Agenda and minutes

Apologies were received from Cllr King, Cllr McKeown and Cllr Ridout.

Cllr Jenkins substituted for Cllr King.

Cllr Parker remains on the committee until officially appointed as Portfolio for Adult Care, however as she had started work on her portfolio and was presenting a report to committee she was substituted by Cllr Sue Evans.

To approve and sign the minutes of the meeting held on 11 March 2014.

The minutes of the previous meeting held on 11 March 2014 were presented.

Resolved:

To sign and agree the minutes of the previous meeting as a true and accurate record.

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

Mr Brian Warwick declared an interest in agenda items 8 and 10, and declared his wish to speak. The Committee noted the standing declarations made by members at previous meetings.

To note any announcements through the Chair.

CQC priority bands update

In the latest CQC priority bands for inspection circulated to the Committee recently, RUH was in the ‘recently inspected’ category.  It has now been confirmed in band 6, the lowest risk band, so all 3 of our acute hospitals are now in band 6.

Invitation to visit Harmoni call centre

4 members of the Committee met with Harmoni on 23 April to discuss the NHS 111 service.  As a result of this they have extended an invitation to the Committee to visit their call centre at Stoke Gifford to see it in action.  3 dates have been proposed, on 10^th, 11^th and 12^th June between 6pm and 8pm when the call centre would expect to be busy.  Any member who would like to attend is asked to complete the list circulated at the meeting.

Joint HOSC for SWAS

On 11 April, the Council hosted a meeting of the joint HOSC for the South Western Ambulance Service.  The ambulance service presented reports on the Trust’s activity and performance, national ambulance quality indicators and hospital handovers, which were discussed by the Committee.  Cllr Colin Hay from Gloucester County Council was elected as the new chairman and the next meeting, date to be agreed, will be in Gloucester.

Sub Group of the multi-agency Cabinet Transformation Committee

The Cabinet Transformation Committee now has a health sub group, the Committee will be kept up to date with their work and alerted with anything of interest.

Cllr Sheila Parker

Sheila Parker remains a member of the Committee until officially appointed as Portfolio holder for Adult Care.  However she has already started work on her portfolio and so will be presenting a paper to the Committee today.

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 Friday 25 April 2014.  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.

There were no questions submitted to the Committee and no members of the public expressed a desire to speak.

At its meeting on 11 March the Committee received a report on the NHS 111 performance from the CCG.  The Committee was concerned about what it heard and asked the CCG to return to its next meeting with updated performance figures.

Patrick Mulcahy, Associate Director of Commissioning for Urgent Care, CCG will be in attendance to present the report and answer questions.

The Committee welcomed Patrick Mulcahy, Associate Director of Commissioning for Urgent Care who presented the report, noting that there were three areas of concern:-

·       Ambulance disposition rate

·       Activity sent to Accident and Emergency

·       Warm transfer rate

Although slight improved had been seen there were still concerns, mainly seen at weekends.

The ambulance disposition rate was seen to rise on Saturdays and Sundays, where the increase in activity to the ambulance trust was causing them issues. Activity sent to Accident and Emergency was in breach of the 5% target.

He noted that Harmoni had just come through a difficult staff consultation on realignment which had resulted in a number of staff leaving. It had been a difficult launch to the contract, however the KPI holiday had now ended and the CCG were now in a position to apply financial penalties if required.

The Committee asked for clarification on the realignment consultation and it was explained that the peaks in activities did not align with the shift patterns. Staff had been consulted with regards to new patterns, and it was presumed that staff had left as the new shift patterns did not suit them, meaning staff numbers were lower than expected, and they would be recruiting.

The Committee commented that it was not a satisfactory position and Mr Mulcahy explained it was a consequence of the nature of the contract, noting that the potential to implement financial penalties now available may focus Harmoni to improve their performance. At busy times calls are re-routed to ‘Conduit’, an approved NHS contractor based in Milton Keynes, trained on Care UK’s clinical systems. The Healthcare professional line was also available as a back-up.

The Committee hoped that improvements would be seen in the coming months as a result of the new shift pattern and new staff that had started. It noted a disconnect with weekend referrals which required all partners to work together to address. The CCG confirmed that they were working on a 7 day practice through enhanced general practices predominantly in towns. There was a need to understand why there were queues in hospitals on Saturdays and Sundays which required further investigation. 

