Agenda and minutes

The Chair will draw attention to the emergency evacuation procedure as set out under Note 5.

Councillors Michelle O’Doherty and Gerry Curran had sent their apologies to the Panel.

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 4.4 Appendix 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.

One question has been received for the Panel from a member of the public.

A member of the public, Paula Riseborough had asked a question relating to Agenda Item 7 (RUH – Ambulance Service / Winter Planning / Treatment Waiting Times). A copy of the question and subsequent answer can be found attached as an online appendix to these minutes.

Councillor Joanna Wright addressed the Panel on the subject of Dentistry and said that there is a severe lack of NHS services locally. She said that where services were available in a number of cases she was aware of significant delays.

She recounted a letter from a member of the public that said that having been unable to find an NHS dentist, had found an ‘affordable’ one and had received treatment that included two teeth being removed and a filling at a total cost of £330.

The letter also told of how her daughter had been waiting two years for a number of teeth to be removed at hospital. It said that on finally receiving an appointment in September she had six teeth removed even though was advised that one could be saved. The daughter asked for the tooth to be removed as she did not have a dentist as could not afford to go private.

Councillor Wright provided the Panel with further evidence from a member of the public and the poor care their son had received following the removal of a wisdom tooth.

He had a double surgical wisdom tooth extraction in August under general anaesthetic at the Royal United Hospital, Bath. He was first referred for the operation by his dentist in 2019 and after a couple of postponements he received a phone call in August 2022 and was told that he could have the operation on Monday 8th August. In the following week leading up to the operation, they did not receive a letter with the date, time, or advance instructions.

They called the hospital the Friday before the operation (5th August) to check if he needed to prepare in any way. During this call, they were given the important information that he must not eat after 7am and not drink water after 10 am on the day of the operation and that he must be collected after the operation by somebody and have someone with him for 24 hours following the general anaesthetic.

On the day of the operation they were told that nobody could wait with their son prior to the surgery. They said he was quite anxious about the procedure, especially as he had never had a general anaesthetic before. The anxiety and lack of support made this a difficult experience for him.

At around 3.30pm their son messaged to say that he was going into the operation. We were given no idea of how long it would be. I was told to call after an hour. After an hour and a half they called to see if he was ready to be collected and were told first of all that they did not know where he  ...  view the full minutes text for item 44.

The Panel will receive a presentation on this item from Simon Sethi, Chief Operating Officer, Royal United Hospitals, Bath.

Simon Sethi, Chief Operating Officer, RUH and Dr Veronica Lyell, Clinical Lead for the RUH Older People’s Unit gave a presentation to the Panel, a copy of which will be available as an online appendix to these minutes, a summary is set out below.

Elective waiting times – RUH within the region

·  RUH performing 10% more elective activity than before COVID to help recover waiting times.

·  Focus on diagnostics: 20% more MRI, 30% more CT and >50% more endoscopy.

·  Currently have no one waiting over 104 weeks with 115 waiting over 78 weeks.

Electives and winter – 300 operations impact

·  Lost capacity due to bed pressures. Currently no joint replacement operations taking place due to bed shortages.

·  Removing winter pressures would increase orthopaedic capacity by at least 22% and up to 48%.

·  Temporary Modular Theatre plan for Circle Bath Clinic for February 2023.

Urgent Care – remains significantly challenged

·  462 – Number of ambulance handover delays over 60 minutes on average each month

Current position on NC2R for the RUH

·  Regression analysis indicates NC2R (Non-Criteria to Reside) accounts for 62% of the reasons RUH struggles to offload ambulances.

·  Integrated Care Board and Council working closely together to improve this area.

·  Average wait to access a reablement bed once referred in BANES? 15 days

·  Average wait to access reablement at home once referred in BANES? 16 days

Councillor Liz Hardman commented that it was recognised that the problems regarding ambulances not being able to discharge their patients was due to bed blocking. She referred to the report and highlighted that currently there are 40 patients waiting to be discharged from the RUH and that this is because of problems with reablement not being able to take place. She asked what needs to happen to unblock the situation.

Simon Sethi acknowledged the importance of getting people home from hospital where possible, but said that there was gap in domiciliary care provision.

The Director of Adult Social Care added that there was a gap in terms of staff hours and that the Council and the RUH have been working on developing their own in house domiciliary care agency known as United Care BaNES. She said that they were looking to provide an additional 1,000 hours by November 2022.

