Agenda and minutes

The Chair welcomed everyone to the meeting.

The Chair drew attention to the emergency evacuation procedure.

Dr Ian Orpen (CCG) and Alex Francis (Healthwatch) had sent their apologies to the Select Committee. Tracey Cox was present at the meeting on behalf of Dr Orpen.

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 Eleanor Jackson declared an other interest as a member of the Council’s Development Management Committee and said that should the subject of the new Hope House Surgery, Radstock arise she would not make any comment.

Councillor Bryan Organ declared an other interest as a member of the Council’s Development Management Committee and said that should the subject of the new Hope House Surgery, Radstock arise he would not make any comment.

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

Richard Samuel, Chairman of the Camden Residents’ Association made a statement to the Select Committee on the subject of Air Quality and Public Health. A copy of the statement can be found online as an appendix to these minutes and on the Select Committee’s Minute Book, a summary is set out below.

He explained that air pollution is a major killer in the UK and that the Department of Health estimates that 29,000 deaths annually are attributable to it. He added that one of the principle pollutants is nitrous oxides which are largely emitted by diesel motor vehicles.

He said that further health impacts are caused by PM particulates which are too fine to be captured by the nasal passages and lodge in the lungs creating risks of cancer.

He stated that the Director of Public Health has a crucial role in taking an overview of the public health risks associated with air pollution and poor air quality. He added that in March this year that DEFRA and the Department of Health issued guidance to Directors of Public Health concerning their responsibilities in tackling this serious issue.

He said that the last report of the B&NES Director of Public Health was published in 2016 and was largely silent on the question of air quality.

He wished to call on the Select Committee to examine why this clear risk to public health has not in the past formed part of the report. He urged the Select Committee to ensure that air quality becomes a top corporate priority for the Council and that the Health & Wellbeing Board is held accountable for clear actions to reduce the impacts of vehicle pollution.

Councillor Geoff Ward commented that the Environmental Health department would have a monitoring role on air quality.

Bruce Laurence, Director of Public Health agreed that this was an important issue and that his team had a role to play in educating public on avoiding high areas of air pollution. He added that guidelines from NICE (National Institute for Health and Care Excellence) were due soon.

He explained that the Director’s report was a 20 page document that provides a summary of a range of topics and that in the next edition there would be a section on air quality.

Councillor Paul May said that all areas of B&NES should be looked at as the levels in Whitchurch were 18% higher than the London Road.

The Chair commented that traffic levels in Saltford were also significant.

Councillor Eleanor Jackson said Westfield was the worst polluted area in B&NES and that the Parish Council was looking to address this through their Neighbourhood Plan. She added she felt that one of the main contributing factors were drivers with their engines on when collecting children from school.

The Chair thanked Richard Samuel on behalf of the Select Committee for his statement.

Councillor Eleanor Jackson addressed the Select Committee following concerns raised by Lady Hylton on the employment opportunities for people with Down’s Syndrome  ...  view the full minutes text for item 81.

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

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

Tracey Cox 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

NHS England and NHS Improvement brought together local health and care leaders at a Discharge Summit last month to review some of the current issues and challenges.  Following this, a key action for the RUH and wider community partners is to adopt a system-wide approach to the delivery of Home First.  This initiative identifies patients who can be discharged early to be safely cared for by therapy staff in their own homes and assessed for their ongoing care needs.

All CCGs and NHS acute trusts received a letter on 9 March 2017 from Simon Stevens, Chief Executive of NHS England, and Jim Mackey, Chief Executive of NHS Improvement, setting out a series of actions to get A&E performance back on track. 

These include:

• Every hospital has a front door streaming model by October 2017 under which GPs and nurses will assess patients to reduce pressure on A&E

·  Rollout of weekend and evening GP appointments to 50% of the population by March 2018 rising to 100% by March 2019

• An increase in the number of callers to NHS111 who receive a clinical assessment

Delegated Commissioning

The CCG’s application to take over responsibility for the commissioning of primary care services from NHS England has been approved.  This new responsibility takes effect from 1 April 2017.

The successful transition to delegated commissioning will rely on continued close working between the CCG and NHS England.

