Agenda and minutes

The meeting received the following apologies:

Councillor Atiqul Hoque substituted by Councillor Peter Evans

Councillor Bob Jones MBE – substituted by Councillor Trevor Carbin

Councillor Mary Champion

To approve and sign the minutes of the meeting held on 10 January 2017.

The meeting considered the minutes of the previous meeting.

Resolved

To approve and sign the minutes of the Health Select Committee meeting held on 10^th January 2017.

To receive any declarations of disclosable interests or dispensations granted by the Standards Committee.

There were no declarations of interest.

The Chairman thanked Steve Wheeler, who was stepping down as a trustee from Healthwatch.

The Chairman drew the meeting’s attention to senior positions in the Council that were being advertised.

The Council welcomes contributions from members of the public.

Statements

If you would like to make a statement at this meeting on any item on this agenda, please register to do so at least 10 minutes prior to the meeting. Up to 3 speakers are permitted to speak for up to 3 minutes each on any agenda item. Please contact the officer named on the front of the agenda for any further clarification.

Questions

To receive any questions from members of the public or members of the Council received in accordance with the constitution.

Those wishing to ask questions are required to give notice of any such questions in writing to the officer named on the front of this agenda no later than 5pm on Tuesday 28 February 2017 in order to be guaranteed of a written response. In order to receive a verbal response questions must be submitted no later than 5pm on Thursday 2 March 2017. Please contact the officer named on the front of this agenda for further advice. Questions may be asked without notice if the Chairman decides that the matter is urgent.

Details of any questions received will be circulated to Committee members prior to the meeting and made available at the meeting and on the Council’s website.

There were no questions submitted under this item.

To receive an update on the development of the STP for BaNES, Swindon and Wiltshire, following the update received in November 2016.

David McClay, Programme Director, attended the meeting to give a presentation and an update on progress made on the Sustainability and Transformation Plan (STP).

Issues highlighted in the course of the presentation and discussion: the common challenges across the Bath, Wiltshire and Swindon footprint including workforce, infrastructure and estate coordination; the scope for collaboration between acute providers; that the plan was published in December; that officers acknowledged it was very technical but an easy read document has been developed (Link to short version); the relationships with Councils and CCGs identifying what is and not in scope; how best to engage with the public – focusing on the higher level strategy; that specific plans in particular communities would take places as they would have done normally through CCGs and GP mechanisms; a move away from competition between acutes towards more clinical specialisms; coordination of some back office functions; how the STP governance is structured and how election may delay some further engagement; the links to the Single View of the Customer programme;

Concern was expressed by Councillor Chris Caswill as to how effectively the Committee could engage with the process of the development of the STP and hold the partners to account.

In response to questions from Councillor Caswill, it was noted that 7 day working was already an area of work prior to the STP and was a recognised challenge; that clustering of GPs will take on a different form depending on the needs of each area; that targets for finance savings will be allocated using a model developed by NHS England who will be validating this model using local information on costs; that the £50m funding gap in social care finding across whole STP area was based on demographic assumptions of pressures, that CCGs are required to generate surplus and Foundation Trusts can invest their surplus; that the STP is a planning vehicle, a coalition of the wiling, not a statutory body.

In response to a question from Councillor King, it was noted that officers were confident of a successful change programme due to the degree of cooperation and the use of data to plan changes.

The Chairman thanked Mr McClay for his presentation and for answering the questions of the Committee.  

Resolved

To note the update on the STP provided and to recommend that the successor Committee under the next Council continues to focus on it as a work priority, with consideration given to a dedicated task group.

To receive an update on the delivery of the Adult Community Health Care Service, following its commencement in July 2016.

The Chairman invited Douglas Blair, Chief Executive of Wiltshire Health & Care, the give a presentation on the delivery of the Adult Community Health Care Service, following its commencement in July 2016. The slides of the presentation were included in an Agenda Supplement.

Issues highlighted in the course of the presentation and discussion included: the staff and governance structure of the new organisation; the length of the contract awarded; the typical work load for community services; how community services have increased activity bearing in mind the pressures on the health system overall; the five main areas of change and the work required to enact those improvements including recruitment; the link to the Better Care Plan and Fund including the ambition of improving patient pathways to help tackle delays in discharge from acute to community services; how training has been given to staff to improve how they support patients in taking control of their health and care; the new ICT equipment and software that has been used to allow staff to update records in the field and thus save on time spent on travel and administration; that all ICT is encypted to maintain security; the plans and challenges for next year including some possible redesigns of services; the role of the organisation in the wider programme of Health transformation.

The Chairman thanked the officer for the presentation and the overview.

Resolved

1.         To note the update on the Wiltshire Health and Care service following its commencement in July 2016, and

2.         To recommend that the successor Committee under the next council receives a further update in September 2017.

To receive the responses of the Health and Wellbeing Board and other partners to the recommendations of the final report of the task group, which was endorsed by Committee in January 2017. Attached is the report, for information, is the report considered by the Board and a further report, outlining the response, is to follow.

The meeting  considered the report, circulating as an agenda Supplement, which provided the responses of the Health & Wellbeing Board and other partners to the recommendations of the Better Care Fund task group, which were endorsed by Committee in January.

Also included in the agenda pack was the BCP update report considered by the Health and Wellbeing Board in February.

James Roach, Integration Director, introduced the responses to the Task Group’s recommendations.

Issues highlighted in the course of the presentation and discussion included: the impact of the steps already taken; the focus for activity in 2017/18; the significant pressures that may limit innovations and investments; the work to enable the Choice policy to be provided across the area and how staff are trained to enable good use of this; that Single View of the customer is a key programme across a range of services; how the balance between seeking swift discharge and patient care would be considered when the policy is reviewed; how can the Better Care Plan model evolve to apply to the wider population.

