Agenda and minutes

Apologies were received from Councillor Deborah Halik, substituted by Councillor Peter Fuller, Councillor Melody Thompson, substituted by Councillor Anna Cuthbert, and Councillor Mary Champion.

To approve and sign the minutes of the meeting held on 27 June 2017.

The minutes of the previous meeting were presented.

Resolved

To approve, for signing by the Chair, the minutes of the meeting held on the 27 July 2017 as a correct record.

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

David Walker, from Health Watch, clarified that his group had been involved in work around the following items:

Impact of Adult Care Charging Policy; and

Customer Engagement with Adult Care.

·        CQC to re-inspect the Great Western Hospital Trust

(Further info can be found here: http://www.cqc.org.uk/location/RN325 )

The Chairman made the following announcements:

1. CQC’s re-inspection of Great Western Hospital Trust

Following a re-inspection, the CQC has found improvement in the services provided by Great Western Hospitals NHS Foundation Trust in Swindon.

Inspectors visited the hospital in March to review the progress made by the trust following an inspection in October 2015.  At the time CQC issued a Warning Notice requiring improvements in the hospital’s emergency department. 

Following this latest  inspection the trust have been rated as Good for being effective, caring and well led, and Requires Improvement for being safe and responsive to people’s needs. CQC has not changed the overall rating of the trust following this focused inspection – which remains at Requires Improvement.

A link to the full report had been included in the agenda pack.

 The Chief Inspector of Hospitals has said,

“I am pleased that we have found improvement in those areas that we had identified as a priority during our last comprehensive inspection.  However it is clear that this is work in progress – and further work is needed.

“I am aware that there are wider challenges within the local healthcare system in Swindon – particularly in the provision of primary and community services – which are creating pressure on the hospital at a time when demand continues to rise. 

“We know that the trust has been working strategically with local partners to shape long term improvements on these issues, as well as acting internally to improve the safety and responsiveness of the service. Both approaches are vital. 

“I am confident that the trust is heading in the right direction. But this is of little comfort to someone who finds themselves today waiting for urgent attention in an overcrowded emergency department. We will continue to monitor the trust closely and return in due course to check their progress.” 

The Committee last received a report from GWH in November 2016 and overall the Committee was satisfied with the improvement plan put in place by the Trust.

2. Work planning meetings with the Executive

In June the Committee supported meetings between the Chairman and the vice-chairman with both the Executive and the CCG in order to discuss key projects and work priorities for the coming 12 months.

These meetings had now been arranged and would report back on the outcomes at our next meeting.

The Chair also formally welcomed David Walker who had been appointed as Health Watch Wiltshire’s representative on the Committee.

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 Wednesday 30 August 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 Friday 2 September 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.

Representations were received further down the agenda.

A report is attached presenting information relating to the ambulance service's activity and performance in Wiltshire.

The Committee last received a performance report from the Trust in September 2016. Members discussed the challenges faced by the service in meeting certain response times, the challenges faced nationally in recruiting sufficient staff to deliver ambulance services and the work underway to reduce the number of inappropriate referrals to the ambulance service.

Paul Birkett-Wendes, Head of Operations for SWASFT’s North Division, will attend to answer the Committee’s questions.

Paul Birkett-Wendes, from SWAST, attended the meeting to present the report which provided an update on performance.

Issues highlighted in the course of the presentation and discussion included: that targets in rural areas are often challenging; how calls are prioritised to send the right resource to the right person; the support to the service provided to the service by community first responders; how demand patterns have changed; the issues facing the recruitment to some rolls such as call-handlers; the impact of the Sustainable Transformation Plans.

The Chairman thanked the officer for the presentation, and for the offer for Councillors to contact the service to visit a call centre or to ride along with staff.

Resolved

To note the information on the ambulance service’s performance in Wiltshire and to thank South West Ambulance Service Trust for providing the report.

Douglas Blair, Managing Director of Wiltshire Health & Care, will provide a presentation on the delivery of the service since its commencement in July 2016.

The Committee received a short update on the service in March 2016.

Douglas Blair, from Wiltshire Health & Care, gave an presentation to the meeting providing a further update on their work following on from the update provided to the Committee in March 2017.

Issues highlighted in the course of the presentation and discussion included:

The organisation’s vision is to enable people to live independent lives; the performance by the organisations including finance; the impact of the delays in transfer of care; the growing demand for health services; the composition of the board including non-executives and organisation representatives; the work, using Healthwatch Wiltshire’s help, to develop organisational values and behaviour; how feedback from the committee was used to impact on plan; the work on discharge pathways and how this is resourced; the use made of additional therapy including animal and art therapy; that there had recently been a CQC inspection and that the report will be published; and some examples of patient feedback.

In response to questions from Councillor Pip Ridout, it was confirmed that the organisation was funded under contract with the CCG; that some funding had been made available through the Better Care Fund; and that developing clear pathways, rather than organisational integration, was probably better at addressing delayed transfers of care.

There being no further questions, the meeting;

Resolved

1.          To note the presentation on the work of Wiltshire Health & Care since the contract’s commencement in July 2016.

2.          To note that the report of the CQC inspection undertaken in June will be circulated to the Committee once published.

