Agenda and minutes

To elect a Chairman for the forthcoming year.

To confirm that Councillor Johnny Kidney be elected as Chair of the Health Select Committee for 2024-25.

To elect a Vice Chairman for the forthcoming year.

To confirm that Councillor Gordon King be elected as Vice Chair of the Health Select Committee for 2024-25.

To receive any apologies or substitutions for the meeting and to note any membership changes.

Apologies were received from Councillor Howard Greeman and Councillor Pip Ridout and from Caroline Finch, Carol Shirley and Mary Reed from the Wiltshire Centre for Independent Living, Diane Gooch, from Wiltshire Services Users Network, from Irene Kohler from Healthwatch Wiltshire, from Victoria Stanley and Fiona Slevin-Brown from the ICB and Katie Davies from Public Health.

There were no substitutions.

Membership Changes

Cllr Mike Sankey had stepped down from the Committee and Cllr Nick Dye had joined the committee having been appointed at the Annual Council meeting on 21 May 2024.

To approve and sign the minutes of the meeting held on 27 February 2024.

Resolved:

To confirm and sign the minutes of the meeting held on 27 February 2024 as a true and correct record.

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

Councillor Clare Cape reconfirmed that she is employed by NHS England but did not feel that there was a conflict of interest due to the nature of her work that she undertakes with them.

Councillor Johnny Kidney reconfirmed that he is a Wiltshire Council Stakeholder Governor on the Council of Governors of the Royal United Hospital in Bath, but that he did not feel it affected the work of this committee.

To note any announcements through the Chairman to be made at the meeting and to note the attached announcement relating to agenda item 8 – Update on NHS Dentistry and Oral Health Promotion.

The Chairman made the following announcements:

Suggested Scrutiny questions

In the agenda pack for the meeting there was a document titled ‘suggested scrutiny questions’. This was a list of scrutiny questions that could be applied to almost any topic that a scrutiny committee might encounter and going forward it would be included for members’ reference in all Overview and Scrutiny agendas.  

Members were encouraged to make use of the document and it was hoped that it may prompt some questions that might otherwise have not been thought of. If a member felt that the list was missing something, then the Scrutiny team would be happy to add further questions in. 

General Election – 4 July 2024

The forthcoming election had had an impact on some agenda items as representatives from the NHS would not be attending the meeting.  The committee were referred to the statement on pages 19-20 of the agenda pack which laid out the approach the committee was taking to the item on NHS dentistry.

Clare O’Farrell

Clare O’Farrell, ICB’s Deputy Place Director would be attending the meeting online on behalf of Place Director Fiona Slevin-Brown and this would be Clare’s last Health Select meeting. On behalf of the committee the Chairman passed on his thanks to Clare for her dedication and contribution to the Wiltshire Integrated Care Alliance and NHS service provision in Wiltshire. 

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 5 June 2024 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 7 June 2024. 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.

No questions or statements were received from the public in advance of the meeting. 

The report seeks to provide an update on the work undertaken to increase dental access and the improvement of oral health for residents across Wiltshire and in particular the focus of vulnerable populations.  The update follows on from a rapid scrutiny report on NHS Dentistry provision in Wiltshire presented to the Committee in June 2023.

The Chairman noted that the report which had been put together jointly by Public Health and the Integrated Care Board who commission NHS Dental Services in Wiltshire sought to improve oral health and access to services for residents across Wiltshire.

Officers responsible for this area of work were not present at the meeting but the Chairman suggested that the Committee could identify areas to focus on when the item is rescheduled.

The Committee reported that they would like to focus on new hygiene plans and oral health with the early diagnosis of oral cancer being higher on the agenda and on how prevention was making a success in treatments.  Also, in the prevention of treatment needed going forward, particularly in children that were showing early signs of early dental decay feeling that education and treatment to prevent occurrences was key.

The Chairman felt that the workforce was an area of concern and that an update on incentives for workforce and access would be welcomed along with details of pilot initiatives in the BSW area.

Resolved:

That the Health Select Committee

1.      Note the contents of the report.

2.      Request the following information when the item is rescheduled for consideration:

i)               The impact of preventative work

ii)              Update on incentives for workforce and access

iii)            Pilot initiatives in the BaNES/Swindon/Wiltshire ICB area.

To receive a presentation on the lessons learned from a survey, led by the Public Health team with the Boater community in Wiltshire.  The link to the full survey analysis can be found here.

The Chairman welcomed Vicki Lofts (Public Health Specialist) from the Public Health team and Kiersty Rose (Senior Business Insight Analyst) from the Data and Business Information Team, who were in attendance to give an overview of the highlights from the survey including the findings and lessons learned.  Councillor Ian Blair-Pilling (Cabinet Member for Public Health, Communities, Leisure and Libraries) was also in attendance and highlighted that this work was completed following Covid, and outreach work undertaken with the realisation that this was a community living with difficult circumstances and challenges in a place without an address.  The findings would also be considered by the Health and Wellbeing Board and that it would be recommended that this be brought back to the Committee in six months’ time to ascertain from other agencies where they were with supporting this community and what changes/improvements had been implemented.

