed will be included in provider contracts to signal the direction of travel of the services.  This is why there is no intention to ask providers of community health and care services being delivered under a sub-contract with Virgin Care to make any large changes to their service from April 1^st.  Associated funding will remain in line with current provision. 

The Council and CCG have now agreed an approach with Virgin Care as Prime Provider to managing the day-to-day commissioning and contracting of services which will provide the maximum benefit for the population of Bath and North East Somerset.

Councillor Dine Romero asked how the commissioning and  ...  view the full minutes text for item 70.

Members are asked to consider the information presented within the report and note the key issues described.

Charlotte Matthews, Public Health Specialty Registrar addressed the Select Committee. A copy of the update can be found on their Minute Book and as an online appendix to these minutes, a summary of the update is set out below.

Sugar Smart Collaborative

One in five reception aged children and one in three 10-11 year olds in B&NES weighs more than is healthy.  Over half of adults in B&NES are likely to be overweight or obese too. 

We have set up a Sugar Smart collaborative to tackle this.  We will be working in partnership with the Jamie Oliver Food Foundation and Sustain (an alliance for better food and farming) to run a year-long campaign to help people spot hidden sugars in food and drink.

Domestic Abuse

It is estimated that 5,936 women aged between 16-59 in B&NES have been a victim of domestic abuse in the past year.  There were 1,110 domestic abuse crimes recorded by the police in 2015/16, an increase of 25% compared to 2014/15.

The B&NES Domestic Abuse Partnership is preparing a bid to the Home Office transformation fund for a range of domestic abuse support including an independent domestic violence advisor for people with complex needs including substance misuse and/or mental ill health.

Smoking

12 Sports Clubs were successful in applying for the first round of our Smoke Free Sports Club grant.  Football, rugby and cricket clubs across the area have received £500 to implement a smoke-free touchline policy for their youth sports with signage and training for staff.  We intend to allocate a further 8 grants by the end of the financial year. 

Our Healthy Lifestyles service is launching an E-cigarette campaign to encourage smokers to switch to e-cigarettes or to help those who are smoking and vaping to get support with quitting tobacco completely. The ‘Time to Switch’ campaign is a new approach to reaching out to vapers (who are predominantly smokers trying to quit) and has been shown to increase uptake of support services in other areas of the country.

Dementia Alliance

After discussion at the Health and Wellbeing Board, B&NES Council, CCG and Healthwatch all agreed to become members of the B&NES dementia action alliance, giving their commitment as organisations to help make B&NES an easier place for people with dementia and their carers to live well in their communities.

HIV Advice and Support

The Public Health team are pleased to have supported the Eddystone Trust to secure funding from St John’s Hospital Trust for a service supporting people living with HIV in B&NES. The Eddystone Trust was commissioned by public health and adult social care to deliver a support service for people in B&NES living with HIV/AIDS, but as part of the budget prioritisation this service is ending in March 2017.  It was a difficult decision to make and public health worked with the Trust to find alternative funding.  The Trust has now been awarded a grant to deliver a two year service  ...  view the full minutes text for item 71.

Members are asked to consider the information presented within the report and note the key issues described.

Alex Francis, Project Coordinator, Healthwatch B&NES addressed the Select Committee, a summary of her update is set out below. 

Broadening the Healthwatch B&NES volunteer base and public ‘voice’

In October 2016, Healthwatch B&NES attended a careers fair at Bath Spa University. We had interest from 15 students who were looking for volunteering opportunities and/or to broaden their experience of community projects. The students expressed an interest in supporting various elements of Healthwatch’s work, including running social media campaigns, supporting delivery of focus groups and to collect / represent the views of a range of local people, such as people that use mental health services and people with learning difficulties.

The Healthwatch B&NES volunteer support officer is now working to train the students and support them to become involved with the project. This is a great success and something that we hope will add an extra dimension to the ‘public voice’ that we hear and represent.

Learning from patient experience

Healthwatch B&NES is delighted to be working with St. James’s Surgery and BaNES Clinical Commissioning Group to explore what works well when engaging patients in changes to General Practice.

Healthwatch B&NES is keen to make sure that patients are given an opportunity to get involved in any changes that are proposed to their GP practice. We are working with St James’s Surgery in Bath to learn how patients were informed and consulted about changes that took place to their practice last year, for example: what information was provided and how; what approaches were used to gather patient feedback; the type of support that was offered to patients needing assistance to respond; and, how patients were informed of the outcome.

Although only a small cohort of patients are involved in this project, we hope that their experiences will provide key learning that can be translated into local best practice for future consultation. A report of the findings will be presented to the B&NES Joint Primary Care Co-commissioning Committee in March 2017. Healthwatch B&NES would like to thank the staff and partners at St. James’s Surgery for their support and work towards this project.

B&NES, Swindon and Wiltshire Sustainability and Transformation Plan (STP)

Since the three local Healthwatch (B&NES, Swindon and Wiltshire) began their involvement in this process we have acted as a ‘critical friend’ to the STP Board and subsequently, the communications and engagement work-stream. Our aims are simple, we are asking for:

·  Consistent, accessible and easy to understand information for the public and VCSE colleagues, explaining what the STP is, and the impacts that any plans and proposals may have on the services people use and the care they receive

·  Inclusive, meaningful, timely and appropriate engagement with the public and VCSE colleagues on the STP, in order for them to better understand how the health and social care system may be changing and to help shape and influence this based on local need

Healthwatch B&NES is working to keep local  ...  view the full minutes text for item 72.

