Agenda and minutes

To receive any apologies or substitutions for the meeting.

An apology for absence was received from Cllr Graham Wright.

To approve and sign the minutes of the meeting held on 6 March 2018.

Resolved:

To approve and sign the minutes of the previous meeting of this Select Committee held on 6 March 2018.

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

There were no declarations of interest made at the meeting.

To note any announcements through the Chairman, including:

The Chairman made the following announcements:-

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 17 April 2018 (4 clear working days, e.g. Wednesday of week before a Wednesday meeting) in order to be guaranteed of a written response. In order to receive a verbal response questions must be submitted no later than 5pm onThursday 19 April 2018 (2 clear working days, eg Friday of week before a Wednesday meeting). 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 members of the public present or councillors’ questions.

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, which was presented to the committee on 7 March 2017 (see agenda) where the following was noted:

·         The Board’s three overarching priorities for 2017-18 were:

o   Overall effectiveness of the Board

o   Personalising safeguarding, and

o   Prevention.

·         The increasing emphasis on a joined-up approach to child and adult safeguarding, including the Single View project.

To receive information from the Chairman of the Board on the board’s key areas of work in 2017-18, and its priorities for 2018-19.

Consideration was given to a report by the Chairman of the Wiltshire Safeguarding Adults Board which updated the Committee on:-

·         Two Safeguarding Adults Reviews the Board had undertaken.

·         How the learning from those reviews would help more effectively.

·         The Board’s Business Plan for 2018-2019.

The Board Chairman explained in some detail the process that had taken place in carrying out the two anonymised Safeguarding Reviews and stressed that much had been learnt from the process and some changes had already been implemented. Further changes would be introduced and he would update the Committee in due course.  It was important to note that the reviews did not seek to apportion individual blame for shortcomings but that all involved sought to work together to determine how improvements and further safeguards could be brought about. 

During discussion, it was acknowledged that there was a need to ensure that before a patient was discharged from care, there was a need to ensure that the person was being discharged to a safe environment and that any appropriate care required was available, including in that individual’s own home. There was generally more emphasis on keeping vulnerable people in the community as much as possible but at the same time due attention needed to be given to potential risks.   

Members were pleased to note the development of an adult Multi-Agency Safeguarding Hub (MASH). However, it was pointed out that the implementation of a MASH in itself would not help agencies to improve outcomes but with adequate resources and successful planning there would be potential for this new operation arrangement to help:

·                Provide effective, consistent, multi-agency safeguarding arrangements.

·                Increase understanding and application of the Mental Capacity Act.

·                To more effectively assess risk.

·                To identify emerging concerns.

The Committee sought reassurance that advocacy was always considered when appropriate as it appeared not to have been used in one of the cases. The Chairman of the Board offered to look into this and report back.

After further discussion during which Members examined the Board’s Business Plan.  

Resolved:

(1)          To thank the Chairman of the Wiltshire Safeguarding Adult Board for presenting his report and answering the Committee’s questions.

(2)          To welcome the Chairman’s offer to circulate, for the Committee, the outcome of the Board’s discussion regarding the data charts included in the report.

(3)          To invite the Chairman of the Board to update the Committee on the outcome of the safeguarding adults reviews mentioned at this meeting, including the offer of advocacy.

(4)          To receive the Board’s next three-year strategy in 2019.

To receive an update from the CCG regarding the Maternity Transformation Plan.

The Committee received the following update which had been provided by the Clinical Commissioning Group (CCG) regarding the Maternity Transformation Plan.

“The CCG has received positive feedback from NHS England on its maternity transformation plan.

The CCG’s dedicated project midwife has commenced in post and they are moving to mobilisation phase.

The dads pad app will be launched in May and work has commenced on developing the maternity app – they had offers of help with the Dads Pad app from interested grandparent members on this committee, so watch this space!

In terms of talking to the public about findings and options, they have extended the timeframes for public consultation to ensure they have appropriate time.

This means the CCG will be seeking the public view on options from September through to December this year.  They will come back to the committee to share the options and all supporting evidence, including next steps when available, and will make sure committee members remain fully briefed.”

Resolved:

To note the contents of the update provided and to welcome further updates at key stages of the project.

To consider Extra Care Housing and Housing Related Support prior to consideration by Cabinet on 15th May 2018.

The Committee received a short verbal update on extra care housing and housing related support prior to consideration by Cabinet on 15 May 2018.  It was noted that there was still some work to be completed in relation to Extra Care Housing and Housing Related Support before the Council could consider tendering for a new provider, which included:-

·         Customer consultation in relation to the type and level of services they would like to be provided at these schemes.

·         Review of care and funding models to ensure that the schemes provided a service which was appropriate and affordable for both the customer and the Council.

·         Develop a specification for each service and commissioning intentions for delivering the service.

It was noted that this work was likely to take 12 to 18 months to complete and that contracts would need to be awarded to ensure that current arrangements were maintained in the intervening period.

The Chairman suggested that a task group with a limited number of meetings, or a Rapid Scrutiny Exercise, might be useful to consider the key points of the review, alternatively an overview & scrutiny Member could be appointed as a representative on the relevant board.  Furthermore, she enquired as to whether the review also included Sheltered Housing.

Resolved:

To note the update and that consultation would take place with the  Cabinet Member for Adult Social Care, Public Health & Public Protection and appropriate officers to agree the best format of scrutiny involvement with the review.

To receive an update on the delivery of the Better Care Plan for Wiltshire and emerging plans for 2018/19.

