Agenda and minutes

Councillor Jess David, Councillor Mark Roper and David Williams (Co-opted Member) had sent their apologies to the Panel.

Councillor Yukteshwar Kumar was present for the duration of the meeting as a substitute for Councillor David.

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 in respect of agenda item 12 (Corporate & Budget Planning 2021/22) as he is a non-executive Sirona board member.

There were none.

Kevin Burnett referred to page 40 of the 23^rd October 2020 minutes and asked if the Escalation Protocol review remained ongoing.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that she was aware that further meetings had been held regarding the Protocol, but it had not yet been finalised. She said it could be circulated when complete.

Kevin Burnett referred to a referred to a previous question and asked if any further information was yet available from the Secretary of State on the issue of funding pressures in the education system.

Councillor Kevin Guy replied that there was not.

Kevin Burnett referred to page 44 of the 23^rd October 2020 minutes and asked if the second A P Benson report was now available.

The Director of Education, Inclusion and Children’s Safeguarding replied that it had been received just before Christmas and a feedback process was now taking place with staff and the steering group before it could be shared on a wider basis.

Kevin Burnett referred to page 46 of the 23^rd October 2020 minutes and asked if an update could be given on two elements of the Winter Plan – Care Act / Lived Experiences.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that Lived Experiences had been raised at the Virgin Care Citizen’s Panel and that she was also in contact with AWP on the same issue.

She added that in terms of the Care Act, in particular easements, that these had been raised at forums for both Care Homes and Homecare and that work was ongoing. She said that none were in place apart from social distancing.

Councillor Ruth Malloy referred to page 41 of the 23^rd October 2020 minutes and asked if Sian Walker-McAllister could send further information on the ‘Got Ya Back’ river safety campaign and the #NeverOK Campaign as mentioned.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that she would pursue that and forward anything she receives.

Kevin Burnett referred to page 56 of the 3^rd November 2020 minutes and asked if an update could be given on the Schools Standard Board (SSB) Sub-Group and the Inclusion Expert.

The Director of Education, Inclusion and Children’s Safeguarding replied that the Sub-Group had met before Christmas to discuss best practice and that work with the St John’s Foundation was underway, but was unable to give a specific update on the Inclusion Expert.

With those matters raised in mind, the Panel confirmed the minutes of the meetings on 23^rd October 2020 and 3^rd November 2020 as a true record.

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

The Cabinet Member for Children’s Services, Councillor Kevin Guy addressed the Panel, a copy of his briefing can be found online as an appendix to the minutes.

Kevin Burnett asked if the Council or schools would be co-ordinating the next round of Free School Meal provision during the February half term.

Councillor Guy replied that schools would be delivering the next package of provision directly. He added that at this stage that there was no confirmation from the Government on provision for the Easter holidays. He stated that the Council were carrying out preliminary work on possible scenarios for those holidays.

Kevin Burnett asked if enough IT equipment was available through schools for those families that need it in this current lockdown period to access learning from home.

The Director of Education, Inclusion and Children’s Safeguarding replied that the DFE has committed to ensuring that families have adequate access to IT. He added that schools have been assessing what additional need there is for IT devices and are ordering accordingly. He said that secondary schools have received equipment already and primaries will have started receiving laptops last week. He stated that the LA remains committed to supporting those most in need, but is assured that schools are advising that they can access the IT that their pupils need. The LA is appraising options to act as a contact for those families who cannot access a school device.

Councillor Liz Hardman commented that she believed that the Early Years Foundation Stage (EYFS) were not able to access digital help funds despite primary schools now teaching remotely.

The Director of Education, Inclusion and Children’s Safeguarding replied that the Council are trying to work with those that need it and that he would be happy to be informed of any particular issues.

Councillor Paul May said that he would like to acknowledge the work of all Children’s Services staff over the last year.

Councillor Alison Born commented that she felt that there was a good service within B&NES for people diagnosed with having Autism Spectrum Disorder (ASD). She asked how would the ‘Waiting List Plus’ initiative that had recently received funding for work across B&NES, Swindon & Wiltshire (BSW) would interface with the current service.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that this work would be carried out in addition to provide support to the services already in place.

