Agenda and minutes

Venue: Council Chamber - Guildhall, Bath. View directions

Contact: Mark Durnford  01225 394458

No. Item




The Chair welcomed everyone to the meeting.




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



The Chair drew attention to the emergency evacuation procedure.





Councillor Geoff Ward had sent his apologies to the Select Committee, Councillor Karen Warrington was present as his substitute for the duration of the meeting.


Alex Francis, Healthwatch had 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 Paul May declared an other interest in agenda item 15 (Your Care, Your Way) as he is a non-executive Sirona board member.




There was none.



At the time of publication no notifications had been received.



There were none.


MINUTES - 28th September 2016 pdf icon PDF 131 KB


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


Clinical Commissioning Group Update

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


The CCG saw increased demand and pressure on services over the summer and performance against the A&E waiting time target (95 per cent of attendees to be seen within four hours) dropped to 79.3 per cent in August 2016.  However, performance for October 2016 improved to 91.5 per cent.


Local performance and progress against the locally agreed A&E Improvement Plan continues to be overseen by regular tripartite meetings of the Royal United Hospitals (RUH), CCGs, NHS England and NHS Improvement.  The newly constituted A&E Delivery Board is focusing on responding to the five nationally mandated actions to support on-going recovery of performance.


CCG Improvement and Assessment Framework


Our assurance ratings for quarter two of 2016/17 are:


Better Health – Good  

Better Care – Requires Improvement

Sustainability – Requires Improvement 

Leadership – Requires Improvement


NHS England acknowledged a lot of good work has been undertaken around leadership and there are many positive examples of the good work the CCG is carrying out.  However, due to concerns around our performance within ‘Sustainability’ and ‘Better Care’, we are also assessed as requires improvement under ‘Leadership’. 


Prescribing changes consultation


On 24 November, the CCG launched a four week period of public engagement on proposed changes to our prescribing policy. The CCG has been reviewing treatments that are shown to be less clinically effective, provide insufficient health benefits and those that do not represent good value for money. As a result, there are two proposed changes to the local prescribing policy:


·  To stop prescriptions of gluten-free products for people with coeliac disease


·  To stop prescriptions for two groups of over-the-counter medicines – painkillers and antihistamines – when they are used for short-term, minor ailments such as mild hayfever, headache, coughs and colds.


Operational Plan


Our draft Operational Plan for 2017-19 has been submitted to NHS England. The final version is due on Friday 23 December. For the first time, plans are required over a two-year period and must support the delivery of the Sustainability and Transformation Plan for B&NES, Swindon and Wiltshire.


NHS England is also providing new funding to improve access and increase capacity in general practice by April 2019.  Our Operational Plan includes a section on how we will support and transform general practice to offer extended opening hours across evenings and weekends.


Delegated Commissioning


Our 26 member practices are voting to decide if the CCG should take on delegated commissioning of primary care from NHS England. We have been working under joint commissioning arrangements in 2016-17 but delegated commissioning would give the CCG greater control over our future and help us to align our plans across community and acute services.


Swindon and Wiltshire CCGs are also expected to move to delegated commissioning so we have agreed that  ...  view the full minutes text for item 51.

Additional documents:


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.


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.


The Mental Health and Wellbeing Charter


The Mental Health and Wellbeing Charter has been created locally by people who have received support for their mental health.  This has involved a partnership between New Hope, St Mungo’s, Healthwatch, Avon and Wiltshire Mental Health Partnership, B&NES Council, other local organisations and Mental Health Commissioners. This has involved partnerships, pilot groups, focus groups and eventually a launch event in May 2016.


The idea of the Charter was introduced and led by Caroline Mellers, a St Mungo’s and New Hope volunteer.  The Charter has been written into contracts for the Mental Health and Wellbeing Pathways in the new commissioning cycle from April 2017.  Caroline has recently received Quartet funding to raise awareness of the Charter to the B&NES mental health sector. 


