Agenda and minutes

The Chair welcomed everyone to the meeting.

The Chair drew attention to the emergency evacuation procedure.

Bruce Laurence (Director of Public Health) had sent his apologies to the Select Committee. Paul Scott (Assistant Director of Public Health) was present as his substitute.

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 Lizzie Gladwyn declared an other interest with regard to agenda item 13 (Mental Health Pathway Review) as she is an expert patient and volunteer for AWP.

There were none.

The Cabinet Member for Adult Care, Health and Wellbeing, Councillor Vic Pritchard advised the Democratic Services Officer that he had not been included within the ‘in attendance’ section of the front page of the minutes.

With this amendment in mind 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.

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

In July over 94 per cent of patients were seen in A&E within the four hour target wait.  However in August this dropped to 90.6 per cent and unverified figures for September indicate a further decline.  Working with the Royal United Hospitals Bath NHS Foundation Trust (RUH), Virgin Care, the South Western Ambulance Service NHS Foundation Trust and many other providers we are beginning our preparations for winter to ensure we can maintain patient safety and performance over the coming months.

GP Survey Results Summer 2017

GPs in Bath and North East Somerset have once again come top of a nationwide patient survey for patient experience.

The July GP Patient Survey showed that 93 per cent of the almost three thousand B&NES residents who took part in the survey in January 2017 rated their experience at their GP surgery as ‘good’. This compares with a national average of 85 per cent.

The continued positive results that B&NES GPs achieve in this survey despite the exceptional pressures on their time and services is testament to GPs commitment to the quality of patient care.

Urgent Care Centre

At the start of August 2017 we appointed the RUH and B&NES Enhanced Medical Services to run the Bath-based Urgent Care Centre after a rigorous procurement process.

The partnership will take over responsibility of the centre from May 2018, and will work closely with B&NES Doctors Urgent Care – which currently runs the service – to ensure a smooth transition.

Helping patients get fit for surgery

From next month we are making changes to the fitness programme we currently provide for patients needing hip or knee surgery. Over 40 percent of participants see such an improvement they no longer require surgery. From October the programme will be extended by up to three months to include weight management support for those with a body mass index (BMI) of 30 or more and smoking cessation advice for smokers. 

One of the ways to improve health and wellbeing is to increase the number of people accessing smoking cessation and weight management services, and evidence suggests that the point of referral to surgery is an opportune moment to encourage people to uptake referrals to these services.

Evidence also suggests that patients who smoke and/or are obese are at higher risk of surgical complications when compared to those who don’t smoke and are a healthy weight.

We plan to roll the scheme out to other surgical procedures next year following consultation with the public about our plans which begins at the start of October.

NHS England consultation on prescriptions for medicines of low value

NHS England has launched a formal consultation on new national guidelines which state that 18 treatments – including homeopathy, travel vaccines and  ...  view the full minutes text for item 36.

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 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.

Community Services : Virgin Care Update

·  Workforce

Virgin Care recognise that recent operational issues have had in some cases a significant impact on staff and the Senior Management Teams are ensuring staff are adequately supported and fully equipped to undertake their roles.

The appointment of the Virgin Care Bath and North East Somerset Managing Director post has now been appointed to and will take up post in early November 2017. 

Work is also underway to finalise arrangements for CCG and Council Commissioning Resource in relation to sub-contracted services that will transfer to Virgin Care on 1st April 2018.

·  Transformation

Transformation plans are progressing and all required contractual milestones for Quarter 1 have been met by Virgin Care.

Considering the Whole Person

Virgin Care launched the Citizens Panel in Quarter 1 against a Quarter 2 deadline, the panel aims to be representative, and open to all and focuses on the views of local people, and seeks views, insight and involvement in local health and care services. There are currently 28 members recruited to the Panel and Virgin Care will seek to ensure that year-on-year the number of members increases. The Virgin Care draft Engagement Strategy has also been shared with Commissioners and Community Champions. The launch of the Carers club will take place in Quarter 2.

Work has also commenced in developing a framework by Quarter 4 that delivers a comprehensive assessment that will enable the production of a holistic care and support plan, specific to the individual and based around their personal goals. 

Red Bag Initiative with local care homes

Ten care homes in B&NES are piloting a new initiative whereby residents who need to visit hospital are accompanied by a distinctive red bag, which contains all relevant medical information as well as their personal belongings.

