Agenda and minutes

Apologies were received from Cllr Peter Hutton.

Cllr Gordon King substituted for the Liberal Democrat Vacancy.

Cllr Mary Champion substituted for Cllr Peter Hutton

To approve and sign the minutes of the meeting held on 30 May 2013

The Minutes of the meeting held 30 May 2013 were presented, and subject to the amendment to Item 62: Apologies, it was,

Resolved:

The minutes of the meeting held 30 May 2013 were signed and approved as a true and accurate record.

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

Cllr Mary Douglas declared that she was a Non Executive Director on the Board of Aster Communities.

Cllr Mary Douglas also declared a non pecuniary interest relating to item 12 on the agenda.

Cllr Helena McKeown declared that she was Vice-Chairman of the Wiltshire Local Medical Committee and a practicing GP.

The Chairman outlined that the Overview and Scrutiny (O & S) Management Committee required the Committee to review the draft Business Plan before the Cabinet meeting on 23 July. As a result the Chairman proposed that the Committee scrutinise the Business Plan under urgent items.

The Chairman informed the Committee that the future of the joint Health Overview and Scrutiny Committee (HOSC) for the Great Western Ambulance Service (GWAS), needed to be decided, following the acquisition of GWAS by the South Western Ambulance Service Trust.  This will be discussed and agreed under urgent items, informed by an update from Cllr Pip Ridout, who attended a recent meeting of the joint HOSC.     

The Chairman stated that the CQC would be in attendance at the September Committee meeting, to report on the follow-up inspection at the RUH. The report from the inspection would be released into the public domain by the end of July 2013.

The Chairman also noted the error on the front of the agenda, detailing membership to the committee, and apologised to Steve Wheeler of Healthwatch for the omission of his name.

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 Monday 24 June 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 from the public were received.

James Scott, Chief Executive of RUH, Bath will be in attendance to provide an update on the progress on the action plan in response to the Care Quality Commission (CQC) inspection report and to present information requested by the Committee at its previous meeting.

James Scott, Chief Executive, RUH gave a presentation to the Committee.  He was accompanied by Francesca Thomson, Chief Operating Officer, and Mary Lewis, Director of Nursing, who responded to members’ questions. The presentation included a summary of the inspection undertaken by the CQC in February 2013, which was noted as being a responsive visit.

The presentation detailed the numbers of nursing staff at the hospital. The numbers had increased over the past three years, with the number of nurses per bed being 2.44.  The Chief Executive stated that there had been some problems retaining healthcare assistants but there were no issues surrounding the recruitment of registered nurses.

The role of agency nurses in regard to the CQC inspection in February was discussed, and it was considered that they were not a substantial causative factor in the outcomes from the February 2013 inspection.

The Chief Executive highlighted how the RUH was co-operating with partners, and outlined the role of the clinical forum that was launched in May 2013. In addition the RUH had appointed a Discharge Development Manager to work with health and social care partners, and had named safeguarding leads that were now engaging with partners.

The Committee asked questions surrounding A&E pressures during the black escalation period at the time of the inspection in February 2013. It was concluded that more senior consultants had been rostered to the Medical Assessment Unit to manage the admission and discharge of patients.

The Committee discussed care package arrangements available to discharged patients. James Scott confirmed work was being done to integrate domiciliary and acute care into the wider care package available in discharge planning at the admission stage.

The Committee then questioned the discussions the RUH had following the inspection with the wider medical community and, in particular, the Avon & Wiltshire Local Medical Committees. It was confirmed that the RUH had also held discussions with the Wiltshire and BANES CCG’s.

The Committee queried the budget development at RUH, and discussed the payment by results tariff. The Chief Executive also outlined the repayment of the Department of Health loan that had been repaid in full in March 2013.

A discussion was held about the use of the Day Surgery Unit to manage inpatients during the escalation period. The Chief Executive stated that there were plans to utilise the day care unit in future for short stay treatment during escalation periods as it was equipped and appropriate to manage this.

A report is attached setting out the changes to the legislation relating to health scrutiny, which came into effect on 1 April 2013, which members are asked to note.

