Agenda and minutes

Venue: Council Chamber - Guildhall, Bath. View directions

Contact: Mark Durnford  01225 394458

Items
No. Item

64.

WELCOME AND INTRODUCTIONS

Minutes:

The Chair welcomed everyone to the meeting.

65.

EMERGENCY EVACUATION PROCEDURE

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

 

Minutes:

The Chair drew attention to the emergency evacuation procedure.

 

66.

APOLOGIES FOR ABSENCE AND SUBSTITUTIONS

Minutes:

There were none.

67.

DECLARATIONS OF INTEREST

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.

Minutes:

Councillor Paul May declared an other interest as he is a Sirona board member.

68.

TO ANNOUNCE ANY URGENT BUSINESS AGREED BY THE CHAIRMAN

Minutes:

Councillor Eleanor Jackson addressed the Select Committee. She explained that a discussion had taken place at the Somer Valley Children’s Centre Advisory Group on the impact that domestic violence has on the health of children. She said that incidents in Midsomer Norton and Twerton had increased since 2014.

 

She informed them of a Bristol based charity called Freedom that provides a 12 week programme for victims. She said that the programme is currently only available to women.

 

She asked the Select Committee to receive a report on the physical and psychological effect that domestic violence has on its victims.

 

She stated that Freedom were looking to fund a further project in Midsomer Norton which would initially cost £6,000.

 

The Director of Adult Care and Health Commissioning replied that this was not a service that was commissioned by the Council. She added that it was a Julian House initiative that was looking to expand. She said that the Select Committee could be provided with further information at a future meeting.

 

Councillor Paul May thanked Councillor Jackson for raising this issue.

 

 

69.

ITEMS FROM THE PUBLIC OR COUNCILLORS - TO RECEIVE DEPUTATIONS, STATEMENTS, PETITIONS OR QUESTIONS RELATING TO THE BUSINESS OF THIS MEETING

At the time of publication no notifications had been received.

 

Minutes:

There were none.

70.

MINUTES - 27th January 2016 pdf icon PDF 166 KB

Minutes:

Councillor Paul May commented that following the report ‘The Strategic Direction of the RUH’, as well as receiving an update on an integrated IT system he wished the Select Committee to receive a further report that considered Clinical Services, Acute Services and the impact of the devolution proposals.

 

The Chair replied that she had discussed this with representatives from the RUH since the meeting and that they were happy bring further reports later in the year.

 

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

71.

Clinical Commissioning Group Update

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

Minutes:

Corinne Edwards addressed the Select Committee, a summary of the update is set out below.

 

Working with Practice Participation Groups

 

All 27 GP practices in B&NES are required to have a Patient Participation Group (PPG). These groups work in partnership with their practices to help patients take more responsibility for their health; contribute to the continuous improvement of services and quality of care; foster improved communication between the practice and its patients; and provide practical support for the practice to implement change.

 

The CCG organised a joint meeting for all PPGs on 14 March which attracted 16 PPG representatives.  The event was well received with the PPGs learning from each other and sharing best practice.  The PPG reps asked for the CCG to support them with creating Terms of Reference and providing training for new members a few times a year.

 

Update on A&E performance

 

Between the months of March to December 2015, an average 89.3% of patients were seen in A&E at the Royal United Hospitals Bath NHS Foundation Trust (RUH) within four hours. 

 

In January this percentage dropped to 76% (against a national target of 95%) and the RUH was one of 30 hospitals in England identified with the worst A&E waiting times for that month. The hospital continues to perform highly on quality aspects of A&E services. It remains one of the top performing trusts in the region in ensuring a swift handover between ambulance and A&E staff. This means patients arriving by ambulance are brought in quickly and ambulance crews are freed up to respond to 999 calls.

 

The System Resilience Group (SRG) continues to oversee implementation of a four-hour recovery plan to strengthen urgent care performance and ensure patients receive the highest quality care.

 

On 24th March we held an Urgent Care Summit with clinical leads from a number of key providers. Participants reviewed emergency admissions data and the range of services currently available and explored what we can do differently in order to reduce the growth in emergency admissions seen during 2015/16 without impacting adversely on patient experience.