Assistive Technology Event


The Council hosted an assistive technology event in Keynsham on the 11th November. 17 providers of innovative assistive technology solutions showcased their services to an audience of over 100 health and care professionals, and some providers gave presentations and demonstrations of their services.


Feedback from the event was universally positive, with many attendees and presenters wanting to see something similar held again, with suggestions to hold an event specifically targeted at service users and carers.


Commissioners are now looking at the next steps to continue raising awareness and the profile of assistive technology within B&NES.


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

Additional documents:


Public Health Update

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 of the update is set out below.


Family Nurse Partnership (FNP)


With our success in reducing the under 19 pregnancy rate, and with the increasing flexibility in the national model and licence requirements the FNP service has been able to widen its eligibility criteria.


The team are working closely with maternity services to ensure that women with vulnerabilities are identified early and referred appropriately and as this is a significant change the service will monitor the uptake closely as there are a maximum number of 80 places at any one time and the service is intensive from pregnancy through to age 2.


Mental health of boys and young men


In line with national guidance the BANES Suicide Prevention Strategy 2016-2019 highlights the importance of:


-  Integrating suicide prevention work within a broader framework for promoting mental health and wellbeing


-  Tailoring approaches to improve mental health in specific groups and reduce risk in high risk groups


These two priorities are reflected in a mini pilot focussing on boys and young men. Like elsewhere in England, in BANES men are three times more likely to die by suicide than women.  Evidence suggests there are a number of reasons why this might be the case.  Stigma around emotional distress and mental illness and social constructs of masculinity make it harder for men to manage feelings of depression or unhappiness in times of crisis and more reluctant to seek (or be seen to seek) help.  


The project seeks to identify good practice across services which will be shared with schools and other settings as case studies. Members of the project are committed to exploring how they can challenge stigmatising views that inhibit help seeking behaviours and make it difficult for boys and young men to talk about their feelings and worries within their setting.


Findings will be shared in an easy to use guide for schools and services and will include case studies and links to other resources.  The opportunity to develop some staff training during the summer term 2017 is also being explored.


Alcohol Control


Blue Light Change Resistant Drinker Training


During October over 90 frontline workers were trained in new approaches to supporting change resistant drinkers.. The demand for the training exceeded expectations and future dates are being planned for 2017.


Tobacco Control


Bath College Smoke Free City Centre Campus


Bath College City Centre site has been supported in its preparation for and implementation of a Smoke Free Site which went live on 5th September 2016. Free prescriptions have been offered for staff wanting to quit and support for students has been promoted via fresher’s week. The College are also ran a whole college campaign during Stoptober. Reducing the number of regular smokers (baseline = 33% smoking at least 1 cigarette a week) is the whole college outcome identified for  ...  view the full minutes text for item 53.

Additional documents:


Healthwatch Update

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



Alex Francis, Healthwatch was unable to attend the meeting. The Chair thanked her for her written report on behalf of the Select Committee which can be found on their Minute Book and as an online appendix to these minutes.

Additional documents:


Sustainability and Transformation Plan Update pdf icon PDF 66 KB

The attached report sets out a strategic summary of the Bath, Swindon and Wiltshire STP ahead of the publication of the full ‘emerging’ plan on the 14th December.

Additional documents:


Tracey Cox, CCG Chief Officer introduced this item. She explained that 44 Sustainability and Transformation Plans (STPs) are in the process of being developed across England as a local implementation plan for the Five Year Forward View (FYFV). She added that the FYFV sets out the five year blue print for transformation aimed at addressing the three health and wellbeing, quality and finance gaps across the NHS and social care.


She stated that the Bath, Swindon and Wiltshire STP full ‘emerging’ plan was due to be published on December 14th.


She said that the plan is at a much earlier stage of development than other STPs and we see this as an opportunity to engage our population in making choices. She added that if we do not continue to make efficiencies, then we know there will be a gap between our patient’s needs and available health and care resources of approximately £300m by 2020/21.