Financial Position

The CCG has regularly reported the rising pressure on its budget caused by the increasing demand for health and care services. We have made considerable efforts over the last twelve months to reduce our expenditure and whilst we anticipate that we will achieve a balanced financial position by the end of the 2016/17 financial year, we will not be able to deliver the required 1% surplus of £2.3m as required by NHS England. 

This will impact on our financial allocation for 2017/18 and financial pressures are set to continue into future years.  If we do not make further efficiency savings the funding gap is projected to be £10m in 2017/18, £15m in 2018/19 and rise to a total deficit of £21m in 2019/20.

We are developing a plan to deliver the significant savings required, balancing this with our determination to minimise the adverse impact on patients. The success of this plan will require greater levels of partnership working with local health and care organisations and our GP members.  We will also work with our wider stakeholders and patients to identify how we can commission services appropriately to continue providing high quality health services for our local population.

Sustainability and Transformation Plan

Before the end of March, NHS England is expected to announce the next steps for STPs and how some STP areas will be supported to accelerate  ...  view the full minutes text for item 83.

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.

Motor Neurone Disease (MND) Charter

The MND Charter is a statement of the respect, care and support that people living with MND, and their carers, deserve and should expect. The Charter was launched by the MND Association in March 2016 and was created to raise awareness and campaign to improve services at a local level.

Councillors can play a vital role in supporting people living with MND and their carers and can influence the planning of services that those living with the disease rely on in our local community (i.e. social care, housing adaptations, carers assessments, health care, public transport). So far, 37 councils have adopted the MND Charter and by adopting the Charter in B&NES, we can publically demonstrate our support.

As the Cabinet Member for Adult Social Care & Health I am seeking the Select Committee’s support and endorsement for adoption of the MND Charter.

Capital Grant for the Purchase of a Drug and Alcohol Recovery House

Developing Health and Independence (DHI) successfully bid for £750,000 of national funding from Public Health England to buy an 11-bed drug and alcohol house currently leased from Knightstone Housing.  DHI are funding the balance of the purchase price and all on-going running costs.  No costs will be borne by the Council. 

B&NES Council supported the bid.

The house is used to provide a safe and secure environment for B&NES residents who need a residential dry-house environment to enable them to overcome drug and alcohol dependence. 

A Memorandum of Understanding has been agreed between the Council and DHI to safeguard the premises in perpetuity for this use and ensure the continuation of an important local service.

Developments in the Domestic Abuse Housing Related Support Sector

After a procurement process the contract for Domestic Violence Refuge and Resettlement services has been awarded to Julian House. The service will provide 10 beds of refuge space in Bath and support for women and children leaving the hostel to resettle in their own accommodation for up to 6 months. This support will help ensure that the women and children are settled, safe and linked into community services and support networks that they need to continue their recovery from the effects of domestic abuse.

By recommissioning this service, we will deliver better value and have therefore been able to release £30,000 p.a. which will be invested in the Serena House Complex Needs Domestic Abuse Refuge service for women and men. This service which is based in Keynsham and Midsomer Norton, was set up in partnership with Curo, DHI and Julian House with an initial investment of £100,000, secured via grant funding following a successful bid to the Government’s Domestic Abuse Fund in 2015.

In February 2017, in response to a  ...  view the full minutes text for item 84.

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.

Weight

Public Health England have done a tracking study from the NCMP (National Child Measurement Programme) of about 34.000 children in 4 Local Authorities showed what happened in Year 6 of children of different weights in reception.

·  For the 28,092 children who were a healthy weight in Reception the vast majority remained a healthy weight by Year 6 (77% girls, 73% boys). However, around a tenth of children who were a healthy weight in Reception became obese.

·  For the 3,128 children who were overweight in Reception 31% remained overweight, 30% became obese and 13% severely obese by Year 6. However, just under a third (27%) returned to a healthy weight.

·  For the 722 children who were underweight in Reception the vast majority (77% boys, 68% girls) gained a healthy weight by Year 6. Just 31% girls and 21% boys remained underweight

Tobacco Control

B&NES Public Health and 8 other local authorities in the South West are jointly funding work with the South West Trading Standards Regional Enforcement Team (SWRET) which aims to reduce illicit supply and demand of tobacco, increase compliance with regulations on marketing and prevent underage sales.

Local area trading standards and public health teams will work with the regional intelligence team to raise awareness of illegal tobacco in local communities, increase local intelligence and take enforcement action where necessary.