This report presents the People and Communities Directorate Plan to the Select Committee for consideration and feedback as part of the Council’s service planning and budget development process.

All Directorate Plans can be viewed at https://democracy.bathnes.gov.uk/ecCatDisplay.aspx?sch=doc&cat=13506

The Strategic Director for People and Communities introduced this item to the Panel. He informed them of the proposal to retain the 2% Council Tax precept for Adult Social Care that was introduced last year. 

He said that growth pressures of up to £4m for 2017/18 have been projected in adult social care particularly as a result of demographic change and inflationary pressures including the National Living Wage. It is considered that the savings proposals of 2.4m set out in the budget papers can be delivered through efficiencies and growth avoidance. This leaves the service with a funding gap of 1.6m. The Adult Social Care precept at 2 per cent will cover this gap and enable us to continue meeting our duties to assess and provide services in line with our existing plans.

Councillor Dine Romero asked if the savings associated with the Prime Provider Social Care & Health Contract were deliverable.

The Director of Integrated Health & Care Commissioning replied that existing savings targets from the Medium Term Financial Plan are incorporated into the contractual arrangements with Virgin and that these will be delivered in line with the approaches set out in the budget papers, including through efficiencies and new approaches to meeting individual’s needs, including support to access services that focus on prevention and enable people to maintain their independence. She added that the savings were challenging but that they were realistic and achievable.

She stated that the implementation of the new social care IT system, Liquidlogic, would support more streamlined business processes including payments to care providers and supporting earlier confirmation of the assessed level of financial contributions provided  / required for those individuals with the means to make a contribution to the cost of their care service. She added that Virgin can support these efficient ways of working by ensuring timely provision of information to be uploaded to Liquidlogic.

Councillor Dine Romero asked if more residents were to be expected to pay for their care.

The Director of Integrated Health & Care Commissioning replied that there is a national regulatory framework in place and that B&NES policies on social care contributions comply with the guidance and framework and that there was no expectation that individual contributions would increase. She stated that the intention is to improve the assessment process and support efficient collection of individual contributions to avoid individuals’ unnecessarily accumulating debt.

She reminded members of the Select Committee that phase two of the Care Act contained a cap on the use of people’s own funds and assets. She added that implementation of phase two had been delayed until at least April 2020 and at this stage no further information was available about whether phase two of the Care Act will be implemented from 2020 and/or be amended before implementation.

Councillor Eleanor Jackson commented that in her opinion growth avoidance should be seen as a cut to services. She said that she was concerned over the revised approach to transport provision relating to Day Care and,  ...  view the full minutes text for item 73.

This paper is to provide an update to the Committee on personal budgets within Bath and North East Somerset.

The Transformation & Strategic Planning Manager gave a presentation to the Select Committee, a copy of it can be found on their Minute Book and as an online appendix to these minutes, a summary is set out below.

What are personal budgets?

A sum of money that it has been calculated is sufficient to meet a persons’ assessed unmet eligible needs.

How can someone use a personal budget?

A personal budget can be used for a commissioned service, a direct payment or a combination of these two elements.

How many people use personal budgets?

Personal Budgets – Adults: 1569

Direct Payments – Adults (included in figures above): 513

Direct Payments – Disabled Children’s Team: 87

Councillor Paul May asked if recipients were monitored for how they spend their budget.

The Transformation & Strategic Planning Manager replied that a review on how the budget is spent will initially take place after six week. She added that following this a frequency of reviews will be determined and that at least one review will take place every twelve months.

She stated that recipients were assessed on their capacity to receive and use appropriately direct payments. An authorised person must make the request for a direct payment on behalf of the recipient if they are judged to be without capacity.

Councillor Paul May said that it looked like a very positive piece of work. He asked, with an aging population in mind if enough controls were in place.

The Transformation & Strategic Planning Manager replied that a good policy was in place.

The Director for Integrated Health & Care Commissioning added that a focus on outcomes was more achievable through personal budgets.

Councillor Geoff Ward asked if the 1,569 people mentioned were totally reliant on receiving their allocated budget.

The Transformation & Strategic Planning Manager replied that recipients could input their own money.

What happens in transition?

There are three main transition points; Children’s Social Care / Adult Social Care / Health. This can be very a difficult time and may cause uncertainty for the person concerned. The aim is for professionals to make this process as supported as possible.

Transition – Children’s to Adults Social Care

Process is centred around the child / young person.

Transitions operational group work together to agreed criteria to identify young people who may be eligible for adult social care support.

Conversations start early with the whole family, school, health professionals etc.

Start early, at age 14, with support in place by age 18.

Transition - Adult Social Care to Health

Nurse Assessor / Community Matron in the Continuing Health Care (CHC) team liaises with other teams, the person, family members and possibly refers to the GP records, and completes the Health Needs Assessment and the decision support tool.

Discussions take place with the person throughout.

Support needs agreed.

Transition – Health to Adult Social Care

Person is no longer eligible for support from health.

Letter sent to the person and adult social care.

Person advised to contact adult social care.

Health  ...  view the full minutes text for item 74.

This report presents the latest workplan for the Select Committee. Any suggestions for further items or amendments to the current programme will be logged and scheduled in consultation with the Chair of the Select Committee and supporting officers.

The Chair introduced this item to the Select Committee and asked for any proposals regarding additional items for the workplan.

Councillor Geoff Ward said that he would like the Select Committee to receive a report on how the Public Health team collaborates with other areas of the Council.

The Director for Integrated Health & Care Commissioning advised that the Select Committee should receive a Your Care, Your Way update at each meeting for the foreseeable future.

The Select Committee agreed with these proposals.