Agenda and minutes

The Chair welcomed everyone to the meeting.

The Chair drew attention to the emergency evacuation procedure.

There were none.

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 Lin Patterson declared an other interest in agenda item 15 (Your Care, Your Way Update) as she has signed a petition regarding the non-privatisation of the Health Service.

Councillor Paul May declared an other interest in agenda item 15 (Your Care, Your Way Update) as he is a Sirona board member.

Susan Charles, WWISE Network made a statement to the Panel on the subject of Warm Water Swimming Pools. A copy of the statement can be found on the Panel’s Minute Book, a summary is set out below.

She asked were members of the Committee aware that the plans for the remodelling of the Bath Leisure Centre & also the initial proposals for Keynsham Leisure Centres do not address the need for a warm water pool suitable for disabled children, young people and adults living with long term conditions so they can exercise & go swimming for leisure & recreation as well as to maintain their health & fitness along with the rest of the community?

She said that in 2014 there was enormous support for the concept, from this committee as well as a number of other committees we talked to at the time, and we were assured the Council & the CCG would be “working closely ... to ensure the new leisure contract provides the best possible service for local people and supports them to live healthy lifestyles”

She added that since then we have met with the consultants & officers who negotiated the contract & had a very positive discussion with the Local Area Manager for GLL - they were all very supportive of it being included in the remodelling plans. She said it is with dismay therefore that we find it is not in the plans for Bath Leisure Centre nor in the initial proposals for Keynsham.

She explained that in Bath a second warm water pool has been included but, at 60–90cm / 2-3ft maximum depth, it is still too shallow for older children, young people & adults. She added that an additional 30cm/1ft depth would make all the difference and this could be quite achievable in the space available in the Leisure Centre.

She stated that with a suitable pool available to them they could all lead a more active lifestyle, not only improving their physical & mental health and quality of life, but also maintaining more independence so needing less costly NHS treatment interventions & less additional support from Social Services – potentially enormous savings as well being in line with the CCGs 5yr plan, the Council’s Joint Health & Wellbeing & Fit for Life Strategies, and the Children & Young People's Plan besides complying with the Council's Protocol for Decision Making, the Council's Equalities Policy & also its Pledge to Young People.

She said that we feel the Council is failing to capitalise on this once in a lifetime opportunity to ensure a warm water pool suitable for everyone living with long term conditions is included in the remodelled Leisure Centres and we ask the Committee to make representation that the design as it is proposed is given further consideration by both the Council & GLL.

Councillor Lin Patterson asked with the cuts the Council have to make to the current budget over the next few years, how the cost of such a pool can be justified.

Susan Charles replied that the changes needed to the proposed design  ...  view the full minutes text for item 20.

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

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

Tracey Cox addressed the Select Committee, a summary of the update is set out below.

Your Care, Your Way

The second stage of the procurement process is now complete and both bidders (Virgin Care and the Sirona partnership) have successfully made it through to the third and final stage.

The bidders’ final responses will be scored by the community champions and our expert evaluators in early August. The organisation with the highest score at the end of this process will be announced on 18 August and will become the preferred bidder. They will then begin eleven weeks of intensive testing and discussions with the CCG and Council to produce a final business case. 

The award of the contract will require formal approval from the Council Cabinet and CCG Board at public meetings on the 9th and 10th November respectively before the new contract begins on 1 April 2017.

A&E performance

Performance of the urgent care system against the four hour target continues to be challenging but there was a slight improvement of 0.7% from April with performance up to 87.6% in May. This is still below the planned trajectory for the year however. 

The four hour performance has been impacted by a number of factors including poor flow into inpatient specialty beds, higher attendances at A&E and more non-elective admissions compared to May 2015 as well as an increase in the number of delayed transfers of care.  A system-wide improvement plan is in place setting out the actions required from the RUH, BaNES CCG and Wiltshire CCG to support recovery.

Primary Care Transformation Fund and Statement of Intent

The CCG has submitted a bid to NHS England’s Estates and Technology Transformation Fund on behalf of our 26 member practices. We are seeking new funding for a range of initiatives including expansion/relocation of practices as well as investment in new digital technology to support e-consultations and self-care. We expect to receive some initial feedback from NHS England at the end of July.

