Agenda and minutes

The Chair welcomed everyone to the meeting.

The Chair drew attention to the emergency evacuation procedure.

Councillor Geoff Ward, Bruce Laurence (Public Health) and Alex Francis (Healthwatch) had sent their 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 Officeror a member of his staff before the meeting to expedite dealing with the item during the meeting.

Lewis Carson, Unison had registered to make a statement and would do so directly before agenda item 9 (Cabinet Member Update).

The Select Committee confirmed the minutes of the previous meeting 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 Ian Orpen 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) during October was 81.7 per cent. The A&E Delivery Board continues to work on developing our plans for managing anticipated increases in activity and pressure during the coming months through the development of a system wide winter plan.

Winter Campaign

We are supporting roll out of the national Help Us Help You campaign this Winter. This family of campaigns includes NHS111 (which launched on 1 October), flu immunisation (launched 8 October), staying well in winter, pharmacy and extended GP hours, known as Improving Access.

Help Us Help You is based on the principle of reciprocity – by following their advice, patients can help GPs, pharmacists and other health professionals to help them stay well, prevent an illness getting worse, take the best course of action and get well again. Help Us Help You resource packs were sent out to all GP practices during October.

Improving access

From 1 October, patients in Bath and North East Somerset (B&NES) can book appointments with a local GP or nurse in the evening and at the weekend. These appointments will be offered at one of three existing local practices. All patients need to do to book an appointment is contact their surgery in the same way as usual. The practice receptionist will advise which surgery the appointment will be held at.

Greater collaboration between BaNES, Wiltshire and Swindon CCGs

BaNES, Swindon and Wiltshire Clinical Commissioning Groups share ambitions and plans to work more closely together, maximising the benefits afforded by working collaboratively and commissioning at scale.

To enable progress towards this vision, at a meeting in common on 4 October 2018, the three CCGs’ Governing Bodies discussed four options for future arrangements for the commissioning and delivery of care services, recognising that some functions could be better done at scale to improve the consistency and quality of outcomes for patients, without losing local clinical decision making.

Of the four options proposed – no change; a formal joint committee for strategic issues; maintain three CCGs with one management team; formal merger of the three CCGs – the three Governing Bodies unanimously agreed that maintaining the three CCGs with one management team would be the most workable solution at this point in time.

A new joint accountable officer will be appointed early in the New Year and a single management team will be introduced from 1 April 2019.

Proposed relocation of national, specialised pain service

The Royal United Hospitals Bath NHS Foundation Trust (RUH) is inviting feedback from those who use or have an interest in pain services currently provided at the Trust’s Royal National Hospital for Rheumatic Diseases (RNHRD) site.

The Trust  ...  view the full minutes text for item 51.

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

Lewis Carson, Unison made a statement to the Select Committee on the subject of Sirona. A copy of the statement can be found on the Select Committee’s Minute Book, a summary is set out below.

The dispute over Sirona’s plans to cut the pay of our members continues and there seems to be no end in sight. To briefly re-mind you of the details, our members have been issued with an ultimatum of being dismissed from their job or accepting a cut to their pay of up to £1000 a year or instead work numerous additional shifts completely for free. Our members do extremely challenging jobs looking after elderly residents with complex medical needs, including dementia.

We have just completed 4 full days of strike action, and have just received a mandate for a further 6 months of strike action. Our members remain resolute that they will not accept this cut to their pay. Sirona are maintaining that they are not able to resolve this dispute by any means due their financial shortages.

We still have 6 years remaining of the current Sirona contract, paid at a flat rate, which gave no consideration to inflation, costs rising or any kind of pay award for staff. It is telling that the troubles have already begun now, even before inflation and costs rises take effect. Our concern is 3 fold.

·  In the immediate sense for the threat to our members pay and the ongoing impasse  which renders strike action perpetually ongoing, without Council Intervention

·  The conditions of our members will be further eroded over the following 6 years as there was no scope for pay increases in the contract awarded to Sirona. Our members are extremely low paid in Sirona, some paid as little as £7.85, just 2 pence above the minimum wage. It is extremely likely in the next few years minimum wage will rise beyond the pay of the majority of the care workers who will become minimum wage employees, and the act of paying minimum wage may hurt Sirona’s finances.

It is extremely worrying that in explaining their rationale for this pay cut, Sirona have explained that they have made all of the efficiencies they can out of non-pay budget, so all further efficiencies must come from pay. Within the next 6 years, as inflation and general price rises kick in and any unexpected costs reach Sirona, they will keep on coming back- eroding conditions further, making the lowest paid poorer.

