Agenda and minutes

Apologies were received from Dr Stephen Rowlands and Debbie Fielding of Wiltshire Clinical Commissioning Group.

To approve and sign the minutes of the meeting held on 15 July 2014.

The minutes of the previous meeting held on 15 July 2014 were presented.

Decision:

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.

Cllr Dr Helena McKeown declared a non-pecuniary interest  due to her position as a GP, the Vice-Chairman of the Wiltshire Medical Committee and a member of the British Medical Association Council.

Cllr Douglas also declared a non-pecuniary interest as her husband  is a nurse in a stroke ward at Salisbury District hospital.

To note any announcements from the Chairman.

It was announced by the Chair that BBC Radio Wiltshire was in attendance and had been granted permission by the Chairman to record the meeting’s procedures in relation to item 7 (Care Quality Commission Inspection Report : Mears Help to Live at Home Wiltshire).

Health Peer Challenge

The Chair announced that this was a voluntary and flexible process commissioned by the council and the local health and wellbeing system to aid their improvement and learning.  It was stated that it would involve a small team of peers giving up their time to spend time in another system to provide challenge on their practice and share learning.  The process was explained to involve a wide range of people and the findings would be delivered immediately. 

The Committee was informed that the Peer Review was due to take place over 4 days on site at County Hall, Trowbridge and aimed to look at how the whole health and wellbeing system fits together including scrutiny.

An agreed focus has been agreed to include the inter-related themes of:

·       Prevention and upstream preventative activity; reducing health inequalities

·       Support for communities

·       Diversionary activity.

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 (acting on behalf of the Corporate Director) no later than 5pm on Tuesday 16 September 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.

It was noted that member of the public, Mr Adrian Higher, would speak before item 7 (Minute No. 73 Refers).

The contract for non-emergency passenger transport service (NEPTS) was awarded to Arriva Transport Solutions (ATS), the contract was effective from 1 December 2013 and runs for five years.  This service is for patients who have a non-emergency medical need and require help with transport to reach their hospital appointment.

At the meeting on 11 March, the Committee expressed concern having received reports of poor experience for some patients and flows through the acute hospitals being affected due the capacity constraints of ATS. A summary of the type of complaints was given and it was found that most fell into the following categories:

a)    Waiting times for collection (from hospital);

b)    Ability to make bookings via the website;

c)     Errors with bookings

These complaints must be investigated and responded to within 25 days.

Some explanation was given to the types of complaints made under the aforementioned headings, stating that previously the PTS contract had inherited three different methods of booking and tracking as a result of the three different Acute Hospitals that the PTS contract serves. This had been somewhat resolved since Arriva had implemented a unified booking system for all Acute Hospitals in the county.

Member’s attention was drawn to an action plan developed by Arriva in accordance with Acute Hospitals in the County which allows for better management and monitoring of the service.

It was resolved that the Committee would receive the attached performance update report at this meeting.

Andy Jennings, Commissioning Manager, CCG and Ed Potter, Arriva Head of PTS South West, will be in attendance to present the report and respond to any questions. 

The Committee welcomed Andrew Jennings and Ed Potter of ARRIVA who presented their performance update report.

It was explained by Mr Jennings that issues were present early in their contract and that they were now working through them. It was stated that the time delay in picking up patients was the area in which there was the greatest need for improvement.

It was highlighted that there was a good degree of performance at Great Western Hospital, an improving degree of performance at Salisbury Hospital, and a poor degree of performance at Royal United Hospital. It was noted that better KPI performances were seen on days with lower levels of activity.

The Committee heard that there had been a challenging couple of opening months. Mr Jennings explained that they had seen a good improvement and would expect to see this again over the next two months and meet all their performance indicators. It was stated that a patient survey had been conducted.

In response to concerns over the 100 Day Challenge Mr Jennings stated that they recognised their key role as a transport provider and would tailor the service accordingly. It was also explained that they had a daily dashboard running for real time performance information.

