Agenda and minutes

The Chair welcomed everyone to the meeting.

The Chair drew attention to the emergency evacuation procedure.

Councillor Bryan Organ had sent his apologies to the Select Committee.

Councillor Tim Ball asked that the Select Committee send their best wishes to Councillor Organ.

Dr Ian Orpen had also sent his apologies to the Select Committee.

At this point in the meeting declarations of interest are received from Members in any of the agenda items under consideration at the meeting. Members are asked to indicate:

(a) The agenda item number in which they have an interest to declare.

(b) The nature of their interest.

(c) Whether their interest is a disclosable pecuniary interest or an other interest,  (as defined in Part 2, A and B of the Code of Conduct and Rules for Registration of Interests)

Any Member who needs to clarify any matters relating to the declaration of interests is recommended to seek advice from the Council’s Monitoring Officeror a member of his staff before the meeting to expedite dealing with the item during the meeting.

There were none.

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.

The Select Committee noted the written update that had been provided by Dr Ian Orpen. A copy of the update can be found on their Minute Book and as an online appendix to these minutes.

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 and 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.

Market Position Statement (MPS) Event

In April, The Council hosted an engagement event with providers and key stakeholders as part of a two month consultation on the draft Market Position Statement (MPS) for adult social care. This event was well attended and the MPS itself well received.

Further consultation is underway to develop the specific commissioning intentions for homecare. Workshops are taking place in June and July with providers, service users, carers and other key stakeholders.

Domiciliary Care Events

Commissioners are actively engaged with providers, key stakeholders and service users / carers in developing the future design model for homecare and held the first of a series of engagement sessions in June 2018.  Providers brought a wide range of ideas for improving services and developing the care sector.

In a vibrant and informative session, service users and carers shared their views of services and what make the biggest difference to their lives.

It was also suggested that the Council create a set of published standards and expectations for service users, carers and providers to all engage with. Further workshops are planned over the summer, from which a high level service model will be produced and refined into a business case for approval to proceed to procurement.

Sirona Dispute

Strike action undertaken by Unison to support staff across the 3 Community Resource Centres and Extra Care facilities in Bath is continuing in July 2018 with a series of further one-day strikes planned against the change to introduce unpaid breaks in line with the rest of the care sector and remaining Sirona employees.  The Council will continue to monitor the situation with Sirona and support service continuity.  Capital investment into the CRCs by the Council continues as planned with new clinical facilities and improvements to the 3 care homes underway (such as dedicated clinical rooms and general refurbishment).  Sirona is currently in the process of registering Combe Lea for nursing care with the Care Quality Commission which will increase the number of dementia nursing care beds available in the B&NES area.

Councillor Lin Patterson asked if any further comment could be made on the pay and conditions of affected staff.

Councillor Pritchard replied that the dispute is between Sirona and their staff. He added that the Council commissions the services of Sirona but has no means by which it can offer a possible resolution to the dispute.

The Director for Integrated Health & Care Commissioning said that following the statement to full Council by Unison, when it was agreed that the dispute could be considered for a cross-party discussion at the Select Committee it could look to keep track of this issue by making an entry on their workplan and that the Chair could decide on the need  ...  view the full minutes text for item 23.

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

Alex Francis, 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.

Accessible Information Standard (AIS)

During 2017 and early 2018, Healthwatch carried out a series of engagement visits to local groups and services to gather people’s feedback, in addition to a running an online survey. Through this work, Healthwatch spoke to 70 people and received a further 39 survey responses.

Findings:

·  It soon became clear that there is a lack of public awareness of the AIS. 28 survey respondents (72%) reported not having heard of the legislation, this was reflected through our conversations with local groups too.

·  20 of the 28 respondents (71%) reported using primary care services in the first instance, which highlights the importance of these services in raising awareness of the AIS with the public.

·  Almost half of the 28 respondents that had not heard of the AIS had a disability or sensory loss that would be recognised and supported through the legislation.

In general Healthwatch found that health and social care staff have a good knowledge of the need to support people with communications needs, however they are not always aware of the AIS legislation, or its requirements on how they work and operate. This is particularly important for organisations to note as the Care Quality Commission is beginning to include compliance with the AIS in its inspections.