Resolved:

To note the report and the Officer recommendations contained within.

To report on the findings of the Francis Report as applicable to Overview and Scrutiny and the implications for health scrutiny in Wiltshire.

A report by the Senior Scrutiny Officer is attached for members’ consideration and comment.

The Committee considered the implications of the recommendations in the report and outlined the importance of these in relation to the business plan.

The Committee discussed the possibility of linking Select Committee members as representatives to acute trusts across the region. The role of Healthwatch was highlighted and the powers at its disposal to ‘enter and view’. The possibility of linking with nominated members in this capacity was also considered.

The scrutiny of Quality Accounts (QA) was considered and the Committee outlined the importance of engaging with partners to ensure that the QA process would be effective.

In response to criticism of minute-taking in Staffordshire, it was noted that a verbatim record of the discussions was not required but that if a member of the Committee wished a particular item to be recorded in the minutes, they should request it.

At the end of the discussion it was:

Resolved:

To note the report and the Officer recommendations, and agree the following proposal:

a)       To investigate opportunities to promote the Committee and its work to encourage more public participation;

b)       In consultation with the communications team, to require officers to monitor local media reports and report any matters of interest to the Committee;

c)       To require officers to investigate the range of health and social care complaints data available and liaise with Healthwatch Wiltshire and the CQC to agree on how this can be made available to the Committee to best effect;

d)       To liaise with Healthwatch Wiltshire and the Wiltshire Health and Wellbeing Board to agree roles and responsibilities and develop a paper that outlines supportive arrangements to work towards similar goals.

e)       To investigate with the acute trusts the possibility of establishing ‘link’ groups with the Committee to inform the Committee’s responses to annual Quality Accounts.

The Committee is asked to consider the work programme, and will be asked to agree any appointments to Task Groups.

Vascular Services

Reine Corley from NHS England – Bath Gloucester Swindon and Wiltshire Area Team will be in attendance to discuss the commissioning of vascular services.

NHS service 111

A brief report has been provided by Harmoni, who provide the NHS 111 service in Wiltshire. 

The Committee noted the written update from Harmoni, and received a verbal update from Debbie Fielding, Accountable Officer, Wiltshire CCG, with regard to NHS 111 performance. The Committee highlighted some concern over the performance in this area. Ms Fielding was able to clarify the steady improvement in key performance areas, and stressed that further improvement would still be needed before the system would be launched in full.

Ian Biggs, Area Director, and Reine Corley, Assistant Director Clinical Strategy, represented the Bath, Glos, Swindon and Wiltshire (BGSW) area of NHS England. They provided a brief update on the proposed changes to vascular services in the region. Committee members discussed the proposed hub and spoke model and highlighted concerns over the viability of some services in the region as a result of the proposals. It was confirmed that routine treatment could still be offered in the region, but specialist treatment would be provided at one of the three proposed hubs.

The Committee noted the items on the forward work plan and reviewed the appointments to task groups. The following expressions of interestwere received for task group membership;

·       Cllr Jeff Osborn and Mr Brian Warwick to the Continence Services Task Group; and,

·       Cllr Nina Phillips to the Review of AWP Services Task Group.

Following these discussions it was:

Resolved:

To note the update from Harmoni and the CCG regarding NHS 111; and

To note the vascular services update from NHS England.

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

The Chairman outlined the Urgent Items for consideration. These were;

The Committee agreed that of the ‘12 deliverables’ as identified by the O & S Management Committee on 25 June 2013, two were directly related to Health. These were:

#5) Support the most vulnerable in our local communities and improve our safeguarding services; and,

#10) Integrate public health at the heart of all public services.

It was noted that the Business Plan was an ‘aspirational document’, and that the Council faced a difficult task to balance the plan against financial restraints.

It was stated that it lacked some key information on timeframes, actions and budgets, and it was suggested that it was difficult to envisage how some of the plans could be implemented without this information.

A formal objection was raised in relation to the limited time the Committee had been given to consider the Business Plan.  