 

Planning for 2016/17

 

We are developing our plans and priorities for next year to ensure high quality care and improve the health and wellbeing of the population we serve. Our Operational Plan is being developed in line with NHS England’s (NHSE) Five Year Forward View that outlines clearly the direction for the NHS and why we need to transform services in order to meet the challenges of the future.

 

We know that to sustain NHS services we need to get better at preventing disease, not just treating it and encourage everyone to take on responsibility to manage their own care.  We also need to focus on inequalities within our local community and reduce variation in health outcomes. 

 

As part of this and in line with NHSE planning guidance, we are working in partnership to develop our five year Sustainability and Transformation Plan (STP) across the wider health and care  ...  view the full minutes text for item 71.

Additional documents:

72.

Cabinet Member Update

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

Minutes:

The Cabinet Member for Adult Social Care & Health, Councillor Vic Pritchard addressed the Select Committee, a summary of his update is set out below.

 

B&NES Better Care Fund Plan 2016/17

 

The 2015 Autumn Spending Review set out an ambitious plan so that by 2020 health and social care are integrated across the country. Every part of the country must have a plan for this in 2017, implemented by 2020.  The Better Care Fund (BCF) is seen as a key enabler for local integration of health and care services.

 

Further details on how the BCF is to be used in 2016/17 were set out by NHS England in the 2016/17 Better Care Fund Policy Framework with detailed guidance on the requirements published on 23rd February 2016.  Local BCF Plans must be jointly agreed and signed-off by the Health and Wellbeing Board.  Timescales for developing, agreeing and submitting plans are challenging with the requirement for a “brief narrative plan” to be submitted on 21st March and final submissions due on 25th April 2016.

 

B&NES BCF Plan 2016/17, which was presented in draft form to B&NES Health and Wellbeing Board on 23rd March, reflects the vision and strategic priorities for integrated health and care set out in and evidenced by existing plans including the Better Care Plan 2014/15-2018/19, CCG 5-Year Strategic Plan 2014/15-2018/19, Health and Wellbeing Strategy and plans associated with the Council and CCG’s joint review of Community Services “your care, your way”.

 

Investment in Out-of-Hospital Services

 

Within the Home from Hospital schemes heading, the Handyperson service which expedites minor adaptations in the home to support hospital discharge is to transfer from the current provider, Somerset Care and Repair to an alternative provider, West of England Care and Repair under an established framework contract to secure the level of service needed and achieve improved value for money.  This change follows a review of the pilot service provided by Somerset Care and Repair.  There will be no adverse impact on the service and, indeed, the change of provider may result in an improvement to the number of people accessing the service as a result of greater awareness of the service and a simplified referral pathway.  Similarly, the support provided to the Royal United Hospital and hospital discharge process will not change.

 

An urgent domiciliary care response service, supporting people waiting to be discharged from hospital to home will be commissioned to further test an approach piloted on a small scale in 2015/16.  The service will complement the reablement and Discharge to Assess schemes and the aim is to reduce the number of days that patients are delayed in hospital, waiting for their care package to begin.  Building on the 2015/16 pilot, the intention is to further develop and test this approach during 2016/17 to evidence its impact and value. 

 

Delayed Transfers of Care Action Plan

 

The DTOC action plan has been developed using feedback from a recent multi-agency review of managing hospital discharges over  ...  view the full minutes text for item 72.

Additional documents:

73.

Public Health Update

The Select Committee will receive an update from Public Health on current issues.

Minutes:

Bruce Laurence, Director of Public Health addressed the Select Committee, a summary of his update is set out below.

 

Annual Health Protection report for B&NES, Glocs. Swindon and Wiltshire

 

This report covers:

  • Infection prevention and control including Health Care Acquired infection
  • Health emergency planning
  • Drug and alcohol services
  • Sexual health
  • Immunisation
  • Screening
  • Protection from environmental hazards including poisons, radiation and biological agents.

 

He informed the Select Committee that this is a major report with a focus on immunisations and screening.

 

He said that they now vaccinate against 18 illnesses routinely (some only in high risk groups e.g. HepB and BCG for Tuberculosis). He added that there are also 12 screening programmes some covering multiple diseases.

