Agenda and minutes

There were none.

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

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

(b) The nature of their interest.

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

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

Councillor Paul May declared an other interest as he is a non-executive Sirona board member.

Pam Richards, Protect Our NHS BANES made a statement to the Panel on the subject of Virgin Care. A copy of the statement can be found on the Panel’s Minute Book, a summary is set out below.

At the meeting on October 1st 2019 I made a statement about Virgin Care’s performance on behalf of Protect our NHS BANES and raised several major concerns. Unfortunately these issues were not fully addressed either by the Chair of the Panel or by the CEO of Virgin Care within her report. 

We remain concerned about staffing levels. In 2018 a detailed summary of workforce data with graphs was published showing:

•  Staff turnover

•  Sickness absence

•  Vacancy rates

•  Agency staffing

•  Number of complaints and concerns

Can you publish the latest statistics in order to assure councillors and the public that Virgin Care is adequately staffed to deliver the commissioned services effectively?

We continue to hear reports of low staff morale. As of October 2019, the staff survey had not been published. Can details of this report and a summary of the independent Picker survey be given to councillors and a summary produced for the public?

Concern was expressed by members of this committee in October about Virgin Care’s substantial budget deficit and the failure to make efficiency savings as outlined in their bid. What is the projected budget deficit for the end of this financial year?

In order to exercise its scrutiny and monitoring function of this large contract, can this Panel institute a formal and regular reporting mechanism to monitor the performance of Virgin Care? This should cover –

•  key performance targets,

•  quality of care,

•  workforce and staffing issues,

•  transformation targets /programmes

•  financial performance

Can this be reported in a dashboard format with a commentary?

The Chairman replied that he was disappointed with the criticism of the Panel and explained that they will be receiving a report from the commissioners at its next meeting in March. He stated that the report will be independent of Virgin and that the commissioners will be asked to incorporate updates on the issues she had raised in her statement.

Councillor Andrew Wait commented that he shared the concerns that had been raised and felt that the responses given at the previous meeting were not specific enough. He said that he would particularly welcome an update on their budget status.

The Chairman referred to the minutes and asked if the Terms of Reference for the Autism Board could be circulated to the Panel.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that she would pursue this on behalf of the Panel.

The Chairman asked if Councillor Wait had received a reply to his question relating to the RUH car park.

Councillor Wait replied that he had done and that in 2017/18 the gross income from these fees was £1.3m.

Kevin Burnett asked if any further information had been received from the Secretary of State regarding the funding pressure in the education system.

Councillor Kevin Guy, Cabinet Member for Children’s Services replied that he would circulate the received letter and stated that the Council were pushing for further information.

The Chairman informed the Democratic Services Officer that on page 16 while discussing the EU exit as part of the CCG Update, Councillor Liz Richardson had been quoted in place of Councillor Liz Hardman.

With these comments and amendments in mind the Panel confirmed the minutes of the previous meeting as a true record and they were duly signed by the Chairman.

The Panel will receive an update from the Clinical Commissioning Group (CCG) on current issues.

Dr Ian Orpen, addressed the Panel. 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.

Working together in B&NES, Swindon and Wiltshire (BSW) – CCG Merger Update

NHS England and Improvement approved in principle our application to merge with Swindon and Wiltshire CCGs on 14 October 2019. This was following support from each CCG Board to merge, stakeholder engagement and communication, and a member practice vote.

The new CCG’s vision will be: Working together to empower people to lead their best life.

We will achieve this by:

•  Working more closely with partner organisations, so people experience services work in a more joined-up way; only have to tell their story once and receive care better tailored to their individual needs

•  Developing a positive, inclusive, people-centred culture and making BSW CCG the best place to work

•  Achieving value in everything we do and more efficient ways of working, so the growing demand for health and care services is affordable

The three CCG’s Governing Bodies are currently meeting in common, but from 1 April 2020 there will be single a Governing Body for BSW CCG.