She said that over the next five years we are planning to change services around five priority areas that will improve our population’s health and wellbeing, improve the quality of care people receive and ensure our services are efficient.


·  Priority 1: Transforming primary care

·  Priority 2: More focus on prevention and proactive care

·  Priority 3: Making best use of technology and our public estates

·  Priority 4: A modern workforce

·  Priority 5: Improved collaboration across our hospital trusts


Councillor Paul May commented that the summary of the Plan before the Select Committee was not detailed enough and that he awaited the publication of the emerging plan. He said that there was only one vague reference made to specialised services, no recognition of devolution, no reference made to Sirona or Virgin Care. He said that residents require more information.


Tracey Cox replied that as the report was a summary of the plan it would not have that level of detail within it. She added that she hoped the points raised would be covered by the emerging plan when it is published in December. She stated that during this process that Sirona had decided to step away from discussions and that now that Virgin Care have been identified as the preferred bidder through Your Care, Your Way that they would be invited to add their thoughts to the plan.


Councillor Tim Ball commented that services should be available to people where they need them and that patients should be allowed to choose the services they want to use.


Tracey Cox replied that she did not anticipate patients within B&NES having to stop using the RUH. She added the process is not intended to disturb patient flow and should be seen as a way of working with the other authorities to provide a better service.


Councillor Eleanor Jackson commented that she was pleased to see within the report there were plans to have ‘Improved access to psychological support for patients with mental health needs’. She asked if following the Brexit decision were plans in place to address the potential  ...  view the full minutes text for item 55.


CQC - RUH Inspection pdf icon PDF 2 MB

The recent inspection report is attached for the Select Committee to read. Officers from the CQC and RUH will attend the meeting.


Catherine Campbell, CQC Inspection Manager gave a presentation to the Select Committee regarding this item. 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.


CQC Inspection: 15-18 and 29 March 2016


The range of services provided by Royal United Hospital Bath NHS Foundation Trust, including the Royal National Hospital for Rheumatic Diseases and the community maternity services required a diverse inspection team:


  • 22 inspectors
  • 29 specialist advisors
  • plus support staff


11 services were inspected:


  • 8 acute services at the Royal United Hospital Bath site
  • 2 acute services at the Royal National Hospital for Rheumatic Diseases
  • The community maternity service (including midwifery led birthing centres)


CQC’s 5 key questions


Safe? Are people protected from abuse and avoidable harm?


Effective? Does people’s care and treatment achieve good outcomes and promote a good quality of life, and is it evidence-based where possible?


Caring? Do staff involve and treat people with compassion, kindness, dignity and respect?


Responsive?  Are services organised so that they meet people’s needs?


Well-led? Does the leadership, management and governance of the organisation assure the delivery of high-quality patient-centred care, support learning and innovation and promote an open and fair culture?


Overall ratings


The trust was rated as outstanding for caring, which is a notable achievement, reflecting high compassion, support and patient involvement in delivering care.


The effective and well-led domains were rated as good and the safety and responsive domains as requires improvement

There was a wide range in the ratings given to individual services:


  1 Outstanding

  6 Good

  4 Requires Improvement


Inspection Findings


Safety: Requires improvement


Effective: Good


Caring: Outstanding


Responsive: Requires Improvement


Well-led: Good


There were many areas of excellent and innovative practice. Risk reporting and safety were largely well managed and the governance systems ensured ownership at an appropriate level. Care and treatment were effective and evidence based. There was very good multi-disciplinary working and programmes that prevented hospital admission. Training was generally good. Staff were caring and compassionate and true dedication to the patients shone through. Services were flexible and responsive. Clinical and overall leadership was strong throughout and there was effective staff engagement.


Outstanding Practice


  We saw numerous examples of outstanding practice in the care and compassion shown to patients as well as involvement in their care and treatment, particularly in services for children and young people and in end of life care.


  The Conversation Project: an initiative to improve communication between staff and patients and relatives about care for the dying patient.