 

All perform well by benchmarking standards but there is room for improvement almost everywhere and the services need constant vigilance and encouragement. None are compulsory in UK and so the public need to be fully engaged and informed. The idea of informed consent is important particularly in screening programmes where there may be a balance between benefits and harms.

 

As well as ensuring a good general level of performance we also focus on inequalities in uptake hence work on cervical screening uptake by practice and also work on bowel screening in people with learning disabilities.

 

Finally a lot of work is going into tackling antimicrobial resistance and to pull this together an antimicrobial stewardship group will be set up that will report to the health protection board.

 

Legionella in water at Paulton maternity unit

 

He explained that a routine sample taken from the water supply at this unit was positive for Legionella at a high level. He said that no patients were harmed, but as a precautionary measure the unit was closed to admissions and work was done to clean and significantly modify the water system. The water is now clear and unit has reopened.

 

He stated that a Paulton Hospital Water Quality Incident Management Group was set up immediately in response to this finding, chaired by Becky Reynolds and including NHS property services, RUH, BaNES CCG. Sirona, comms. teams, PHE, AWP and others.

 

 

He said that this was a good example of successful multi agency work and also demonstrated the role of the Council’s public health function in overseeing and ensuring prompt joint action.

 

Health Inequalities Inquiry Day: 11th May

 

He informed them that this event is being organised on behalf of the Health and Wellbeing Board. It will include presentations from local residents, front line professionals and an external speaker from an area that has managed high levels of inequality and deprivation imaginatively. There will also be workshop sessions looking at what different partners contribute to reducing inequalities now and how we could work together more effectively. 

 

Teenage conceptions

 

He said it was really pleasing to note that in the latest (2014) data, the rate of teenage conceptions in B&NES was 12.3 conceptions per 1,000 women aged 15-17. This is a very low figure with less than 20  ...  view the full minutes text for item 73.

Additional documents:

74.

Healthwatch Update

The Select Committee will receive an update from Healthwatch on current issues.

Minutes:

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

 

Helping to improve patient engagement

 

She informed them that last year Healthwatch B&NES carried out its first Enter and View visit to a primary care setting – Oldfield Dental Practice in Bath. She said that following the release of the Enter and View report in the autumn, mydentist (formerly IDH Limited) the company that owns the practice, contacted Healthwatch B&NES to discuss approaches they can use to improve patient engagement in order to better understand their experiences.

 

She said mydentist expressed their hopes to engage with local Healthwatch projects across England in order to enhance independent scrutiny of the services they provide. She added that they had secured agreement to promote local Healthwatch information in all mydentist practices across the west of England region.

 

Sustainability and Transformation Plans

 

She stated that Healthwatch B&NES has started discussions with NHS B&NES Clinical Commissioning Group (CCG) to explore how public consultation can be built into the development of the area’s Sustainability and Transformation Plan. She said that these conversations will develop during April in conjunction with CCGs and local Healthwatch projects in Wiltshire and Swindon.

 

Implementation of the Accessible Information Standard

 

She said that The Care Forum was working with B&NES Council to plan and deliver a network to raise awareness and share experiences of implementing the Accessible Information Standard (AIS).

 

She explained that the Accessible Information Standard comes into force in July 2016 and aims to ensure that disabled patients receive information in formats that they can understand and have appropriate support to help them to communicate. She added that all NHS and publicly-funded adult social care services must follow AIS by law, under section 250 of the Health and Social Care Act 2012.

 

She said that if Councillors do receive correspondence on any matters relating to the residents’ experiences of using local health and social care services that would be of interest to Healthwatch then to contact them in any format they wish to enable further discussion.

 

Councillor Paul May asked if since the Enter and View visit to Oldfield Dental Practice Healthwatch had taken a pro-active role in looking at other practices.

 

Alex Francis replied that they have not approached any other practices directly, but the report had been sent to NHS England and the Care Quality Commission (CQC). She added that Healthwatch meet with the CQC on a quarterly basis to share intelligence gathered about local services.

 

The Director of Adult Care and Health Commissioning said that the subject of Dentistry Services was due to be discussed at a future meeting of the Select Committee.

 

Councillor Bryan Organ asked if Healthwatch were involved with the work of Patient Participation Groups (PPGs). He suggested that Healthwatch may be involved in future training for PPGs.