Councillor Alison Born said that she would like to commend the work of the local Public Health team over the past year.

Councillor Rob Appleyard replied that they really are a highly functioning group that provide so much support work across the Council and to the universities and other partners. He added that he would like to thank the Director of Adult Social Care, Complex and Specialist Commissioning and all staff within Adult Services for their work over the past year.

Councillor Paul May asked how the Covid-19 vaccination programme was progressing locally, particularly in terms of residents  ...  view the full minutes text for item 61.

The Panel will receive an update from the B&NES, Swindon & Wiltshire Clinical Commissioning Group (BSW CCG) on current issues.

Dr Bryn Bird, B&NES Locality Clinical Chair addressed the Panel. A copy of the update can be found as an online appendix to these minutes, a summary of the update is set out below.

Covid-19 Mass Vaccination Programme

December saw the start of the roll out of the coronavirus vaccination programme in Bath and North East Somerset, Swindon and Wiltshire. Initially a local vaccination centre was set up in Sulis Manor Road Surgery in Coombe Down with vaccinations coordinated by GP Federation BEMS.

Vaccinations have been under way in our area since before Christmas and, to date, more than 35,000 people across Bath and North East Somerset have received the lifesaving vaccine thanks to the hard work and dedication of colleagues working across the area.

During the week commencing 4th of January, additional sites began to offer the vaccine at Batheaston Medical Centre and the Somer Centre in Midsomer Norton.

A central vaccination centre was opened at the Bath Pavilion on 12^th of January and a further site at West View Surgery in Keynsham on the 14^th January.

We would very much value your support in helping to reassure any concerned residents who are worried about potentially being missed off the vaccine list, that as soon as it is their turn to be vaccinated, they will receive details of their appointment either by phone or letter.

Should you or any resident have a specific vaccine-related question, please feel free to get in touch via our new dedicated vaccine mailbox, which can be reached by sending an email to bswccg.vaccinequery@nhs.net.

Temporary closure of Paulton Minor Injuries Unit and wider system pressures

The health and care system across Bath and North east Somerset, Swindon and Wiltshire is experiencing extreme pressure as a result of the rapidly rising number of patients needing treatment for Covid-19, in addition to the usual pressures connected to more general winter related illnesses and high levels of staff sickness.

As a result of this, the Minor Injury Units (MIUs) at Paulton Hospital and Trowbridge Community Hospital will be closed on a temporary basis so staff can be redeployed to provide vital additional capacity elsewhere in the local area.

Similar plans were put in place during the first national lockdown with MIUs closing in April, before a gradual reopening for appointments only from August onwards.

It is important to highlight that the closure of these MIU is a temporary measure and the decision will be reviewed on an ongoing basis with a view to reopening the units as soon as it is feasible and sustainable to do so.

Home oximetry monitoring service

Bath and North East Somerset, Swindon and Wiltshire CCG has launched a new service across the area designed to enable clinically vulnerable patients with Covid-19 who are isolating at home to measure their own oxygen levels and send data into local hospitals.

If clinicians spot any early warning signs in terms of low blood oxygen levels – which can lead to complications  ...  view the full minutes text for item 62.

An update document has been provided for the Panel. A representative from the HIP2 team will be present at the meeting to answer questions.

Simon Cook, RUH HIP2 Programme Director introduced this item to the Panel, a summary is set out below.

Health Infrastructure Plan 2 (HIP2)

Second phase announced October 2019 (HIP2) – a rolling five-year programme of investment in health infrastructure, encompassing:

·  capital to build new hospitals,

·  modernise our primary care estate,

·  invest in new diagnostics and technology, and

·  help eradicate critical safety issues in the NHS estate

Invited to bid for up to £450m – A once in a generation opportunity.

Programme Plan Overview

Strategic Outline Case to be submitted by December 2021 following development work on the Strategic Case, Commercial Case, Economic Case, Financial Case and Management Case during the year. We are keen to submit the case sooner if possible to improve the chance of securing the funding for the local system.

A Once in a Generation Opportunity

We are working with our system partners to ensure that the plans we develop will be fit for the future of health and care for our population.

