Agenda and minutes

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Contact: Mark Durnford  01225 394458

No. Item




The Chair welcomed everyone to the meeting.




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 Geoff Ward had 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.


Councillor Tim Ball declared an other interest in agenda item 8 (Clinical Commissioning Group Update) as he is a patient at the Number 18 Surgery.




There was none.



At the time of publication no notifications had been received.



John Drake, Unison made a statement to the Select Committee on the subject of Sirona. A copy of the statement can be found on the Select Committee’s Minute Book, a summary is set out below.


Since the Council meeting on July 12th 2018 discussions have taken place and currently Sirona have agreed to postpone their proposal to dismiss and re-engage staff on new contracts. As a result of this decision Unison has agreed to cancel proposed strike action.


Extensive consultations have taken place between UNISON representatives and those workers who would be affected and the decision was taken to reject the proposals from Sirona on the basis that members would be impacted in one of two ways:


Individuals would lose 30 minutes pay per shift, which for someone working 6 shifts per week is a loss of income of 3 hours per week. Or alternatively individuals could remain on their current income but would accrue hours which they would then owe Sirona and then be forced to work additional shifts per month to make up the shortfall in hours for the same pay.


UNISON believes that the Sirona Board and Senior Leadership Team are well intentioned in their efforts to provide quality care but our experience is of an organisation that is poorly managed, unable to retain & recruit staff in its CRCs and Extra Care.


UNISON believes that the Council could and should instruct Sirona to halt all plans for a reduction of pay for its front line care staff.


This matter will fall into the lap of the Council sooner rather than later and we feel the Council should step in and tell Sirona that their actions are unfair.


Councillor Robin Moss commented that the current Council administration will state that this is an independent contract and therefore the Select Committee and the Council itself have little to no power to act. He added that he felt it was important for the Select Committee to take further action and to request that Sirona’s decision remains suspended until a full discussion on the matter has been had by the Select Committee.


Councillor Lin Patterson said that she agreed totally with the comments made by Councillor Moss.


The Director for Integrated Health & Care Commissioning said that if the Select Committee were minded to they could discuss that matter further at a future meeting. She added that as previously confirmed, the Select Committee do have limited powers to intervene in this matter and could refer the issue back to the Council, Cabinet or the Cabinet Member for further consideration.


However, as previously stated the Council is not in a position to intervene directly in this matter, which is a dispute between an independent organisation and its staff group. She clarified that neither the Council nor the Select Committee can instruct Sirona to halt its plans as proposed by UNISON in the statement to the Select Committee.


Councillor Vic Pritchard, Cabinet Member for Adult Care, Health & Wellbeing commented that for the Select  ...  view the full minutes text for item 35.


MINUTES - 18th July 2018 pdf icon PDF 126 KB


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.


CCG Ratings for Cancer and Maternity Services


New ratings on cancer and maternity services were published in August 2018 highlighting where CCGs are performing well and identifying where improvements are required. We have been rated as 'outstanding' for both cancer and maternity services. The assessments are conducted using the same indicators used within the CCG Improvement and Assessment Framework (IAF) but are separately conducted by independent panels.


GP Patient Survey


GP Practices in Bath and North East Somerset (B&NES) have again been rated as amongst the very best in the country, according to our patients. The results of the latest GP Patient Survey found that, of the 2,828 residents questioned, 91 per cent rated the overall experience at their GP surgery as ‘good’ – the fourth highest in the country and just two percentage points away from the top spot. The results are also higher than the national average of 84 per cent.


Primary Care Strategy


This month we published our Primary Care Strategy that outlines how we intend to support GP practices in B&NES over the two-year period. It focuses on five main areas and what we are doing to address them:


Access to care / Models of care / Workforce sustainability / Workload / Estates and infrastructure


You can read the full strategy and one page summary here.  


Closure of Number 18 Surgery


On 28 September Number 18 Surgery will merge with the Heart of Bath Medical Partnership and the current Number 18 Surgery site will close.


All patients currently registered with Number 18 Surgery will transfer to the Heart of Bath Medical Partnership, unless they give instructions otherwise. The transfer is being carefully planned to make the process as smooth as possible for everyone.


The majority of staff from Number 18 Surgery, with the exception of Drs Charlie Berrisford and Linda McHugh, will be moving across to join the Heart of Bath Medical Partnership. Therefore, patients will continue to see many of the same staff once the merger has taken place.


The decision to close Number 18 Surgery arose because of an increase in patient activity but a decline in patient list size, meaning the business is unfortunately no longer financially viable.