She stated that this is an important issue to address as for every day that a patient stays that is longer than necessary the outcomes will not be as good. She added that she was aware of the RUH Pathway Escalation Team that has a focus on recovery and therapy.

She said that work was also ongoing within the Ambulance Service with regard to decisions about where best it is for a patient to be taken for treatment.

Councillor Paul May asked for an explanation of the different patient pathways.

Dr Veronica Lyell replied that the pathways are set out as follows:

·  Pathway 0 – No additional support required

·  Pathway 1 – Intermediate care and reablement services provided in their own homes.

·  Pathway 2  ...  view the full minutes text for item 45.

This update summarises the work overseen during 2020/2022 by the Bath and North East Somerset Strategic Suicide Prevention Group. It provides background and context to the subject, a brief overview of suicide prevention in B&NES and key achievements during this time.

The Associate Director for Public Health introduced the report to the Panel. He explained that in 2020 the Suicide Prevention Strategy 2020-2023 was launched outlining the commitment from all partners to work together to reduce suicide in B&NES, aligning to the BSW Suicide Prevention Strategy.

He said that the Strategic Suicide Prevention Group has in this time carried out work within schools, the Community & Wellbeing Hub and supported the work of Bath Mind - Breathing Space.

He informed the Panel that the Group has worked with Avon & Somerset Police and the local Coroner to receive notification within a day of any suicide taking place.

He spoke of the Beside project service which is run by Second Step and said that the provision of this service is a commitment from the NHS Long Term Plan funding. He said that the service began running in July 2021 and offers emotional and practical support within a few days after losing someone to suicide for people over 16years old, whether they are a family member, next of kin or a loved one.

He stated that a stakeholder event had been held last week to begin to establish priorities for a future strategy.

He said that the number of incidents locally (48) had fallen in B&NES during 2019-2021. Female and male rates both fell with the male rate still slightly higher than the England average. This was the lowest 3-year rate since 2009-2011.

Councillor Liz Hardman commented that 25% of people who committed suicide had been in contact with health professionals, usually a doctor in the last week before they died and that many had seen a health professional / doctor a month before. She asked are there any links / sharing of information between the Integrated Care Board with its GP surgeries and the suicide prevention team which could prevent some deaths happening. If not, could something be put in place.

The Associate Director for Public Health replied that a GP representative does sit on the Strategic Suicide Prevention Group and that training and workforce development on this subject was ongoing across the BSW footprint. He added that the GP discussions may have been about pain or symptoms and not mentioned suicide.

Councillor Hardman referred to page 42 of the agenda and the proposed action to increase awareness of Counselling Services from Bath Mind and said that she had found out that there was a four month waiting list for these services. She asked if the Council provided any funding for this service.

The Associate Director for Public Health replied that it does receive funding from B&NES and the BSW ICB. He said that Breathing Space does provide an in-person service and/or evening phone support which is open seven evenings per week. He added that Mental Health Commissioners may know further about the waiting lists mentioned.

Councillor Hardman asked how do we ensure that Schools are using resources which supports the delivery of a whole school or setting approach to Mental  ...  view the full minutes text for item 46.

The Panel will receive an update from the B&NES, Swindon & Wiltshire Integrated Care Board (BSW ICB) on current issues.

Laura Ambler, Place Director for Bath and North East Somerset, BSW ICB gave a presentation to the Panel, a copy of which will be available as an online appendix to these minutes, a summary is set out below.

Purpose

The purpose of ICSs is to bring partner organisations together to:

•  improve outcomes in population health and healthcare

•  tackle inequalities in outcomes, experience and access

•  enhance productivity and value for money

•  support broader social and economic development.

BSW Integrated Care System

•  NHS England – Performance manages and supports the NHS bodies working with and through the ICS

•  Care Quality Commission – Independently reviews and rates the ICS

•  BSW Integrated Care Board (ICB) – Allocate NHS budget and commission services, produce a five-year system plan for health and care services.

•  BSW Integrated Care Partnership (ICP) – Develop an Integrated Care Strategy that addresses the assessed health and care needs of the people in BSW.

How the BSW ICS is made up

Integrated Care System (ICS) – Organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area.

Integrated Care Alliances (ICA) – Place-based partnerships of NHS, councils, community and voluntary organisations, local people, carers. Lead the design and delivery of integrated services at place.

BSW Integrated Care Board (ICB) – Statutory NHS organisation. Develops a plan for meeting the health needs of the population, Manages NHS budget and Arranges for the provision of health services in BSW.