The Committee asked Mr Mulcahy to comment on the graph seen on page 19 of the agenda which detailed the performance of NHS 111 callers referred to A&E. It was his view that acuity levels had increased and this view was supported by A & E colleagues. He noted a data issue which meant that A&E referrals could not be separated from minor injuries unit referrals. Harmoni had been asked to rectify this.

The CCG were working with colleagues to understand whether patients were being sent to A&E due to gaps in provision elsewhere. If identified these would be addressed strategically.

The Committee thanked Mr Mulcahy for attending and asked for a further update to be brought to the next meeting.

Resolved:

The Committee noted the performance report on NHS 111.

Following the meeting on 11 March, the concerns of the Committee were reported in the local media.  These reports were picked up by Harmoni, providers of the NHS 111 service in Wiltshire, and as a result they requested a meeting.  An invitation was extended to all members of the Committee and on 23 April, 4 members, including the Chair and Vice Chair, met with 3 representatives with Harmoni.

Cllr John Noeken will provide a verbal update.

Cllr Noeken noted the meeting held on 23 April between Harmoni and members which had provided a good understanding on how Harmoni were moving forward.

The Committee hoped to see the positive impact of changes during their visit to a call centre which would take place between 10–12 June 2014.

Vascular services are a specialised service and, as such, are commissioned by NHS England.  Wiltshire is served by three hospitals, each of which falls within a separate Vascular Network.  Salisbury Hospital is in the Dorset Vascular Network, Great Western Hospital in the Gloucestershire and Swindon Vascular Network and the RUH in the Bath, Bristol and Weston Vascular Network.   

The report presented relates to the proposed changes to the Bath, Bristol and Weston Vascular Network only, although reference is made to the two other networks.

Members had concerns about proposed changes to the vascular service in January 2013 and wrote to the Director of the local NHS England team in February 2013 to voice their concerns.  The report attached addresses those concerns. 

The Committee is asked to consider the report and specifically the recommendations under paragraph 10 of the report.

Steve Sylvester, NHS England BNSSSG Area Team Head of Specialised Commissioning in the SW, Lou Farbus, NHS England BNSSSG Area Team Head of Stakeholder Engagement for Specialised Commissioning in the SW, Debbie Hart, NHS England BNSSSG Area Team, Lead Service Specialist for Specialised Commissioning in the SW (i.e. our lead commissioner for vascular services), Marcus Brooks, Consultant Vascular Surgeon, University Hospital, Bristol representing Bath, Bristol, Weston Vascular Network and Johnathon Earnshaw, Consultant Vascular Surgeon Cheltenham General Hospital representing Swindon, Gloucestershire Vascular Network will attend to present the report and answer questions.

The Committee welcomed Lou Farbus, Steve Sylvester and Debbie Hart from NHS England, Marcus Brooks – Consultant Vascular Surgeon, University hospital, Bristol and Jonothan Earnshaw – Consultant Vascular Surgeon, Cheltenham General Hospital.

Dr Farbus showed the Committee a short video which summarised the local case for change and what is being proposed, a link to which can be found below:

http://www.england.nhs.uk/south/south/bnsssgat/vascular-services/

She introduced the report which explained that the population of Wiltshire was served by three vascular networks – the Dorset Vascular Network, The Gloucestershire and Swindon Vascular Network and the Bath, Bristol and Weston Vascular Network. The report related to proposed changes to the Bath, Bristol and Weston Vascular Network.

The proposal was to improve outcomes for vascular patients by commissioning a ‘hub and spoke’ model of care that concentrated in-patient vascular surgery in an arterial centre. The hub for the Bath, Bristol and Weston Vascular network was a new state of the art arterial surgical hub being built at Southmead, Bristol. All other vascular diagnostic, day case surgery and outpatient care would still be kept in local ‘spoke’ services, as currently. The proposal allowed the vascular services currently providing support for people from Bristol, North Somerset, parts of Somerset, South Gloucestershire, parts of Wiltshire and Bath and North East Somerset (BANES) to work together as a network to jointly meet the criteria outlined in the national service specification that is to be implemented across England in a way that is safe, sustainable and increases access to centre level care for some people.