We also presented our statement of intent for general practice at all five of the Council’s Area Forums over the past few weeks.  There has been broad support for our vision and approach from all five areas with a range of feedback collected about the provision of GP appointments on evenings and weekends.

GP Patient Survey Results

GP practices in B&NES have scored highest in the country for patient experience in the latest GP Patient Survey.  The results show that 94% of B&NES patients describe their experience at their GP surgery as ‘good’, compared with a national average of 85%.

Councillor Eleanor Jackson questioned the response rate of the survey and asked what proportion of patients had responded.

Tracey Cox replied that 3,185 people replied to the survey which was a 46% response rate.

Councillor Tim Ball commented that in his opinion the local GP service was excellent.

Councillor Lin Patterson asked if it were possible to see a breakdown of responses by area.

Tracey  ...  view the full minutes text for item 22.

The Cabinet Member will update the Panel on any relevant issues. Panel members may ask questions.

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

Serena House Refuge Service

A new refuge accommodation service for domestic abuse survivors has been launched in Bath and North East Somerset with the help of £100,000 government funding.

Bath & North East Somerset Council secured the funding from the Department for Communities and Local Government (DCLG) in December last year after successfully bidding in order to establish refuge services that can work with clients (both women and men with or without children), who have complex or multiple needs.

The new service is called Serena House and it will provide up to eight new units of refuge accommodation in B&NES.  The first 2 units have been secured with the help of Curo and were due to open last month (June) and are situated in Keynsham where there are 2 more units in the pipeline. The project group, which includes B&NES Council (Supporting People Team), Curo, DHI and Julian House, is looking to secure further accommodation in Midsomer Norton and Radstock  which, along with Keynsham, has been identified as an area with high need and no existing refuge provision.

B&NES/Swindon/Wiltshire Sustainability and Transformation Plan

All areas in England are required to have a Sustainability and Transformation Plan (STP) showing how local health and care services will evolve and become sustainable over the next five years.  To deliver plans that ae based on the needs of local populations, local health and care systems came together in January 2016 to form 44 STP “footprints”.  In most cases, these footprints bring together more than one local authority/Clinical Commissioning Group (CCG) area.  Bath and North East Somerset is in a STP footprint with Swindon and Wiltshire.  Health and care organisations in these three areas are working together on an STP for B&NES/Swindon/Wiltshire (BSW) with the aim of improving our local population’s health and wellbeing, to improve service quality and to deliver financial stability.

The health and care needs of the STP population are diverse and we are developing a joint approach that takes this into account. We will also ensure it aligns with individual organisational plans, including, in B&NES the your care, your way community services review and, also, with local Health and Wellbeing Strategies.

Closure of Rosewell Care Home, High Littleton

The closure of Rosewell is progressing well; Rosewell at the beginning of the home closure had 55 occupied beds.

The Council, CCG and Sirona Care & Health have ensured that every resident has an allocated social worker. Steps have been taken to ensure that residents can be safely transferred to alternative care providers in order to best serve their needs. And residents and their families will have as much choice and control over their move as possible.

As of the 14^th July 2016 there are 22 residents left, of these -16 have new homes and planned dates for moves. The remaining 6 are awaiting assessments  ...  view the full minutes text for item 23.

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

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

He said that when Public Health came under the umbrella of local government it became responsible for primary prevention, but that there was limited capacity for secondary prevention for which the NHS retained some responsibility. Although the distinction is somewhat arbitrary it is illustrated by the fact that the new national diabetes prevention programme is funded through the NHS.

He commented that Public Health support the efforts of the Sustainability and Transformation Plan whilst recognising the need for local plans to remain.

Health Inequalities Summit

This was a really well attended event that showed good support from local services to identify areas of need.

E.coli

He explained that this latest case started in the South West of England and that around 150 reports have been made nationally. He added that whenever a case is reported it involves a large piece of work to identify the source and prevent further cases. He said that imported salad leaves were the contributing factor on this occasion and urged the public to wash salad leaves prior to eating them.

Children’s Health Scrutiny Panel

The meeting focused on the areas of Children’s Mental Health, Childhood Obesity and the General Health of Children. He said that it was a very useful session to hold.