However, there are many opportunities to be gained from the merger with the Heart of Bath Medical Partnership. Not only does it mean that patients will have the choice of three sites across Bath, with two of these close to the current Number 18 Surgery premises, but they will also have access to a wider range of services and benefit from more practice team skills.


Flu campaign


People in B&NES aged over 65 years will receive a new type of flu jab this year, which is considered to be more effective than other available vaccines.

The  ...  view the full minutes text for item 37.

CCG Update September 2018 pdf icon PDF 80 KB


Cabinet Member Update

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.


Update on the Community Mental Health Services Review


In the summer of 2017, the Council and CCG started to review the way in which mental health services need to be delivered for the population of B&NES.


The review is being carried out in four key stages:


·  Phase 1: Analyse and Plan (May 2017 – Aug 2017)


·  Phase 2: Design and Specify (August 2017 – January 2018)


·  Phase 3: Develop final service model (February 2018 – February 2019)


This is the phase we are currently in. We have six working groups who are looking at everything people are telling us and developing detailed options for how community mental health services could be delivered in the future.


·  Phase 4: Implementation and Delivery (March 2019 – April 2019 onwards)


Next steps


Further engagement will now take place with key groups and once complete,

the draft service models will be created and formally consulted on with the public.  It is expected that a final service model will be developed and put in place from April 2019.


Homecare Review


Homecare services are currently provided in Bath & North East Somerset by a range of local providers, who deliver in the region of 140,000 hours of homecare per annum.


We are currently undertaking a review of homecare services, working closely with Virgin Care in readiness for a new homecare pathway and contracts from July 2019.


Between June and September 2018 the project team have been undertaking a period of research, evidence gathering, engagement and co-design with key stakeholders. 


Possible Future Models

We have produced a draft possible future service design for Bath & North East Somerset which has been well-received by both providers and commissioners.  We will also be working to develop these ideas with a group of carers, via the Carers’ Centre.  


Next Steps


Once we have finished this period of co-design of a possible future model, we intend to make it available to the public for comment and suggestions, taking on board their feedback before finalising the service model which, subject to approval, is planned to go live in autumn 2019.


Reablement Service Review


Reablement services in B&NES are commissioned through the Better Care Fund, and include three key pathways:

·  Home First (from hospital)

·  Admission Avoidance (to hospital)

·  Planned Reablement


They are provided by Virgin Care, as our prime provider, with additional

Reablement Worker capacity commissioned from 3 Strategic Partners: Care Watch, Care South and Somerset Care.


Commissioners are currently leading a project to review and redesign the existing Reablement Service, gathering together evidence on existing strengths and opportunities for development both in-year and longer term.  We are working closely with Virgin Care, as our prime provider, to design a new service to come into effect from autumn 2019. 


Planned  ...  view the full minutes text for item 38.

Cabinet Member Update September 2018 pdf icon PDF 92 KB


Public Health Update

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.


Public Health Newsletter


Sugar Smart


Following Sugar Smart Exeter's pioneering effort in 2017 to get the city's residents to take on sugar reduction challenges, Sugar Smart UK is taking the challenge and here in B&NES we are joining in! It's a month-long challenge to encourage people to be smart about their food and drinks choices and to try to reduce the amount of added sugar consumed during September.

Learn more about each of the challenges by downloading the resource pack and tracking your progress.


Organ Donation Week 3 – 9 September 2018


Right now across the UK, there are around 6,000 people in need of an organ transplant, including around 150 children and teenagers. On average three people die every day in need of an organ transplant because there just aren’t enough organ donors.


More people are needed to sign up to the NHS Organ Donor Register now at It only takes a few minutes to register and those that sign up are being encouraged to tell their family that they want them to support their decision to donate and save lives.


Please encourage conversations in communities and help to raise awareness of this important campaign.


Know Your Heart Age


Is your heart age older than you? On the 4th September 2018 as part of the One You campaign Public Health England are launching their One You Heart Age Test.  The tool is a quick, online resource which uses physical and lifestyle related questions to calculate your heart age.    It highlights the need to know your numbers, such as blood pressure and cholesterol, and helps you to understand how to live healthier for longer. Adopting a healthy lifestyle can reduce your risk of dementia. So use the tool, know your risk and remember there really is only One You!  Test your heart age here.


Start4Life launched the 24/7 Breastfeeding Friend on Google Assistant and Google Home


The 24/7 Breastfeeding Friend has been developed to provide friendly advice to mothers who have questions and need support with breastfeeding at any point, day or night. The tool is voice activated using the Google Home app or Google Assistant, meaning mums can get NHS-approved advice and daily breastfeeding tips in the moment and when they may have their hands full. 


