Agenda and minutes

To note any apologies for the meeting.

No apologies were received for the meeting.

To approve and sign the minutes of the meeting held on 10 September 2013.

An amendment was proposed to item 96 of the minutes of the meeting held 10 September 2013.

Resolved:

To approve the minutes of the previous meeting, subject to making the necessary amendment, as a true and accurate record of the meeting,

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

Standing Declarations of Interest were made by:

Cllr Helena McKeown

Cllr Mary Douglas

Cllr Gordon King

Cllr Sheila Parker

Steve Wheeler

To receive any announcements from the Chair.

The Chair made the following announcements:

New WSUN member

The Chair noted that the Wiltshire & Swindon Users’ Network (WSUN) have a non-voting seat on the Committee, and welcomed Diane Gooch, chair of WSUN to the meeting. Diane replaced Linda Griffiths who retired from the Committee in July.

Meeting with NHS England and Public Health England, Taunton 2 Oct

The Vice Chair outlined the main points of note from the meeting, which was deemed to be very productive. The Committee were invited to note that NHS England are preparing a pack for regional HSCs explaining developments and a matrix of information sharing.          We have agreed to regular networking meetings with the HSC in Bath, Gloucester and Swindon.

Acute Hospitals

The Chair and Vice Chair have now met with all three acute hospitals, and it has been agreed that the HSC will monitor their PALS complaints information.

CCG

It was confirmed that constructive talks had been held with the CCG, on how the HSC and Health Partners can best work together. It was emphasised that the HSC is keen to be involved early in any CCG initiatives.

Media monitoring

Local media is now being monitored by Democratic Services to identify any matters of interest to the HSC.  Members are also asked to alert HSC to any issues as soon as they are seen as a concern.

NHS 111

An update was tabled at the meeting, and Dr Steve Rowlands, chair of the CCG, gave an update on the position regarding the NHS111 service. It was confirmed that Harmoni commenced full service on 28 October. The HSC was satisfied with the monitoring systems in place, but requested that the CCG provide an update on Harmoni’s performance at the March meeting of the Committee.

Vascular Services

A report on vascular services from the CCG was expected at the meeting, however, when specialised services commissioning was taken over by NHS England, the rules around who leads on patient and public engagement and working with HSCs changed.

It was confirmed that this work is now being done by the Bristol, North Somerset, Somerset and South Gloucestershire NHS Area Team, who commission services for the whole of the South West. They are currently planning patient and public engagement and will be writing to all the HSCs in the area. Members were asked if there were any specific questions that would need to be asked regarding; patients, carers and the public, and to respond with these when the CCG and providers conduct the public engagement.

Any questions can be sent to Maggie McDonald (Senior Scrutiny Officer at Wiltshire Council) who will make sure they are forwarded to the Bristol team.

Agenda order

The Chair agreed to take the Continuing Health Care item before the Public Health Annual Report.

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 Tuesday 12 November 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 had been received from members of the public.

In February 2013, the Care Quality Commission (CQC) made an unannounced inspection of the Royal United Hospital (RUH).  James Scott Chief Executive, RUH, attended the Committee in July 2013 to present the RUH’s Action Plan in response to the February inspection report.

The CQC returned to the RUH in June 2013 to undertake a follow-up inspection and produced their report in October 2013 (copy attached).  James Scott will be in attendance to present the Action Plan in response to the June inspection and answer members’ questions.

James Scott, Chief Executive of Royal United Hospital (RUH), Bath, was in attendance to present the RUH action plan in response to the Care Quality Commission (CQC) Audit that highlighted a number of concerning findings. James Scott introduced Helen Blanchard, Director of Nursing at RUH who was also in attendance to answer questions from the committee.

James Scott outlined the upcoming inspection of the RUH on 4 December, which will be conducted under the new inspection regime. He went on to detail the new inspection arrangements including the membership of the inspectorate and their new powers. Following this, James Scott discussed public listening events that were being conducted to engage with users and members of the public as part of the inspection process. Events will be held on 5 December 2013 at Bath Race Course and County Hall in Trowbridge. Both events will start at 6.30pm.

Helen Blanchard discussed the action plan and reaffirmed that the RUH was concentrating on taking ownership of the issues and findings, with a focus on making the necessary sustainable changes. The importance of accurate record keeping was discussed with a focus on both professional, CQC and regulatory compliance. The recording of patient risk assessments on admission were also discussed, alongside discharge information. Helen Blanchard commented that, measures had been taken to improve both areas, and was confident that this would be reflected in the outcomes of future inspections. Patient dignity was also discussed, with changes made to staff training, practice and awareness. The monitoring arrangements were discussed, and it was confirmed that the Trust Quality Board continues to monitor the progress of the action plan on a fortnightly basis.

Cllr John Noeken expressed disappointment with the CQC findings, stating historic findings from previous reports and inspections had again been replicated in the most recent report. Cllr Noeken expressed concern over the action plan and the findings from the CQC, and stated that the effectiveness of the actions, findings and recommendations would be tested in full over the winter period.

Cllr Helena McKeown stated concern at the findings in the report and stated that the RUH appeared to be overloaded with policy and internal meetings. Cllr McKeown questioned the hospitals recruitment policy, and in particular the number of nurses appointed by the RUH. A number of examples of patient treatment were cited and the role of record keeping in these examples was questioned. James Scott stated that £750k had been spent on frontline nursing staff, and that the nursing ratios were adequate to manage the patient flow at the RUH. James Scott noted the changes that had been made at operational level to support the handover between shifts.

The role of agency staff was discussed and it was confirmed that agency staff are not used on night shifts. Cllr Gordon King expressed concern from personal experience at the hospital’s operational level, where it was stated that there was a lack of senior vision across the wards. Cllr King also stressed concern at the number of  ...  view the full minutes text for item 105.

