Agenda and minutes

The Chair welcomed everyone to the meeting. She asked the Select Committee and others who were present to stand and observe a minutes silence for those who had died in the recent bomb attack in Manchester.

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 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.

There was none.

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

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.

New rapid response falls service

This month, a new pilot service has launched in B&NES - the Falls Rapid Response Team – to assist people aged over 65 years who fall while at home. Since the pilot began on 2 May, the team has already helped 39 patients.

The team includes a specialist paramedic and an occupational therapist and can respond to up to four people in B&NES each day. The team helps the person get comfortable, and carries out a home-based falls risk assessment to recommend any necessary interventions that could help prevent future falls.

The pilot is the result of collaboration between BaNES CCG, South Western Ambulance Service NHS Foundation Trust, Virgin Care and Bath’s Royal United Hospital. It operates between 8am and 6pm, seven days per week.

HANDiApp launches in B&NES

A free smartphone app launched in B&NES at the end of March to help parents and carers of young children access expert advice about the six most common childhood illnesses. Since its launch, over 4,000 people have downloaded it.

We know that 34 per cent of all users have used Handi App for advice on dealing with high temperatures, and 17 per cent have used it for information on newborn problems and chestiness in children over one year old.

The paediatric HANDiApp is also available for health care professionals who care for young children. So far, there have been over 900 downloads by community healthcare professionals and almost 850 uses of the hospital pathway. This pathway gives medical advice using a traffic-light system based on the seriousness of the symptoms presented.

The project team – involving staff from the CCG, Council, RUH and Wiltshire CCG – will assess whether the emergency department (especially paediatric emergencies) and/or GPs perceive that attendance by children with high temperature, chestiness, newborn problems, diarrhoea and vomiting and tummy pain has reduced.

Antimicrobial resistance

BaNES CCG has the highest proportion of Antibiotic Guardians in the country according to Public Health England (PHE) data for 2016. A total of 134 out of every 100,000 B&NES residents has pledged to do their part in tackling antibiotic resistance.

The CCG and Council have also been shortlisted for a PHE Antibiotic Guardian award for their work with primary schools in B&NES. The children designed posters to illustrate what they had learned and these posters were displayed in locations all around B&NES. The general public were encouraged to ‘hunt’ for the posters and upload photographs of them to social media.

Cyber attack

On Friday 12 May, the NHS became one of a number of targets of a malware attack. NHS Digital led the response, in close connection with the National Cyber Security Centre, the Department of Health and NHS England.

While no NHS organisations  ...  view the full minutes text for item 8.

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.

Improved Better Care Fund (iBCF) 2017/18-2018/19

The Improved Better Care Fund (iBCF) Policy Framework was published in April 2017. Adult Social Care Grant conditions and detailed implementation guidance from NHS England (NHSE) were due to be published in April 2017.  However, publication has been delayed and whilst the revised date for publication has not been confirmed it is not anticipated that this will be in advance of the general election on 8 June. 

In Bath and North East Somerset 2016/17 saw a continued increase in pressure on the adult social care budget. These have arisen as a direct result of implementation of the National Living Wage and the costs associated with purchased care packages.  In addition, there are pressures arising from support to people with complex and acute needs in their own homes, including those with a learning disability transitioning into adult services and living longer with high levels of care and support needs.  There is also an increasing demand for high dependency residential care and nursing care home placements.

Health and Wellbeing Board Development

Following the introduction of the Health and Social Care Act in 2012, a formal Health and Wellbeing Board (HWB) was established in order to bring together leaders from the local health and care system to improve health and wellbeing.

There is a strong commitment to working in partnership to improve health and wellbeing, good relationships between Board members and a clear understanding of the needs and issues within B&NES.

As part of a series of reflective sessions last year, members began to articulate the direction they wanted to see the Board move in. This includes the Board’s focus on building a truly whole-place approach to health and wellbeing in B&NES - bringing organisations together around the local people and communities we all serve.

The HWB proposed to broaden its membership to include wider representation from key health and social care providers and public services. This would enable the HWB to more directly engage these wider services, identify areas of common focus and demonstrate their stake in the health and wellbeing agenda. The proposed new membership included representation from Police, Fire, Housing, and Education as well as providers from Acute, Community, Primary and Voluntary Sector Care.

The HWB wrote to these proposed new members during the early part of this year to engage them in these proposals and seek their view on whether they would be interested in joining the Board. This included a voluntary sector recruitment process to identify a representative.

These changes have been set out in a revised terms of reference which was presented to Council at the 18th May AGM and formally adopted.

Councillor Geoff Ward asked what work was being done to ensure that  ...  view the full minutes text for item 9.

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.