Summarising the more detailed presentation included in the agenda pack, the following was highlighted:

·        That boaters are a seldom heard community and the Council wanted to build a better understanding of those living on boats on the Kennet & Avon canal in Wiltshire and noting that the Canal and River Trust reported 2000 individual boat sightings in 2022-23, they wanted to find out more, so a survey was commissioned as it was previously believed only around 500 boats were on the canal in Wiltshire.

·        A walk was organised for September 2023 with 40 council and partners staff involved and in pairs the volunteers talked to boaters to publicise the survey and the ways in which it could be completed.  The volunteers provided summaries of their conversations with the boaters which highlighted the joys of life on the water and the challenges, and the volunteers were also able to provide feedback on the infrastructure and facilities available;

·        The survey ran for 4 weeks and consisted of 68 questions across multiple topics.  There were 218 responses which is around 10% of the estimated population, most were completed online, and some were returned by post or returned to collection points;

·        89% lived on their boats all year round and almost a quarter had been living on their boat for 10 years or more.  24 respondents (11%) had children under 19 living on boats;

·        63% of responses mentioned the benefits of the environment and community as reasons for living on boat feeling that it was less impactful on the environment and there was freedom, peace and beauty.  Challenges faced in boater live emphasises issues with facility access, mooring difficulties, maintenance costs and the hardship faced during winter;

·        The boaters were asked about their access to services and almost 40% reported that accessing clean drinking water was difficult or very difficult.  Following this a meeting was held with the Canal and Rivers Trust and a Working Group will be set up to look to improve this along with the disposal of refuse and sewage waste.  The Canal and Rivers trust funding had been reduced and boaters were paying more for their licence  ...  view the full minutes text for item 33.

To receive a briefing on the Wiltshire Health Improvement Hub developments including the highlights of the service and its 10 year celebration, the key metrics from the last financial year and service developments working towards a smokefree generation.

The Chairman noted that the Health Select Committee had closely followed the development of different initiatives to support residents to improve their health outcomes and to mark 10 years of the service, Gemma Brinn (Public Health Consultant – Health Improvement) and Sally Maynard-Smith (Public Health Practitioner – Health Improvement SVC Lead) joined the meeting to share the progress of the service and the current work around smoking cessation.

Councillor Ian Blair-Pilling (Cabinet Member for Public Health, Communities, Leisure and Libraries) highlighted that the Committee had requested this update and was happy to welcome Officers to give details of the work that had been carried out of the last 10 years.

Summarising the more detailed presentation included in the agenda pack, the following was highlighted:

·            The service had gone through several name and iterations over the last 10 years culminating in the Wiltshire Health Improvement Hub and specialises in behaviour change and helping Wiltshire residents make positive lifestyle changes;

·            The service was managed by 3 Public Health Practitioners and includes a team of Health Coaches and a Wellbeing admin team, and they provided 1-1 and group support on smoking cessation, emotional wellbeing and weight management;

·            There had been various milestones over the 10 years and changes made to adapt to current needs.  Since Covid there had been a shift in the way that the population has viewed health and emotional mental health and wellbeing and there was a refocus of the service to emotional wellbeing and personal resilience;

·            In 2021 there were funding streams available to Public Health teams including an obesity grant, so the team was expanded to support those with a high BMI to reduce their weight and work towards a better lifestyle;

·            There was then a restructure of the service and in 2022 there was a Healthy Mind pilot group programme launched, and E-cigarette pilot launched to help people attempt to stop smoking;

·            In 2023 a Group Stop smoking programme was launched with Apprentice Health Coaches being recruited.  In 2024 a Smokefree generation grant was received which led to a 4^th team being created dedicated to smoking cessation and this was a really successful piece of work;

·            Details of a client’s journey through the service were shared and the large proportion of those that wished to receive support would receive this either through 1-1 support or with a group programme;

·            Those with alcohol addiction are referred to the Connect or Turning Point services, but if it was not an addiction but the client wishing to manage their alcohol intake better, they would be supported through this service;

·            30% of clients were received through self-referral, 60% through primary care referrals and 10% with other referrals;

·            The number of clients supported in 1-1 sessions since the inception in 2018 had jumped significantly and there was an additional group of coaches recruited in one go.  During Covid there was a dip in those supported and the Health Coaches were allocated to activities.  Different ways of working were rolled out  ...  view the full minutes text for item 34.

The report (which is to follow) seeks to update the Committee on the Continuing Health Care Fund and its management in Wiltshire.

