Agenda and minutes

To receive any apologies or substitutions for the meeting.

Apologies were received from Councillors Anthony Pickernell, Pauline Church and Caroline Corbin. 

To approve and sign the minutes of the meeting held on 18 January 2023.

Resolved: 

To approve the minutes of the previous meeting held on 18 January 2023 as a true and correct record subject to the inclusion of Councillor Mike Sankey in the list of attendees.

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

There were no declarations of interest.

To note any announcements through the Chair.

The Chairman expressed his condolences to the friends and family of the late Helen Jones, former Director of Commissioning and Procurement, noting her important contribution to the Committee.  

The Chairman updated the Committee on the previously agreed-upon discussion between the Chairman and Vice-Chairman of the Committee and their counterparts from B&NES and Swindon Borough Council over the programme of health and social care integration and opportunities for collaboration. The Chairman notified the Committee that due to the upcoming elections for those two councils in May, those discussions have been postponed until June 2023.  

The Chairman noted two upcoming briefings for Committee members in March 2023. He encouraged members to attend and participate in both the Carers’ Support Strategy and Service Commissioning briefing on 10 March 2023 and the Good Lives Alliance Framework Retender on 17 March 2023. 

The Chairman advised that Committee that they were expecting to receive Quality accounts from health providers for review in May 2023. 

The Chairman congratulated Emma Legg on her recent appointment as Director for Adult Social Care. 

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 21 February 2023 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 23 February 2023. 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 was no public participation.

A presentation will be provided to give an overview of the Joint Strategic Needs Assessment (JSNA) in Wiltshireand how the findings will inform planning for health services and policies. 

Kate Blackburn, Director of Public Health, presented an overview of Wiltshire’s Joint Strategic Needs Assessment (JSNA) from 2022. 

In particular, the Director commented on population and deprivation, life expectancy and causes of death, diseases and ill health, alcohol, drugs, smoking, weight and physical activity, education and employment, and housing, crime, and the environment.  

Members discussed whether data was available for local areas, as that was often what interested the public the most. The Director confirmed that publication of detailed data was due in late Autumn 2023. The Committee also asked about the status of smoking across the County and drew attention to the disparity between the average life healthy expectancy (which was confirmed as a self-reported and subjective metric) of deprived and non-deprived residents. Members discussed how the JSNA was a statutory requirement and would be used to inform decision and strategy in Wiltshire, although not as part of Bath, Swindon and Wiltshire (BSW). Finally, the Committee asked about whether the report factored in any sort of plan for a potential future pandemic, to which the Director replied that while the report does not cover that specifically, it is considered elsewhere in Public Health.  

Resolved: 

·       To note the content of the Joint Strategic Needs Assessment 2022? 

·       To ensure the findings of the Joint Strategic Needs Assessment 2022 informs the work of the Committee.? 

·       To review the trends for Wiltshire in 12 months’ time.? 

Councillor Clare Cape joined the meeting at 10:47am. 

A presentation of the draft Joint Health and Wellbeing Strategy will be provided for scrutiny prior to the final version being considered by the Health and Wellbeing Board on 30 March 2023. The Committee will have the opportunity to reviewand respond to the strategy consultation questions. 

David Bowater, Senior Corporate Manager for Levelling Up, then presented a draft of the Joint Health and Wellbeing Strategy.  

The Senior Corporate Manager explained that along with the JSNA, the Joint Local Health and Wellbeing Strategy (JLHWS) provides the foundation upon which the health and wellbeing board exercises its shared leadership across the wider determinants that influence improved health and wellbeing, such as housing and education. An effective JLHWS should enable commissioners to plan and commission integrated services that meet the needs of their whole local community, particularly those of the most vulnerable individuals and the groups with the worst health outcomes. The Senior Corporate Manager stated that the recently updated JSNA had informed the development of the draft JLHWS together with the workshop held on 1 December 2022 and input from a steering group incorporating public health, social care, NHS and Healthwatch Wiltshire representatives.  

The Committee discussed the integration of services, recruitment, and staffing concerns, as well as the potential for partnership with the private sector to work on preventative measures. The Senior Corporate Manager explained officers’ plan for targeted outreach and expressed a reluctance to become fixated on potentially changeable data. Members also asked about how the strategy might be evaluated, to which the Senior Corporate Manager responded that more so than through Key Performance Indicators (KPIs), outcomes ought to be measured through the JSNA.  