World Mental Health Day


World Mental Health Day is observed on 10th October every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health.  This year has a particular focus on young people and mental health in a changing world.  To mark the day in B&NES we are encouraging schools and other young people’s settings to explore the idea of Five Ways to  ...  view the full minutes text for item 39.

Public Health - Select Committee - Sept 18 Briefing pdf icon PDF 588 KB


Healthwatch Update

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.


Trans Health & Wellbeing Survey


In 2017, Healthwatch B&NES worked with other Local Healthwatch in Bristol, North Somerset, South Gloucestershire, Swindon and Wiltshire to jointly commissioned a survey into the health, care and wellbeing needs and experiences of local Trans* and Non-binary** people. This work was carried out by The Diversity Trust, a local organisation that specialises in engaging with equalities groups.


*Trans is an umbrella term for people whose gender identity and/or gender expression diverges in some way from the sex they were assigned at birth.


**Non-Binary refers to any gender that is not exclusively male or female. A similar term is gender neutral or gender queer. Some other non-binary identities include: agender, bigender and genderfluid.


A series of recommendations have been made as a result of this survey, including:


·  The need for transgender awareness training for health, care and wellbeing staff

·  The need for service providers to develop policies on challenging transphobic bullying, harassment, victimisation and discrimination in line with the Equality Act (2010) and the Public Sector Equality Duty (2011).

·  A recommendation for service providers to develop a Trans Inclusion Policy, involving and consulting with Trans staff and patients, on best practice in supporting Trans colleagues and patients through their transition.


Lay Involvement With Healthwatch B&NES


Following the recommissioning of Healthwatch B&NES from 1 April 2018 we have reviewed our governance and the roles that lay people play in how Healthwatch B&NES is run. Our newly established Executive Board provides leadership, sets work plan objectives and oversees the delivery of Healthwatch B&NES to ensure that it effectively captures the public ‘voice’ and uses its role to influence and shape the provision of local health and social care services.


The provider link volunteers aim to work closely with key Trust personnel to help facilitate regular dialogue, share feedback from the public (and receive a response where possible), and increase understanding around the work that each organisation is doing.


This approach has worked well with the RUH, with our lay representative being a valued member of the Patient Experience Group, having regular meetings with the Trust Chair and Head of Patient Experience, and being involved more widely in RUH activity, e.g. recruitment of a new Complaints Manager.


‘What matters to you?’ public event


On 4 July 2018 Healthwatch B&NES held an open meeting in Saltford for members of the public and representatives from VCSE organisations to 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:


·  Prescribing policy reviews and the implementation and consistency of prescribing across the district.

o  Attendees were unclear whether the prescribing reviews were being led locally or nationally, and whether  ...  view the full minutes text for item 40.

Healthwatch B&NES Update September 2018 pdf icon PDF 215 KB


BSW Maternity Transformation - Consultation approach pdf icon PDF 98 KB

The following information outlines the approach to be taken in engaging and consulting with the public and key stakeholders about the proposal for change.

Additional documents:


Sarah Merritt, Head of Nursing & Midwifery, RUH and Tamsin May, Head of Communications, B&NES CCG introduced this report to the Select Committee.


Sarah Merritt said that the Maternity Services reconfiguration programme is committed to continuing to engage with all relevant stakeholders. She added that early engagement and involvement has aimed to create an understanding of the challenges faced and the need for change, and contributed to the co-creation of the proposal for change.


She explained that Stage 1 Approval was gained in May 2018, an initial Stage 2 meeting took place in July 2018 and that a further meeting would take place in October to gain approval for consultation.


Tamsin May highlighted some of the guiding principles to the Select Committee.


  • We will clearly set out what we are proposing, why these changes are needed, and why we are consulting with patients and the public. People must be very clear how their views and feedback will be used/have influence, and what the full consultation process involves.


·  We will consult with different groups in ways that are meaningful and appropriate for them including face to face meetings and surveys.


·  We will use communications and engagement channels which will provide patients, public and other stakeholders out of area information and opportunity to feedback on the proposal.



·  We will make sure that information and events are fully accessible, and are shared widely over a sufficient time period, so that all groups can fully engage in the consultation process.


·  We will share stakeholder feedback publicly and explain our final decision(s) with honesty and transparency.