The Chairman welcomed Sarah-Jane Peffers (Associate Director for Patient Safety and Quality and All Age Continuing Care) to the meeting who was present to update the Committee on Continuing Health Care and its management in Wiltshire.

Summarising the more detailed presentation shared at the meeting (attached as Appendix 1 to these minutes), the following was highlighted:

·            Continuing HealthCare (CHC) is a package of care provided outside of a hospital setting that is arranged and funded by the NHS. It's provided to individuals who have complex health needs that are primarily healthcare related. To determine eligibility for CHC, individuals undergo an assessment process which considers their overall health and care needs;

·            Mandatory quarterly reporting to NHS England monitors Integrated Care Board’s (ICB) performance and activity in all areas of the CHC process and there are 3 set key performance indicators.  The quarter 4 2023-24 data shows that 53% of all CHC assessments were completed within 28 days of notification that an eligibility outcome was required and whilst this was a significant increase from the position in quarter 1 it remained below national targets and they wished to improve on making progress in that area;

·            The BSW ICB would have to ensure that they respond to the all age continuing care requirements as they were seeing increases in the elderly population who were also having more long term health conditions, therefore needing additional support;

·            The intention of the Fast Track Pathway is that it should identify individuals who need to access NHS Continuing Healthcare quickly, with the minimum delay, and with no requirement to complete the Checklist or the Decision Support Tool (DST).  Therefore, the completed Fast Track Pathway Tool, which clearly evidences that an individual is both rapidly deteriorating and may be entering terminal phase, is sufficient to establish eligibility;

·            For individuals in care homes, registered nurses are usually employed by the care home itself. To fund the provision of such nursing care by a registered nurse the NHS makes a payment direct to the care home. NHS Funded Nursing Care (FNC) is a standard rate contribution towards the cost of providing registered nursing care to individuals who are eligible. Local Authorities are not permitted to provide or fund registered nursing care.  Eligibility for NHS Continuing Healthcare (CHC) should always be considered before a decision is reached about eligibility for FNC. The CHC checklist is used to determine the need for a full CHC assessment, if the checklist is negative and nursing needs are identified then FNC is authorised;

·            There were a number of transformation activities that were being undertaken to continue to identify those individuals that are eligible for CFC.  An improvement in the 28 day assessment target was expected to achieve 80% by the end of quarter 1 2024-25.  They had seen an increase in referrals for CHC and would work with colleagues in the South West to further increase referrals.  There was now a System CHC Transformation Group chaired the Chief Nursing Officer of the BSW ICB.  There  ...  view the full minutes text for item 35.

To receive a briefing as preparation for the forthcoming CQC inspection of Wiltshire Adult Social Care. 

The Chairman highlighted that in January 2024 the Committee received a presentation of the work being carried out in anticipation of an inspection of Adult Social Care by the CQC.  That Council had now received notification of an inspection and Emma Legg (Director of Adult Social Care) and Debbie Croman (Adult Social Care Inspection Lead) were welcomed to the meeting to talk the Committee through the preparations to date.

Summarising the more detailed presentation included in the agenda pack, the following was highlighted:

·            The inspection of Adult Social Care had commenced on 15 April 2024 and would take place across a period of 6 months, with three phases.  The first was an information return with over 200 evidence items being submitted for the CQC to review and they would then contact registered care providers to request feedback about Wiltshire Council;

·            The next stage was case tracking which would be 2 weeks’ notice of 50 case files to be shared with the CQC and from those 10 would be selected for them to review in detail with the person/carer being contacted to speak about their personal experiences around the care received.  That feedback from the providers and the service’s self-assessment would help to triangulate evidence when they are reviewing the service;

·            Stage 3 would be a site visit with notice being given anytime before 15 October 2024 and would last for 2-3 days involving a range of focus groups with staff, people and carers.  The focus groups could also take place in the community if that worked well for those participating in them.  Eight to ten inspectors would be involved in this work;

·            The four inspection themes were, working with people, providing support, ensuring safety and leadership.  The self-assessment reflected the co-produced Adult Social Care vision and the service’s strengths and areas for development; and

·            To support staff teams, people, carers and partners in preparation for the next steps in the inspection process, a range of resources and support had been implemented or were planned.

The Chairman thanked Officers for the presentation.

The Committee asked questions about the recent peer review and if this had helped with the preparation for the inspection, was the service confident in the services provided, what clients would be involved in the inspection and the types of care being received by them and where, what a coded case file was, ow the team were manging the current workload and if the inspectors would wish to talk to members of the Committee.

Cllr Jane Davies (Cabinet Member for Adult Social Care, SEND and Inclusion) reported that she was very proud of the team and all staff involved with the excellent work that they do, and that the scrutiny was welcomed and that it could only make them even better.

Resolved:

That the Health Select Committee continues to receive ongoing updates related to the CQC inspection of Adult Social Care.