On 21 January 2020, following a member practice vote, Dr Andrew Girdher from Box Surgery was appointed the new GP Clinical Chair for BSW CCG. Locality Clinical Chairs (one for each locality) and locality GPs (one for B&NES and Swindon, and three for Wiltshire) will also join the Clinical Chair on the new BSW CCG Governing Body. Interviews for the secondary care specialist, registered nurse and lay member positions on the Governing Bodytake place from 29 January 2020.

Winter pressures impacting on urgent care services

As has been the case elsewhere in the country, the extreme pressure that affected urgent care services in B&NES throughout the Christmas and New Year period has continued into January.

The CCG is committed to doing all it can to support colleagues working in in acute and community services. We’d like to express our gratitude to those who have worked tirelessly to ensure that our local people are treated with the highest possible quality of care.

Along with colleagues from across health and care in Swindon and Wiltshire, BaNES CCG is part of a new taskforce that meets weekly to plan and implement quick actions to help reduce pressure across the system.

Some of the actions that have been taken so far include:

·  Improved data sharing across the system that is enabling teams to quickly understand how providers are managing at any given time

·  A continued drive for consistency in the urgent care offer across BSW CCGs

·  Developing the Single Health Resilience Early Warning Database (SHREWD) in the BaNES system and Alamac in Swindon to ensure that system escalation actions are in line with trigger indicators , so that they are timely to support patient movement and discharges across health and care partners.

NHS England’s  ...  view the full minutes text for item 35.

The Cabinet Member(s) will update the Panel on any relevant issues. Panel members may ask questions on the update provided.

Councillor Rob Appleyard, Cabinet Member for Adult Services addressed the Panel. 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 Resource Centres and Extra Care Support Services

Following the decision by Sirona Care and Health last year to give notice on the contract to run these services, we have agreed that the best option to ensure continuity of high-quality care for residents and a smooth transition for staff, residents and tenants, is for the Council to become the direct operator of these services by September 2020. This news was shared with residents, tenants and staff last week. Detailed planning work for the transfer is being undertaken in partnership with Sirona.

Care co-ordination

One of the key priorities that residents highlighted during the extensive Your Care Your Way engagement process was to ensure that the service response to care needs was better co-ordinated and so the creation of a care co-ordination centre was one of the key improvements that Virgin Care were commissioned to deliver. In December, the Corporate Director and I visited the new centre that they have established at Peasedown St John and met some of the staff who have come together in one office and are now much better able to co-ordinate their responses, ensure prompt call handling and cross-cover for each other. I can see this helping residents and other professionals enormously in ensuring they receive a timely and joined up response when help is needed.

Domestic Violence & Abuse

Panel members will have seen within the papers recently published on the budget proposals, that we are proposing to support the ongoing delivery of local services to support victims of domestic violence and abuse - £152,000 per year. This funding has been at risk with external funding sources coming to an end. The leader has agreed that these services will move into my portfolio as there is such a key link with safeguarding vulnerable adults, in addition to the important links with safeguarding children and community safety.

Outbreak of novel Coronavirus in China

As you would expect, our Public Health team are keeping a watching brief on the progression of this outbreak. So far there are no known cases in the UK and the local risk is therefore currently considered to be very low. Any action needed in the UK will be led and co-ordinated by Public Health England, who provide advice and guidance to the public and local agencies as necessary in the event of any significant new development affecting the UK.

Bruce Laurence, Director of Public Health added that guidance relating to the virus was to be issued later today. He stated that 73 tests had been carried out in the UK and that so far all had been negative.

Councillor Liz Hardman said that she was concerned with the decision taken by Sirona to give notice on their contract.

Councillor Appleyard said that there  ...  view the full minutes text for item 36.

This update provides a summary of the Maternity Service Reconfiguration programme, which has been running for the past three years across BaNES, Swindon and Wiltshire (BSW). It includes an update on the decision made by BSW Governing Body on January 16th 2020 and next steps.

