Agenda and minutes

It was clarified that the vacancy on the Committee was a result of Cllr Thorn being appointed to the Health & Wellbeing Board. The vacancy would be filled following the next Council meeting on 9 July 2013.

The Membership of the Committee as appointed by Full Council on 14 May 2013 was noted.

Apologies were received from Cllr Helena McKeown.

Cllr Gordon King substituted for Cllr Bob Jones MBE

Cllr Mary Champion substituted for Cllr Bill Douglas

Cllr Sue Evans substituted for Cllr Peter Hutton

Cllr Terry Chivers substituted for Cllr Jeff Osborn

Cllr Pat Aves substituted for the Lib Dem Vacancy

To elect a Chairman for the ensuing year.

The Democratic Services Officer invited nominations for Chairman. Cllr Sheila Parker nominated Cllr Christine Crisp and this was seconded by Cllr John Noeken.

Cllr Crisp was elected Chairman of the committee unopposed, as no other nominations were received.

To elect a Vice Chairman for the ensuing year.

Cllr Crisp invited nominations for Vice Chair. Cllr Pip Ridout nominated Cllr John Noeken and this was seconded by Cllr Parker. Cllr Chris Caswill nominated Cllr Helena McKeown and this was seconded by Cllr Gordon King.

A vote was held to decide the Vice Chair position, and it was decided by 7 votes to 5 that Cllr Noeken would be elected as Vice Chair.

The previous Committee included the following non-voting stakeholder representation:

·         Advisor on social inclusion for older people (Brian Warwick)

·         Wiltshire and Swindon Users’ Network (Linda Griffiths or Dorothy Roberts)

·         Wiltshire Involvement Network (Phil Matthews) – NOTE: This organisation ceased to exist as at 1 April 2013.

Following the changes to the health and social care system, the Committee may wish to consider stakeholder membership of the Committee.  Members are also able to invite appropriate representatives to consider specific activities or projects as they arise.

The following were confirmed as non-voting co-opted members:

·       Advisor on social inclusion for older people (Brian Warwick)

·       Wiltshire and Swindon Users’ Network (Linda Griffiths or Dorothy Roberts)

·       Steve Wheeler (Healthwatch Wiltshire)

To approve and sign the minutes of the meeting held on 14 March 2013.

The minutes of the meeting held 14 March 2013 were presented, and subject to the amendment to Item 52: AWP Charterhouse, It was,

Resolved:

The minutes for the meeting held March 14 2013 were signed and approved as an accurate record.

To receive any declarations of pecuniary and non-pecuniary interests or dispensations granted by the Standards Committee.

It was noted that Steve Wheeler was a member of RUH Foundation Trust.

A discussion was held on personal interests in using local hospitals and care centres, as Cllr Pip Ridout and Cllr Gordon King outlined possible personal interests as family members used some local health services.

As a result, there were no Declarations of Interests to note

The Chairman outlined the meeting of the Joint OSC for GWAS that was to be held in June/July and requested a volunteer from the committee to attend on behalf of Wiltshire Council. Two possible dates had been identified (28 June and 12 July 2013). Cllr Pip Ridout agreed to attend but requested a deputy in case she could not attend. Cllr John Noeken agreed to deputise for the meeting if held on 12 July 2013.

The Chairman also highlighted that the Committee Rooms at Monkton Park would be unavailable until 2014. The Chamber would also not be available for the July meeting, and the venue for the next meeting would be circulated when available.

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 above 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 above no later than 5pm on Wednesday 22 May 2013.  Please contact the officer named on the first page 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 were received from the public.

The final report of the Mid Staffordshire NHS Foundation Trust Public Enquiry, chaired by Robert Francis QC, was published on 6 February 2013.  The report considered the evidence of over 250 witnesses, over a million pages of documentary evidence and put forward 290 recommendations.

Whilst the report attributed accountability for the failures at Stafford Hospital to the Trust Board, it also pointed to the systematic failure of a wide range of national and local bodies to respond to the concerns raised about patient care.  The report says,

‘…that at every level there was a failure to communicate known concerns adequately to others and to take sufficient action to protect patients’ safety and wellbeing from the risks arising from those concerns.’

Chapter 6 of the report relates to patient and public involvement and scrutiny. The inquiry took evidence from councillors and senior officers with responsibility for health scrutiny in Staffordshire.  The report goes into some detail in its observations and a number of the recommendations made relate directly to overview and scrutiny.