Resolved: 

·       To note the draft Joint Health and Wellbeing Strategy for consultation 

·       To review the implementation plan and monitor performance 

·       To receive a progress report 12 months after publication, to review progress against the objectives of the strategy. 

A presentation will be provided to set out the draft Integrated Care Strategy for Bath & North East Somerset, Swindon and Wiltshire (BSW) for consideration by the Committee.This follows a request by the Committee in January to review the draft strategy as part of the consultation and design process.

Introducing the next item, the Chairman reminded the Committee that in January 2023, they received an update on plans for an Integrated Care Strategy (ICS) for Bath & North East Somerset, Swindon and Wiltshire (BSW). He then introduced Fiona Slevin-Brown, Place Director for Wiltshire on the BSW Integrated Care Board (ICB) and William Pett, Associate Director of Policy and Strategy at the Integrated Care Board, to present the draft strategy.  

The Associate Director then presented an update on BSW’s draft ICS. He explained that the ICS was intended to encapsulate enabling, organisational, service and place-based strategies, warning that there was no legal enforcement behind the strategy and was therefore dependent on buy-in and support from partners. He clarified for the Committee that the fundamental purpose of the ICS was to support integration to meet local healthcare, social care and public health needs in such a way as to address local needs, engage a broad range of people, communities and organisations, address complex problems that require a system response and multiple partners, and to create space to address population health and wellbeing and support socio-economic development. The Associate Director also pointed to the challenges facing the ICS, including ensuring the strategy is driven by community and resident engagement, co-owned and developed with partners across the system,and sufficiently robust in spite of a short development window.  

Members observed that the document at present was too technical and jargon-heavy to be accessible to the general public and questioned the use of the term “left shift” to describe their migration away from hospital care. They also discussed utilising social media and video content to better promote and communicate the Strategy, as well as working alongside other companies like local sports teams through the Integrated Care Partnership. Members expressed concern over how easy it would prove to move away from spending so much on acute care, having been attempting to do so for so long already. The Associate Director replied that the Strategy did not indicate an abandonment of the Life Cycle approach but expressed a hope that through the new model of a legal structure for bringing systems together rather than relying on market competition (which he personally considered a barrier to success), they might finally make more progress. He also explained that it was important for the Strategy to be measurable and assured members that a progress report after 12-14 months would be wholly achievable. Questions were asked about the potential for an increase in community care funding and the possibility of reopening community hospitals like in Melksham. The Place Director stated that NHS estates should be enablers, and that the Strategy would seek to utilise them by either reopening them, refurbishing them, or rebuilding on them. On a similar note, the Vice-Chairman asked about the Peasedown St. John Diagnostic Centre, to which the Place Director advised that the Committee should bring that item back to a future agenda  ...  view the full minutes text for item 22.

To update the Committee on the work and challenges of Wiltshire Council’s Hearing and Vision Service.

Councillor Jane Davies, Cabinet Member for Adult Social Care, SEND and Inclusion, then introduced Emma Townsend, Head of Hearing and Vision Services, who proceeded to present an update on the work of her team as requested by the Committee.  

The Head of Hearing and Vision Services presented on the prevalence of visual impairment in Wiltshire, the structure of the Hearing and Vision Services team, the role of Rehabilitation Officers and the areas of development, including an action plan.   

Members asked about the state of the waiting list and learned that the list was risk-based as well as chronological, and that sometimes patients defer their own appointments, giving the appearance of longer waiting times. The Committee also asked about who funds the service, to which The Head of Hearing and Vision Services responded that as the service is believed to actually deliver significant financial benefits, the Council factor it into their Adult Social Care offer. The availability of Rehabilitation Officers for the Visually Impaired (ROVIs) was also discussed, as well as personal assistants and access to employment through partnerships with job centres. Councillor Davies informed the Committee that the County was currently above the national average for employment in the deaf community, although more could still be done. The risks and challenges of the proposed ROVI apprenticeship position were also discussed. The Chairman asked about what work is being done to preserve aural health in Wiltshire, to which the Director of Public Health advised that there was next to no work being done at present besides nation-wide campaigns, such as the current awareness campaign associating hearing loss with dementia.  