The Committee heard that the proposal was supported by the CCG, with discussions over how local provision was retailed, and local GP’s were involved with pathway development.

Dr Rowlands, Chair of the CCG explained that the proviso that local pathways are developed that GPs can support.

In response to questions it was confirmed that current there were mixed outpatient clinics at RUN, however they would be keeping a purely vascular clinic at a location yet to be determined. Although it was clear on a national level that the direction was moving to a 7 day service, this was currently not commissioned and the proposal was Monday to Friday. A decision had to be made on hoe surgeons were used during work, under current funding arrangements it did not allow weekend clinics although surgeons were on call at weekends. The Committee noted that provision of a full 7 day service was a direction of travel they would like to see.

The Committee highlighted concerns over travel and also if any thought had been given to carers and relatives. It was explained that at a public consultation event where the majority of people had come from Wiltshire and all but 5 of the public were either patients or carers, they had indicated that they would be prepared to travel up to an hour for an outpatient appointment and up to 90 minutes for surgery. A new non-emergency patient transport service, provided by Arriva, was available,  ...  view the full minutes text for item 40.

The Continence Services Task Group was established in October 2013 following a rapid scrutiny exercise which highlighted concerns about the provision of continence products following the implementation of a new contract.

The chairman of the Task Group, Cllr Jeff Osborn, will attend to present the report (attached).

The Committee is asked to endorse the Task Group’s report and refer the recommendations to the relevant executive bodies for response.

Cllr Jeff Osborn, the chairman of the task group, presented the task group’s final report and recommendations to the Committee.

He noted that incontinence was the second highest reason for people going into care, after dementia. It was an issue of human dignity – a hidden embarrassing problem.

Medequip currently ran the service and whilst the initial transfer had not been handled well most problems had been resolved within eight weeks and currently there were few complaints about deliveries.

The task group found that there was not sufficient choice in provision, which was a result of cost. The recommendations were focussed around commissioning, which was the joint responsibility of the CCG and Wiltshire Council.

The Committee heard that there had been mistakes made on decisions around the services, with no real public consultation. There was an apparent lack of concern regarding dignity, no account of personal needs and no understanding of the social and personal impact. The delivery service of 8 weeks was questioned, being not practical for some users, especially those in sheltered accommodation.

A motion to amend the third recommendation seen in the report, adding the words ‘by the task group’ to read:

c)       That the home delivery service of incontinence products is reviewed by the task group after 6 months to assess progress made

was seconded and agreed.

Concern was raised that health and social care plans mentioned in paragraph 17 of the report were separate.  Attention was also drawn to the ‘false economy’ mentioned in paragraph 56; this would be addressed by the joint commissioners.

The Committee heard that incontinence could also be linked to increased risk of pressure ulcers.

Cllr Keith Humphries, Cabinet member for Public Health, Protection Services, Adult Care and Housing (excluding strategic housing) addressed the Committee and gave his thanks for the comprehensive report which had raised grave concerns. He explained his intention to bring all parties involved together to work towards a better solution. These intentions were echoed by Dr Rowlands from the CCG.

Mr Wheeler, Healthwatch representative, stated he would take the report to their meeting next week and ask for their support for the recommendations.

An update would be brought to the July meeting on future plans for the service.

Resolved:

The Committee agreed:

1)    That the joint commissioners re-evaluate the home delivery service of incontinence products currently being offered, taking into consideration the issues raised above;

2)    That the task group meets with Wiltshire Clinical Commissioning Group to discuss their findings

3)    That the home delivery service of incontinence products is reviewed by the task group after 6 months to assess progress made

At its meeting on 11 March the Committee expressed an interest in receiving the figures for delayed transfers to care and requested that reports on the latest figures should be provided at each of the next three Committee meetings.

Cllr Keith Humphries will attend to present the latest figures for delayed transfer to care.

The Committee is asked to note the report and comment as appropriate.

The Committee welcomed Cllr Humphries who presented the report, noting it was a complicated issue and explained that the figures were used to identify trends.