A brief comfort break was held at 12.35pm.

The meeting resumed at 12.40pm.

The interim report seeks to present the initial findings and recommendations of the rapid scrutiny of the new Mental Health Strategy being developed by the Bath and North East Somerset, Swindon and Wiltshire (BSW) Integrated Care Board (ICB).  The Committee is asked to review and approve the recommendations.

The Chairman highlighted that in September 2023 the Committee received a progress report on the development of the ICB’s new mental health strategy and it was agreed to carry out a joint rapid scrutiny of the strategy with the Children’s Select Committee.  A meeting was held on 26 April 2024 to consider the draft strategy and that group noted that the strategy looks to address concerns both the select committees have had around early access to help, preventative work and support following treatment. 

The group were encouraged by a shifting focus on expenditure to allow more community-based provision.  However, without seeing the delivery plan there was uncertainty about the capacity to deliver and the accessibility of services in Wiltshire.  The committee would need to understand how the strategy aligns with other strategies and informs future commissioning.

The Chairman highlighted that the Rapid Scrutiny Group’s recommendations were as follows:

Recommendations 

The Health Select Committee agree: 

i.           That the rapid scrutiny group need to review the delivery plan of the mental health strategy to be able to draw meaningful conclusions and recommendations. 

ii.          That the rapid scrutiny group meet again when the Delivery Plan has been drafted (possibly September 2024) to review how the strategy will be implemented in Wiltshire. 

iii.         That they will review a) how the overarching mental health strategy is aligned with existing strategies (e.g. carers support, dementia strategy) and b) how the strategy informs commissioning of related services. 

There were no questions from the Committee. 

Resolved:

That the Health Select Committee approve the recommendations of the rapid scrutiny of the mental health strategy as stated in the interim report.

The Committee is invited to comment on the quality accounts submitted by the two hospital trusts, the RUH in Bath and Salisbury NHS Foundation Trust.  A formal response will be completed by the Chair and Vice Chair by 14 June 2024.

The Chairman reported that a Quality Account is a published report about the quality of services and improvements offered by an NHS healthcare provider.

Health Select Committees and other stakeholder bodies are asked to consider and respond to the quality accounts of health providers in their area.  The response deadline for the two hospital accounts is the end of this week and input was welcomed from the committee.

Royal United Hospitals Bath NHS Foundation Trust

The Committee noted that there was a discrepancy about the number of members of staff at the RUH, with page 88 of the agenda pack stating that there were 6442 and later in the report the figure is 8142 and was this perhaps a vacancy gap, to what extent are they managing the budget to ensure that there is a quality of service to the public with those possible vacancies in play to be able to provide an effective service?

The Committee asked how the Quality Account priorities are arrived at and if they differ each year.

Salisbury NHS Foundation Trust

A Committee member commented felt that the production of the document was an exercise to prove that the Department for Health had taken on areas of concern, reviewed their policies, and completed training but he felt that it was short on quality outcomes and data, asking what the value is gained from the quality accounts and what value the committee can add to them.  It was suggested that this could be the Committee’s standard response to all quality accounts and that this would be discussed further with the Senior Scrutiny Officer outside of the meeting when they were looking at providing a response to the quality accounts.

A Committee member felt that there was divergence in the two quality accounts and suggested that there be a template for these so that they could be more comparable.

The Chairman felt that the quality accounts were missing a summary which could highlight 3 measures for quality, and these could be considered when others are asked for feedback usually in a really short space of time.

A Committee member questioned the term significant harm and felt that it did not explain it well as serious harm for one person might not be the same for another and felt it would be interesting to see how that would be defined.

Wiltshire Health and Care Quality Accounts

The Chairman explained the Wiltshire Health and Care quality accounts had been received after the agenda for the meeting had been published and so these had been circulated to the committee as a supplement.  There were no questions or comments from the committee.

Resolved:

That the Health Select Committee

1.          Include the feedback raised at the meeting in the formal response to the RUH and Salisbury Hospital in relation to their Quality Accounts for 2023-24.

2.          Request that providers allow more time in the future for the committee to review and respond to the quality accounts and to include a summary of  ...  view the full minutes text for item 38.

To review the Committee’s forward work programme in light of the decisions it has made throughout the meeting.

The Committee noted that the Forward Work Programme (FWP) would be updated to reflect any changes made throughout the meeting.

Councillor Mary Champion reported that she would soon be meeting with a resident who had asked a question about delays in diagnosis for dementia. Julie Bielby (Senior Scrutiny Officer) highlighted that the Committee was due to receive an update on Dementia Care at their September 2024 and that a representative from the ICB would be happy to be invited to attend the Councillor’s meeting if required.

Resolved

That the Committee approve the Forward Work Plan.

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 Wednesday 17 July 2024 at 10.30am.

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