Resolved: 

·       To note the content of the detailed presentation? 

·       To receive the findings of the upcoming review of the hearing and vision service. 

To present a summary of the Market Sustainability Plan for Wiltshire, required by Central Government and due for publication on 27 March 2023.The Committee are invited to review the implications of the market forsocial care services for Wiltshire residents.

Commissioning Manager Jessica Chapman, Head of Commissioning for Adults SEC Melania Nicolaou and Head of Finance for Adults and Health Sarah Rose then joined the meeting remotely to present a progress report on the Market Sustainability Plan for Wiltshire.  

The Commissioning Manager explained the purpose of the plan andthe allocated funding and issues it will be used to address. She described how the Plan needed to revolve around an assessment of the current sustainability of local care markets, an assessment of the each’s service market’s future changes before October 2025 and a plan for each market to address sustainability issues, where identified. She explained that the next steps for the plan focused on further provider engagement and fee-setting, with a final Market Sustainability Plan due to be presented to Cabinet on 28 March 2023.  

The Committee sought reassurance that the market was indeed sustainable, which the Commissioning Manager was able to provide. She also elaborated on the premise behind block care beds and their merits. The discussion then turned to the challenges in presenting a career in care as a viable and attractive option to young people entering work, both through an appealing pay rate and effective promotion. Members also remarked upon the difficulties facing carers when it came to undertaking training to advance their careers, while also observing that there are some positive examples of career progression in the Council and that not all carers are interested in career progression. Councillor Davies was keen for Committee members to advocate shared lives caring in their communities, while Mary Reed spoke on the importance of forming meaningful relationships, and that those relationships were important to the carers as well.  

Resolved: 

To note the development of the Market Sustainability Plan for Wiltshire. 

A programme is provided for approval at the Committee’s request. This follows a discussion of the proposed Inquiry Session at January’s Committee meeting. 

The Chairman acknowledged the programme for the upcoming Inquiry Session included in Appendix 1 for approval, noting that the programme would be further developed in collaboration with health and social care staff and with the Committee.  

Councillor Cape advised that she had submittedseveral comments on the programme in advance of the meeting via the Vice-Chairman, and the Chairman confirmed that those comments had been received by the Senior Scrutiny OfficerJulie Bielby and would be duly considered. Councillor Cape suggested that an earlier date would be preferable to a later one; the Committee touted a date in spring as being the most favourable option.  

Resolved: 

To approve the draft programme and its further development and publish the date before the next meeting. 

The Committee is invited to review its forward work programme in light of the decisions it has made throughout the meeting.

The Chairman noted that the Forward Work Programme (FWP) would be amended to include the proposal to carry out a Rapid Scrutiny into NHS Dental Services, for which, as of April, the ICB would become the new commissioning body.  

Irene Kohler raised the recent presentation on maternity services by Lucy Baker and requested feedback on those strategies. Similarly, Councillor Howard Greenman asked for an update on diagnostic provision.  

Diane Gooch enquired about the Council’s dementia strategy, to which theDirector of Adult Social Care advised that the Council was still early in its development of the strategy but could request that a draft be brought into the FWP.  

Diane Gooch made the point that prior to the Directors involvement, the Committee had been directly involved in the development of such strategy. Irene Kohler suggested that it would be preferable for the Committee to see an early draft as well, rather than seeing it for the first time after it had been finalised. The Director responded that she warmly welcomed the input of the Committee and expressed a desire to involve and consult as widely as practicable in the strategy’s development.  

Resolved: 

·       To approve the inclusion of a Rapid Scrutiny into NHS dental services on the Forward Work Plan 

·       To add the actions raised during discussion at this meeting 

·       To add an update on the Maternity Services Transformation from January’s meeting to understand the impact of the transformation on services 

·       To add an update on the integrated care centres 

·       To ensure HSC and community stakeholders are involved in development of dementia care strategy at an early stage. 

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

There were no urgent items. 

To confirm the date of the next meeting as 10.30am on 8 June 2023.

The date and time of the next meeting was confirmed as 8 June 2023 at 10:30am.