Consideration was given to an update report from the Portfolio Delivery Manager – Integration, Wiltshire Council and Clinical Commissioning Group on the Better Care Funding Programme, which included an update on the Section 75 agreement for 2018/19. This had been presented to the Health and Wellbeing Board on 29 March 2018.

It was pointed out that:-

·         Overall non-elective admissions for Wiltshire were around 10.7% higher

than last year, but this was driven in the main by changes in coding at a

couple of trusts and some transfer of responsibility from Specialised to

CCG Commissioning, without these changes the increase would be

around 4.8%. Avoidable emergency admissions were down 1% and

admissions from non-LD (Learning Disability) care homes were down nearly 3% on the same period last.

·         New permanent admissions to care homes remained at historically low

levels due in part to availability of care homes.

·         The percentage of people at home 91 days post hospital discharge

had reduced, data quality issues were causing issues with regards to

the production of accurate performance information which was being

managed to ensure reliable information for 2018-19.

·         The number of Delayed Transfers of Care days continued to fall and

performance was improving on that seen earlier in the year, however our

position remained above the planned trajectory.

·         Urgent care at home continued to see more referrals, with 72 in

January, which was close to the target of 80 people, however the % of

admissions avoided was lower at 75%

·         Help to live at home activity increased in January for new cases, the

total was 47 compared to 28 in December

·         Urgent Care at home activity had increased 36% on the same period

last year which aligned to the delayed days that had reported 6.4%

lower than the same period last year, but remained well above trajectory

for October 2017. This was a positive move as the Better Care Fund

workstreams embedded; however further work was required to enable the system to be sustainable in 2018 and into 2019.

·         Intermediate Care Bed admissions were at a level broadly similar to the

same period last year but discharges were 2% higher. Domiciliary Care

activity for new clients was 4.5% higher than the same period last year

and ongoing support was 7.2% higher suggesting the new models of

care to support Home First was starting to change the system model

from residential to normal residential of choice.

During discussion, Members enquired as to how reliable was the data information provided for 2017/18; it was explained that the figures for 2015/16 were somewhat overstated but new systems were now in place which resulted in the provision of more accurate data and also the easier and more efficient discharge of patients from hospital with a new recording system.

The Committee was reminded that the Better Care Plan Task Group had previously recommended to this Committee at its meeting on 10 January 2018 that the monitoring of the Better Care Plan be monitored, as a topic for scrutiny,   against the  ...  view the full minutes text for item 38.

To consider a summary regarding delayed discharges.

The Committee received a summary of DTOC (Delayed Transfer of Care) delayed days for January 2018 which showed:-

·         Wiltshire delayed days increased by 29.8% (482 days) in January, which was 775 days higher than the trajectory of 1,325 days.

·         NHS delays were 1,306:

-       Increased in January by 26.4% over trajectory by 511 days.

-       Great Weston Hospital, Swindon, Royal United Hospital, Bath and Wiltshire Health & Care had the largest number of delays.

·         Adult Social Care delays were 657:

-       Increased in January by 37.1% over trajectory by 236 days.

-       Salisbury NHS Foundation Trust and Wiltshire Health & Care had the largest number of delays.

-       Acute delays accounted for around 65% of Adult Social Care delays.

During discussion, it was noted that there was a great deal of work being undertaken by all agencies involved to help overcome the problems associated with delayed discharges.  The Care Quality Commission (CQC) was due to publish a report on a systems review but this would not be available until June 2018.

Members considered how best scrutiny could be involved in helping to overcome this problem and a suggestion was made that possibly a member of this Committee might be appointed to one of the boards involved with the Better Care Plan, possibly the Integration and Better Care. A further suggestion was made that possibly the Chairman and Vice-Chairman of this Committee attend meetings of the Health and Wellbeing Board and report back on issues to this Committee.

Resolved:

(1)                To ask the Cabinet Member for Adult Social Care, Public Health & Public Protection to provide a brief update, possibly as a Chairman’s Announcement, on the outcome of the CQC review (to be published in June) and the key actions for Wiltshire.

(2)                To welcome an update on the Better Care Plan and Delayed Transfers of Care after winter 2018 (in the spring of 2019) including Allocation of Better Care Fund.

(3)                To invite the Cabinet Member to consider further scrutiny involvement such as appointing a member of this Committee to one of the boards involved with the Better Care Plan.

To receive any updates on recent activity for active task groups and from members of the Health Select Committee who have been appointed as overview and scrutiny representatives on programme boards.

The Committee received updates on the activities of active task groups and from members of this Committee who had been appointed as overview & scrutiny representatives on programme boards.

Resolved:

(1)             To note the updates on task group activity provided.

(2)             To note that Cllr Haley Spencer had stepped down from the Children & Adolescents Mental Health Services (CAMHS) Task Group and endorse that it continue as a 4-member task group.

(3)             To congratulate Natalie Heritage, Senior Scrutiny Officer, on the considerable contribution she had made to the work of this Task Group.

The Committee is asked to consider the work programme.

The Committee received a document showing the relevant items form the Overview & Scrutiny Forward Work Programme.

Resolved:

To note the Forward Work Programme for this Committee.

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

There were no urgent items of business.

To confirm the date of the next meeting as 11 July 2018 at 10.30am.

Resolved:

To note that the next scheduled meeting of the Committee was due to be held on Wednesday 11 July 2018, at County Hall, Trowbridge, starting at 10.30am.