Agenda and minutes

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Contact: Mark Durnford  01225 394458

No. Item




The Chair welcomed everyone to the meeting. On behalf of the Select Committee she wished to send Councillor Eleanor Jackson their best wishes for a speedy recovery.



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 Eleanor Jackson had sent her apologies to the Select Committee and Councillor John Bull was present as her substitute for the duration of the meeting.



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.


There were none.




There was none.



At the time of publication no notifications had been received.



Adam Reynolds addressed the Select Committee. A copy of his statement can be found online as an appendix to these minutes and on the Panel’s Minute Book, a summary is set out below.


There is much that people can do individually to protect their health including driving safely, avoiding tobacco smoke and air pollution, exercising regularly and having regular check-ups. But many health risks are also influenced by community factors, including transportation and land use planning decisions.


Transport, in particular, affects health in various ways. Transport policies and planning decisions affect rates of cancer, cardiovascular disease and traffic collisions. Three of the largest causes of reduced longevity in the UK and can also affect people’s ability to access health-related goods and services such as food and health care.


I feel that B&NES Highways and Planning departments are biased in various ways that stimulate automobile dependency. There are many justifications for reforms to the approach Highways takes that will create more efficient and diverse transport systems, of which improving public health should be the primary factor in their design and decision making process.


Will the Committee consider making public health a core remit of the Highways and Planning departments?


Councillor Vic Pritchard, Cabinet Member for Adult Care, Health & Wellbeing replied that it was his responsibility together with colleagues in the Public Health team to oversee such matters. He added that the Health & Wellbeing Board had recently been reconfigured cover the elements raised.


He said that it was integral to the decision making process and he assured the Select Committee that discussions do take place between himself and the Cabinet Member for Transport and Highways and the Cabinet Member for Development.


Adam Reynolds commented that he felt that some schemes were still completed in isolation and he gave the example of the Two Headed Man junction.


Councillor Pritchard replied that the measures put in place at this particular site were designed to prevent congestion as the road is used by very few cyclists.


The Chair thanked Adam Reynolds for his statement on behalf of the Select Committee.


MINUTES - 24th May 2017 pdf icon PDF 140 KB


Councillor John Bull asked a question on behalf of Councillor Eleanor Jackson. He said that she was still seeking a response to a question raised at a previous meeting in relation to the consistency of procedures and appointments at the RUH.


Councillor Vic Pritchard replied that if a little further information could be provided he would take it direct to the RUH as he sits as a member of their Board.


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


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


Local system performance appears to have improved in June with 91 per cent of patients seen in A&E within the four hour target wait.  Performance this month (as at 14/07/17) currently stands at 92.6 per cent.  Both the June and July figures do require further validation.


Quarter one review with NHS England


We met with NHS England on 3 July to review our position at the end of the first quarter of 2017/18.This session included  a detailed review of what we are doing in relation to diabetes care and childhood obesity as well as progress on our Financial Recovery Plan.


We have self-assessed ourselves using the CCG Improvement, Assurance & Assessment Framework.  We continue to self- assess ourselves as ‘good’ in two out of the four domains and as ‘requires improvement’ against the ‘Better Care’ area (this reflects current performance issues against a number of NHS Constitution targets) and against ‘Sustainability’ due to the CCG’s financial position. 


New Director of Nursing and Quality announced


We are pleased to announce that Lisa Harvey will be joining us as our new Director of Nursing and Quality after Dawn Clarke left for a new role in Shropshire.  Lisa will officially join us from the 4 September 2017. She is currently working at South Gloucestershire CCG where she has been the Deputy Nurse Director since 2013.


Mental Health Pathway Review


We are working with Bath and North East Somerset Council to carry out a review of community mental health services between May – October 2017.


We will be engaging with a wide range of groups and individuals over the coming weeks, and will use this information, along with other research, to develop a set of models for future community mental health services. As part of our engagement, we have created a survey for those who provide services, people who use services, and those who care for them.


Preferred provider selected for urgent care services across B&NES, Swindon and Wiltshire


Medvivo has been selected to the preferred provider stage of a procurement process to run integrated urgent care services across Bath and North East Somerset (B&NES), Swindon and Wiltshire.  The healthcare provider, which has very recently been rated as ‘Outstanding’ by CQC, will be the lead provider, working in collaboration with Vocare and B&NES Enhanced Medical Services (BEMS+). 