·  HIP2 will introduce the much needed capital investment (up to £450m) to the local economy

·  HIP2 is a catalyst for change across the local health and care system - we are challenged and excited by the need to consider what the future model of care will look like

·  HIP2 is not simply about buildings – it demands an integrated approach to future service delivery

Our HIP2 ambition:

“Achieving better outcomes and experiences for patients and families through flexible integrated care using innovations that work, and supporting ageing well”

Clinical Vision and Model of Care

The following has been developed with input from partners including

the BaNES Integrated Care Alliance:

·  Proactive, preventative care that plans to maintain health and wellbeing, continuously improve clinical outcomes, and reduces healthcare inequalities for our population at all stages of life, supported by the right infrastructure at a health and wellbeing campus

·  A population health approach – supported by data and analytics in a transformed digital and IT infrastructure – to intervene early and prevent deterioration, with patient held data and interaction through apps as the default, improving the experience of healthcare for our population

·  Full integration across the system (primary care, social care) to meet the breadth of needs, based on a stratified model of population health

Investment Objectives

Underpin achievement of our clinical transformation objectives, and hence improve patient outcomes & experience: providing care closer to home through integrated local models of care, reducing health inequalities, contributing to delivery of the Trust Strategy, BSW Strategy and NHS Long-Term Plan commitments by 2030 or earlier.

Provide a feasible solution for resolving operational challenges.

Develop a sustainable estate solution: providing flexible capacity to serve our population for the next 25 years and beyond, adapting to future changes in service delivery; building a Net Carbon Zero estates footprint by 2030.

Critical Success Factors

Enable delivery of excellent patient care incl. care closer to home & reduced health inequalities through integrated local models of care, realising the BSW Strategy and NHS Long-Term Plan commitments.  ...  view the full minutes text for item 63.

This paper outlines what has taken place since the B&NES Mental Health Review, the changes to the range of mental health services in place for children, young people and adults, and the transformation work now underway to improve peoples’ experience of services and mental health outcomes.

The Senior Commissioning Manager for Specialist Services introduced this report to the Panel, a summary is set out below.

The B&NES Mental Health Review ran from 2017 to 2019, culminating in a

formal public consultation, then a full business case approved by the Care and

Health Board in March 2019.

The key recommendations of the Review included:

·  Improving access and care coordination.

·  Delivering a more integrated, preventative and personalised approaches that people asked for.

·  Developing a stepped approach to crisis avoidance with the creation of a B&NES Place of Calm (a comfortable and calm setting which delivers

practical and emotional support) and a Wellbeing House to provide preventative support for people with low to moderate mental health needs.

·  Adopting the Thrive model for the delivery of mental health services

An All-age Mental Health Transformation Strategy was created by commissioners, partners and people with lived experience for B&NES, Swindon and Wiltshire (BSW) in 2018/2019. The Strategy is based on the Thrive model of delivery.

The Strategy and Thrive model are delivered locally through the B&NES Mental Health Collaborative. This is the delivery group for embedding joint working across a wide range of organisations.

A Place of Calm (called Breathing Space in B&NES) was set up by Bath Mind in early 2020. Due to Covid19 and issues securing suitable premises, the service initially opened virtually, offering telephone support to those who were at risk of escalating into mental health crisis. From January 2021 the service will move to a mixed model of delivery, working from new premises.

A Wellbeing House was set up by Curo operating 5 days a week. However,

additional short term funding (BSW Winter Pressures and Covid19) has enabled both Bath Mind and Curo to work together to increase staffing, extend the opening hours and to operate the Wellbeing House as a step up /step down model catering for people with more complex needs during the pandemic. This has been very successful and a model we are keen to maintain in B&NES.

Covid19 has had a huge impact on individuals, their families and services alike

and has led to new emerging demands on services. A BSW ‘Heart of the Crisis’

virtual listening event was held in October with people with lived experience and frontline staff, to sense check how people were experiencing services during the pandemic.

During the pandemic, staff in mental health services across the statutory and

voluntary sector have regularly reported significant increases in the acuity and

severity of mental health presentations for both young people and adults. There is evidence to show that individuals being detained to inpatient settings are needing to remain there for a longer period due to the acuity on admission. Services are also seeing an increase for individuals who may have not been receiving secondary mental health services prior to detention or referral.