Members are asked to note that it is intended to bring a report to the next meeting of the Committee, which will look specifically at the implications for overview and scrutiny arising from the Francis Report.  The report will set out the key messages arising from the Francis Report and consider the relevant recommendations to enable the Committee to identify any areas for development for health overview and scrutiny in Wiltshire.

A brief update was made to the committee informing them that a report would be taken to the next Committee to enable identification of any potential areas of development or consideration.

Members may have seen reports in the local media and be aware that the Care Quality Commission (CQC) made an unannounced inspection at the Royal United Hospital (RUH) in February 2013.

The CQC looked at two different parts of the hospital, the older people's wards and the day surgery unit.  It found that the RUH was not meeting the required standard in the following four categories:

·         Respecting and involving people who use services

·         Care and welfare of people who use services

·         Cooperating with other providers

·         Records.

The CQC has provided the following comment.

‘Following inspection at the RUH Bath in early February the Trust sent an action plan to CQC outlining how the trust intends to achieve compliance with the areas of concern identified in our inspection report .  CQC have accepted the action plan and will return to the hospital to check compliance again when the dates in the action plan have passed.  The inspection will be unannounced so we are unable to confirm when the inspection will occur.

‘The inspection in February was a responsive inspection following local information raised with CQC raising concerns about the manner in which patients had been discharged during a period of 'black alert' in January.  Upon arrival at the hospital the scope of the inspection was extended to review the care of patients accommodated in 'escalation' areas at the hospital.  Shortly after the inspection we were informed that the Trust had stopped using the day surgery unit (DSU) as an escalation area.  Due to continued high levels of urgent admissions the trust was unable to maintain that position.  We have been in touch with the trust since the inspection and been informed of the immediate actions taken by the trust to ensure care quality and safety had been improved for patients accommodated in the DSU. ’

Both the CQC inspection report and the RUH action plan in response to the report are attached.  Members are asked to note these reports.  The Committee will be kept informed of developments and a further update provided following the CQC follow-up inspection.

Jocelyn Foster, Commercial Director, RUH was in attendance to answer questions from the Committee.

The Committee discussed the Care Quality Commission (CQC) report and agreed that the report findings were distressing.  Disappointment was expressed that the CQC was not present at the meeting.  The Committee asked Ms Foster to summarise the headlines of the report and the actions against them.

Ms Foster did so and also clarified the instances of ‘black escalation’ at the Hospital.  She explained that this occurred when there were no spare beds in the hospital, all areas were in use and ambulances were not able to ‘off-load’ the patients they carried. She confirmed that there were currently no empty wards that could be used during a black escalation period. 

The Committee addressed some of the grading awarded to the RUH and stated it believed some of the categories to have been far too generous considering the seriousness of some of the findings. The Committee asked Ms Foster how the RUH planned to improve performance and how this would be followed up by the CQC in future.

Ms Foster explained that a future follow up inspection would be unannounced to test the integrity of any completed actions. The RUH was currently in the process of implementing changes to processes and systems as a result of the CQC inspection.

The Committee stated that it would have like to have challenged the CQC on its report findings, as there was a belief that it echoed the findings of a similar report in 2010.

The Committee then scrutinised the supplementation of ward staff and the role of agency nurses.  The Committee were concerned over staff resources in nursing.

Ms Foster commented that one of the problems with escalations was matching ward staff to reflect patient needs across the hospital. The report had highlighted problems in this area.

A councillor stated that one of the key Safeguarding issues from the report was around co-operating with partners, and asked what was being done to improve performance in this area.

Ms Foster stated that the RUH believed this to be an area of concern, and had been working with other providers to identify how this could be enhanced.

The committee also expressed concern around the use of agency nurses and their potential contribution to the findings in the report.

Ms Foster stated that RUH operated with a full complement of nursing staff, but would return with the figures to address any concerns the Committee had.

The Committee also requested that the Chief Executive of the RUH be asked to attend the next meeting to address some of the points raised by the Committee.

Deborah Fielding, Accountable Officer, CCG  stated that the CCG would be working with the RUH and the Bath and North East Somerset CCG at Board level to address the areas of concern in the report.

The Committee wanted it noted that, whilst it had concerns, it remained supportive of the RUH. 

The Committee requested the following data from the RUH  ...  view the full minutes text for item 71.