Councillor Geoff Ward asked how many E.coli cases had been reported within B&NES.

Dr Laurence replied that one, possibly two cases had been reported.

Councillor Eleanor Jackson said that data from a report later in the agenda shows that we have good figures locally in terms of sexual health and she asked if this was due to successful education work.

Dr Laurence replied that good services were available locally in terms of contraception and teenage pregnancies.

The Public Health Development & Commissioning Manager added that it was a really responsive that had good staff within it.

The Chair thanked Dr Laurence for his update on behalf of the Select Committee.

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.

Healthwatch B&NES Annual Report 2015-16

She said that the third year of The Care Forum’s contract to provide Healthwatch B&NES has been its most successful yet, with an 89% increase in the amount of patient and public engagement work carried out compared to the previous year.

She said that strong collaboration between staff, partners and volunteers has been the main contributor to the project’s success. Although a small project team, the dedication and commitment of its volunteers has enabled us to carry out six Enter and View visits to care homes across the district, and receive over 240 individual comments covering all aspects of health and social care, from GPs to hospital, care homes to community based support. We are pleased to say that last year also saw recruitment of eight new Healthwatch volunteers, increasing the project’s volunteer base by around 30%.

Healthwatch B&NES priorities 2016-17

The Healthwatch B&NES advisory group met in June to set the priorities for the project during 2016-17. These priorities have been selected in line with the strategic focus established by the B&NES Health and Wellbeing Board, the feedback that Healthwatch B&NES has gathered over the last 12 months and The Care Forum’s organisational objectives.

The three priority areas for Healthwatch B&NES this year will be:

Mental health – with particular focus on the new inpatient development at Combe Park; Child and Adolescent Mental Health Services (CAMHS); and the lived experiences of mental health service users and their carers – with the aim that this will feed into the B&NES Mental Health Collaborative Alliance

Access to services – specifically implementation and impact of the Accessible Information Standard legislation

Urgent care – including people’s experiences of using three main points of access: NHS 111, community pharmacists and NHS Choices.

Sustainability and Transformation Plan (STP)

Over the last couple of months Healthwatch B&NES has been working in conjunction with Healthwatch Swindon and Healthwatch Wiltshire to explore the role that it can take in supporting development of the B&NES, Swindon and Wiltshire STP.

There is a valuable role for Healthwatch to play in engaging with the public and voluntary sector regarding the STP. In addition to meeting with James Scott, STP strategic lead, and colleagues at NHS BaNES Clinical Commissioning Group, representatives from the three Healthwatch projects across the footprint have also been invited to sit on the STP Board.

At present it is anticipated that engagement around the STP will begin in September. In the meantime Healthwatch B&NES is working closely with partners to ensure that engagement is a key part of this process.

Councillor Lin Patterson asked what role Healthwatch plays in terms of prevention. In particular, she asked their view regarding funding for over 18 year olds leaving CAMHS. She said that this should be focussed upon prior to it becoming a crisis.

Alex  ...  view the full minutes text for item 25.

This paper has been prepared to ensure that the B&NES Health and Wellbeing Select Committee are kept up-to-date with the planned relocation of the Royal United Hospital’s (RUH) Sexual Health Clinic, along with clinicians and support staff, from the RUH’s Combe Park site, to shared premises at the Bath Riverside Health Centre.

The Associate Director for Integration, RUH introduced this report to the Select Committee. She explained the planned relocation of the Royal United Hospital’s (RUH) Sexual Health Clinic, along with clinicians and support staff, from the RUH’s Combe Park site, to shared premises at the Bath Riverside Health Centre. She stated that the Trust is planning to relocate the Clinic at the end of 2016, to share ground floor premises with the Contraception and Sexual Health (CaSH) services currently provided by Sirona.

She added that other services currently located at the Centre include Bath and North East Somerset Enhanced Medical Service (BEMS) and Avon and Wiltshire Mental Health Partnership (AWP).

She said there would be no change in the level of service provision for patients of the Sexual Health Clinic and that the RUH will continue to provide the same range of services at the Riverside Health Centre and patients will continue to be seen and treated by the same team to the same high standards.