It was stated that the plan lacked key focus on sustainability, children’s health and obesity. It was suggested that impact assessments for children should be conducted on all corporate strategies.

The Committee welcomed the Officer recommendations made in the Francis report and implications for Health Scrutiny report (above) and felt that they should be incorporated into the Committee’s response to the Business Plan. The Committee agreed that the Plan needed greater focus on partnership working. 

At the culmination of the discussion, it was

Resolved:

1)    To incorporate the recommendations from the Francis Report and implications for Health Scrutiny report into considerations for the plan.

2)    To suggest the inclusion of greater focus on children, sustainable futures and obesity.

To further consider the Business Plan as the Committee work plan evolves.

Cllr Pip Ridout explained that the previous GWAS region, covering six local authority areas, was now SWAST (northern region).  SWAST covered 14 local authority areas but joint scrutiny arrangements did not exist outside the northern region; SWAST would welcome further joint scrutiny arrangements.  The existing joint HOSC had requested that each participating health select committee should consider whether or not it wanted the current joint arrangements to continue, noting that new terms of reference would have to be developed.  The ‘pros and cons’ of continuing the joint HOSC were explained and it was confirmed that scrutiny officer support would be available to members attending the joint HOSC.

Resolved:

To support the continuation of a joint HOSC to scrutinise the SWAST(northern region);

That should the joint HOSC continue, Cllr Pip Ridout or Cllr John Noeken would represent Wiltshire Council at future meetings.

The next meeting will be held on 17 September 2013 at 10:30am in the Council Chamber at Monkton Park, Chippenham SN15 1ER.

The date of the next meeting was confirmed as 17 September 2013 at 10:30am in the Council Chamber, Monkton Park, Chippenham SN15 1ER.

POST MEETING NOTE

The date of the next meeting was changed to 10 September 2013. The venue and time remained the same.

To consider passing the following resolution:

To agree that in accordance with Section 100A(4) of the Local Government Act 1972 to exclude the public from the meeting for the business specified in Item Number 13 because it is likely that if members of the public were present there would be disclosure to them of exempt information as defined in  paragraph 1 of Part I of Schedule 12A to the Act and the public interest in withholding the information outweighs the public interest in disclosing the information to the public.

Resolved:

To exclude press and public from the next part of the meeting by virtue of Paragraph 3 of Part 1 of Schedule 12A of the Local Government Act 1972.

James Cawley Service Director for Adult Care & Housing Strategy will be in attendance to present the report on Help to Live at Home tender options.

James Cawley, Service Director for Adult Care & Housing Strategy, presented the report to the committee outlining progress on the Help to Live at Home (HTLAH) programme. This included plans to re-tender the contract for HTLAH in some areas of Wiltshire following the decision of Aster Homes to terminate its contract.

The Committee asked what had been learnt from the failure of the Aster contract and what had been done to ensure this was not repeated in future.  It was confirmed that much had been learnt through discussions with providers, including those who had tendered unsuccessfully.  Discussions had also been held with sub providers in an attempt to further understand their operational limits.

The Committee supported the plan to welcome tenders from smaller, local providers and questioned the role of large providers and sub-contracting in this sector.  The Committee questioned if sub-contracting would form part of the tender criteria and, if so, how it would be evaluated.  It was confirmed that whilst the Council could not prevent providers from sub contracting work, this would form part of the scrutiny of future tenders.

The Committee discussed the role of zero hour contracts.  It supported any moves that would remove such contracts and called for investment in the service.  There was an objection to the use of any zero hour contracts as part of the tender agreement, in the belief that they were dangerous to staff and provided no protection.  The Committee was informed that zero hour contracts could not be ruled out, but that the Council was working towards encouraging salaried contracts for care staff. At the end of the discussion it was;

Resolved:

1)    That adult care be invited to provide further detail on their investigations into improving the HTLAH contracts and their correlation with it and pay structure, and also the associated training and retention for contracted staff; and,

2)    For this to be dealt with by a task and finish group later in the year.

NB Cllr Helena McKeown abstained from voting and asked that this be recorded.