Through our engagement we identified many areas of good practice, where organisations are working hard to comply with the AIS legislation, including the Ophthalmology and Audiology departments at the Royal United Hospital (RUH) and Avon and Wiltshire Mental Health Partnership NHS Trust (AWP).

Following our engagement, we held a workshop for local health and social care providers to find out what Healthwatch had learnt, share best practice and learn from one another’s experiences of implementing the AIS.

We invited the RUH and AWP to present to the group and share what they have done to comply with the legislation. Their insight was well received and attendees reported finding it useful to hear what had worked well, the challenges that these organisations had faced and how they had worked (or are still working) to overcome them.

Healthwatch is now going to work with colleagues at The Care Forum to set up an online provider forum for organisations across the West of England to continue sharing resources, information and experiences around the AIS.

‘What matters to you?’ – Public Event

On 4 July 2018, Healthwatch B&NES held an open meeting at Saltford Village Hall for members of the public and staff / volunteers from community or voluntary groups to come and share their experiences of using local health and social care services, or those of the people that they work with or support.

Topics or concerns raised by attendees, included:

·  Non-emergency patient transport services

·  Prescribing policy reviews, implementation and consistency of prescribing  ...  view the full minutes text for item 24.

The Select Committee will receive a presentation on this item from Jane Shayler and Dr Ian Orpen.

The Director for Integrated Health & Care Commissioning gave 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 is set out below.

National and local context

•  Future arrangements for commissioning and delivery of services are changing

•  Recognition of  benefits of working more closely with the Council to join up services locally

•  Desire to secure ongoing clinical leadership and develop place-based approaches

Key terminology

•  Neighbourhoods (30k-50k) – Groups of GP practices coming together e.g. primary care at scale, Primary Care Home models 

•  Place (250k-500k) – In line with Council boundaries - integration of primary, secondary and social care

•  Systems (1million +) – Like Strategic Health Authorities - self-regulating with 7-8 regions nationally each covering populations of  5-10m

The plan for B&NES

From 1 April 2019:

•  One team made up of CCG and People & Communities directorate

•  One management structure

•  One integrated commissioning and delivery function for health, social care, children & young people’s services and education transformation

What does this mean?

•  Pool or align all commissioning budgets

•  Create a new governance structure

•  Co-location of staff (over time) 

Case study: Joint Agency Panel

•  Funding packages for individuals with a high level of needs

•  Combined resources allocated to meet individual requirements

Our organisations in numbers

•  Council: 700 employees work in People & Communities / £85m budget (75% of overall Council budget)

•  CCG: 75 employees / £261m budget

Three groups

•  Group A – Integration (inc. commissioning, quality and safeguarding) – Formal consultation on new structure for some departments in September whilst options are still being considered on others.

•  Group B – Centralisation – Mapping exercises underway, timescales vary.

•  Group C – Delivery – Savings plans and change processes already underway (independent of integration programme).

Engagement activities

•  Online survey / Lunchtime drop-in events

•  Team meetings / Interviews with senior managers

Key themes – positives

•  Emphasis on staff training & development

•  Joining up IT systems

•  Key values: open, honest, supportive, positive, curious, inclusive, understanding each other

Key themes – challenges

•  Too high-level, more detail required

•  Capacity to deliver multiple change programmes

•  Some groups fearful of being overlooked:  Children and young people’s services /  Social workers /  Clinicians

Governance arrangements

•  Dual decision making process, both with a formal vote.

•  Meeting in shadow form currently, public meetings from end of 2018 / early 2019

•  Observer status intended to be similar to the arrangements for the Health & Wellbeing Board

Fitting the pieces together

•  Transfer of some commissioning functions to Virgin Care

•  The Council’s ‘Changing Together’ Programme

•  Council & CCG Integration Programme

•  Commissioning at scale across B&NES, Swindon and Wiltshire (STP)

Councillor Lin Patterson asked if any loss of staff was planned as part of this process.

The Director for Integrated Health & Care Commissioning replied that none was anticipated. She  ...  view the full minutes text for item 25.