In January 2012 the then Health and Adult Social Care Select Committee established a non-executive working group (between Wiltshire Council and the NHS) to review NHS Continuing Healthcare (CHC) and the Council’s partnership working arrangements for both CHC and joint packages of care.

NHS CHC is a package of continuing care provided outside hospital and arranged and funded solely by the NHS, for people with ongoing healthcare needs.  Where a person has health and social care needs, but their main needs are health needs, the NHS is responsible for funding both the health and social care services required.  NHS CHC is free, unlike social and community care services, which are means-tested.

The working group presented its report to the Health Select Committee in July 2012 and made 7 recommendations, one of which was that the Committee should receive an update on developments at its meeting in January 2013.  This was deferred until March 2013 when Deborah Gray, Deputy Director of Nursing and Patient Safety, NHS Wiltshire and Sue Geary, Head of Performance, Health and Workforce, gave an update on the CHC arrangements.

At the meeting in March it was stated that the pathway had been improved, although some actions were still to be completed. It was confirmed that the responsibility for CHC now fell to the Wiltshire Clinical Commissioning Group (CCG).  As some actions were still incomplete the Committee requested an update at its meeting in September 2013.  This was deferred until November 2013. 

A copy of the CHC report and updated recommendations are included for consideration. Jacqui Chidgey-Clark and Dina Lewis, Wiltshire CCG will be in attendance to discuss the report and to answer any questions.

Jacqui Chidgey-Clark, Director of Quality and Patient Safety at Wiltshire Clinical Commissioning Group (CCG) was in attendance with Dina Lewis, Associate Director of Quality to update the committee on the progress of the Continuing Health Care (CHC) action plan.

Jacqui Chidgey-Clark provided a background overview of the CHC programme. The work had been originally undertaken by the PCT, and had transitioned across to the CCG earlier in 2013, and was conducted in joint partnership with Public Health.

The committee discussed the partnership working arrangements, and it was confirmed that the continuing healthcare update, would also be reported to the Joint Commissioning Board and in turn to the Health and Wellbeing Board.

The Committee discussed the eligibility figures for CHC in the region and it was confirmed that the figures were reported to the Clinical Governance Group. It was stated that the CHC programme had been recently assessed for compliance and there had been no conflicts identified.

The Committee discussed the Joint Commissioning Board and its accountability to the Health and Wellbeing Board.

Resolved:

To note the progress of the Continuing Health Care action plan.

Wiltshire’s Annual Public Health Report 2012/13 can be accessed from the following link:

http://www.wiltshire.gov.uk/latestnews.htm?aid=146117

John Goodall, Associate Director, Public Health will be in attendance to present the report and to answer any questions from the Committee.

John Goodall, Associate Director of Public Health was in attendance to present the Public Health Annual Report 2012/13. It was stated that the report was published as a statutory requirement for public health, as part of the independent arrangements prior to transition.

A short presentation was made to the Committee on the content of the report. This contained the transitional arrangements and a summary of the integration of public health in the Council’s mainstream business. The presentation focussed on promoting healthy local communities, and creating a lasting health legacy for the people of Wiltshire, in addition to outlining the vision, current work and challenges ahead for public health.

The Committee questioned the planned health checks, and the health inequalities between various social groups. John Goodhall agreed to provide the social inequality data and comment after the meeting. The Committee discussed the treatment of Chlamydia and early intervention strategies, and also questioned the commissioning arrangements for mental health and public health crossover. It was confirmed that a paper would be made available for scrutiny detailing these commissioning arrangements.

The Committee also questioned the monitoring arrangements in place for public health, and it was confirmed that the previous monitoring arrangements had novated as part of the integration arrangements. A discussion was also held on domestic abuse, and it was requested that more information on multi-agency working would need to be provided.

The Committee suggested that limited data was represented in the report, and requested further data in future.

The Committee discussed the importance of older people’s representation in the Annual report and requested that in future, greater focus be placed on social isolation and the role of area boards in tackling these issues.

Resolved:

1)    To note the Public Health Annual Report 2012/13.

2)    To receive an update against the Public Health Annual Report 2012/13 in May 2014 following the outcome of the Joint Strategic Assessment community events.

The Committee is asked to consider:

a)    Outstanding items on the forward work programme

i)       Help to Live at Home

ii)     Urgent Care / Winter Pressures

b)    Task Group updates

i)       Transfer to Care Task Group

ii)     Clinical Commissioning Group (CCG) Task Group

iii)    Continence Services Task Group

iv)   Review of AWP services (Dementia)

v)     Air Quality Joint Task Group

The Committee discussed the forward work programme and the award of the contract to the Mears Group for the provision of the Help to Live at Home service. The Committee discussed upcoming winter pressures and urgent care arrangements for Acute Hospitals in the county.

Resolved:

1)    The Committee noted updates from the following task groups, and agreed to include as the Draft Work Programme in the single Overview and Scrutiny Work Programme:

-       Transfer to Care

-       Continence Services

-       Review of AWP Services

-       Air Quality (Joint with Environment Select)

-       Clinical Commissioning Group

2)    To review the work of the Help to Live at Home providers following advice from the Associate Director of Adult Care Commissioning, Safeguarding & Housing.

3)    Review the effectiveness of the CCG’s Winter Planning arrangements at its meeting in March 2014

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 Health Select Committee will be held on Tuesday 7 January 2014 in the North Wiltshire Room - County Hall, Trowbridge BA14 8JN.

The date of the next meeting was noted as being 14 January 2014, to be held at 10:30am, in the North Wiltshire Room, County Hall, Trowbridge BA14 8JN.