Agenda and draft minutes

The Chair welcomed everyone to the meeting.

The Chair drew attention to the emergency evacuation procedure.

Alex Francis, Healthwatch sent her apologies to the Select Committee.

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 Liz Hardman made a statement to the Panel on the subject of the Maternity Services Transformation Consultation. A copy of the statement can be found on the Panel’s Minute Book or as an online appendix to these minutes, a summary is set out below.

This consultation is about reducing the choices facing women in our area. Maternity services will be concentrated in large district hospitals such as the RUH, Great Western Hospital, Swindon and Salisbury District Hospital.

Two of the led Birthing Units at Trowbridge and Paulton will be closed. This means women won’t have a choice as to where to have their babies in the Paulton and Trowbridge areas. It will have to be the RUH.

So you can imagine how congested parking in the RUH is going to be not to mention pollution levels in Bath, with increased numbers of heavily pregnant women now travelling by car or ambulance to the RUH to give birth and to have post-natal care.

We have been told that Maternity Units like Paulton and Trowbridge are underused. Bed usage has been calculated unfairly by breaking it down to each bed. So, if only one of the 5 beds is being used this will give them a calculation of 80% of how often the beds are empty, rather than assessing how often women are staying at the centre. At least one woman is using a post-natal bed 75% of the time.

The consultation suggests that in place of these postnatal beds, midwives will be able to provide more support closer to home. This doesn’t make sense in terms of staff usage, as at present there is one midwife and one midwife Care Assistant working over a night shift in Paulton Hospital, caring for up to 5 families. To replace this with staff doing home visits overnight is unsafe, worrying and inefficient.

I’m afraid to say that the whole transformation Maternity process looks to be

an elaborate cover up to conceal the endemic staff shortages in the RUH and to siphon off midwives from our Community Maternity Units to our larger hospitals. In August 2018, the RUH had a shortage of midwives of 14.4%. This was the greatest shortfall since 2015.

Local midwives have told us they like working near their homes and don’t want the expense of travelling to Bath and parking fees.

Promoting births and after care at the RUH will increase traffic congestion and parking problems in the Bath area. Community birthing units at Paulton and Trowbridge run effectively are cheaper and more cost effective than expensive Hospital Birthing Suites.

We need to consider the needs of our communities before making decisions on the outcomes of this consultation.

Councillor Lin Patterson said that she had attended a briefing day and was impressed with the presentation plans for the changes proposed and that the staff present appeared to be in approval. She asked if there was time for the proposals to be re-examined.

Councillor Hardman replied that in general she believed  ...  view the full minutes text for item 77.

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

Specialised Commissioning have committed to updating the Select Committee regarding progress with the new Bath Renal Unit.

Fiona Hughes, Specialised Commissioning – South West Hub introduced this item to the Select Committee. She said that she was pleased to be able to report that the new dialysis unit is intended to be at 36 Box Rd, Bathford, Bath, BA1 7QH.

She stated that planning permission has been submitted for the site (Reference: 19/00759/FUL) and that full plans and artists view of the outside of the unit are now on the noticeboard at the RUH site and a copy of the drawings of the outside of the unit were attached with the report. She added that a decision was expected towards the end of April.

She explained that updates to both staff and patients were ongoing and that an open day was planned to take place.

Councillor Lin Patterson commented that she was worried that the site to the North East of Bath would be an issue for patients without cars to access.

Fiona Hughes replied that for most patients there will be a reduction in travel time and that public transport links are in place and that she could provide more information regarding this.

Councillor Geoff Ward said that he was supportive of the move and that Box Road is accessible to patients from Bath and Wiltshire via public transport. He added that he initially had concerns as there is limited off street car parking in the area, but that sufficient on site provision for patients and staff to park has been made in the application. He said that the local Parish Council were in support for such an important facility.

Fiona Hughes confirmed that the planning application includes provision for 20 on-site parking spaces.

Selena Riggs, Head of Supplier Management, Specialised Commissioning said that the majority of patient transport will remain in place, but that the on-site provision may see more patients choose to drive. She added that it was acknowledged that staff find it difficult to park at the RUH.

Councillor Robin Moss said that in his opinion it was good to see a facility situated outside of central Bath. He agreed that access to the RUH is a real issue, but stated that public transport will not work for a number of patients.

Dr Ian Orpen said that if granted this will be a good outcome for the service as it is not possible for it to remain within the RUH. He added that it is hoped that the new facility will go some way to normalising the condition.

Selena Riggs said that the proposed model will be replicating others across the country.

Councillor Bryan Organ commented that recent discussions had taken place regarding patient transport. He asked when the site would be operational.