In response to a question from Councillor Caswill, it was noted that there was good evidence, in comparison to similar authorities, that Wiltshire had performed well.

The Chairman thanked Mr Roach for his work in this area and for responding well to the issues raised by the Task Group.

Resolved

1. To note the responses to the Final Report of the Better Care Plan Task Group and the actions outlined in the report;

2. To note the outline approach for the Better Care Plan in 2017/18;

3. To invite the new Director of Integration and the Better Care Fund for Wiltshire Council to a future meeting of the Committee once appointed; and

4. To note that in its final report the Better Care Plan Task Group recommended further scrutiny work under the next Council on:

-       The Single View project

-       Performance monitoring of the Better Care Plan’s five national performance areas

-       The integration of services across Wiltshire’s health care sector

To receive a presentation from the Chairman of the Board on his priorities for 2017-18. In November 2016 the Committee noted the publication of the Board’s annual report for 2016-17 and invited the Chairman back to provide further information on his priorities for the coming year.

The LGA Members guide to Safeguarding Adults is attached for Members’ information.

The Chairman welcomed Richard Crompton, Chairman of the Wiltshire Safeguarding Adults Board, to present his priorities for 2017-18.

The LGA Members guide to Safeguarding Adults was included in the Agenda papers for Members’ information.

Issues highlighted in the course of the presentation and discussion included: that the report had previously been considered by the Health Select Committee; the picture based on previous the year and the issues arising for the coming year; how the Care Act, placing Adult Safeguarding on a similar statutory footing to Children’s Safeguarding, had brought the work into greater focus; the different partners and agencies involved in the Board; the impact of demographic and financial pressures on the issues of adult safeguarding; the three main areas of focus; the development and publication of staff guidance; the information sharing protocol; the  high-risk behaviour policy which identifies preventative work; efforts to enhance training; auditing case files to enhance self-assessment; the increased officer support to the Board; increasing the profile of the Board through better visibility; the funding made available from Health and Police, along with the Council; the need to review performance data from a range of partners; the links to Healthwatch; how the adult and children safeguarding boards can work together to identify transition issues; how boards look at family issues not just at individuals; the potential to develop a hub based approach; whether Adult Safeguarding could have a stronger presence on the revamped YourCareYourSupport website; and that financial exploitation was an important issues to address.

Resolved

1.    To thank the Chairman of the Wiltshire Safeguarding Adults Board for outlining the Board’s priorities for 2017-18.

2.    To note that the Board’s three overarching priorities for 2017-18 are:

a)    Overall effectiveness of the Board

b)   Personalising safeguarding, and

c)    Prevention.

3.    To note the increasing emphasis on a joined up approach to child and adult safeguarding, including the Single View project.

In April and June 2016 the Committee received reports on proposed changes to the Adult Care Charges Policy. In June the Committee resolved,

1. To express concern at the reported level of response to the consultation and ask Cabinet to consider whether it provides a sufficient basis from which to implement changes.

2. If Cabinet implement changes to the charges, to receive an update on their impact, six months after implementation.

The proposed changes were subsequently agreed by Cabinet in July 2016.

A report, included in the pack, outlines the further engagement work being delivered by Healthwatch in order to assess the impact of the Policy.

At their meetings in April and June 2016 the Committee received reports on proposed changes to the Adult Care Charges Policy.

At the June meeting, the Committee resolved;

1.      To express concern at the reported level of response to the consultation and ask Cabinet to consider whether it provides a sufficient basis from which to implement changes.

2.      If Cabinet implement changes to the charges, to receive an update on their impact, six months after implementation.

The proposed changes were subsequently agreed by Cabinet in July 2016.

At the invitation of the Chairman, Cllr Jerry Wickham, Cabinet Member for Health and Adult Social Care, introduced a further which outlined the further engagement work being delivered by Healthwatch in order to assess the impact of the Policy.

Issues highlighted in the course of the presentation and discussion included: that new people to the system were, on the whole, accepting the changes, but that the had been a small number of complaints from existing customers being reassessed; that Healthwatch had been commissioned to undertake some engagement work; that senior officers would attend to explain the changes; individuals can received some targets support at those meetings; how lessons can be learnt for the future to make the information clearer for people to understand; and how vulnerable people can be supported to understand changes.

Resolved

To note that the Cabinet Member has commissioned Healthwatch Wiltshire to undertake a more thorough investigation into the impact of the implementation of the new Policy, and following this work a full report will be made available to the Committee and Cabinet.

To highlight key aspects of the work undertaken by the Select Committee during the 2013-17 Council and to recommend topics as legacy items to the Management Committee for possible inclusion in a new overview and scrutiny work programme after the elections.

Henry Powell presented the report which highlighted key aspects of the work undertaken by the Select Committee during the 2013-17 Council, and which recommend topics as legacy items to the Management Committee for possible inclusion in a new overview and scrutiny work programme after the elections.

The Chair thanked all for their contributions over the course of the last four years, and invited members to contact Henry with any additional suggestions.

Resolved

1.    To agree that the topics listed in the report be recommended to the Management Committee as requiring further work in the new Council.

2.    To note the next steps described in paragraph 8.

3.    For the Committee’s terms of reference to be circulated to its membership under the new Council.

4.    For further suggestions to be sent to the officers.

5.    For the final list of topics suggested for future scrutiny to be circulated.

To consider any other items of business that the Chairman agrees to consider as a matter of urgency.

There were no urgent items.

The next scheduled date is 27 June 2017.

It was noted that the next meeting would be at 10.30am, Tuesday 27 June, County Hall