The red bags will stay with the patient for the duration of a hospital visit and contain specific admission and discharge checklists for medical staff to fill out. These lists will help ensure that every member of the medical team receives exactly the same information, and nothing gets misplaced or miscommunicated on the way in or out of hospital.

The initiative is being introduced jointly by the CCG and Bath & North East Somerset Council into initially five nursing and five residential care homes in B&NES. It was first launched in 2016 by Sutton Clinical Commissioning Group and the design of the B&NES pilot has had important input from hospital matrons and palliative care nurses at the Royal United Hospitals Bath NHS Foundation Trust.

Efficient communication helps build good working relationships and working practices between the care home and hospitals, which ensures that a resident’s hospital admission and discharge is also efficient.

The pilot launched in September 2017 and  ...  view the full minutes text for item 37.

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

Paul Scott 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.

Physical (in)activity

Sport England have published a report based on a survey from 2015-6 into levels of activity in adults from 40-60. 4 out of 10 (41%) adults aged 40 to 60 in England walk less than 10 minutes continuously each month at a “brisk pace” which equates to moderately intense physical activity that brings cardiovascular benefits.

There is a small gender difference: 18.9% of men vs. 20.4% of women but a more striking socio economic inequality, with 32.9% of adults aged 40 to 60 from the most deprived areas being classed as physically inactive, compared to 11.3% in the least deprived areas.

Part of the national strategy to increase levels of activity is the development and promotion of the “Active 10” idea and app. by Public Health England which is encouraging adults to build 10 minutes continuous brisk walking into their day as a simple way to improve their health. The ‘Active 10’ app has been developed to show how much brisk walking a person is doing each day and how to incorporate more of it into their lifestyles. You can visit the website:  http://po.st/Active10_Bath_NESomerset or search active 10 in the app store to download it free.

He informed the Select Committee of the Bathscape Walking Festival that took place from the 16th – 24th September 2017. He explained that the Bathscape Landscape Partnership aims to reconnect people with the unique natural setting of Bath and the surrounding area.

Responding to a burst water main

On July 19th a water main burst at Willsbridge in South Gloucestershire that caused a loss of supply to 35,000 properties in Keynsham, parts of Saltford and Kelston. This then led to a combined response from the B&NES environmental health and public health teams, the local NHS, residential and nursing homes, various businesses and of course Bristol Water, and similar counterparts in South Gloucestershire.

In the event water was off for just about 24 hours, which caused much inconvenience, but no real serious problems or outcomes.

The silver lining to the cloud of such an event is that we get the chance to test emergency response and business continuity plans for real across partnerships. And in this case, as ever, there were some good findings and some lessons to be learned where things didn’t go so well.

On the plus side some findings of what went quite well were:

• Good feedback from Domiciliary Care providers
• Internal team work to help affected businesses/vulnerable groups
• Virgin Care business continuity plans and offer of help from District Nurses to vulnerable patients.
• Public Protection phoning around high risk premises
• Out of hours list and contacts
• Red Cross were very helpful
• We were ready to open the Council’s control room

Some things that went less well were:

• Poor communications from Bristol Water; gravity  ...  view the full minutes text for item 38.

Select Committee members 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.

Non-emergency patient transport

During quarter two, BaNES Clinical Commissioning Group (CCG) approached Healthwatch to ask if we would be interested in undertaking some joint work around the non-emergency patient transport service provided by Arriva Transport Solutions. Healthwatch agreed as this is a service that we regularly receive feedback about, and have raised concerns with the CCG about in the past due to the quality of service that people have reported.

A joint visit was carried out in early August between Healthwatch and the CCG, which included a ‘ride-along’, which allowed us to experience patient transport first-hand. During the ride-along staff spoke to patients and drivers about their experiences of using and providing the service. The visit also included an opportunity to speak to patients that had arrived at, or were waiting to be collected from, the Royal United Hospital, Bath.

All of the feedback gathered during the visit has been pulled together into a joint report. The CCG has shared the report with Arriva for comment.

B&NES community mental health review

In August, Healthwatch met with commissioners and staff from B&NES Council, BaNES CCG and Virgin Care to discuss the community mental health review that is currently underway. During this meeting Healthwatch shared all of the feedback that it had received regarding community mental health services, both from people that use these services, and also their carers or relatives.