Locally commissioned services have reported increasing activity as children and young people have returned to school with increased levels of anxiety. Supporting  ...  view the full minutes text for item 64.

This report outlines the progress made in establishing a Violence Reduction Unit to help address serious violence in Bath and North East Somerset and the plans for taking this work forward in support of a new ‘serious violence duty.’

The Head of Young People's Prevention Services introduced this report to the Panel, a summary is set out below.

There is no universally adopted definition of serious violence. The national

serious violence strategy (2018) focused on knife and gun crime and homicide

and included drug dealing and robbery. A broader Avon and Somerset definition, developed in response to stakeholder feedback, added serious domestic abuse, serious sexual assault and rape. Locally, the focus to date has been on domestic abuse, youth violence, including knife crime and violence associated with the street community.

Bath and North East Somerset initially bid for funding to establish a Violence

Reduction Unit in 2019 as part of the wider Avon and Somerset Police and Crime Commissioner’s bid to the Home Office. The ‘hub and spoke’ model adopted, with a central strategic group and the five Local Authorities each developing their own approaches and receiving a proportion of the grant funding is particular to Avon and Somerset.

The Violence Reduction Unit is a virtual team made up of Local Authority and

Police staff with directly relevant roles. It benefits from a proportion of a dedicated Home Office grant of £1.6m for Avon and Somerset, with Bath and North East Somerset receiving £114,884 representing 10% of the overall allocation, based on population and level of reported serious violence.

Local governance arrangements support a joined-up approach, with a multi-agency steering group overseeing delivery of the work plan and reporting principally to the Exploitation Sub Group of the Community Safety and Safeguarding Partnership but also to the Youth Offending Service Management Board, the Domestic Abuse Partnership and the Early Help and Intervention Sub Group. This is fitting as its ambition that children and adults lead lives free of serious violence at home and in their communities is a crosscutting agenda.

The core requirements in the first year of operation were to complete an all-age

serious violence problem profile with a focus on under 25s and a response plan

that in turn contributed to the wider Avon and Somerset submission to the Home

Office. The problem profile was undertaken by Crest, drawing on publicly

available and local data from a range of partners, together with qualitative

information from young people and professionals, facilitated by Youth Connect

South West and Lemon Gazelle respectively.

It concluded that although Bath and North East Somerset has a low overall rate of recorded violence relative to its population size, certain serious violence offences had increased significantly in the last five years.

The profile also highlighted that the demand for drugs is comparatively high in Bath and North East Somerset and that county lines are in operation, with their known links to exploitation and serious violence.

The response plan for 2020-21 identified key strategic and operational actions to address the risk of serious violence.

Work is underway to produce a logic model and/or pathway framework to identify the services available to address the risk of serious violence against known risk factors and to identify gaps. This will  ...  view the full minutes text for item 65.

The Panel will receive a presentation on this item at the meeting.

The Chief Operating Officer introduced this item to the Panel and gave a presentation, a summary of which is set out below and will be attached as an online appendix to these minutes.

Budget 2021/22 Headlines

Revenue operating cost changes

•  Council growth requirement of £19.1m, driven by:

-  Material rebasing of income budgets due to Covid

-  Funding new demand pressures, Children’s and Adults Social Care

-  Contract Inflation

•  Council Savings requirement of £8.33m across all portfolios

•  Covid risk / contingency reserve of £5m proposed

Budget funding changes

•  Reserve funding requirement of £10m, to be repaid in future years

•  Council tax increase 1.99% & Adult Social Care precept 3% proposed

New 2021/22 budget pressures / Covid impacts

Emerging MTFS pressures £15.24m

•  Commercial Estate £5m

•  Parking £4m

•  Heritage Services £4.24m

•  Other pressures £2m

Strategic Financial Planning Themes

Stabilise – Short term

•  Reduce reliance on commercial income.

Transition – Medium term

•  Reset business plans looking at new delivery models

•  Revise the Council’s operating structure

•  Maximise opportunity through IT and smarter working

Change – Long term

•  Implement new strategies for:

• Social Care delivery
• Resident focussed service delivery model

Areas of strategic priority and focus over the next two years

•  Continued investment to support the most vulnerable people in our communities.