If awarded the contract in the autumn, Medvivo will be responsible for running the NHS111 service across B&NES, Swindon and Wiltshire, developing the service model so callers can be put through to a ‘clinical hub’ of experienced health professionals who can make assessments and advise and arrange urgent care if required. 


In collaboration with Swindon and Wiltshire CCGs and Wiltshire Council we are following a detailed and robust procurement process, with sharp focus  ...  view the full minutes text for item 22.

Additional documents:


Cabinet Member Update

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


Councillor Vic Pritchard, Cabinet Member for Adult Care, Health & Wellbeing 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.


Better Care Fund (BCF) 2017-19 Guidance


On the 4th July 2017, NHS England, the Department of Health (DH) and Department of Communities and Local Government (DCLG) announced the publication of the Integration and BCF planning requirements for 2017-19. The document sets out the detailed requirements for plans based on the 2017-19 Integration and BCF policy framework published on 31st March 2017.


In B&NES, planning for the Better Care Fund has been underway for some time and the plan will now be finalised over the summer with the aim of being signed off by the Health and Wellbeing Board in early September before the submission deadline of 11th September 2017.


He stated that funding for Adult Social Care will require cross party support.


AT- Home Project

The Council has been awarded £50,000 from the LGA to develop the use of Assistive Technology (AT) within the reablement services in B&NES.


Our adult social care pathway is focused on reducing the need for complex health and social care interventions. Within this, our integrated reablement and rehabilitation service provides therapy and support for adults in their home environment enabling them to maintain or regain their independence.


With a range of AT tools, we will pilot a variety of apps and devices, identifying those delivering the most benefits. Where we identify gaps in the market we will use the knowledge and enthusiasm of Bath:Hacked, our Council/community initiative that uses open data and smart thinking to benefit our residents, to generate new ideas and prototypes. 


The project is expected to complete in March 2018.


Councillor John Bull said that he agreed with the comment made referring to cross party support for Adult Social Care. He asked on behalf of Councillor Eleanor Jackson for the Select Committee to carry out some scrutiny work in relation to Care Homes.


Councillor Pritchard replied that this request would be subject to available resources, both monetary and officer time.


The Chair commented that Care Homes are regularly inspected by the CQC and would not want to replicate their work.


Councillor Bull said that the work would relate more to levels of provision that are currently available and planned for the future.


The Director for Integrated Health & Care Commissioning said that a report could come to a future meeting of the Select Committee that would address the challenges of the Home Care market.


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

Additional documents:


Public Health Update

Members of the Select Committee 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.


Council to take Time to Change Employers Pledge


Bath and North East Somerset Council is in the process of working towards taking the Time to Change Employers Pledge.  By signing the pledge the Council is demonstrating a commitment to change how we think and act about mental health in the workplace and make sure that employees who are facing mental health problems feel supported. 


We are aiming to sign the Pledge on World Mental Health Day 10th October 2017 and are planning some media promotion to surround it. 


Adopting HarmLess as an approach to supporting young people who self-harm


In Autumn 2017 we will be replacing the existing Multiagency Guidance for Staff Working with Young People who Self-harm with a new web based support resource called HarmLess. Created by Child and Adolescent Mental Health Services (CAMHS) colleagues at Oxford Health,  HarmLess provides more comprehensive information and links as well as an assessment tool designed and trialled for used by teachers / youth workers/ GPs etc.


Family Nurse Partnership Service


The FNP service delivers a licensed, evidence-based home visiting intervention for first time vulnerable younger mothers from 16 weeks in their pregnancy up until the child’s 2 year review.


The team consists of one full time supervisor with a maximum caseload of 5 and 4 (0.8WTE) family nurses with a case load of 18 families each, and there is one vacancy currently.


There has been a reduction in teenage pregnancies locally, and consequent reduction in notifications of under-19s to FNP. In agreement with the National FNP Unit B&NES have extended the eligibility criteria to include under-25s with 2 additional vulnerability factors. For 4 months the service did not see any increase in notifications, which raised the issue of how women are identified as vulnerable in early pregnancy and how they are signposted to early help services. Many of the women identified are in their second time pregnancies.