Health Champions

The Councils’ Organisational Development Action Plan for 17/18 includes the key objective to develop a network of champions for health and wellbeing and to use management information and data to promote initiatives that encourage healthy life styles and productivity.

We are currently recruiting up to 12 Health Champions from across all departments of the Council. These champions will be given accredited training, support and a small budget to work with their team to promote staff health and wellbeing

ASIST – Suicide Prevention

In 2016 B&NES alongside the six other local authorities in the AGW Public Health area received funding to deliver ASIST (Applied Suicide Intervention Skill Training).  This money from Public Health England covered the cost of additional training for two BANES trainers both of whom already have considerable mental health experience as employees from AWP and DHI, as well as the delivery of a two year programme of delivery for frontline staff working in the BANES area. 

ASIST training provides an evidenced based approach to supporting a person who is experiencing suicidal thoughts with an emphasis on getting them to a place of safety.  At the end of year one 88 members of staff have completed the 2 day ASIST training with the majority working in adult services and from a range of organisations.  These include Council workers, Avon Wiltshire Partnership, educational settings, police , Sirona and a range of third sector organisations . The training for  ...  view the full minutes text for item 85.

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

The Chair announced that no report was available on this occasion.

The Select Committee will receive a presentation regarding this item.

James Scott, RUH Chief Executive introduced this item through the form of a presentation. A copy can be found on the Minute Book and as an online appendix to these minutes, a summary is set out below.

GP Referral Map

He showed Members a map that clearly displayed that the majority of referrals from GP practices in B&NES were to the RUH and that only Chew was the exception to this. He said that although this made the RUH a busy site he had no interest in changing referral patterns.

The RUH Site

He described the RUH as a ‘District General Hospital, with attitude’. He said that amongst other services available were the diagnosis and treatment of Cancer, Radiotherapy and a Dementia research project.

He said that he wished to applaud the good work of the CCG that allows patients from Wilshire and Somerset to be treated there and that he planned to develop services for the local population.

Cardiac MRI

Most advanced form of heart imaging.

One scan – look for:

·  Heart function

·  Valve disease

·  Heart attacks

·  Reduced flow

·  Inflammation

Service started 2014 – 381 scans have been carried out

Prior to 2014 patients had to go to Bristol or Oxford.

Endo Bronchial Ultra Sound (EBUS)

Procedure for sampling lymph nodes

Using bronchoscope with an ultrasound probe

RUH diagnosed 230 people/year with lung cancer (second highest in cancer network)

Hyper Acute Stroke Unit

Provide Thrombolysis (clot busting) service 24/7;

Treat a significant number of patients each year;

Patients admitted to a Stroke Unit are:

·  More likely to survive the stroke;

·  More likely to make a full recovery from the stroke;

·  More likely to return to own home

Primary Percutaneous Coronary Intervention (PCI)

Current gold standard treatment for heart attacks;

Service started in 2010;

Current provision is:

·  24/7 networked service with Bristol Heart Institute (BHI);

·  07:00 to 19:00 Mon-Fri at RUH;

·  Outside of this, at BHI;

Most important process measure is Door to Balloon time;

All RUH individual Consultant outcome data submitted nationally & compares well.

Councillor Paul May said that it was important to Councillors and the local community to understand any possible tensions from hospitals within Bristol to the RUH and the role the Select Committee can play through the STP process and devolution.

James Scott replied that clinical relationships are strong and that already a great number of patients flow into the RUH from Wiltshire. He added that although Health did not form this first round of devolution work he said that he would take steps to protect the RUH in any subsequent part of the process.

Councillor Eleanor Jackson explained that she was a patient at six clinics within the RUH and all of them have different ways of corresponding.

James Scott replied that he had already challenged the team involved with the records system to adapt it to one of uniformity.

Councillor Paul May asked if the RUH had any links to the local universities.

James Scott replied that it had many, across numerous departments.  ...  view the full minutes text for item 87.

This report provides the Select Committee with the outcomes of Patient and Public Engagement activities completed relating to the proposal to relocate the RNHRD Rheumatology and Rheumatology Therapies services.

