Agenda and minutes

To receive any apologies or substitutions for the meeting.

Apologies for absence were received from Councillor Mary Champion, and from Councillor Mike Sankey, who was substituted by Councillor Kelvin Nash.

To approve and sign the minutes of the meeting held on 5 September 2023.

Resolved:

To approve and sign the minutes of the meeting held on 5 September 2023 as a true and correct record.

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 Chairman, including:

The Chairman made announcements pertaining to a recent briefing from Hampshire Together, a meeting with representatives from BANES and Swindon Scrutiny, briefings on changes to the Prescriptions Ordering Direct service, plans for Primary Community Care and the development of the Community JSNA for next year. He also announced plans for a joint rapid scrutiny session on the Emotional Wellbeing and Mental Health Strategy alongside the Children’s Select Committee for early December. Finally, he noted that the agreed actions from the Committee’s 13 October meeting on the Inquiry session into urgent care had been incorporated into the Forward Work Programme.

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 26 October 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 on30 October 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.

An overview of Community Pharmacies and their role in primary care.? The presentation will also look at the provision in Wiltshire and the challenges in providing services across the county. 

The Committee received an overview of Community Pharmacy Services and their role in primary care from Victoria Stanley, Sammer Tang and Helen Wilkinson. The Committee heard an update on the functions now delegated to the Integrated Care Board (ICB), and how it was largely the same colleagues working with prior expertise retained. Helen Wilkinson updated the Committee on service provision, highlighting the essential, advanced and locally commissioned enhanced services on offer.

On the topic of quality assurance, a number of indicators were identified, with anti-coagulants being looked at as well as respiratory indicators, safeguarding and core competencies. Similarly, the presenters noted the Dispensing Services Quality Scheme that which rewards practises for high quality dispensing services.

It was explained that the Pharmaceutical Services Regulations Committee were responsible for overseeing current and future levels of need, and that a Pharmacy Integration Fund (PhIF) had been established, with significant pilot schemes being launched across South-West England.

The presenters noted that it was important to acknowledge that pharmacies are autonomous businesses making decisions based on profitability in a challenging environment. The ICB were in support of community pharmacy much like they are with general practise and want to maintain a high street presence but were faced by challenge of large corporate bodies making decisions independently of ICB guidance. Community pharmacies are grouped heavily around Swindon, Trowbridge and Salisbury, and support is provided when notified of a market exit, including a liaison with the outgoing provider to ensure safe closedown processes were in place.

The presenters remarked on serious workforce challenges in Bath & North-East Somerset, Swindon and Wiltshire (BSW), with the region experiencing the second-highest pharmacist vacancy rate in England, with similar problems in other positions. While the workforce split aligns with regional and national trends, BSW has the lowest pharmacist per 10,000 GP patients in England, and the presenters expressed that they wanted to promote pharmacists as a career more.

Councillors raised issues regarding the closure of a third pharmacist in Warminster and the capacity issues facing the Amesbury pharmacist, asked questions regarding the distinguishing features of community pharmacies, the balance of face-to-face and online interaction, and the potential to recruit from the University of Bath.

Resolved:

• To note the content of the presentation.

·       To request an update on community pharmacy provision in Wiltshire in 2024.

Asummary of the Primary and Community Care Delivery Plan for Wiltshire by B&NES, Swindon and Wiltshire Integrated Care Board (BSW ICB). 

Fiona Slevin-Brown and Caroline Holmes presented the Primary and Community Care Delivery Plan, a strategic document to support broader integrated care strategy and implementation planning. Market engagement events and stakeholder oversight groups were all important parts of creating the document. Its objectives focus on prevention and early intervention, fairer health and wellbeing outcomes and excellent health and care services.

Caroline Holmes explained that they used feedback from a range of clinical and non-clinical stakeholders and sources to develop and iterate the delivery plan. Feedback came from market engagement sessions, 1-2-1 interviews, oversight group sessions, feedback forms and an autumn engagement phase currently ongoing, focusing on health and wellbeing boards, overview and scrutiny committees etc., with a public engagement plan in development.

Members sought clarity on population health data, specific examples of transformation priorities and interventions and the importance of public engagement going forward.

Resolved:

• To note the progress being made in developing the Primary and Community Care Delivery Plan.?

·       To request the opportunity to consider the ‘Roadmap for Delivery’ and, if available, findings from engagement with the public around the plan and examples of specific actions or initiatives.?

An introduction to the work of the Wiltshire Health Inequalities Group, including the aims and remit of the group. 

The Committee then heard from the Wiltshire Health and Inequalities Group. It was noted that health inequalities were both unfair and unavoidable, but can be measured in many different ways, ranging from life expectancy to the ability of individuals to make healthy choices. It was explained that the Group found itself in a unique situation regarding the aftermath of the Covid-19 pandemic and the ongoing cost-of-living crisis. The presenters shared the NHS Strategy for reducing healthcare inequalities, the CORE20 PLUS 5 approach, designed to support Integrated Care Strategies (ICSs) to drive targeted action in healthcare inequalities improvement. They recognised that children and young people were a unique demographic, with a different five areas of focus. Looking at the Wiltshire context, local plus groups included routine and manual workers and Gypsy, Traveller, Roma, Showmen and Boater (GTRSB) community members.