Domestic abuse: Some successes with funding


Approximately £270k over 3 years funding has been secured for Home Office transformation fund for domestic abuse services. This provides additional prevention work in the community, a youth based domestic abuse awareness programme and enhanced provision for survivors of domestic abuse with complex needs.


This is in addition to:


£100k from DCLG over 2 years for enhanced resettlement services

40k for two years from St. John’s Hospital to Southdown for support to low and medium risk cases.


A successful Avon-wide, police-led bid to support our MARAC process (MARAC being Multi-Agency Risk Assessment Conference), which manages cases in the community.


But… the situation for our domestic abuse services is still very fragile with a severe lack of mainstream recurrent funding from the Council and NHS, leaving a number of key services vulnerable to ending next year.


NHS Health Checks


Over 6,500  ...  view the full minutes text for item 24.

Additional documents:


Healthwatch Update

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



Alex Francis, Team Manager - Healthwatch B&NES and Healthwatch South Gloucestershire 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.


NHS Quality Accounts


During quarter one, Healthwatch B&NES undertook its role to receive, review and respond to the NHS Quality Accounts. These reports, which are published annually, capture the work that NHS providers are carrying out to improve the quality of care and treatment that they provide.


Healthwatch B&NES responded to five Quality Accounts during this period, including:

·  Royal United Hospitals Bath NHS Foundation Trust

·  Avon and Wiltshire Mental Health Partnership NHS Trust

·  Arriva Transport Solutions Limited

·  Care UK

·  South West Ambulance Service NHS Foundation Trust


Healthwatch will arrange to meet with providers throughout the year to seek updates on the work that is being carried out and track their progress.

It is hoped that a closer working relationship with NHS providers around the Quality Accounts will enable Healthwatch to have a stronger understanding of the improvements that are being made locally, and the impact that patients can expect to see in the services that they receive.


Work plan: Healthwatch B&NES 2017/18


In March 2017, the Healthwatch B&NES advisory group met to discuss the project’s work priorities for the year. Based upon feedback received from local residents and Healthwatch champions during the past 12 months; intelligence gathered by Healthwatch representatives and staff at meetings and boards; and consideration of the strategic priorities for health and wellbeing in B&NES, the following topics have been selected for staff and volunteers to focus on:


·  Mental Health

·  Accessible Information Standard (AIS)

·  Urgent Care

·  Sustainability and Transformation Plan (STP)


New Healthwatch B&NES team


Following some staff changes at The Care Forum during April and May, I am pleased to announce a new member of the team, Dan Hull, who is joining us as Healthwatch B&NES engagement officer. Dan will work alongside me and Pat Foster (Volunteer Support Officer) to engage with the public, gather their views on local services, and help to promote the project and its role as an independent voice for local people.


Councillor Tim Ball asked what help can be given to members of the public who have autism and have difficulty in accessing information.


Alex Francis replied that she had had a recent conversation with a member of the public in South Gloucestershire on this matter and acknowledged that it is a difficult area to know where to signpost people. She added that she thought that within B&NES there was an Autism Planning Group.


The Director of Integrated Health & Care Commissioning said that she would see what further information was available locally.


Councillor Bryan Organ asked the purpose of scrutinising the Arriva Transport Solutions Quality Account.


Alex Francis replied that they provide Non-Emergency Patient Transport.


The Chair thanked Alex Francis for the update on behalf of the Select  ...  view the full minutes text for item 25.

Additional documents:


Your Care Your Way Update - Health and Social Care Community Services : 100 Day Report pdf icon PDF 99 KB

This report provides an evaluation of the ‘First 100 Days’ of the Virgin Care contract, which started on April 1st 2017.


The YCYW Community Services Programme Lead introduced this item to the Select Committee. She stated they were confident that the process had gone well in the majority of areas. She said that Virgin Care are now operating under as business as usual state. She asked for the Select Committee to consider what future reporting process it would like to establish.


Jayne Carroll, Virgin Care highlighted some of the key issues that had been identified since the beginning of the contract.


Staff Pay


During the first pay run following the transfer in April Virgin Care reported that all 1,300 colleagues who had transferred were paid successfully with only a few issues raised.

During the May pay run the vast majority of colleagues received salary payments in full but a proportion of Virgin Care colleagues, those who received increments or who were undertaking additional, hourly-paid work experienced an issue with their pay. Virgin Care took immediate action to swiftly resolve these issues.