In response to questions Mr Jennings explained that transport bookings can be made at any time, and for the patient to be declared ready later that day. The Committee heard that problems were caused by the previous variety of services. It was explained that due to the complexity of different journeys provided and recorded in different ways it was extremely difficult to gather comprehensive data from them.

Resolved:

To receive a written report from ARRIVA at the next meeting.

To discuss the recent Care Quality Commission Inspection Report in respect of the Mears Help to Live at Home service on the request of the Chair and Vice Chair on account of concerns that have arisen as a consequence of the report.

Mears were awarded the Help to Live at Home contract for the East and South regions of Wiltshire on 21 August 2013 and mobilised in a four week time period; the contract commenced on 30 September 2013.

The Committee receive a Position Statement from Mears along with the Action Plan as presented to the CQC in response to the CQC Inspection Report.

It is understood that Mr Adrian Higher, as a member of the public and witness, wishes to speak to this item.

Bernadette Walsh, Chief Operating Officer and Alan Long, Executive Director of Mears will be in attendance to respond to any questions.

Member of the public, Mr Adrian Higher, spoke about his experience with MEARS.

James Cawley, Associate Director – Adult Care Commissioning, Safeguarding and Housing then addressed the Committee. It was heard that MEARS were appointed just over a year ago. Mr Cawley explained that they were looking to move away from zero-hours contracts and towards encouraging small to medium sized suppliers, and that MEARS stood out above everyone else.

The Committee asked whether the Council would have found out about the multiple failings had it not been for the review of the contract. It was explained that it was Wiltshire Council that instigated the review in response to complaints received and concerns raised. It was heard that MEARS and the Council would resolve the problem together.

In response to questions it was heard that issues arose within June/July 2014. It was explained that prior to this there was no involvement with MEARS, and that they would not bring in a new supplier overnight. It was also heard that moving to four main suppliers had brought with it daily reports and given a more robust knowledge of what was going on.

The Committee thanked Mr Adrian Higher for his attendance and sharing his first-hand experience.

The Committee welcomed Mr Alan Long and Miss Bernadette Walsh who  were in attendance to discuss the recent Care Quality Commission Inspection Report in respect of the Mears Help to Live at Home service.

Apologies were expressed to those who had seen the service deteriorate over the past year, some 40 cases.

It was explained that after the acquisition of Careline, the majority of staff left without notice, including 2 managers. It was explained that the recruitment of new care staff was a challenge, and that the low staff levels placed huge pressure on the branch, and that they were only just starting to recover. The Committee heard that there were now 168 members of care staff and that recruitment was at the heart of their plan.

It was explained that in the three months prior to May 2014 there were no complaints. During May it was heard that this reached 28 complaints. It was noted that currently the complaints were at single figures, and that they hoped to see them go back to zero.

Members of the Committee were invited to visit their branch and speak to staff.

In response to questions over how much of a surprise the drop in service quality was it was explained that what caught them out was the quantity of staff that left in May and the level of disruption caused.

In response to questions over the level of support for workers it was explained that they were given a basic introduction. The Committee heard that what was needed was introduction to MEARS. It was also heard that staff had previously not had sufficient training, but that this has been actioned to be put right, and that staff are currently being put through re-training and refreshers.

The Committee asked  ...  view the full minutes text for item 73.

Following concern raised by Cllrs Gordon King and David Jenkins upon reading a media report in respect of the Care Quality Commission Inspection Report on the Westbury Court Care Home’s failure in an unannounced inspection; it was requested by the Vice Chairman that this item be included in the agenda.

Particular reference was made in the Report to inadequacies identified across the following: providing care, treatment & support that meets peoples’ needs; caring for people safely and protecting them from harm; quality & suitability of management; and insufficient staffing.

The full CQC Inspection Report can be accessed via this link.

The Committee are asked to consider whether any further action is required and what this may entail if necessary, including its addition to the forward work programme.

Cllr King introduced the CQC inspection report on Westbury Court Care Home. Concerns were expressed over multiple failings in the care home including the number of qualified people in the home, the safeguarding of residents, and the looseness of the system. It was also mentioned that they had been asked to provide an action plan by 21 August, but one had not yet been presented.