An options paper outlining the themes and proposals for community mental health provision in B&NES is expected to be released in the autumn. Healthwatch has offered to run a public meeting for people to discuss the options in more detail, and also a Health and Wellbeing Network meeting so that voluntary, community and social enterprise (VCSE) colleagues can have their say. Details of these events will be shared widely once confirmed.

Safeguarding adults

Healthwatch is a member of the Local Safeguarding Adults Board; we are currently working closely with B&NES Council, BaNES Clinical Commissioning Group, Avon and Somerset Police and other partners to undertake three safeguarding adults’ reviews.

Healthwatch aims to provide a lay perspective on each case; asking questions about how local safeguarding policies and procedures have been implemented, and helping to establish how effectively local organisations have worked together to safeguard the individuals concerned. Once complete, the findings of these reviews will be published, including recommendations for the future and any key learning to ensure best practice is implemented.

Sustainability and Transformation Partnership (STP)

In August, Healthwatch B&NES and Healthwatch Wiltshire met with the new STP Programme Director and Programme Manager to discuss Healthwatch’s role in the revised governance arrangements, and review the communications and engagement approach that has been in place to date. Local Healthwatch reiterated the need  ...  view the full minutes text for item 39.

This paper has been prepared to ensure that the B&NES Health and Wellbeing Select Committee are kept up-to-date with the proposed relocation of the Royal National Hospital for Rheumatic Diseases (RNHRD) Bath Centre for Fatigue Service (BCFS) from the Mineral Water Hospital site to a purpose built RNHRD and Therapies Centre on the RUH’s Combe Park site.

Clare O’Farrell, Deputy Chief Operating Officer, RUH introduced this report to the Select Committee. She informed them that there will be no change in the level of service provision for patients of the RNHRD Bath Centre for Fatigue Services. She explained 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 stated that the proposed new location will provide better facilities, including enhanced group rooms and improved waiting room facilities. There will be improved physical access, including flat access to the new Centre, ground floor clinic and group rooms and a purpose designed building which can better accommodate those with restricted mobility.

She said around thirty attendees were present at an informal engagement session which was convened earlier in the year, as an addition to a pre-arranged Friends and Family event. She explained that they had the opportunity to see plans and hear about the detail for the new Centre. She said that attendees were generally positive about new and improved facilities on the understanding of the same quality of service at the new location.

She explained that a total of 22 people completed at least some of the engagement questionnaire, with 17 completing the full questionnaire.

She said that subject to the Committee’s endorsement of the plan to relocate the RNHRD’s Bath Centre for Fatigue Services to a purpose built RNHRD and Therapies Centre on the RUH’s Combe Park site, construction of the Centre will get underway in 2017, and the services will relocate when the new build is complete, scheduled for 2019.

She added that the next phase of PPE activities relate to proposals to relocate the RNHRD’s Pain Management services. Planning is underway to launch the final round of PPE activity in early 2018.

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 Bath Centre for Fatigue Services from the Mineral Water Hospital site to a purpose built RNHRD and Therapies Centre on the RUH’s Combe Park site.

In line with the Your Care, Your Way full business case, the Mental Health Pathway is currently being reviewed by commissioners. This report provides an update on that review with particular focus on key themes which have emerged during the engagement phase.

The Community Services Programme Lead introduced the report on behalf of the Senior Commissioning Manager for Mental Health who was unable to attend. She informed the Select Committee that a review of the mental health pathway is being undertaken by the Council and Clinical Commissioning Group in order to determine the best model for the future commissioning of community and statutory mental health services across health and social care.

She explained that the review aims to identify how people access services, the quality of the services received, how they leave services and ongoing support. She added that it will seek to identify how services link together and in particular how physical and mental health services work together.

She said that the review will also identify areas of best practices within B&NES, what is working well, where there are gaps, duplication, potential for sharing resources and areas for improvement.

She gave the Select Committee some examples of the comments made during the initial engagement interviews.

·  The voluntary sector in BANES is excellent – but statutory services need to support them and service users and carers to use and further develop them.

·  Peer working, peer mentoring, volunteering and befriending are important elements of the recovery process and require further development.