She informed the Select Committee that a focussed clinical and patient and public engagement on the planned relocation of the service from the RUH Combe Park site, to the Riverside Health Centre, ran from 18th April to 27^th June, a period of ten weeks, asking people to share their thoughts on the plans to relocate, including any benefits, concerns or anything additional people felt needed to be considered ahead of moving.

She said that the majority of respondents were positive about the plan to relocate the service, identifying easier travel and access including better public transport links, central location and co-location with CaSH as amongst the benefits of moving to the Riverside.

She explained that the HIV Clinic will continue to run on the same morning as a separate clinic, so patients will share the dedicated waiting area only with other HIV patients during this time and not with other Sexual Health patients. She added that there would be a separate reception desk and waiting room for patients attending the Sexual Health Clinic.

She said that subject to the Select Committee’s endorsement of the plan to relocate the Sexual Health Clinic to the Riverside Health Centre in Bath, the intention is to relocate the Clinic on World AIDS Day, December 1^st 2016.

Councillor Paul May said that this was a prime example of working with the community.

Councillor Eleanor Jackson commended the excellent work of the project.

The Select Committee RESOLVED to:

·  Note the outcome of the impact assessments and patient and public engagement activities which provided opportunities for patients, staff, stakeholders and the public to provide feedback on the planned move, and which confirmed that the effects of this change are considered minimal and that there are a number of positive aspects to the change, for current and future patients and for the wider healthcare community.

·  Endorse the proposal to relocate the Sexual Health Clinic from the RUH’s Combe Down site to the Riverside Health Centre in Bath.

The integrated GP out-of-hours and Urgent Care Centre service has been reviewed by commissioners, together with the provider Bath and North East Somerset Doctors Urgent Care (BDUC), to identify changes to better match staff capacity to patient demand.

The Commissioning Manager for Urgent Care and Non-Acute Services introduced this report to the Select Committee. She explained that in order to better meet the needs of patients, the service will make the following three key changes:

·  From July, remove GPs from the rota at the Urgent Care Centre on weekdays from 08:00-12:00, but retain Nurse Practitioners who have the skills and experience to provide appropriate care and treatment for patients.

·  If no major issues are identified with the above action, removal of GPs from the rota at the Urgent Care Centre from 12:00 – 16:00 from September, again with Nurse Practitioner cover during this period.

·  Introduction of a weekend remote telephone triage shift to facilitate GPs managing the telephone queue more quickly. This is in addition to the GP staffing that is already in place at the Urgent Care Centre and facilitates the service meeting the multiple priorities of patients in the Centre and those who are at home or on the phone.

Councillor Lin Patterson asked what would happen if a GP were required by a patient.

The Commissioning Manager for Urgent Care and Non-Acute Services replied that analysis suggests it is very unlikely that a GP is required to meet patient demand in the specified period, however if required, a GP can be referred to by telephone. She added that patients would then be streamed appropriately according to their condition.

Councillor Eleanor Jackson commented that she had personally found this service to be invaluable. She referred to the section of the report which stated there are ‘no financial implications’ from this decision and asked would the service not be cheaper without a GP in situe.

The Commissioning Manager for Urgent Care and Non-Acute Services replied that there were no implications to the CCG through their current contract.

The Select Committee RESOLVED to approve the three recommendations above as indicated by the bullet points.

The Select Committee will receive a presentation on this matter from Dr Lou Farbus, Head of Stakeholder Engagement & Specialised Commissioning.

The Select Committee were given a presentation on this matter from Dr Lou Farbus, Head of Stakeholder Engagement, NHS England (South), a summary of her presentation is set out below.

What is specialised commissioning?

Planning, funding, procuring, and performance monitoring specialised services.

Specialised Services = less common illnesses, conditions, treatments or services.

How do I know what is ‘specialised’?

Specialised services now cost £15bn a year across 146 specialised (‘prescribed’) services that are commissioned by 10 specialised commissioning ‘hubs’ across England.

The list of specialised services is under constant review. Each service comes under one of six ‘Programmes of Care’:

·  Internal medicine – digestion, renal, hepatobiliary and circulatory system

·  Cancer

·  Mental health

·  Trauma – traumatic injury, orthopaedics, head and neck and rehabilitation

·  Women and children – women and children, congenital and inherited diseases

·  Blood and infection – infection, immunity and haematology

How are they commissioned?