Lucy Baker, Director of Service Delivery, BSW CCGs introduced this item to the Panel, a summary of her presentation is set out below.

Future Vision

Our 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.

Journey so far

·  We began talking to women about their maternity experiences in 2017

·  We have now worked with over 4,000 women and families, plus our staff and partner organisations

·  Their feedback, together with national guidance such as ‘Better Births’, has led to these recommendations for future maternity services across the BSW region

·  Partner organisations include Great Western Hospital Trust, Salisbury District Hospital, Royal United Hospital Bath, and B&NES, Swindon and Wiltshire CCGs

Assurance process

·  NHSE - 7 stages of assurance & 5 Key Tests for consultation

·  Clinical Senate Review

·  Independent Travel Impact Analysis by NHS South Central & West CSU

·  Independent analysis of public consultation responses by Bath Centre for Healthcare Innovation and Improvement (CHI2) School of Management, University of Bath

·  Independent Expert Panel Review

Case for change

Current activity in relation to births across BSW were split between:

85% Obstetric Unit Births

6% Freestanding Midwifery Unit Births (provided by the RUH)

7% Alongside Midwifery Unit Births (GWH)

2% Home births

Complexity in obstetric care:

·  Increase in complexity

·  Impact of safety improvements

·  Patient choice and expectation

·  AMU provide opportunities for more women to access midwife led care

·  Enables obstetric focus

·  Decrease in transfer times

Benefits of midwifery led birth:

·  Safe for mothers and babies

·  Significantly fewer interventions No difference in caesarean birth rates between AMU and FMU

·  Clinical evidence shows that a low risk woman birthing in an obstetric unit has a higher probability of an assisted birth

Staff experience and satisfaction

·  Low number of births in FMUs impacting on maintenance of clinical skills and confidence

·  Reduced need for short notice redeployment of staff - Improved staff satisfaction

·  Flexible workforce will help to support improvements in continuity of carer models

·  Right staff, right place, right time

·  Improved utilisations of staff resource

·  Opportunity for enhanced multi-disciplinary working

Our consultation in numbers

·  1,855 consultation responses over 15 weeks

·  662 face to face conversations

·  1,193 completed surveys were returned

Public Consultation - independent analysis

·  66% strongly agreed/agreed with creation of AMU

·  70% strongly disagreed/ disagreed with closure of postnatal beds

·  59% strongly disagreed/ disagreed with reduction in FMU. 40% Strongly agreed or agreed

The team listened to feedback and as a result 4 post-natal beds will remain open for a further 12 months in Chippenham to allow further time to co-create new pathways with mums and families.

Consultation feedback themes

·  Improved infant feeding support. Particular focus on night time breast feeding support. More early identification of infant feeding issues and support

·  Better screening and continuity of care for mental health both in pregnancy and postnatally

·  People and staff to continue to be involved in co-design of community hubs and AMUs including parking provision at RUH

·  More antenatal education for mums and families  ...  view the full minutes text for item 37.

This report sets out the current position on the Council’s draft Corporate Strategy to the Panel for consideration and feedback.

The Director for Partnership & Corporate Services introduced this item to the Panel. He explained that the draft strategy had been launched in December 2019 and had been discussed by the Council’s two other Policy Development & Scrutiny Panels earlier in the month. He stated that the document sets out the Council’s core purpose, policy focus and key commitments as well as describing the organisation’s approach to monitoring performance and managing its budget.

He added that Councillors have also been invited to attend the Corporate Policy Development & Scrutiny Panel on February 3^rd where the Draft Budget will be discussed in more detail.

He highlighted the following area within the draft strategy.

OUR FRAMEWORK

ONE:  We have one overriding purpose – to improve people’s lives.

This might sound simple but it brings together everything we do, from cleaning the streets to caring for our older people. It is the foundation for our strategy and we will ensure that it drives our commitments, spending and service delivery.

TWO: We have two core policies – tackling the climate and nature emergency and giving people a bigger say. These will shape everything we do.