A joint report from Wiltshire Council and Wiltshire Clinical Commissioning Group (CCG) is attached outlining their intent regarding health and social care integration in Wiltshire.

The meeting considered the report outlined The Statement of Intent which set out the ambitions of partners for developing health and social care integration in the next few years.

There being no further questions, the meeting;

Resolved

To note the Statement of Intent on Integration, which set out the ambitions of partners for developing health and social care integration in the next few years;

That Councillor Christine Crisp be appointed as representative on the Adult Social Care Transformation Board.

A report is attached detailing the impact of the new adult care charging policy on individuals and providing data as to the expected full year financial impact.

A report will also be brought to Cabinet on 15 September 2017.

The meeting considered the paper which provided an update on the implementation of the Policy including the Healthwatch Review and actions taken by the Council in respect of that review.

Issues highlighted in the course of the presentation and discussion included: that in July 2016, after a period of public consultation facilitated by Healthwatch Wiltshire, the Cabinet agreed to implement a new Adult Care Charging Policy which came into effect in August 2016; that an update on the Policy was provided to Health Select Committee in March 2017 and the Committee noted that the Cabinet Member had requested Healthwatch to

undertake a review of implementation;

In presenting the report, Councillor Jerry Wickham recognised the good work undertaken by Healthwatch in their review, commended the hard work of staff in processing the changes and supporting people; and apologised to those negatively affected earlier in the process.

In response to concerns raised by Councillor Gordon King, Councillor Wickham stated that he did believe that the Cabinet made the decision based on the correct information but that lessons had been learnt.

The Chairman thanked the Cabinet Member for the update and asked for a further report in two meetings time.

Resolved

1.          To note the report detailing the impact of the new adult care charging policy on individuals and providing data as to the expected full year financial impact.

2.          To receive a further progress report on this matter, including how lessons have been learnt, in January.

A report is attached summarising current commissioning arrangements for customer engagement within adult care and options for the future procurement of these services.

A report will also be brought to Cabinet on 15 September 2017.

The meeting received the briefing note which informed the Committee of current contract and funding arrangements that the Council has with User Led Organisations and Healthwatch Wiltshire to engage with customers on adult care services and provided an outline options for future service commissioning.

The meeting received representations from the Cabinet Member, Councillor Jerry Wickham; from User Organisations representatives including the Wiltshire Centre for Independent Living, Wiltshire & Swindon Users Network and People First. Contributions were also received from Brian Warwick, Wiltshire Older People’s Champion.

Issues highlighted in the course of the presentation and discussion included: the support that is given to disabled people and their families in Wiltshire; the costs of organisations and the proportion spent managing the organisation; the opportunities for partnership working; the work down to engage with users who are traditionally disengaged with the health care system or have difficulty accessing services; the importance of good governance in the running of charities; that no preferred option had been identified in the report to Cabinet.

Councillor Wickham, in response to the issues raised, stated that he would propose that the contract, originally due to finish in March 2018, should be extend by 2 months to enable further discussion with the ULOs to address the issues identified in the report.

There being no further questions, the meeting;

Resolved

1.    To note the work underway to determine options for future commissioning of user engagement in adult social care and that the Cabinet Member has indicated the contract will now be extended for two months to allow further work to be done.

2.    To thank the user led organisations for attending and providing input on this matter.

A report is attached regarding a contract award following the Integrated Urgent Care commissioning exercise.

A report will also be brought to Cabinet on 15 September 2017.

The meeting received the paper which provided an update on the joint procurement process between Wiltshire Council and Wiltshire CCG, in partnership with B&NES CCG and Swindon CCG for integrated urgent care services. It was noted that a report would be brought to Cabinet on the 12th September to request delegation of authority to progress and award the contract.

There being no further questions, the meeting;

Resolved

To note the update on the joint procurement process between Wiltshire Council and Wiltshire CCG, in partnership with B&NES CCG and Swindon CCG for integrated urgent care services.

The Committee is asked to consider the work programme.

The revised Forward Workplan, circulated as a supplement, was presented.

Resolved

To note the updated workplan.

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

Strategic Outline Programme

Sarah Clement, Wiltshire CCG, presented an update regarding the Strategic Outline Programme. A copy of the report considered by the CCG Board in July was circulated as a supplement,

Issues highlighted in the course of the presentation included: that as the organisation responsible for planning and funding healthcare in Wiltshire, the Wiltshire CCG was currently reviewing local health services, including current primary care (GP practice) services, and the creation of a blueprint for the future; the need to rebuild a health and social care system that is sustainable for future use for our communities; that the review takes into consideration the challenges of changing population, clinical standards and financial pressures; that there are also clinical challenges to consider, such as availability of skills and staff while maintaining quality standards of care; that without additional funding, the CCG must work out how these challenges can be solved before they impact on the quality of care provided for local residents; that part of the solution lies in an Out of Hospital strategy, which considers which health services are provided in community settings, and where they are located; that, as some councillors are already aware, the development of these new clinical models impacts significantly on how and where we use both the existing estate as well as potential new buildings; that as options become more focused, further consultation would be required; that partners are being engaged with and a further report will be presented to the Committee in the new year.

Resolve

To note the update, and the request to report again in the new year.

10:30, 7 November 2017.

The date of the next meeting, Tuesday 7^th November, was noted.