BSW Integrated Care Partnership (ICP) – Statutory committee, formed between the ICB and local authorities. A broad alliance of organisations concerned with the health and wellbeing of the population. Author of the Integrated Care Strategy. Advocate for innovation, new approaches and improvement.

Local Authorities – Responsible for social care and public health functions and other services for local people and businesses.

Integrated Care Strategy

‘Should set the direction of the system’ …., ‘Setting out how commissioners in the NHS and local authorities, working with providers and other partners, can deliver more joined-up, preventative, and person-centred care for their whole population, across the course of their life’.

BSW Care Model

We are focussing on a range of initiatives that will improve the health and wellbeing and experience of care including:

•  Population health, Prevention and Wellbeing focussed programmes

•  Integrated Neighbourhood Teams

•  Care Coordination

•  Mental Health and wellbeing

•  Learning Disabilities and Autism

•  Maternity

•  Recovery of elective care services

•  Urgent care services

From April 2023 the ICS will also take on delegated commissioning responsibility for dental services, general ophthalmic services and pharmaceutical services.

Five key parts to the model:

•  Personalised care

•  Healthier communities

•  Joined-up local teams

•  Local specialist services

•  Specialist centres

Councillor Liz Hardman asked what differences we will see in this new service compared to what we had with Clinical Commissioning – will it mean an improvement in services for  ...  view the full minutes text for item 47.

The Chairman asked for the following matter to be chased on behalf of the Panel.

Minute 35: B&NES Child and Adolescent Mental Health Update

Councillor Curran asked if any stats were available on the numbers of children and young people who receive therapy treatments and those in receipt of medication as a result of their diagnosis.

Jane Rowland replied that she would need to check on those figures and reply to the Panel in due course.

Councillor Andy Wait commented that he had enquired about whether a representative from Keynsham Now would like to address a future meeting of the Panel and that he had possibly found a volunteer.

The Chairman offered for them to attend the Panel meeting scheduled for 8^th November if available.

The Panel confirmed the minutes of the previous meeting as a true record and they were duly signed by the Chairman.

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

Councillor Alison Born, Cabinet Member for Adult Social Care was unable to attend the Panel and had circulated her update prior to the meeting. A copy of the update will be attached as an online appendix to these minutes.

Referring to the update, Councillor Andy Wait asked what inspections had been taking place in the interim for Adult Care if the previous inspection process was suspended in 2010.

The Director of Adult Social Care replied that provider services had continued to be inspected in terms of Domiciliary Care, Care Homes and HCRG contracts and that this resumption was an inspection of Social Care Practice, with a focus on carers and their experience.

Councillor Wait asked if there were any plans in place for the Winter to try to alleviate the increasing pressures that mental health services are facing with rapidly escalating demand and significant staff shortages.

The Director of Adult Social Care replied that there is a Pride Board which is an alliance of Mental Health staff for both Adults and Children’s Services, Oxford Health and AWP that meet regularly to discuss how to manage commissioning pressures.

The Panel RESOLVED to note the update that had been provided.

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.

Kevin Burnett suggested that a representative from the Youth Forum attends a future meeting to update on their work and any input they are having to the work of the Council.

The Chairman replied that he would discuss that with the Director of Children's Services & Education at their next agenda planning meeting.

Chris Batten said that he would like the cost of residential care for children to be addressed in some way following a BBC report earlier in the month that said costs were spiralling due to companies seeking an increased profit margin.

The Director of Adult Social Care replied that she and the Director of Children's Services & Education had recently began a piece of work focussing on 16 – 19 year old residential placements and what is commissioned locally. She said that they had started work with a company that will help us to work with providers to look at their profit margins.

She added that she felt that current costs were market driven and that their responsibility was to achieve good outcomes for the individual and their family.

Chris Batten asked why the former ‘Care Hotel’ provision was not being progressed for this Winter as it would surely alleviate some of the problems in terms of available hospital beds at the RUH.

The Director of Adult Social Care replied that last year the RUH were not really able to refer patients to the hotel as it was not equipped with what they required for certain patients.

Councillor Liz Hardman asked for a future report that gave more detail on local mental health services, especially CAMHS.

Councillor Joanna Wright asked if the Panel were due to receive any financial reports that would look at inflation and the effect this was having on Care Home Allowances.

The Director of Adult Social Care replied that these are set nationally and therefore there was little the Council could do.

The Panel acknowledged these comments and RESOLVED to the workplan as printed.