Members will recall that Cllr Jane Scott, Leader of the Council, referred to SWAN Advocacy at full Council as the organisation that provides advocacy services on behalf of the Council.  SWAN Advocacy is in the process of preparing a funding application for the second stage of a Big Lottery Fund application.  This is to fund a specialist dementia advocacy service throughout the county to complement the work undertaken as part of their contract with Wiltshire Council; a successful application will result in over £350,000 over 4 years.

As part of the application, SWAN Advocacy have undertaken consultations with a range of stakeholders.  They would now like to seek the views of the Committee; they would also like to quote the meeting as part of their evidence in the application.  Irene Kohler, Chair of SWAN Advocacy, will deliver a presentation and answer members’ questions.

Irene Kohler, Chair of Board of Trustees of SWAN Advocacy made a short presentation to the Committee on the role of SWAN Advocacy and the service it provides. A summary was also given of the application to be made to the Big Lottery Fund (BLF) to secure funding for a specialist dementia advocacy service that will complement its existing work in the region.

The Committee asked Ms Kohler about the service including:

·       Availability of the service in the County;

·       Working alongside the Alzheimer’s Society

·       Office areas and availability;

·       Work with the Health and Wellbeing Board;

·       Role of the service in supporting memory assessments.

The Committee expressed its gratitude to SWAN Advocacy on behalf of Wiltshire Council for the service it provides and strongly endorsed the project proposal and BLF application.

The Overview and Scrutiny Management Committee is due to meet on 23 May, after the publication of this agenda.  The Management Committee will consider the recommendations of the previous Council in respect of legacy items for the work programme of this Committee.  Should they be accepted, the legacy items for the Health Select Committee will comprise the following topics:

*NHS 111 service (rapid scrutiny)

At the last meeting of the Committee, concerns were raised about the performance of the NHS 111 service and particularly its impact on the ambulance service.  As a result it was agreed that a rapid scrutiny exercise should be conducted into the NHS 111 service but, due to the imminence of the local elections, that it should be added to the legacy items for the Committee.  It was subsequently agreed that there was sufficient time to conduct the exercise before the elections.  It was then established that the BANES and Wiltshire Clinical Commissioning Groups (CCG) had decided to delay the start of the 24/7 cover for the service and were due to meet to consider a number of options in relation to the provision of the service by Harmoni.  It was considered inappropriate to undertake a rapid scrutiny at that time and the Committee wrote to Harmoni urging it to work with the CCG to ensure that it delivers a high level of service for Wiltshire residents and that patient safety is paramount.

The Committee is asked to consider the legacy items and any additional topics, including those arising from the overview and scrutiny induction event on 16 May, for inclusion in the forward work programme.

The Chairman informed the Committee that the O & S Management Committee had accepted the legacy work programme from the previous Council; therefore the topics listed were adopted as the work programme for the Committee.  In addition, at the scrutiny induction event, four suggestions were made for possible inclusion in the work programme.  It had been agreed that officers would undertake some initial investigation on each topic and they would be returned to the Committee for consideration.

She also explained that the O & S Management Committee had agreed to direct each Select Committee to engage in early discussions with cabinet members, portfolio holders and service directors to gain a more informed understanding about Executive priorities.  The Committee agreed to extend this approach to its health partners.

The Chairman reminded the Committee that it had been intended to conduct a rapid scrutiny exercise into the NHS 111 service, but a letter had been sent to Harmoni instead, pending discussions between Harmoni and the CCG.   Deborah Fielding provided a brief update on the situation and explained that the contract was being monitored to ensure the successful implementation of the service.

The Committee was informed that the O & S Management Committee had suggested that any Councillor’s who had sat on task groups that were to be continued in the new Council, should be re-appointed, subject to them wishing to continue.  Any vacancies should be appointed by the chairman and vice-chairman.  The Committee agreed to adopt this approach. 

Following discussions of the legacy items it was,

Resolved:

That the Health Select Committee would extend discussions on priorities to relevant Health Partners to establish a more informed understanding.

To AGREE the legacy items (as listed on the agenda) from the previous Health Select Committee, as part of the work programme.

Legacy Task Groups would continue and that reappointments would include members who had been re-elected, subject to their desire to continue.

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

There were no urgent items.

The next meeting of the Health Select Committee will be on 02 July 2013.

The next meeting would be held: 10:30am on 2 July 2013.

POST MEETING NOTE:

This will be held at: Council Chamber, Trowbridge Civic Centre, St Stephens Place, Trowbridge. BA14 8AH