 

Alex Francis replied that they have made some PPGs aware of the role that they perform.

 

The Chair thanked her  ...  view the full minutes text for item 74.

Additional documents:

75.

Primary Care Strategy Briefing pdf icon PDF 103 KB

This report provides an overview of the emerging primary care strategy in B&NES and the context within which it is developing.

Minutes:

Corinne Edwards introduced this report to the Select Committee, she explained that in August 2013 NHS England launched ‘Improving general practice – a call to action’. She said that this work sought to engage and support action to transform services in local communities. She stated that growing reports of workforce pressures including recruitment and retention problems were noted.

 

She informed them the vast majority of GP practices in England hold either GMS or PMS contracts. The GMS contract is nationally negotiated, however all B&NES practices hold PMS contracts, locally agreed to better tackle particular needs of patients based on local priorities. She added that NHS England has undertaken a ‘PMS Review’ to ensure any extra funding above and beyond what an equivalent GMS practice would get is clearly linked to providing extra services.

 

She said the CCG is currently in joint commissioning arrangements with NHS England and will continue to do so during 2016/17 along with Wiltshire and Swindon CCGs. She added that co-commissioning was an opportunity for CCGs to have increased responsibility and influence over local decisions affecting primary care (medical).

 

She stated that NHS England and the CCG have invested in the development of a two year local project to pilot aspects supporting our strategy development.  The project, ‘Primary Care – Preparing for the Future’ (PCPF), delivered by Bath and North East Somerset Emergency Medical Services (BEMS+) runs until October 2016.

 

She explained that in October 2015, NHS England announced details of the ‘Primary Care Transformation Fund’. She said that this national fund covers the period from 2016 to 2019 and provides £750m to improve access and the range of services available in primary care, through investment in premises, technology, the workforce and support for working at scale.

 

She said that the CCG has been working with GP practices, representatives from Your Health Your Voice, Your Care Your Way and BEMS+ amongst others in order to draw together common themes arising from the relevant activities already underway. She added that this is intended to form the basis of any bid to the fund, and will in turn support the development of a primary care strategy.

 

Councillor Brian Organ commented that he was pleased to see that the first two practices (Catherine Cottage and Rush Hill) that had been inspected by the CQC had both received overall ratings of ‘Good’. He added that he felt that some members of the public were still finding difficulties in booking emergency appointments, but recognised that the service for longer term appointments was working well.

 

Councillor Tim Ball commented that he had recently found that the online repeat prescription service had crashed whilst in use and wished to make the appropriate officers aware.

 

Councillor Eleanor Jackson said that she had been contacted by a number of residents to say that they would like more continuity of service by being able to see the same GP at appointments.

 

Corinne Edwards replied that she was aware that continuity of GP’s is important to some  ...  view the full minutes text for item 75.

76.

Alcohol / Substance Misuse Update pdf icon PDF 102 KB

This paper is to give an update on the outcomes of young people’s and adult’s drug and alcohol treatment, including a young people’s update.

Additional documents:

Minutes:

The Drug and Alcohol Team and Young People’s Drug and Alcohol Commissioner gave a presentation to the Select Committee, a summary is set out below.

 

Drug Misuse

 

Parental drug use is a risk factor in 29% of all Serious Case Reviews.

 

A typical heroin user spends around £1,400 per month (2.5 times the average mortgage).

 

Alcohol Misuse

 

27% of serious case reviews mention alcohol misuse.

 

Alcohol misuse accounts for 17% of road fatalities.

 

B&NES Adults in treatment

 

More than 70% of adults in treatment in B&NES are complex & have multiple needs.

 

Growth in Alcohol Clients

 

Between 2012-13 and 2014-15 the number of clients in treatment to address alcohol misuse rose from 388 to 647 and the providers are working very flexibly to meet capacity.

 

It is estimated that there 200 are ‘Blue Light’ clients in B&NES costing the community more than £7 million per annum (Source Alcohol Concern). Agencies have been trained and provided information and practical tips on working with these clients.

 

Alcohol Concern is extending the project to support the families of ‘Blue Light’ clients and B&NES have again confirmed their desire to be part of this.