  We saw some outstanding practice within the outpatients department, in how staff treated and supported patients living with learning difficulties.


  The Royal National Hospital for Rheumatic Disease was a centre of excellence for lupus care and treatment.


  The Fibromyalgia service had been developed in response to patient need and was now being set up to become a franchised model to share the programme with  ...  view the full minutes text for item 56.

Additional documents:


CQC - AWP Inspection pdf icon PDF 612 KB

The recent inspection report is attached for the Select Committee to read. Officers from the CQC and AWP will attend the meeting and give a brief presentation.


Tony Fletcher, CQC Inspection Manager introduced this report to the Select Committee. He explained that the inspection visit was carried out over a two week period from 16 May to 27 May 2016 and covered a large geographical area and range of services.


He stated that during the inspection we visited 37 wards, four health based places of safety, 28 community teams and spoke with:

• 127 patients

• 22 carers

• Members of the executive team and trust board, including the chief executive and the chair

• Twenty two senior managers

• 93 service and ward managers

• 357 other staff, including registered nurses, health care support workers, doctors, psychologists, occupational therapists and practitioners.


He highlighted three key areas from within the report.


Wards for patients with dementia were not dementia friendly with the exception of ward four in Bath. However, environmental security in the forensic and secure services had improved significantly since our inspection in June 2014 and risk were managed well at both a ward level and individual patient level.


We had serious concerns with the timeliness of Mental Health Act assessments for people detained in the places of safety. Data showed that a significant number of people were in places of safety for over 12 hours waiting for assessment, and many for two or three days. There were eight occasions between March 2015 and April 2016 where people were there beyond the legal limit of 72 hours.


There were also delays in the attendance by the child and adolescent mental health (CAMHS) service (provided by another trust) when there was an admission of a young person. One young person was detained under Section 4 of the Mental Health Act due to the lack of availability of a second doctor to undertake an assessment at the place of safety.


He said that they had found that the trust had made some significant improvements to the safety and quality of services, staffing levels and governance arrangements even at the time of inspection.


Councillor Paul May commented that he was pleased to hear the progress being made especially with regard to governance.


Tony Fletcher replied that key appointments had been made by the Director of Nursing. He added that a further inspection would likely take place in 2017 to assess if the changes are working.


Councillor Paul May asked if the inspection assessed whether the services provided were appropriate for the needs of the community.


Tony Fletcher replied that it did not. He said that the inspection assessed the safety of the provision being provided.


Councillor Eleanor Jackson commented that it was good to see a vast improvement of the ligature policy as it had previously been inadequate. She said that there remained a shortage of around 29 acute beds which had seen some patients sent to Salisbury and Harrogate.


Tony Fletcher replied that he had heard evidence of patients being sent a long distance for acute provision.


Councillor Eleanor Jackson urged for better care in the community with  ...  view the full minutes text for item 57.

Additional documents:


Your Care, Your Way

The Select Committee will receive a presentation regarding this item.


The Director of Integrated Health & Care Commissioning and the YCYW Community Services Programme Lead gave a presentation to the Select Committee regarding this item. 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.


The Director of Integrated Health & Care Commissioning said that she welcomed the key role that the Select Committee has played in the process so far and will continue to play.


She stated that the process should not be seen as solely about Virgin. Wider provider market is critical to the success of delivering transformation and we need to work together as a single system for the population of B&NES.


Virgin Care –  Our Values and Vision


Think – Strive for better

·  Challenge / Improve / Learn


Care – Heartfelt service

·  Communicate / Understand / Inspire


Do – Team spirit

·  Involve / Resilience / Hold to account


The future of Community Services


New model of integration

Care co-ordination



Councillor Lin Patterson asked if the questions raised by the Community Champions have been recorded.


The YCYW Community Services Programme Lead replied that all the questions and full tender documentation have been published on the YCYW website and were publically available. She added that the first round of questions were set primarily by the Cabinet Office and that as the process moved on the questions were more detailed and developed by Commissioners, relevant Subject Matter Experts and Community Champions.