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

Dr Bruce Laurence, Director of Public 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.

He began by stating his support of the current integration work as both parties share a common goal of ensuring health and prosperity for all residents. In response to earlier comments relating to cure / prevention he said that this remains a source for discussion, but he felt that there is an increased understanding for the need for prevention whilst at the same time recognising that more resources are currently situated with cure.

Air quality

Air pollution damages lives with harmful effects on human health, the economy and the environment. It is the largest environmental risk to the public’s health, contributing to cardiovascular disease, lung cancer and respiratory diseases. It increases the chances of hospital admissions, visits to Emergency Departments and respiratory and cardiovascular symptoms which interfere with everyday life. In the most severe cases it increases the risk of death, especially for people who are already vulnerable.

There is now an extensive body of evidence that long-term exposure to everyday air pollutants over several years contributes to the development of cardiovascular disease (CVD), lung cancer, and respiratory disease. Particulate matter (PM) is inhaled into the lungs and ultrafine PM0.1 is thought to pass into the blood causing many adverse outcomes including systemic inflammation.

A Clean Air Charging Zone for Bath - to improve air quality, the Government has told 28 Councils in England, including B&NES Council, to achieve compliance with NO2 limits ‘in the shortest possible time’ and by 2021 at the latest. This is part of their National Air Quality Action Plan. There are a number of hotspots in our area where concentrations of NO2 (caused by vehicle emissions) exceed the acceptable national and European limit of 40 µg/m3.

Amesbury neurotoxin incident

Public Health England considers that the risk to the public after the latest poisoning which has now caused one death, remains low. There is a major effort underway to find the source of this latest event. Although the persistence of different such agents in the environment varies, it is thought most likely that this contamination occurred via some sort of container where it was more protected from the elements. Therefore advice is being given to the public to avoid contact with any syringes or other containers that are found lying around in the relevant areas. Other advice given on a “very precautionary” basis that people who have visited certain sites should wash clothes or bag them securely if they need dry cleaning.

The B&NES public health team have offered support to their colleagues in Wiltshire should the need arise. 

The Public Health Newsletter

•  Free mental health training – Connect 5: Places on autumn and spring level 1-3 courses now available

Connect 5 is an accessible, evidenced based training programme that is  ...  view the full minutes text for item 26.

The Select Committee will receive a presentation on this item from Kirsty Matthews, Virgin Care.

Kirsty Matthews, Managing Director, B&NES Community Health and Care Services gave 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 is set out below.

1 year on – Achievements

•  Feel the Difference Fund funded a choir to help people with speech problems after a stroke communicate and express themselves, a ‘meet and greet’ for Shared Lives Carers, Lego therapy building blocks for children with autism and an electronic lobby sign in for the Ambulatory Care team to improve their welcome.

•  Worked with partners to launch a Rapid Response Falls service, which is helping avoid the need for people over 65 who fall at home to be admitted to hospital.

•  Home First service regional winner in the NHS70 Parliamentary Awards.

•  Recent recruitment campaigns have been successful in the recruitment of support workers and physiotherapists – areas that were proving hard to recruit to.

2017/18 Transformation Progress

Joined up care

•  Mobile working pilots undertaken, with colleague engagement in trailing and selecting devices.

•  Working with other partners to understand benefits of integrated records and developing the product for roll out.

Consider the whole person

•  Strengths based model for social care (3 Conversations) being piloted across social care

•  Citizens panel launched with over 50 members

Focus on prevention

•  Development of an advice hub, joining up all wellbeing services  (launch in July 18)

•  Engagement and development with VCSE to deliver a directory of services across B&NES

Valuing workforce and volunteers

•  Go-live of the Volunteer pass, working with other organisations now well embedded across B&NES

•  Safe transfer of volunteer centre services enabling this volunteering service to continue and sharing expertise of developing volunteers throughout community services

2018/19 Transformation Focus

•  SPA – Single Point of Access

•  CCS – Care Coordination Service

•  ICR – Integrated Care Records

•  Working Practices

Service Quality Report

•  Extended clinic times to accommodate people who work

•  Clinic in a box for sixth formers

•  100% uptake of infant immunisation at 24 months

•  Three conversations model

•  Friends and Family Test recommendation rate of 97%

•  B&NES Supported Living Services positive feedback from a recent CQC inspection, Bath obtained a rating of Good, waiting report for North East Somerset

B&NES priorities

•  Workforce plan to strengthen recruitment, decrease agency spend and develop workforce

•  Delivering Year 2 Transformation Plan

•  Meeting the B&NES System Needs, including expanding the Home First service and Reablement review

Councillor Tim Ball commented that Community Paediatricians currently have no home and are hot desking at the Rush Hill Surgery.