 

Recovery outcomes for B&NES alcohol clients

 

The rate of successful completions for B&NES alcohol clients is consistently high at between 46% – 50%.  This is considerably above the national average.

 

56% of parent’s successfully complete alcohol treatment. B&NES investment in local services has attracted a good deal of worthy commendation for its hospital alcohol liaison service, and for alcohol recovery outcomes. PHE recognises that alcohol has been a strategic priority for some time and an effective drug and alcohol treatment service is an essential component underpinning this wider treatment system.

 

Opiate / Non Opiate recovery rates

 

Supporting opiate users to overcome dependence is challenging, in B&NES currently 6.4% of opiate clients have successfully left treatment (who have not relapsed) compared to national performance of 7%.

 

Over 70% of adults in treatment have either ‘high’ or ‘very high’ complexity (e.g. poly drug and injecting use). There are good outcomes for other drug users in B&NES where approximately 40% successfully leave treatment (and do not relapse).

 

Harm Reduction

 

The rates for Hepatitis B vaccination and Hepatitis C testing remain much higher than the national average (B&NES is amongst the top performing areas with approximately 94% of eligible clients tested for Hepatitis C compared to 80% nationally and over 60% of B&NES clients have completed a course of Hepatitis B immunisations compared to 30% nationally.)

 

A needle and syringe exchange programme (NSP) continues to be delivered from treatment centres in Bath and Midsomer Norton, and pharmacies throughout B&NES to reduce the risk of blood borne viruses; reduce drug litter; and deliver harm reduction advice to service users on over-dose prevention, safer sex and reducing risk-taking behaviour. 

 

During 2015/16 the providers changed how they deliver NSP to the most vulnerable or hard to reach clients (complex opiate users and steroid users) working  ...  view the full minutes text for item 76.

77.

Your Care, Your Way Update

The Select Committee will receive a presentation on this item at the meeting.

Minutes:

The Your Care, Your Way Project Lead gave a presentation to the Select Committee, a brief summary is set out below.

 

The Procurement Process

 

65 expressions of interest were given.

 

4 bids have been received and the names of those will be made public on April 18th.

 

In May the process will see the 4 bids reduced down to 2 with the aim of announcing the preferred provider in mid-July.

 

Critical Success Factors

 

·  A person not a condition

 

·  A single plan

 

·  Managing change

 

·  Information

 

·  Value for money

 

 

Commercial Model

 

Prime Provider

·  Living well and staying well

·  Regaining health and independence

·  Enhanced and specialist support

 

Learning the lessons from elsewhere

 

Rigorous evaluation and assessment of risks within the procurement, including re-assessment of bidders where there are material changes to their arrangement during the process, and a full awareness of ownership and legal structures associated with partnership arrangements

 

The ability to triangulate the narrative (quality response) of a bid with income and staffing assumptions contained within a bid

 

A commitment to proactive engagement with, and full reporting to, Executive Officers and Members

 

Continuing Engagement

 

·  Information Sharing

 

·  Events

 

·  Community Champions

 

Councillor Eleanor Jackson said that she had concerns over the preferred provider being able to make too much profit.

 

The Your Care, Your Way Project Lead replied that the matters of value for money and profit are both assessed as part of this process. She added that they were not looking for this to be a bidding war and that it was about how we can use £70m to the best of its ability. She stated that a large amount of due diligence will take place.

 

Councillor Paul May asked if the project had been subject to audit, both internally and externally.

 

The Director of Adult Care and Health Commissioning replied that the Council’s Section 151 Officer has been involved throughout the process.

 

The Chair thanked the Your Care, Your Way Project Lead for her presentation on behalf of the Select Committee.

Additional documents:

78.

Select Committee Workplan pdf icon PDF 111 KB

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.

 

Minutes:

The Chair introduced this item to the Select Committee.

 

Councillor Paul May asked for a new date to be set for when the RUH Strategic Plan can be discussed. He said that if it were possible he would like their Chief Executive to be present at the meeting.

 

The Chair asked for members to state clearly what information they would like to receive from the RUH.

 

Councillor Eleanor Jackson suggested that the new Chief Executive of AWP should also be invited to a future meeting of the Select Committee.

 

The Select Committee RESOLVED to agree with these proposals.