·  Transitions between CAMHs and adult mental health services sometimes do not work well.

·  Dual diagnosis (substance misuse and mental health) service users can fall between gaps - too risky for IAPT but not severe enough for other services.

She stated that it is anticipated that an initial assessment of options will be considered by the Council / CCG Joint Commissioning Committee in October 2017, and that this will be followed by a more detailed options appraisal to be presented in November / December 2017 with the aim of implementing from April 2018.

Councillor Bryan Organ asked if the matter of transitions had improved recently.

The Community Services Programme Lead replied that there had been some improvement. She said that through the review 15 CAMHS users had been interviewed. She added that the question remains as to whether Children’s Services should extend to 25 years of age or for what period there should be an overlap. She stated that this issue was high up on the list to be resolved.

Councillor Lin Patterson commented that she was pleased to see this issue receiving the appropriate attention.

Councillor Eleanor Jackson raised the matter of being able to access services and that this may be different for members of the public who are based more rurally to those within the city. She added that she had seen information that reported that 1 in 4 girls suffer from some form of depression.

The Community Services Programme Lead that the engagement with young people throughout this process was key. She added that in particular officers were keen assess their aspirations and talk of how they access services. She said that as parto the review that Bath Area Play Project and Off The Record have held focus  ...  view the full minutes text for item 41.

This paper provides a briefing on the care homes market in Bath & North East Somerset (B&NES). It offers an overview of the quality and supply in current provision as well as introducing some key gaps and challenges in the sector.

The Commissioning Manager for Adult Social Care introduced this report to the Select Committee. He informed them that the Care Quality Commission (CQC) lists 60 care homes in B&NES. The ‘Older Persons’ portion of that market consists of 36 homes offering 1,375 beds in total. He added that roughly a quarter of this capacity supports dementia care.

He explained that the Council currently has 320 active placements in B&NES, including 34 Continuing Healthcare beds on behalf of the CCG. This is a market share of 23%. The remaining beds are either vacant or occupied by placements from other Local Authorities/CCGs or self-funders. The Council and CCG also make some out of area placements though this is a minority.

He said that as of 11th September 2017, there are 40 available vacancies across B&NES and 11 of these are for nursing beds.  However, the bed types do not always match the needs of people assessed and not all of them are affordable to the Council. Almost half of the 40 vacancies are in one particularly expensive home. This puts a lot of pressure on the Council when securing placements and can also cause delays in hospital discharge. 

He stated that the majority of care homes in B&NES are rated by CQC as ‘Good’ though a few do ‘Require Improvement’ in one respect or another.

He explained that between 2016 and 2017, 6 care homes in B&NES closed with the loss of almost 200 beds. This was due to a range of factors but again has reduced capacity significantly, pushed up fees and led to greater pressure on hospital discharges. The commissioning team has a successful track record in managing these closures and ensuring continuity of care for residents.

He informed the Select Committee of the ‘Discharge 2 Assess’ beds project. He said that this was a result of joint commissioning across the Council and CCG in partnership with the not-for-profit sector. He explained that commissioners are piloting a scheme to deliver 5 short-stay beds to assess people’s long term care needs. This alleviates pressure on hospital discharge and allows people’s long term needs to be more accurately assessed outside the acute hospital setting. It will also help the Council to place people in a more planned way and negotiate fees with providers with more time.

The Chair asked if there were any concerns over staffing levels within care homes.

The Commissioning Manager for Adult Social Care replied that B&NES is a member of the ‘Proud to Care-South West’ campaign. This seeks to make social care a more attractive career option and tackle the longstanding challenges of recruitment and retention in care homes. He added that there are enduring issues of staff turnover and shortage, with close attention on the possible impact of the UK leaving the European Union.

Councillor Bryan Organ asked if the Council had working connections with St. Monica’s Trust.

The Commissioning Manager for Adult Social Care replied that there is an established  ...  view the full minutes text for item 42.

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 Chair introduced this item by noting that the Select Committee were due to receive the Local Safeguarding Adult’s Board Annual Report at its November meeting.

Councillor Bryan Organ proposed that they receive a report in November regarding Non-Emergency Patient Transport Services.

Councillor Lin Patterson proposed that a report on Midwifery Services be submitted to the Select Committee.

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