Virgin Care reports that the most recent pay run in June was successful and no further issues are anticipated.


Bank Staff


At the time of transfer it was not possible to migrate the Bank Solution from Sirona Care and Health to Virgin Care, it was recognised that there was a risk to both operational safety and agency costs on an ongoing basis.


Virgin Care undertook a proactive campaign to recruit bank staff and this has resulted in 250 members joining the bank and Virgin Care are undertaking a number of actions to support this; to continue the successful recruitment campaigns, to put in some additional resource to support bank allocation and additionally to implement a new IT software package for arranging and booking bank so staff find it easier to identify and post shifts they need to fill via bank.


Virtual Desktop and Network Roll Out


As part of its 100 day plan, Virgin Care has undertaken a complete replacement of the IT infrastructure used by the services they deliver. This project lays the foundations for the delivery of the new services and the transformation planned for the future, but was also driven by necessity as Virgin Care were only able to use the existing IT network for 100 days after transfer.


This large scale project required all devices and networking equipment to be replaced across 32 sites in Bath and North East Somerset by 1 July 2017 with all colleagues provided with new equipment and access details for both IT and telephony. 


As would be expected with any project of this scale, users reported some issues and these were logged and resolved or mitigated in line with the project plan. As the new system was rolled out to more users, the number of issues being raised increased but Virgin Care continued to mitigate and resolve issues so that services were able to continue to operate, making use of business continuity plans wherever necessary.


On 3 July 2017, Virgin Care took the precaution of enacting their Internal Major Incident Plan,  ...  view the full minutes text for item 26.


Home First Service Development pdf icon PDF 295 KB

This paper aims to provide the Health and Wellbeing Select Committee with an outline overview of the Home First service model, which was implemented within Bath and North East Somerset in March 2017.


The Senior Commissioning Manager and the Commissioning Project Manager introduced this item by giving a presentation to the Select Committee. 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.


Time is the currency


·  Time is the currency of health and social care

·  It is used to measure a range of aspects from waiting times, A&E Performance Times, DTOC’s to the length of social care visits.

·  However time is also the most important currency for our patient's. We know that the average patient admitted to hospital is within their last 1000 days.


The Last 1000 Days


·  If you had 1000 days remaining, how many would you choose to spend in hospital?

·  This thought has led to development of a social movement within the NHS called the Last 1000 days. This is about recognising that time is the most important thing for our patients and thus patient’s time must be important to those who care for them.

·  The Select Committee were shown video of a poem by a nurse called Molly Case, which was commissioned by NHS England that outlines the importance of this movement.


Home First


·  Home First (also known as discharge to assess) is based upon the principle that it is aimed, where safe, for all patients to be discharged home as soon as they no longer require care that can only be provided in an acute hospital bed.

·  Here Rehabilitation, Reablement and outstanding health and social care assessments can be undertaken at the right time and in the most appropriate environment for the patient to increase independence & fully assess their long term needs.

·  It ensures patients aren’t making decisions about their long term care needs whilst in crisis

·  If patients are unable to safely return home then temporary options need to exist to allow assessments to be undertaken in an environment which will best meet their needs.




·  It reduces the risks associated with prolonged hospital stays such as increased risk of infection and functional decline.

·  It ensures patients independence & functioning is optimised, allowing for a true assessment of their long term care needs.

·  It improves patient flow through the hospital, ensuring patients are discharged in a timely manner, decreasing delayed transfers of care and improving A&E performance.


Home First Pathways


·  Whilst the rationale for Home First is clear, responsive pathways need to exist to support this principle.

·  Within B&NES it has been agreed with other system partners in Wiltshire and Somerset, that we will utilise a number pathway options for the RUH facing system. This ranges from patients needing no additional support to go home, to those who need support in long term care settings.

·  Within B&NES Pathway 1, home with additional support, has had the most significant work to date.


Home First Pathway 1


·  Within B&NES the Home First Service (Pathway 1) is delivered by the Integrated Reablement Team. The Reablement team  ...  view the full minutes text for item 27.

Additional documents:


Select Committee Workplan pdf icon PDF 107 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.



The Director for Integrated Health & Care Commissioning advised the Select Committee that they could place on their workplan for September the following reports.


Mental Health Pathway Review


Care Home Provision


The Select Committee RESOLVED to approve these items for their workplan.