THREE: To translate our purpose into commitments, we have identified three principles.  We want to prepare for the future, deliver for local residents and focus on prevention.

Councillor Liz Hardman said that she felt it was difficult to comment on the draft strategy without any budget figures attached to it and called for the budget to return to the agenda of all Panels to discuss their remits separately in future years. She queried how the Council will ‘Re-shape the way we work with children, young people and families in order to reduce demand for high cost, specialist children’s social care placements’.

Councillor Andrew Wait commented that he quite liked the draft of the strategy and its focussed approach. He said that he would welcome further information on the Community Engagement Charter and stated that he would like to see more reports referencing the Parish Charter in the future as this was an area the Council could improve upon.

Councillor Paul May suggested the Parishes be surveyed to gain their feedback on the Charter.

Kevin Burnett offered a note of caution by saying that not all people’s lives will necessarily be improved by increasing the use of new technology. He welcomed the draft strategies approach to improving the inequalities in life experience, including education, employment and health outcomes for local residents.

The Chairman said that he felt the draft strategy was very headline in its approach and offered nothing new in terms of ideas from the previous administration. He called for further explanation of the Council’s workings alongside WECA as he personally was yet to see any advantages.

He added that he would be interested to see how Citizens’ Juries will improve decision-making.

Councillor Jess David commented that she would have liked to have seen more detail relating to the section of the draft strategy in terms of  ...  view the full minutes text for item 38.

This report puts forward a process and timeline for developing a food poverty action plan for B&NES and investigating the refresh of B&NES Food Strategy.

Jane Middleton addressed the Panel. A copy of the statement can be found on the Panel’s Minute Book, a summary is set out below.

You may remember I brought the idea for a food poverty action plan to the Council meeting in May 2019. So I’m really pleased to see this work being done. And I’m pleased that the report has used the work by Sustain as the basis for some of its research.

All the research makes clear that the main driver of food bank use is welfare policy, especially Universal Credit. This is significant, because we need to remember that the problem is not food shortages; it’s lack of income, whether from benefits or from work.

The key aim of the food poverty action plan must be to try to ensure that people don’t need that food aid in the first place. Unlike charities, the Council can tackle some of the structural causes of food poverty – for example, make sure that the welfare support scheme provides appropriate tailored support rather than just handing out food bank vouchers.

On the specifics of the report, first of all:

Point 3.6 concerns data collection to assess ‘the prevalence and risk of food poverty’. I would strongly urge you to engage with academics on this (either at the University of Bath or elsewhere), in order to arrive at a rigorous, independent assessment of the scale of the problem. There are academics who have carried out this kind of study, and councils who have worked with them, so it shouldn’t be difficult to set that up.

Point 4.7 lists the specific objects of the food poverty action plan. It is, in parts, quite vague – in particular, the point: ‘To develop a food poverty action plan for B&NES with a focus on preventative activity’. I would suggest replacing this with the wording: ‘To prepare and deliver a formal food poverty action plan to identify barriers to accessing affordable and nutritious food and actions to address them’

I would also like to see the following objectives included:

• ‘To reduce residents’ dependency on charitable food aid’;

• ‘To maximise access to local welfare provision and discretionary funds (such as Discretionary Housing Payments and Council Tax Support) and ‘ensure maximum uptake of other entitlements (such as free school meals)’;

• ‘To take measures to avoid means of support that people find stigmatising, e.g. food vouchers’.

In this way, the emphasis is on council action and, while it’s important that the council should support the work of local charities, the main intention should be to take preventive action so people don’t have to rely on charity in the first place.

The Public Health Consultant introduced the report to the Panel. She explained that the report was in response to the Council passing a motion on Food Poverty on 11th July 2019 requesting:

• The Children, Health & Wellbeing Policy Development and Scrutiny Panel to work with local organisations and develop recommendations for a Food Poverty  ...  view the full minutes text for item 39.