·  For the residents of the 8 affected Care homes across Bath, Keynsham and Midsomer Norton. The deterioration of working conditions and the resultant impact on recruiting good staff is going to impact the residents.

We require urgent action to resolve this on-going dispute and prevent wave after wave of further strikes. We call on the Council to either bring the Residential and Extra Care services back in house, or re-negotiate the contract to a level which not only prevents erosion to our member’s pay and working conditions, but  ...  view the full minutes text for item 52.

Select Committee members are asked to consider the information presented within the report and note the key issues described.

The Select Committee noted the written update supplied by Dr Bruce Laurence in his absence. A copy of the update can be found on their Minute Book and as an online appendix to these minutes.

A review of maternity services has taken place over the last two years, and the views of over 2000 women, families and staff who work in these and related services have been listened to across Bath and North East Somerset, Swindon and Wiltshire. The formal consultation was launched on the 12th November 2018 and will run until 24th February 2019.

The Senior Commissioning Manager for Preventative Services was joined by Rhiannon Hills, Women & Children’s Divisional Manager, RUH to give a presentation to the Select Committee. A copy of the presentation can be found on their Minute Book and as an online appendix to these minutes, a summary of the presentation is set out below.

Our Journey so Far

•  We began talking to women and families in 2017 about their experiences of pregnancy, labour and birth across the counties of B&NES, Swindon and Wiltshire

•  Their feedback, together with national guidance such as ‘Better Births’, has led to development of a proposal for future maternity services across the BSW region

Choice of place of birth

•  11,200 births annually in B&NES, Swindon and Wiltshire

•  85% Obstetric Unit (65% were high risk, 20% were low risk), 6% Freestanding Midwifery Units (RUH), 7% Alongside Midwifery Unit (Great Western Hospital), 2% Home Births.

•  Increasing pressure on services in our obstetric units at Royal United Hospital and Salisbury District Hospital

•  Lack of parity across the Local Maternity System

Changing clinical needs

•  Average age of a woman giving birth is now 35

•  More and more high risk pregnancies (eg high blood pressure, diabetes, obesity) which  need medical support in a hospital setting

•  50% - First time mothers who need to transfer from midwife led community hospital unit to obstetric unit in hospital for extra medical support with their birth

•  9 Post-natal beds available in the community: 5 in Paulton, 4 in Chippenham: Empty 95% of the year

Right staff, right place, right time

•  We don’t always have right staff in the right place at the right time to offer the services women want to receive and we want to provide.  This is a particular challenge for Royal United Hospital

•  We have the right number and mix of staff, but they’re not based in the right locations

•  RUH staff currently support births across four community midwifery units, the hospital obstetric unit and home births, 24 hours a day, 7 days a week - often staffing empty buildings and empty beds

Issues

•  Staff too busy looking after empty beds and buildings or travelling from community hospitals with very low births to extremely busy obstetric units, often at short notice, which they dislike. Frustrating for staff – effect on morale, retention and skills

•  We want to increase opportunity for home births but staff are not able to promote and support due to existing working patterns

•  We’re not giving women the service they want

Our proposal

Element 1

•  Continue supporting births in 2, rather than 4 Community hospital units. Women will be able to deliver their baby at Chippenham or Frome

•  Trowbridge and Paulton proposed as pilot sites for our new community hub model of care

•  Antenatal and postnatal clinics will continue at Chippenham, Trowbridge, Frome and Paulton

Elements 2 / 3

•  To create two new Alongside Midwifery Units,  ...  view the full minutes text for item 54.

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 Democratic Services Officer informed the Select Committee that they could expect to receive a Service / Financial Plan report at their January meeting alongside the Prevention report listed on the workplan from Dr Bruce Laurence.

Referring to an earlier point in the meeting Councillor Eleanor Jackson asked if the Select Committee would consider asking for further information from the CCG regarding the future of the Renal Unit at the RUH.

The Director for Integrated Health & Care Commissioning replied that this service is not commissioned through the CCG, but if requested they could seek to find out further information on behalf of the Select Committee.

Councillor Bryan Organ asked for the Select Committee to receive a report on Non-Emergency Patient Transport Services.

The Director for Integrated Health & Care Commissioning replied that this request should be passed to the CCG to ask them to provide a consolidated report of what services are available within B&NES.