Fiona Hughes replied that the intention is to be operational from September 2019.

Councillor Organ invited her to attend the next Community Transport meeting which recalled would take place on April 5^th.

Fiona Hughes replied that if she could be given further details of this meeting she  ...  view the full minutes text for item 79.

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.

Tracey Cox – Chief Executive for BaNES, Swindon and Wiltshire CCGs and STP

Tracey Cox has been appointed as Chief Executive of BaNES, Swindon and Wiltshire CCGs and will also lead the Sustainability and Transformation Partnership for the region.  

Tracey formally took up her new position at the start of March. She will oversee closer working between the three local Clinical Commissioning Groups, which will operate with a single senior management team, use their collective resources more efficiently and streamline their respective decision-making arrangements.

Update on A&E performance and national performance targets

Local system performance against the A&E waiting time target (95 per cent of attendees to be seen within four hours) during January was 72.9% and for February 70.6%. This data comes as NHS England considers dropping the four-hour target, which was introduced in 2004.

Instead of aiming to see and treat virtually all A&E patients in four hours, the sickest patients will be prioritised for quick treatment. NHS England wants to ensure that patients who come in to A&E with, for example, heart attacks, acute asthma, sepsis and stroke start their care within an hour.

The changes will be piloted this year and, if successful, could be introduced in 2020.

New targets will be introduced for mental health care with the goal of ensuring that everyone who needs urgent crisis care in the community receives it within 24 hours.

Access to other community mental health services - for children and adults - will be expected in four weeks. This is the first time that these services will have had targets attached to them.

Integrated Health and Care Strategy development

B&NES, Swindon and Wiltshire’s Clinical Board is leading a piece of work to create a strategy for a joint approach to health, care and wellbeing across the region.  The Integrated Health and Care Strategy will become the key component of B&NES, Swindon and Wiltshire’s Five Year Plan and drive many of the changes which need to be implemented in the wider health and care system over the next five years.

A programme of engagement working in conjunction with Healthwatch England will be underway across B&NES, Swindon and Wiltshire over the coming weeks to seek the views of local people on a range of health and care issues.

Engaging on our local plans following publication of the Long Term Plan

In January NHS England published its Long Term Plan, which sets out key priorities and ambitions for the service over the next ten years. Over the coming months, the NHS in B&NES, Swindon and Wiltshire will be working with patients, the public and partners – including local councils, the voluntary and community sector and social care – to develop a local plan for the  ...  view the full minutes text for item 80.

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 Care, Health and Wellbeing 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.

Mental Health Review

The full business case containing the outcomes of the Mental Health Review and transformation plans were submitted to the Health and Care Board for approval on 6th March 2019.  Board members approved the recommendation to work with existing system leaders to deliver the new Thrive model of Mental Health provision in B&NES.

There are many strengths in existing community mental health services locally with strong examples of innovation and partnership working across system leaders and third sector organisations.

Thrive supports the provision of mental health services using a whole-system, population-based approach which focuses on the mental health and mental illness needs of different groups of people as well as the needs of individuals. It enables integration across health, education, social care and voluntary sector, with a central focus on delivering improved outcomes for people.

Reablement Review: Update on engagement with people who use the service

We have worked with colleagues from the CCG and Virgin Care to carry out in-depth interviews with 10 people who have used the reablement service.  We visited people from across the B&NES area that has accessed reablement services for different reasons.  Overall, people are highly complementary about the service and said it provides a great deal of confidence and support to them.

People generally understood that reablement was different from long-term support both because they would pay for long-term support, but also because it was a qualitatively different approach that encouraged them to help themselves.  However, for some the term reablement was a confusing one and there is an opportunity for us to improve how we let people know exactly what reablement is, who the different people are that they might see, and why people might come from different organisations.  This might be achieved through a leaflet co-produced with people who use the service, perhaps giving some examples of people’s stories from using the service. 

These findings will now inform the development of a revised reablement model going forward.

Councillor Robin Moss commented that in a previous update to the Select Committee the issue of improvements within Virgin Care were identified and said that it would be useful to see their current performance figures.

Councillor Pritchard replied that the failings that were recognised were being addressed, but that the publication of performance review would not be accelerated for election purposes.

Dr Orpen said that he recalled from the January meeting that Kirsty Matthews, Managing Director, BANES Community Health and Care Services had offered to provide the Select Committee with updates on behalf of Virgin Care as it goes through its transformation processes.

Councillor Bryan Organ commented that it was his view that the reablement leaflet be circulated as soon as possible.

The Chair thanked Councillor Pritchard  ...  view the full minutes text for item 81.

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

Dr Bruce Laurence 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 is set out below.