Future plans following the group’s launch event in April 2023 included an annual conference, and a link to system activities, assurance and governance. A strategy refresh was due in 2024, anticipating an upcoming shift in how community services are provided.

Councillors asked questions of the validity of the 2019 deprivation data and the constraints of national data sets, the impact of the CORE20PLUS5 approach, the striking omission of obesity and the importance of addressing other issues like housing for long-term success.

Resolved:

·       To note the work being carried out by the Wiltshire Health Inequality Group.? 

·       To request an impact report if available.

Councillor Kelvin Nash left the meeting at 12:20.

A presentation of Wiltshire Adult Social Care Key Performance Indicators (KPIs), including the last 6 months from April to September 2023.  An outline of Wiltshire’s returns for the national Adult Social Care Outcomes Framework (ASCOF). 

The Committee received a presentation from Emma Legg, Tamsin Stone and Councillor Jane Davies on Wiltshire Council’s Adult Social Care Key Performance Indicators (KPIs), including the last 6 months from April to September 2023.  The presentation provided an outline of Wiltshire’s returns for the national Adult Social Care Outcomes Framework (ASCOF). 

Tamsin Stone described the main metrics for adult social care, noting growth rate had continued, work completion rates were improving and speeding up whilst adult social care demand continued to rise.

The presenters highlighted that the Adult Social Care Outcomes Framework (ASCOF) had recently been deemed not fit for purpose, as it was not providing the right information, with different metrics in the midst of being reviewed. The Committee were advised that an investment in voice and participation activity was being pushed to get a more current and useful data set, with some provisional 2022/23 results likely very dated.

Councillors noted that some of the statistics being used were only relevant and useful if the sample size was included, and that steps were being taken to improve the punctuality of data collection. Questions were also asked of Wiltshire Council’s progress with community conversation work and micro-provider provisioning.

Resolved:

·       To note the content of the report.

·       To request an update of performance figures in six months and the final figures for the Adult Social Care Outcomes Framework (ASCOF) when available.

An annual update of the NHS Health Check programme in Wiltshire. 

Councillor Ian Blair-Pilling – cardiovascular disease remains main cause of mortality, national programme commissioned in Wiltshire to seek to address risk and early signs of problems, fitting in with early prevention and intervention, came to Committee in March 2022 when Covid recovery was in its infancy, big changes in data since then.

Introducing the next item on NHS Health Checks, Councillor Ian Blair-Pilling noted that cardiovascular disease remained the leading cause of mortality, with a national programme commissioned in Wiltshire to address the risks associated with it and recognising early signs of potential cardiovascular problems.

Gemma Brinn noted that the Health and Social Care Act 2012 made it mandatory for local authorities to make arrangements for provision of NHS Health Checks to their eligible population (residents aged 40-74 without certain pre-existing conditions) once every five years. She also added that the standard of quality assurance was very important. She said that there was an encouragingly quick pick-up in health check numbers post-Covid, and that the number of completed health checks has continued to rise, albeit with some fluctuation.

Describing the model from April 2024 onwards, Gemma Brinn explained that there would be no change in delivery, but that it would address the universal population, with a 5+5 years contract model. A new outreach provider was intended to reduce health inequalities and take checks into the community and use a contract for 3+2 years. Outreach provision would aim to reach and engage with population groups unlikely to otherwise engage with primary care and would also include out of hours checks and covering areas where GPs do not deliver.

Market engagement began in September 2023 with good attendance and interest from providers, with a contact awarded in January 2024, where a mobilisation plan was required from the successful bidder upon awarding of the contract. Councillor Blair-Pilling noted that the system allowed for financial wiggle room to ensure the best effect is achieved across the two contracts for primary care and outreach provision.

Councillors enquired about whether the model incorporated remote work and the potentially beneficial lack of specificity in the contracts, with Councillor Blair-Pilling also advocating the use of the heart rate monitors available on loan from Wiltshire Libraries.

Kate Blackburn, the Director of Public Health, took this opportunity to note the recent national government initiative on a smoke-free generation, in which the legal age of smoking would annually increase by one year. She explained that this would have a massively positive impact on the disease profile in which tobacco and obesity and the main drivers. She noted that additional funding amounting to approximately £500,000 had been ringfenced for smoking cessation services and that the government initiative presented an important opportunity for capitalisation regarding protecting children and young people from the harms of smoking. She added that consultation was live until 6 December 2023 and that the government was encouraging responses.

The Committee responded with unanimous positivity towards the initiative, also commenting on the future risks posed by vaping and the potential  ...  view the full minutes text for item 78.

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

The Committee reviewed the Forward Work Programme. The Chair stated that it would be updated based on today’s meeting.

Councillor King suggested including the allocation of continuing care money from the NHS, noticed a number of errors, including regarding to dementia and mental health, money not readily available enough.

Resolved:

• To approve the Forward Work Programme.
• For the Chair and Vice-Chair to consider how the Committee will respond to a concern, raised by a local support group on behalf of carers, around delays in dementia diagnoses. 

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 17 January 2023.

The date of the next meeting was confirmed as 17 January 2024.