James Cawley, Associate Director – Adult Care Commissioning, Safeguarding and Housing then addressed the Committee. When asked if a future report could contain a comparison with neighbours he explained that each community was with different cultures, and what was working in one community may not be appropriate to use in others.

Improvement had been seen in the overall figures for 3 months however this was not going down as fast as was wanted. The Better Care plan would help address this, and there was ongoing work on both systems and culture. An external provider had been engaged to work with teams in the south of the county to look at culture change, and how to avoid a ‘blame culture’ at a local level. The systems thinking team were looking at how the systems work within the Salisbury Hospitals Foundation Trust, to bring the culture and systems together.

He noted that there were three CCG locality groups each with their own ideas, giving three pathways around three different communities. There would be more work around the Better Care plan, for example the review of the STARR bed system and a 25% in the delayed transfer to care figures had to be achieved in the next two years. The Committee’s input would be welcomed throughout the process.

Dr Rowlands from the CCG noted that hospital avoidance would also be looked at, to support more people at home.

Although health and social care were not yet joined, Dr Rowlands recognised that joint funding was the way forward, meaning problems were addressed together.

The Committee queried the role that community hospitals could play and Dr Rowlands confirmed there was no intention to open community hospitals other than those existing. The same level of care could be provided in care and nursing homes closer to patient’s homes. Data had shown that length of stays had been no shorter in Trowbridge Community Hospital than it was in RUH.

Mr Cawley confirmed that there was no issue with the Salisbury Foundation Trust not reporting delayed days weekly as stated in paragraph 18c of the report.

The Committee welcomed the work being done to address cultural issues. It noted the need for discharge nurse and care co-ordinators to be joined into the integration agenda, and gave Mr Cawley and his team every support. With regard to the layout of the report it asked that in future versions the charts were made bigger

Resolved:

The Committee:

1.     Noted the report; and

2.     Gave its full support to the work Mr Cawley and his team were undertaking in this area.

In January 2011, the Cabinet approved a 10 year development strategy to modernise and improve the way that older people’s accommodation is provided, develop and adopt an integrated accommodation system, ensure the best use of increasingly scarce resources and respond to local needs in local communities.

An update report on the Older People Accommodation Development Strategy is provided. The Committee is asked to note its content and comment as appropriate.

Councillor Keith Humphries presented the report which provided an update on the progress of the implementation of the Older People Accommodation Development Strategy.

He drew attention to the new bungalow project which had funding of £2 million per year over the next 10 years. This project would build old peoples bungalows in rural villages, allowing older people to stay within their communities. This could potentially release larger family homes and provide possible carer employment within the community. There would be a basic design which would be modified around the communities and would be quickly built using a modular 2D / 3D system, subject to the relevant planning consent.

The Committee asked whether these would be sheltered accommodation and who would own them. It was explained these would not be sheltered accommodation but council owned with affordable rent, clustered in small rural communities. A different approach could be taken with having care contracts linked to clusters, possibly including tied houses for care workers, thereby linking communities and care into the rural location.

The first ten sites had been identified; – a site in Malmesbury was already started and money had been allocated to another in Devizes.

Cllr Rogers noted that he was not aware of the scheme planned for the Fugglestone Red development mentioned in paragraph 26. It was agreed that a briefing would be arranged.

Resolved:

The Committee noted the progress of the Older People’s Accommodation Development Strategy.

The Council has been working with the CCG to develop a community centred joint five year Mental Health Strategy.

An update report on the work so far is attached.  The draft Strategy will be submitted to the Committee once it has been completed, after which it will go out to formal consultation.

Cllr Keith Humphries will attend to present the report.  The Committee is asked to note the report.

Cllr Parker, Portfolio Holder for Adult Care, including Learning Disability and Mental Health presented an update to the Committee on the work of Public Health to produce a joint Mental Health Strategy for the county with the Clinical Commissioning Group.

The Committee noted the lack of mental health beds and the importance of having beds in communities, highlighting these must be in the right place.

Resolved:

The Committee noted the report.

The Committee has received a letter from the CQC (attached) which sets out its inspection programme for April – June 2014.  In Wiltshire, the CQC intends to inspect only one organisation, the Avon & Wiltshire Mental Health Partnership NHS Foundation Trust (AWP).  The inspection will start on 9 June.