Clare O’Farrell, Associate Director for Integration, RUH introduced this report to the Select Committee. She explained that there will be no change in the level of service provision for patients of the RNHRD Rheumatology and Rheumatology Therapies services. She stated that the same range of outpatient services will be provided at the new RNRHD and Therapies Centre and patients will continue to be seen and treated by the same team to the same high standards, only the location will change.

She added that there is no impact on patient choice, as relocating the service does not reduce the number of appointments or clinics available. Inpatient beds and residential beds will still be provided.

She said that the RUH has good public transport links and is accessible via the Odd Down Park and Ride. She stated that the RUH provides over 350 visitor and patient spaces across the site, and around 100 blue badge spaces. She informed the Select Committee that there is no patient or visitor parking available at the Mineral Water Hospital site other than two Blue Badge parking spaces, so for some patients the proposed new location will be easier to access due to the availability of onsite parking.

She spoke of how the Trust had held an engagement event where attendees had the opportunity to meet with clinicians, hear more about the new RNHRD and Therapies Centre, provide feedback on plans to relocate and have any further questions answered.

She said that the overall tone of the day was positive; participants were grateful for the opportunity to learn more about the planned new centre, appreciated hearing directly from clinicians, welcomed the opportunity to ask questions and ultimately felt reassured that the same services would continue, provided by the same team. 

She explained that the next phase of PPE activities relate to proposals to relocate the RNHRD’s Bath Centre for Fatigue Service (BCFS) and Pain Management services. Planning is underway to launch PPE activities for the BCFS in March 2017.

Councillor Geoff Ward said that he supported the proposals within the report.

Councillor Lin Patterson asked if in the new arrangements to be proposed for Fatigue and Pain Management the provision would remain the same.

Clare O’Farrell replied that retention of the same services is planned.

Councillor Paul May said that he felt that the work carried out so far regarding the transfer of services was exemplary.

Councillor Eleanor Jackson asked for better provision of buses to the site with wheelchair accessibility and spaces to sit once on board.

The Select Committee RESOLVED to:

i)  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 proposed 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.

ii)  Endorse the proposal to relocate the RNHRD Rheumatology and Rheumatology Therapies services from  ...  view the full minutes text for item 88.

This report is in response to Councillors within B&NES having raised a concern about potential impacts on local pharmacies because of changes to the way that community pharmacies are funded. 

Paul Scott, Assistant Director of Public Health introduced this item to the Select Committee. Also in attendance were Joe Prince, Senior Public Health Research and Intelligence Officer, Jerry Long, Avon Local Pharmaceutical Committee (LPC) and Ben Holbrook, Larkhall Pharmacy.

He explained that the new contract had been implemented from October 2016 and a national representative body for NHS community pharmacy (the Pharmaceutical Services Negotiating Committee) had expressed concern about a potential national reduction of £113 million in funding in 2016/17 (a reduction of 4% compared with 2015/16), increasing to an overall 7.5% reduction compared with current levels during 2017/18.

He said that in recognising the risks to some pharmacies, the Department of Health have included a component of the new contract (the Pharmacy Access Scheme) that allows for some protection against these losses for pharmacies that are:

·  More than a mile away from its next nearest pharmacy (measured by road distance)

·  Is on the pharmaceutical list as at 1 September 2016; and

·  Is not in the top 25% largest pharmacies by dispensing volume.

He stated that local pharmacies are largely funded by NHS England and that if a pharmaceutical company wishes to open a new premises, they need to make an application to NHS England to do this.  He explained that unless there was a significant gap identified in the Pharmaceutical Needs Assessment (PNA), then it was very unlikely that NHS England would approve a new pharmacy application.

Jerry said that these were savage cuts that, according to Government figures could see 3,500 pharmacies in England close, with around 8 – 10 in B&NES.

Ben Holbrook said within his pharmacy a staffing restructure had already taken place and that it was dependent on funding from NHS England. He added that he would like to see a Minor Ailments Service introduced as he felt that around 15 times a day his pharmacy saves people from having to see a GP.

Joe Prince informed the Select Committee that assessing the need for, and supply of, local pharmacy provision is done through a statutory process by the B&NES Health and Wellbeing Board.  It must undertake a PNA every three years, with the next one due in 2018.

Councillor Tim Ball said that he was concerned over the possible staff reductions at pharmacies and that this could be a danger for the public.