The Care and Support Charging and Financial Assessment Framework and the Direct Payment Policy came before the Panel on the 1st October 2019 prior to the conclusion of the public consultation. The public consultation has now concluded, and the policies have been amended with consideration of the feedback received.

Lara Varga made a statement to the Panel. A copy of the statement can be found on the Panel’s Minute Book, a summary is set out below.

The Equality Impact Assessment is inadequate. It’s required by law. Quite frankly it needs re-viewing, and seems to be the work of people who know little about Equality and Diversity issues. For example, (just one of several issues ) no extra issues have been identified for women under these new charges under the heading 'Examples of what the service has done to promote equality'.

If we refer to the United Nations Special Rapporteur report (November 2018) on Extreme Poverty in the UK, under the heading : 'The Hardest Hit', it says that:

"The costs of austerity have fallen disproportionately upon the poor, women, racial and ethnic minorities, children, single parents, and people with disabilities. The changes to taxes and benefits since 2010 have been highly regressive, and the policies have taken the highest toll on those least able to bear it. The government says everyone’s hard work has paid off, but according to the Equalities and Human Rights Commission, while the bottom 20% of earners will have lost on average 10% of their income by 2021/22 as a result of these changes, top earners have actually come out ahead.

According to 2017 research by the Runnymede Trust and Women’s Budget Group, as a result of changes to taxes, benefits, and public spending from 2010 through 2020, Black and Asian households in the lowest fifth of incomes will experience largest average drop in living standards, about 20%".

These figures are only set to worsen under this current Conservative government. Disabled women, are hardest hit, for example by period poverty now reaching epidemic numbers across the UK within the poorest low income groups.

I had requested to view the Equality Impact Assessment written report back in December 2019, at a meeting with Anne Marie Strong and was told there wasn't one, because the council plans to do an internal " ghost " try out of the new system this February. NOW I finally see there is an Equality Impact Assessment, it states that some service users will be adversely affected , but the only mitigation offered is that 'Cases of individual hardship can be considered on a case by case basis'.

 i.e only the very articulate can have their needs met with such a set-up.

I am very concerned many vulnerable people may decline a needed service because of increased costs, including myself at this time. I have also said many times this whole consultation appears to be focused more on Seniors with care needs and not Disabled people, who are disabled for life with chronic and challenging life-long conditions.

The Risk Register Lite (graph) ( appendix 4) makes it clear that there will be 2 high risks and 2 medium risks , the response written to these also seems inadequate  and will incur extra staff costs. What are your opinions on the two high risk  ...  view the full minutes text for item 40.

The Panel will receive a verbal update on this item from the People and Communities Strategic Director.

The Corporate Director (People) addressed the Panel, a summary is set out below.

Adoption West scrutiny arrangements

Following the establishment of Adoption West, a provider of adoption services owned jointly by 6 local authorities, a joint scrutiny arrangement is being developed with representation from each area. A terms of reference is being drafted and the intention is that an annual report would be provided to this panel.

Music Service

We are continuing to explore with neighbouring Councils and with the Arts Council (who are the main funder) how to ensure that we have a sustainable future service model for this key service which enables local children and young people to enjoy a range of music tuition and experiences. Further updates will be shared once a way forward has become clear.

Youth Justice Plan update & Education Results Provisional analysis

Briefings have been circulated separately for panel members on these topics, for information. Any questions can be directed back to the authors and/or requested for a future meeting agenda.

The Chairman thanked him for the update on behalf of the Panel.

This report presents the latest workplan for the Panel. Any suggestions for further items or amendments to the current programme will be logged and scheduled in consultation with the Panel’s Chair and supporting officers.

Councillor Liz Hardman asked for the subjects of the Community Resource Centres and Extra Care Support Services and School Attainment Project to be added to the workplan.

The Corporate Director (People) commented the Panel had earlier agreed to receive a report from independent commissioners relating to VirginCare.

Councillor Hardman suggested that the report covers the issues raised by Pam Richards and contract governance.

The Panel agreed with these proposals.