Improving access to childhood immunisations for Gypsy, Roma and Traveller (GRT) families temporarily residing in ‘unauthorised’ encampments

Gypsy, Roma & Traveller (GRT) children are identified as being at higher risk for missing immunisations, in particular those communities that travel more frequently. The aim was to improve access to childhood immunisations for GRT families temporarily residing in ‘unauthorised’ encampments through implementation of a new pathway. 

The new pathway was tested in autumn 2018 at the Lansdown Park and Ride encampment. The multiagency team accessed the site, HNA was completed and all eligible children received immunisations. GRT experience significantly poorer health yet despite this greater health need, there is low uptake of health services, including preventative health care. When the new pathway was tested the local GP practice prioritised the children as a vulnerable group to ensure immunisations were received and the multiagency team were able to make recommendations to the Environmental Protection Team regarding the length of stay.

Female Boaters and Access to Cervical Screening

A focus group was delivered with female boaters to examine the barriers to accessing cervical screening.

The waterways are managed by the Canal and River Trust and the current guidance states that boats that do not have a fixed mooring must ‘bonafide navigate’ the waterway. The guidance means a boat must make a progressive journey from point A to point B, (A and B must be a minimum of 20 miles apart) staying up to 14 days in each place before continuing on their journey. The potential impact on boaters complying with the guidance is vast. In order to comply a boater will potentially be more than 20 miles away from their GP, school, place of work and social networks for part of the year. The cruising guidance therefore has a potential negative impact on access to healthcare, education, employment and there are increasing reports that the isolation from social networks is impacting mental wellbeing. In addition to the complexities of distance, the most populated areas to cruise (Bath – Devizes) span two counties making referrals across local authorities challenging. 

Findings from the focus groups

• The participants had either not attended or were overdue their cervical screen
• General lack of knowledge around screening programme from the focus group participants.
• The majority of the barriers were practical. They were related to priorities, being too busy, simply putting it off and ‘meant to go but didn’t get round to it’
• Difficulties registering with GPs and not being registered with a GP was another barrier for not receiving invites. The pressure to keep moving along the canal made registering with GPs difficult.
• The boaters felt that often GPs were not supportive in terms of registering and using alternative addresses. There was a sense from the group that there was stigma and discrimination once they had disclosed they  ...  view the full minutes text for item 82.

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 Alex Francis. A copy of the update can be found on their Minute Book and as an online appendix to these minutes.

This paper provides an update on the review’s progress to date.

The Commissioning Manager for Adult Social Care introduced this report to the Panel. He explained that homecare services are currently provided in Bath & North East Somerset by a range of local providers, with contracts awarded to four ‘strategic partners’ in 2008.  He said that a review of homecare services is currently being undertaken in readiness for putting in place a new homecare approach and contracts from Autumn/Winter 2019/2020. 

He stated that in doing so the Council has been mindful of opportunities to:

·  Explore innovative new ways to support people at home and maximise their independence

·  Consider the needs of those living in rural and harder to reach communities

·  Ensure our model will be sustainable for the future, for providers and the workforce, as well as being cost-effective for the Council

He stated that the Council have continued to consider the standards of the Ethical Care Charter in their recommissioning approach and it has also reviewed national best practice and research, and engaged widely with local stakeholders.

He highlighted some of the key findings from the engagement activities:

• There is support for the use of assistive technology alongside traditional homecare approaches, although people are keen that this does not replace the human side of care. People want care delivered flexibly in a way that doesn’t disrupt their existing quality of life, and which is personalised to their needs.

• People value consistency of care workers, and dislike having too many different people in the house. They want people they are familiar with, reliable timings, and a care worker who engages with the person using the service and any family or carers.

• There is a need to provide opportunities to develop the workforce and promote the value of care, and care as an attractive career.

He said that having listened to engagement feedback we developed a list of ‘outcomes’ to capture people’s aspirations and expectations for a new service. He stated that these set the foundations for future success and demonstrate what will be different for local people who use the service, and how the service will feel to use. He said that the outcomes should allow us to measure the effectiveness of future services ensuring that they continue to make a positive difference to people’s lives. He added that during December and January we ran a public consultation on these outcomes and our proposals.

He informed the Select Committee that a final business case is now being developed, in collaboration with colleagues from across the Council and CCG that will set out our final model and procurement approach founded on work to date and that this will be signed off by Joint Commissioning Committee and the Health and Care Board in spring/summer 2019.

Councillor Robin Moss said that it was good to hear of proposals to recruit and retain more staff, but asked of the costs associated with this area of work.

The Commissioning Project Manager replied that the Council has been working within the United Kingdom Homecare Association Costing Model and  ...  view the full minutes text for item 84.