To be most safe and cost effective specialised services need to be planned and commissioned using populations of at least 1 million, which is larger than the populations served by most Local Authorities and Clinical Commissioning Groups, with many of the rarer conditions needing much larger planning populations than this. Consequently, specialised services are not provided in every hospital and tend to be found only in larger ones, which perhaps provide a range of specialised services. It is for these reasons that specialised services are commissioned on behalf of people who live in many different localities, both within and outside of the South West of England.

The benefits

·  Achieve the best outcomes for patients & carers by reducing ‘occasional practice’

·  Improve the patient/carer experience by concentrating resources in state of the art facilities

·  Build clinical competence

·  Improve the training of specialist staff

·  Ensure cost-effectiveness in provision

·  Make the best use of scarce resources [including staff expertise, high-tech equipment, donor organs, etc].

·  Support research and innovation

Challenges

·  We can’t please all of the people all of the time – services that move closer to some move further from others

·  Limited resources

·  Geography and infrastructure

·  Demand and capacity

·  Stakeholder engagement & maintaining momentum on shifting sands

Operating Model Design Principles

The South Way:

·  One team, and one way of working across the South

·  Principle of subsidiarity – local action on local issues

Integrated contract management:

·  Integrated contract, finance, clinical, service and business intelligence teams to deliver a multidisciplinary contract management approach.

·  Working as a team

Clear accountability:

·  Clear leadership responsibilities and lines of accountability

Better control:

·  Increased structure and improved processes to enable greater financial and operational control

South West Collaborative Commissioning Service Specific Priorities

• CAMHs
• Perinatal Mental Health
• Low/Medium secure
• Rehabilitation – inclusive of Neuro-rehab and Spinal Cord Injury
• Vascular – specifically Devon & Cornwall, and
• STP (unknown at July ‘16) and locality specific (e.g. Devon Success Regime; Cornwall Devolution) priorities

Planned Business (but not as usual)

·  Planned national procurements: CAMHS & PET/CT

·  Service Spec Compliance: Derogation

·  Quality & Safety: Performance Management

·  Responding to changes triggered by EU Referendum as necessary

·  Supporting and assuring the PPE re: migration of services  ...  view the full minutes text for item 28.

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

The Select Committee received a presentation from the Your Care, Your Way Project Lead, a summary is set out below.

She explained that the outline bid stage had concluded 10 days ago and that an Evaluation Team, including the Community Champions will now assess the two bidders final responses in the form of a draft contract. She added that references from people who already work with the bidders would be sought in the next stage.

She said that a ‘Question Time’ event had been held recently where positive feedback was received for both bidders.

She stated the intention to announce a preferred bidder on August 18^th.

Councillor Geoff Ward asked if the preference of the Community Champions was taken into account.

The Your Care, Your Way Project Lead replied that each member of the Evaluation Team registers their score independently.

Councillor Geoff Ward asked if they have been given any guidance as part of the process.

The Your Care, Your Way Project Lead replied that training sessions have been held for them and that they have been advised that they are not comparing the bidders against each other they are comparing them against the agreed criteria. She added that they were relishing getting into the detail of the draft contracts.

The Chair asked how much would the process cost.

The Your Care, Your Way Project Lead replied that it would be £1.1m, but that this was within existing resources.

The Director of Adult Care and Health Commissioning added that this figure includes legal advice, consultation and engagement. She said that she felt that the project had been carried out very well.

Councillor Eleanor Jackson asked if any profits would be put back into the service if Virgin Care were awarded the contract.

The Director of Adult Care and Health Commissioning replied that this was raised at the ‘Question Time’ event and it was stated that no dividend would be taken by Richard Branson and that he was the sole shareholder.

Councillor Eleanor Jackson asked what happens if after a preferred bidder has been selected something happens or is identified that parties cannot agree on.

The Your Care, Your Way Project Lead replied that then there is the option to roll back to the other bidder at a slight delay to the project.

The Chair thanked her for her presentation on behalf of the Select Committee.

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 Select Committee approved their workplan as printed.