James Cawley then addressed the Committee. Mr Cawley stated that there is a rigorous process to deal with these issues at an officer level and asked that if Councillors have any concerns after visiting care homes that they let them know. Mr Cawley acknowledged an issue over when to engage scrutiny and local members, it was stated that this would be looked at and that the Committee would be notified in the future.

Mr Cawley explained that this was a relatively brand new care home experiencing some difficulty which was to be expected with new management. It was stated that permission should be granted for the Committee to see their action plan.

It was stated by the Committee that as a Council they need to make it better for people to become carers.

James Cawley answered the Committee’s concerns over response times to issues of improperly administered medications. Mr Cawley assured the Committee that as soon as they are made aware of such problems they take immediate action.

The Committee heard that there will be a follow-up CQC inspection within three months for the care home to demonstrate how they have responded to the initial inspection report.

In response to questions over how to report concerns with care homes it was heard that Councillors should contact James Cawley with any issues. It was also heard that they could contact Healthwatch.

Resolved:

1.     To receive the Westbury Court Care Home action plan when available.

2.     To provide the Committee with a seminar on the management of care home contracts.

A report by Cllr John Noeken, Chairman of the Task Group, will be circulated.

The Committee welcomed Dr Celia Grummitt and Cllr Noeken who introduced the task group report.

Cllr Noeken drew attention to the scheme to provide dementia care beds in the homes of the Order of St. John Care Trust. It was heard that there are currently three homes to be rebuilt in the future. Cllr Noeken also drew attention to the excellent work commissioned over the past few months with regards to dementia awareness, and the scale of enthusiasm demonstrated towards addressing the problems.

Cllr Noeken emphasised the importance of early intervention by clinical services and GP’s and stated that the number of those diagnoses each week with dementia had increased. Cognitive stimulation therapy was heard to be an important service which should be provided for those with mild to moderate stage dementia. It was heard that Cllr Noeken was encouraged by support groups and acknowledged that importance of signposting patients to services they may require.

Cllr Noeken thanked Maggie McDonald for her great work and assistance.

The Committee welcomed Dr Celia Grummitt who commented on the report. Dr Grummitt described the triangle of patient, therapist, and carer as the three key aspects of importance in dementia. It was heard that rates of dementia diagnosis were rising and that work was continuing to improve this. It was also heard that there were issues of elderly becoming stuck in hospital beds as there was not adequate care at home for them to go to.

The Committee thanked the Chair of the task group for the excellent job he had done.

The Committee raised the issue of rural isolation and questioned whether there should be a link with the Better Care Plan and Dementia Care. Irene Kohler stated that she would be happy to bring the Swan Pilot Report to the Committee.

The Committee stated that in regards to paragraph 49 it welcomed the work being done in hospitals and that it would be good to expect a response in six months addressing them specifically. The Committee heard from James Cawley that as with all scrutiny reports it will be forwarded to Cabinet.

The Committee stated that when moving money from long term treatment to addressing issues care needs to be taken that those with long-term symptoms do not suffer. James Cawley stated that a care pathway was being produced to highlight who has which responsibility.

Resolved:

1.     To endorse the report’s recommendations and receive comments from Cabinet and CCG.

2.     Comment: The Committee questioned whether recommendations can be managed within the current framework, or if more funding is necessary.

AWP has recently undergone a Care Quality Commission Inspection, an update on the current position of AWP and details of the inspection will follow for discussion and review by the Committee.

The item was agreed to be deferred to the next meeting when an action plan and more time was available.

At the last meeting, the Committee received an announcement from the Chairman regarding a question posed on charging for GP services. It was noted that motions on the subject had been put forward at relevant conferences with more detailed and varied information than the Committee received. It was agreed that the item be brought back to this meeting for a fuller explanation.

Cllr Dr Helena McKeown was invited to provide additional information in support of the item. She clarified that the motion that was tabled at the last meeting was from a meeting of the Conference of Local Medical Committees that does not make BMA policy. Wiltshire LMC submitted one part of the motion and as Vice Chairman of the LMC, was asked to propose the motion, which is not her own proposal but a part of a democratic process of debate.