Injury Prevention

B&NES Injury Prevention Partnership is promoting the Child Accident Prevention Trust’s ‘Child Safety Week’ during 5^th – 11^th June. The theme for the week is Safe Child: Sharing is Caring and we will be encouraging families and professionals to play their part in keeping children safe by sharing their experience and knowledge of the practical things to do to help prevent injuries.  

Mental Health Awareness Week 8-15^th May

This was a national promotion that had been well publicised and which provided an important opportunity to promote ways to maintain good mental health and challenge stigma around mental ill-health. With the theme of ‘Thriving or Surviving?’ this year’s campaign had been concerned with promoting the message that good mental health is much more than the absence of mental health problems and talking about mental health is important.

Within the Council the staff Health and Wellbeing Group arranged a series of free workshops for staff on a range of issues including workplace mindfulness, movement for the mind, food and mood, T’ai Chi and mental health awareness for managers.  As a part of this Public Health have also organised and delivered a series of Time to Change sessions for staff across a range of organisations including the CCG, RUH, Council, housing and third sector organisations.

Sexual health of young people in care needs assessment

The Sexual Health Board has recently completed a health needs assessment looking into the sexual health needs of Young People in Care in B&NES, developed in partnership with colleagues in the Council, RUH, Sirona and Virgin Care, and with significant input from young people.

The review found that there are good partnerships between a range of B&NES services and a strong commitment to ensuring that young people’s sexual health needs are met. The report makes a number of recommendations under five themed areas and an action plan has been developed to take the recommendations forward.

Two interesting studies from Scotland:

·  An analysis was done of the Scottish Health Surveys 1995-2012 with data from over 50,000 people in total. Disadvantaged social groups have greater alcohol-attributable harms compared with individuals from advantaged areas for given levels of alcohol consumption, even after accounting for different drinking patterns, obesity, and smoking status at the individual level.

“Experiencing poverty may impact on health, not only through leading an unhealthy lifestyle but also as a direct consequence of poor material circumstances and psychosocial stresses. Poverty may therefore reduce resilience to disease, predisposing people to greater health harms of alcohol."

·  A study of over a quarter of a million people showed that cycling to work reduced all-cause mortality, mortality from cancer and cardiovascular disease by almost half. Commuting by walking showed lower levels of CVD mortality but to a lesser  ...  view the full minutes text for item 10.

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

Alex Francis, Team Manager, Healthwatch B&NES 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.

Enter and view programme

During this quarter the enter and view team undertook visits to two care homes (Cranhill Care Home and Cedar Park Residential and Nursing Home, both in Bath), with a further visit having to be re-scheduled due to a Care Quality Commission (CQC) inspection.

The team has devised a programme of visits to take them through to autumn 2017. This programme has been shaped with input from the commissioning manager for care homes at B&NES Council, and the CQC.

In addition to the programme of visits for 2017, Healthwatch B&NES is also planning to carry out re-visits to providers that we have visited over the last two years to see how the recommendations that were made have influenced practice and people’s experiences of using services.

Healthwatch B&NES has recently presented to the Care Home Forum to inform care home managers about the enter and view function. Healthwatch B&NES hopes to maintain a positive working relationship with this forum in order to share learning and themes from enter and view visits, and develop links with settings and key personnel across the district.

Learning from patient experience

In January 2017, a project was outlined for Healthwatch B&NES to work with St. James’s Surgery and BaNES Clinical Commissioning Group in order to explore what works well when engaging patients in changes to General Practice.

A questionnaire was circulated to the patients that were affected by the closure of Weston Church Hall walk-in service in 2016. Healthwatch received 13 responses - 19% of those patients affected. Although a small number of responses, the feedback received provided insight into how communication about changes to services could and should be shared and how people felt processes such as this could be improved.

The responses received about the St. James’s Surgery suggested that patients had been well-informed of what was being proposed and were offered the opportunity to have a say in a way that was convenient for them.

Urgent care – gathering people’s views on local services

During this quarter, Healthwatch B&NES held five focus groups to understand people’s views and experiences of using local urgent care services. Throughout these sessions, Healthwatch B&NES spoke to 39 people, including those living with chronic conditions and their carers, and gathered feedback about what is working well and what could be improved.

The feedback gathered related to a number of services, including: NHS 111, the Urgent Care Centre at Combe Park, the Minor Injuries Unit at Paulton and the out of hours GP service. The report is being drafted and will be shared with providers and the Clinical Commissioning Group shortly. The full report and any responses from providers will be released in June 2017.

Councillor Paul  ...  view the full minutes text for item 11.

A copy of the Charter is attached to this agenda. The Select Committee will also receive a brief presentation at the meeting.

Caroline Mellers, Charter Lead, St Mungo’s / New Hope and Ralph Lillywhite, St Mungo’s Bridges to Wellbeing Manager gave a presentation to the Select Committee on the Mental Health & Wellbeing Charter for Bath & North East Somerset.

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.