The letter asks the Committee to share any feedback which is relevant about the quality of care provided by AWP and any of the services it provides.

Any member of the Committee who wishes to reply individually can email  mhinspections@cqc.org.uk, ensuring that the subject line of the email is:

Avon & Wiltshire Mental Health Partnership NHS Foundation Trust Q1 Mental Health Inspections.

The Chairman drew attention to the letter seen at pages 83-84 of the agenda, which provided details of their inspection programme for April – June 2014. In Wiltshire one organisation, the Avon and Wiltshire Mental Health Partnership NHS Foundation Trust would be inspected, starting from 9 June. Any feedback relevant to the quality of care provided by AWP and any of the services it provides could be shared with the CQC by emailing mhinspection@cqc.org.uk  with the subject line: Avon & Wiltshire Mental Health Partnership NHS Foundation Trust Q1 Mental Health Inspections.

The Committee raised concern over the Charterhouse facility in Trowbridge which had been closed as a temporary measure due to the building being not fit for purpose.

Resolved:

The Committee agreed to raise the issue of the requirement for additional mental health beds with the inspectors.

It is usual for full Council to review Committee membership in May.  In line with this, and following consultation with the Chairman and Vice Chairman, the non-voting stakeholder membership of the Committee has been reviewed.  There is a wish to see stakeholders on the Committee who represent registered bodies that reflect the demographics in Wiltshire.

The following non-voting stakeholder membership is proposed:

Wiltshire Healthwatch - Steve Wheeler

Wilshire and Swindon Users’ Network (WSUN) – Diane Gooch

Age UK - tbc

Alzheimer’s Society - tbc

SWAN Advocacy - Irene Kohler

The Chairman noted that Brian Warwick’s new appointment to become Chairman of the steering group on Older People’s Strategy meant he would be stepping down as a member of the Health Select Committee. The Southwest Seniors Network, of which Mr Warwick was the Chairman, would hold their AGM in September, at which they would suggest a new representative.

The Committee thanked Brian for his long term service and wealth of knowledge.

In reviewing the non-voting stakeholder membership of the committee it was suggested that an additional non-voting stakeholder, Swan Advocacy be invited to join the Committee.

Resolved:

To proposed to Council the following non-voting stakeholder membership:

Wiltshire Healthwatch – Steve Wheeler

Wiltshire and Swindon Users’ Network – Diane Gooch

SWAN Advocacy – Irene Kohler

Southwest Seniors Network - TBC

To note verbal updates on Task Group activity.

Transfers to Care Task Group

Due to the resignation of two members of the Task Group, an invitation for additional members was extended.

Avon and Wiltshire Mental Health Partnership / Dementia services

Cllr Noeken highlighted the excellent meeting held at the beginning of March in Salisbury with a carer’s group. The dementia strategy consultation had slightly overtaken other work, and they awaited the outcome of the consultation.

Help to Live at Home Task Group

The inaugural meeting of the Help to Live at Home Task Group is to be arranged shortly, once the report from the peer review of Help to Live at Home is received.

The Committee heard that the number shown on the back of the pamphlet – 0300 456 6011 may not be working correctly and needed checking, which the task group would address.

The Chairman congratulated the Continence Services task group on its work and final report, minute no. 41 referred.

The Committee is asked to consider the work programme.

The Committee noted the forward work programme.

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

Draft responses from the Committee to the Quality Accounts for the South West Ambulance Trust and Salisbury Hospital had been circulated prior to the meeting. Amendments were agreed and the final responses would be forwarded to the respective providers.

The Committee had not yet received the Quality Accounts from the RUH and GWH.

Resolved:

The Committee agreed that Cllr Noeken would draft a response on the quality accounts for RUH and GWH and circulate to members for comment.

The Committee is asked to note the date of the next meeting, which is Tuesday 15 July at 10.30am in the Kennet Room, County Hall, Trowbridge.

The date of the next meeting was confirmed as being Tuesday 15 July 2014, at 10.30am and would be held in the Kennet Room at County Hall, Trowbridge, Wiltshire BA14 8JN.