Virgin Care – The Team


Virgin Care Executive Team

Local Virgin Care Delivery Team


Councillor Karen Warrington commented that she believed in this project and said that continuity would be key. She stated that we owe our residents a great service.


Mobilisation - Managing Safe Transfer


Safe Transfer Group

Meetings held with Sirona every week

First 100 days (from April 1st 2017) – Services to remain static in this timeframe

The workforce are such an integral part of this process


Outcomes Based Commissioning


Proactive review of services

More efficient front line services

Economies of scale


Councillor Eleanor Jackson asked how members of the public would be assured about IT security / reliability.


The YCYW Community Services Programme Lead replied that a joint communication would be issued regarding a change of service provider. She added that anyone not wanting their data transferred would have the opportunity to report back to their GP.


Councillor Lin Patterson asked how the Select Committee can be assured that the data it sees is true.


The Director of Integrated Health & Care Commissioning assured the Select Committee that robust performance management and data checking processes are in place. She added that accurate and up to date information is paramount to the success of the project.


Achieving Value for Money


Block funded contracts


All investments and savings will be discussed in great detail


Acknowledge that further due diligence is still to take place


Councillor Eleanor Jackson asked how the financial figures for the next seven can  ...  view the full minutes text for item 58.

Additional documents:


Re-commissioning of Urgent Care Services pdf icon PDF 88 KB

This paper will brief the Select Committee on BaNES CCG’s procurement strategy in relation to NHS111 as well as the current GP Out of Hours, Urgent Care Centre and Homeless Health service.


The Commissioning Manager for Urgent Care and Non-Acute Services introduced this report to the Select Committee. She explained that BaNES CCG is:


·  Procuring the NHS 111 and Integrated Clinical Hub services with Wiltshire and Swindon CCGs.

·  Procuring the GP Out of Hours service with Wilshire CCG, as part of the above procurement process to facilitate integration of services.

·  Separately procuring the Urgent Care Centre service (at the front door of the Royal United Hospitals).

·  Separately commissioning the Homeless Health Service.


Councillor Lin Patterson asked if NHS 111 advisors would have access to nurses and doctors.


The Commissioning Manager for Urgent Care and Non-Acute Services replied that they would as there is a need to clinical support within the call centre.


Councillor Lin Patterson asked if any practices had yet said that they were willing to take part in the Homeless Health Service.


The Commissioning Manager for Urgent Care and Non-Acute Services replied that it was in the early stages of the process, but stated that they would not be left without a service.


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


LSAB Annual Report 2015-16 pdf icon PDF 79 KB

The Local Safeguarding Adults Board Annual Report 2015-16 highlights the work of the Board during the period and provides information and analysis of safeguarding case activity for the Health and Wellbeing Select Committee to note.

Additional documents:


The Head of Safeguarding & Quality Assurance introduced this item to the Select Committee. She informed them that the Board meets on a quarterly basis and has six multi-agency sub-groups that report to it.


She stated the Board works closely with the Responsible Authorities Group who have a remit for all domestic abuse incidents and the LSCB who are concerned about the impact of domestic abuse on children and young people.


She said that during the reporting period 2015-16 B&NES received 1,137 new alerts /referrals (now called concerns). At the end of March 2016, 162 cases remained open and 1,104 had been closed. The 1,137 concerns received was an increase of 53% when compared with 2014-15.


She said that it was important to make care personal, but that providing a personal solution sometimes meant that we were unable to meet our set timescales.


The Select Committee RESOLVED to note the Annual Report, Executive Summary and Business Plan.


Select Committee Workplan pdf icon PDF 114 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.



Councillor Eleanor Jackson proposed that the Select Committee looks at the issue of Community Pharmacies in B&NES in March 2017 following the recommendation made by Council at its meeting on 10th November 2016.


The Select Committee RESOLVED to agree with this proposal.