She informed the Select Committee that the consultation and communications for the programme is being led by Wiltshire Clinical Commissioning Group on behalf of the Bath & North East Somerset, Swindon and Wiltshire Local Maternity System. She added that the Wiltshire CCG’s communications team, with the support of the Local Health Economy Communications Working Group (LHECWG), is responsible for the planning and implementation of the consultation plan and approach and will:


  • Meet regularly as a local health economy communications and engagement group, and provide briefings and updates to communication colleagues from neighbouring CCG and provider organisations


  • Work with Healthwatch and CCG PPE leads to ensure service user voice in discussions and decisions.


  • Ensure consultation responses are thoroughly considered and are included as part of the decision making process.


She stated that materials are to be developed to support the consultation will and will include, but not be limited to:

  • Core consultation document
  • Easy read summary of the consultation document
  • Frequently asked questions (FAQs) and answers
  • Posters and leaflets summarising key information and signposting to feedback channels
  • Dedicated website
  • Survey for use online and hard copy.


She said that copies of the consultation document will be distributed to health and community settings and stakeholder groups across the local maternity system area as appropriate. She added that the consultation document will be made available in alternative versions e.g. large print, audio, on request.


She stated that a range of communications channels and  ...  view the full minutes text for item 41.


Community Eye Care Services (Ophthalmology) pdf icon PDF 81 KB

The paper describes the pressure on the ophthalmology service at the Royal United Hospitals Bath Foundation Trust as a result of increasing demand and a national shortage of consultant ophthalmologists. 


Catherine Phillips, Senior Commissioning Manager for Acute Care, BaNES CCG introduced the report to the Select Committee. She explained that there is pressure on the ophthalmology service at the Royal United Hospitals Bath Foundation Trust as a result of increasing demand and a national shortage of consultant ophthalmologists.  She added that this has resulted in long waiting times to be seen and potential patient risk, for eye care pathways in B&NES.


She informed them that the main provider to the population of B&NES for planned (elective) and urgent (non-elective) Ophthalmology activity is the RUH, managing approximately 78% of total B&NES activity.


She stated that the RUH Ophthalmology service has not achieved the 92% Referral to Treatment (RTT) target of 18 weeks since July 2017, although the service had achieved the target in previous years. She said that this has resulted in current waiting times of 36 weeks for a General Ophthalmology appointment. She added that the number of follow up appointments that have been delayed has also increased within this period.


She highlighted some of the actions the Clinical Commissioning Group and Royal United Hospitals are taking to improve quality and safety, and provide a more effective and efficient service through the procurement of new community based pathways.


·  BaNES CCG is in the process of commissioning a Community Eye Service which will particularly benefit a range of patients. Clinically, the model includes pathways for Minor Eye Conditions, Intraocular Pressure (IOP) Referral Refinement, Ocular Hypertension (OHT) & Stable/Suspect Glaucoma monitoring Cataract Referral Refinement and Cataract follow up.


·  Firstly, patients who have recently identified that they have an eye condition, such as a scratch, foreign body, lumps and bumps in the eye, blurred vision, watery eyes, flashes and floaters. These patients will be able to visit an optometrist in the community to be seen within 2 working days, usually on the same day. For the majority of patients, these eye conditions will be resolved in the community but referral routes will be in place for patients to be sent to the RUH for further urgent treatment if required.

·  Secondly, patients with suspected cataracts or glaucoma will receive a second and more detailed assessment and discussion in the community in order to ensure the right patients are referred to secondary care. There are benefits to the health system of ensuring only patients that need and want further treatment are referred, but also to patients who will be able to speak to someone more rapidly (within 4 weeks) about their potential condition and their options.

·  Thirdly, patients who have received a procedure in secondary care (e.g. cataract removal) or who have a condition that the consultant ophthalmologist considers is stable (e.g. stable glaucoma) will be able to see a local optometrist for their follow up appointment instead of returning to their secondary care provider. This will be more convenient and is more likely to meet the appropriate follow up timescales, e.g. annual follow up for glaucoma. Should the patient’s condition change, the  ...  view the full minutes text for item 42.


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 Chair introduced this item to the Select Committee.


Councillor Robin Moss reminded them that earlier they had discussed adding items to the workplan on the subjects of Sirona and Mental Health Preventative Work (Wigan Deal).


The Select Committee agreed that they would prefer to have a special meeting to discuss Sirona rather than waiting for the next scheduled meeting in November. 


The Cabinet Member for Adult Care, Health and Wellbeing, Councillor Vic Pritchard said that he agreed the matter does require further discussion. He added that the Council were already doing a great deal of work contained within the Wigan Deal.


The Select Committee RESOLVED to approve the proposals to their workplan.