Ben Holbrook replied that a Pharmacist would always have to be present, but that at his pharmacy the Main Counter Assistant was now part time and this meant that Cholesterol and Diabetes checks were not always possible.

Councillor Eleanor Jackson how could local pharmacies be preserved and whether co-location within a premises such as a Post Office were possible.

Jerry replied that one pharmacy in Chew Magna was considering a co-location option. He added that a professional outlook would need to be maintained for pharmacy services at such a premises.

Ben Holbrook encouraged the public to use the services available at their local pharmacy to highlight their  ...  view the full minutes text for item 89.

This report sets out the safeguarding assurance arrangements the Local Authority has in place. It aims to provide assurance to the Health and Wellbeing Select Committee that children and adults with care and support needs are effectively safeguarded.

The Head of Safeguarding & Quality Assurance introduced this report to the Select Committee. She informed them that from 1st April 2017 Virgin Care will be responsible for managing safeguarding concerns regarding adults with care and support needs; however, AWP will continue to manage concerns relating to individuals with mental ill health in the same way they do currently.

She added that the Local Authority team are responsible for chairing the Safeguarding Adult meetings and AWP and Virgin Care will administer and coordinate the cases.

She stated that safeguarding is embedded in all services that are within the scope of Your Care Your Way.  The overarching contract with Virgin Care has a specific safeguarding schedule which includes health and social care safeguarding requirements.. There is also a specific specification about Statutory Adult Social Care functions and this includes details about safeguarding.

She said that agencies which are part of the dynamic purchasing system the safeguarding schedule will also apply. This provides the Local Authority, BaNES NHS CCG, LSCB and LSAB assurance that safeguarding responsibilities are clearly and consistently articulated for all agencies commissioned under Your Care Your Way.

She explained that the LSCB and LSAB Annual Reports and business plan are shared with Scrutiny Panels and the Health and Wellbeing Board. She added that within the Annual Reports all partner agencies complete an account of how they are performing with the Board indicators and what their agencies are doing to ensure the safeguarding of children and or adults.

She informed them that the Multi-Agency Safeguarding Hub (MASH) provides the Boards with further assurance that children and adults at risk are not being missed. It does this by gathering information from a number of agencies about cases the Local Authority and Sirona care and health have a concern about but on the information first received are not confident the threshold for safeguarding intervention has been reached. By taking an enhanced look through gathering information from more sources a more effective decision can be made as to how to proceed and whether safeguarding is in fact required.

Councillor Lin Patterson asked who has responsibility for safeguarding within Academies.

The Head of Safeguarding & Quality Assurance replied that this would be done by the Academies themselves as the Local Authority has no right to attend. She added that they are required to complete a Section 175 Self-Assessment which the Governors have to sign off. She said that if staff have concerns they can report it to the LADO (Local Authority Designated Officer). She said that the Child Protection Forums are well attended by the majority of schools and academies.

 The Select Committee RESOLVED to note the safeguarding assurance arrangements the Local Authority has in place.

The Select Committee will receive a presentation regarding this item.

Sue Blackman and Jayne Carroll 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 update is set out below.

Safe Transfer

·  A Safe Transfer Group is in place and working alongside Virgin Care.

·  Important that there is no change seen by patients and staff on April 1^st

Managing Sirona Staff Transfer / Induction

·  Positive feedback from Sirona staff

·  Consultation complete

·  Management Briefings prior to transfer

·  Arrivals information sent to all colleagues

·  Arrivals events in April & May for all colleagues to attend

Safe Transfer - Day 1 to 100

·  Day 1  Readiness plan

·  Our 100 day plan

·  Finalising our transformation plan through feedback from our Arrival Events

·  Virgin Care Ambassadors in attendance from April 1^st

Councillor Paul May requested that the Select Committee receives regular updates on this matter from the Director of Integrated Health & Care Commissioning.

The Director of Integrated Health & Care Commissioning agreed with this request and confirmed that it would be a standing item on the agenda for the Select Committee until further notice.

Following on from the earlier discussion relating to the Potting Shed, Radstock she said that an officer had spoken with Bath MIND and had established that the funding had not ceased and that there was to be further talks on how the funding should be used.

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 RESOLVED to approve their workplan as printed.