•  Continued commitment to secure action to address the climate and ecological emergency.

•  Focus on supporting the local economy to recover from the impact of the pandemic.

•  Support the “Preparing for the Future” programme to modernise the council with a focus on improved asset management and flexible working.

Adult Social Care Growth

Adult Social Care Savings Proposals

Specialist and complex commissioning – contract and procurement review: £537,000. Strategically commission and procure a range of care and support services sufficient to meet identified needs and address gaps in B&NES and provide better value for money for people with complex and specialist needs.

Community – Review of care package delivery: £1,988,000. Review of existing packages to identify efficiencies

Public Health Savings Proposals

Services to be delivered in a different way: £153,000. Following the previous uplift to the Public Health Grant, and the securing of the Integrated Sexual Health Service into a fixed payment 5 year term, funds will be reallocated to cover Public Health services delivered elsewhere within the Council.

Reduction of Post: £112,000. Part time post removed, reduction in Senior Leadership posts to be actioned, alternative grant funding will cover the Senior Leadership requirement during the continued pandemic with the removal of the post being actioned once we are through it.

Children’s & Education Services Growth

Children’s & Education Savings Proposals

Children's Centres: £43,000. Service efficiencies, provision is maintained, delivered in an alternative way.

School Improvement: £87,000. School Improvement to be funded  ...  view the full minutes text for item 66.

The Panel will receive an update on this item from the Directors of Adult Social Care & Children & Young People.

The Director of Adult Social Care, Complex and Specialist Commissioning addressed the Panel, a summary of her briefing is set out below and will be attached as an online appendix to these minutes.

Covid19 and Support to Individuals and Providers

We have continued to see an increasing rise in the number of people with care and support needs and staff supporting these people with Covid19. We are working closely with providers to support them alongside our colleagues in Public Health and across the wider Partnership.

We have had confirmation that PPE will remain free until the beginning of June extending this from the end of March.

We are working closely with providers and are supporting as much as possible the roll out of the vaccination programme which is underway across B&NES.

Update from Safeguarding Adults and the Quality Assurance Team

The Council have been participating in work undertaken by the LGA on the impact of Covid-19 on Adult Safeguarding.

Monthly reporting was provided on a voluntary basis by 92 Local Authorities who hold adult social care responsibility. The national data closely aligned with our experience in B&NES - safeguarding concerns dropped markedly during the initial weeks of the COVID-19 lockdown period, only to return to and then exceed normal levels in June 2020. 

The report noted a slight increase in concerns relating to domestic abuse, self-neglect and psychological abuse. Locally we did not see an increase in domestic abuse safeguarding concerns but did experience an increase in self-neglect issues.

BCSSP Strategic Plan

The BCSSP is developing its strategic plan for 2021-2024. To do this, the current strategic plan is being reviewed and reflected on to ensure learning is captured and where necessary, actions progressed.

The work from the first 12 months of the BCSSP is being utilised to identify priorities for the partnership and a development day is being scheduled for March to consult with partners on those priorities and transcribe them into (SMART) actions for the BCSSP subgroups. This will be shared with the Panel.

The Director of Children & Young People addressed the Panel, a summary of her briefing is set out below and will be attached as an online appendix to these minutes.

Thanks to Staff

Thanks to all our staff across Children’s Services, our schools and colleges and our commissioned services for their hard work and commitment to supporting all children and young people across B&NES. Our offer has remained in place as the responsibility has not lessened during lockdown.

Social Care

Children Social Care are actively supporting all families open to Social Care, so it is very much business as usual. We are continuing with face to face visiting for all children and young people unless risk assessment indicates this is not appropriate. The Local Authority Children Centres remain open and our Youth Offending Service continue to provide direct interventions for our young people at risk of offending in Broad Street. Connecting Families continues to deliver a comprehensive programme of support.

Young Ambassador  ...  view the full minutes text for item 67.

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.

The Chair introduced this item to the Panel.

He reminded them that during the course of the meeting today they had agreed to receive a future report on the work of the Voluntary Sector and how it interacts with the Council.