Background

·  Why the Charter was developed? - The aim of the Charter is to inform those who work with people with mental health issues about the key areas which support wellbeing. It promotes a shared approach between those using services, their families, friends, groups and professionals to support each person’s unique mental health needs.

The idea of Charter was introduced and led by Caroline Mellers, initially as a St Mungo’s and New Hope volunteer. Caroline has a personal and professional background in mental health, having used crisis, and inpatient services. She worked for the District Health Board in New Zealand as a service evaluator and now works with a number of local statutory and 3rd sector organisations in B&NES.

·  What supports people’s mental wellbeing? - The Charter supports the key aims of New Hope which are to ‘affect positive change in treatment and support services’ and to ‘give service users and carers a voice’.

·  Scope of the Charter - The Charter highlights the 10 Guiding Principles that reflect the support people need for their mental health and wellbeing. Local organisations are invited to sign up to these principles.

St Mungo’s Bridges to Wellbeing

·  New Hope - New Hope is an organisation of volunteers working to improve mental health services in Bath & North East Somerset. We focus on co-production: working together with other groups to produce great work.

·  How the Charter fits with the multi-agency services approach – Worked alongside many organisations including Healthwatch, Council and the recent Your Care, Your Way consultation.

·  ‘Bridging the Gap’ report – This report currently underpins mental health commissioning strategy. One of the key findings of the report was the impotance of ‘statutory services and other support networks working together to optimise support for the individual’.

·  Building Bridges to Wellbeing – Our service works with people with low to moderate mental health needs in Bath and NE Somerset.

Our aim is to enable clients to have more independent and fulfilling lives by developing peer support networks and groups.

Creating the Charter – How it happened

•  Led by people who have used services

•  Steering group – local organisations

•  Initial Charter design – Two Focus groups

•  Consultation - Ten focus groups, over 100 people who had received support for their mental health

•  Final Charter & ‘In Practice’ document

What is the Charter?

•  In 2 parts: i) 10 point Charter

    ii) In Practice document

•  Increases awareness of mental health needs

•  Integrates the views of people using services into service delivery

•  Supports staff to understand and follow the philosophy of  ...  view the full minutes text for item 12.

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.

Review of safe transfer

·  No major incidents have occurred within the first 54 days

·  1,300 colleagues safely transferred on 1st April. People using services also experienced a safe transfer and no disruption to services they were using.

·  All safety and quality requirements during this transfer period were achieved.

·  Virgin Care are now actively participating in a number of Boards, delivery plans and urgent care planning activities

·  A comprehensive 100 day plan is being deployed including review of services, operating procedures and policies. The progress on the 100 day plan and risk registers are shared weekly with commissioners.

Developments so far

·  People – we have had attendance from over 90% of teams at arrivals events, with overwhelming positive feedback.

·  Support – we have a single point of access for queries and to enable us to support those that need help quickly.

·  Communications – we have continued to engage with stakeholder groups and have proposed an external engagement strategy which is due to be discussed with community champions next week

·  Systems and people – we have rolled out over 200 new phones to enable staff to get access to emails on the move. Positively received by colleagues

·  Pay – all colleagues, carers and subcontractors have received first payments successfully.

Coming up in the next month….

We have been:

·  Working with the commissioners on developing the Service Development and Improvement Plan, including reviews of: mental health services, continuing health care and reablement

·  Undertaking pathway review of home-first implementation across community services and are quickly developing a new roll-out plan. Next month the plan will be launched

We will be:

·  Launching the review and redesign of wellbeing services, involving all partners

·  Implementing our ‘Virtual Desktop’ environment in June

Lessons Learnt

·  Our engagement and the involvement of Community Champions was deemed ‘gold standard’ but we need to consider in the next stage how we increase the diversity of the group

·  Internal communications and co-production with staff is as important as communications and engagement with the public

·  Internal communications and co-production with staff is as important as communications and engagement with the public

Councillor Eleanor Jackson asked if any re-evaluation of Home Care had taken place by VirginCare since April.

The Director for Integrated Health & Care Commissioning replied that a re-commissioning of Home Care Services will take place in the future, but that no packages have been reviewed as part of the safe transfer process. She added that some recipients of care may have been due an annual review or have had their care package reviewed for a specific reason.

Alex Francis asked if any timeframes were available for the reviews mentioned and when public involvement would take place.

Jayne Carroll replied that reviews will be discussed initially with the Community Champions  ...  view the full minutes text for item 13.

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 asked about the possibility of commencing an update of the Home Care Review.

The Director for Integrated Health & Care Commissioning replied that it was the role of the Chair’s and Vice-Chair’s to meet and discuss whether a particular review should be carried out. She added that at this moment in time she could not allocate any further resources for a review. She said that the previous review was a good piece of work, but that it did take a long time to carry out.

She stated that quality of Home Care is a priority for the Council and that there are processes in place for any concerns to be raised.