Kirsty Matthews replied that this was as a result of a flood at Ash House and that opportunities were upcoming and sites were being assessed.

Councillor Lin Patterson asked if a Post Traumatic Stress Disorder (PTSD) could be set up through the Feel the Difference Fund.

Kirsty  ...  view the full minutes text for item 27.

This paper updates members of the Committee about the work currently taking place to improve maternity services across the B&NES, Wiltshire and Swindon as part of the Sustainable Transformation Partnership (STP).

The Senior Commissioning Manager for Preventative Services gave 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 is set out below.

Future Service

Our Local Maternity System (LMS) vision is for all women to have a safe and positive birth and maternity experience and to be prepared to approach parenting with confidence.

Each LMS is required to produce a Local Maternity Transformation Plan. This was developed with the input and engagement of women and their families, clinicians, maternity staff, a range of partners (Health visitors, Family Nurse Partnership and Children’s Centres) and other stakeholders through a number of workshops. Informal engagement took place with more than 2,000 women.

Our future offer to our women and families will include:

•  Continuity of care (20% by 2019)

•  Improved personalised care and choice with parity of access

•  Creation of Clinical Maternity Hubs to provider ante and postnatal care close to home

•  Delivery of seamless pathways across organisational and geographical boundaries

B&NES, Swindon & Wiltshire (BSW) Local Maternity System

Maternity Transformation workstreams

•  Continuity of carer

•  Antenatal and postnatal care

•  Safer care

•  Personalised care and choice

•  Perinatal Mental Health

•  Workforce transformation

•  Working across boundaries / multi agency working

BSW LMS Maternity Services

•  Choice currently not equitable across the LMS footprint

•  Proposals for change will ensure choice options are met for majority of population across the LMS footprint

Choice of place of birth

•  11,247 births across the LMS in 2017/18, of which 85% were in an obstetric unit

•  7% were in a Alongside Midwife Unit (GWH) and 6% in a Freestanding Midwife Unit (RUH)

•  RUH has seen an increase in numbers of births at the Obstetric Unit and a corresponding decline in numbers of births in their FMUs / home birth

Councillor Lin Patterson asked why the numbers of women giving birth at home or in freestanding midwifery units had dropped and subsequently increased in the obstetric unit. 

The Senior Commissioning Manager for Preventative Services explained it was in part due to the increase in complexity of the needs of women giving birth, especially older women and women with a higher BMI. She added that access to pain relief and concerns about the need to transfer during labour to the obstetric unit in birth (which can be 30% - 40% of women having their first babies) were also factors.

LMS Challenges

•  Lack of parity of provision

•  Future sustainability

•  Workforce – Right staff, right place, right time

•  Delivery of Better Birth agenda

Clinical leadership

•  Strong clinical leadership of process

•  Dedicated LMS Midwife

•  Multi-disciplinary clinical involvement and staff engagement – obstetrician, neonatologist, midwives, MCAs and administrative staff

DadPad app

As part of the Local maternity transformation plan, a DadPad app was launched across B&NES, Wiltshire and Swindon in June and has been shared with a wide  ...  view the full minutes text for item 28.

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 said that a report on Ophthalmology had been arranged for September and progress on the Council / CCG Integration would come in the form of their regular update items.

The Chair asked if it would be possible to receive an update on the NHS 111 service.

Councillor Lizzie Gladwyn asked if the Dentistry Services report could be scheduled for September.

The Director for Integrated Health & Care Commissioning replied that she would enquire as to the feasibility of the requests made.