Cllr Dr Helena McKeown further explained that the British Medical Association makes its policy at its Annual Representative Meeting on 26 June, where she submitted a motion through the agreement of the BMA’s South West Regional Council, set out below:

i)   rejects any proposal of a means tested monthly levy to pay for the NHS;

ii)  rejects the proposals from the Commission on Health and Social Care that the way to pay for social care is to charge for either GP or hospital appointments;

iii) demands that the funding of long-term social care is resolved without jeopardising the principles of the NHS;

iv) reasserts our belief as doctors that universal healthcare must be free at the point of delivery and available to all regardless of an individual's ability to pay.

All parts of this motion were passed either unanimously or with overwhelming support, as is the policy of the British Medical Association.

The Committee is asked to be aware of the context of the issue in the light of the original announcement and further information provided.

The item was agreed to be deferred to the next meeting.

This item features on the forward work programme for the Committee to receive on an annual basis.

The Committee is asked to comment on the draft version of the annual Wiltshire Safeguarding Adults Board report.

Margaret Sheather, Independent Chair, Wiltshire Safeguarding Adults Board, will be in attendance to present the report and respond to any questions.

The Committee welcomed Margaret Sheather who introduced the annual Wiltshire Safeguarding Adults Board report.

Miss Sheather stated that since the Better Care Act was in place she welcomed the equality of status with children’s safeguarding. It was also mentioned that the Committee might like to receive reports back on the implications of the Better Care Act throughout the year.

Miss Sheather outlined some of the key issues listed in section four of the report. It was stated that the findings of the report revealed no malice or wilful neglect, but did discover a lack of awareness. It was heard that there was a continuing increase in the volume of safeguarding work coming through, and that the assessment of people’s needs under the mental capacity act was creating a bigger workload for safeguarding.

It was heard that the board had given their final review of the report and that it was to be signed off subject to comment from the Committee. It was also heard that it will be taken forward to the Health and Wellbeing Board in November 2014

Questions were asked on the increase in numbers in the care home sector which were not mentioned in the report. It was heard that there was a dramatic increase in alerts, and that about 28% of alerts were converted into strategy actions. James Cawley stated that care homes were discouraged from making alerts as they were flooded with safeguarding issues every time they rung up for advice.

The Committee queried the logic used with regards to the increased volume and suggested that it could not be proven either way whether things have stayed the same or had gotten worse. Miss Sheather stated that an increase was likely a result of awareness being raised.

Resolved:

The Committee noted the report.

To review the Draft Joint Mental Health and Wellbeing Strategy.

Cllr Sheila Parker, Portfolio Holder for Adult Care - including Learning Disability and Mental Health, will be in attendance to present the Strategy and respond to any questions. The Strategy will have received by Cabinet on 16 September.

The Committee welcomed Cllr Sheila Parker who introduced the Draft Joint Mental Health and Wellbeing Strategy.

The Committee heard that the strategy’s aim is to create communities and an environment in which good mental health and recovery for those with mental health problems is provided, along with reductions in discrimination.

It was explained that they were currently working with Communications and the Mental Health Team in order to create an approach, contact had also been made with the Wiltshire/Swindon Network.

The timeline was described having been considered by Cabinet in September. It was heard that the draft strategy would go back to the board in November, and the consultation was to launch on 10 October 2014 to coincide with Mental Health Day.

The Committee commented that they were looking at the strategy after it had been to Cabinet, and that it would have been more useful if it had been brought to them before this.

Resolved:

1.     The Committee welcomed the strategy.

2.     The Committee noted that it was hard to find out who was in charge of which, that joint working was important and that it hoped this would be flagged in the action plan.

3.     The Committee noted that there was not much in the strategy in relation to alcohol and drugs, and that there were difficulties in knowing whether alcohol agencies or the AWP should be involved.

4.     It was agreed that an official comment from the Committee would be written and sent along with the draft strategy.

To review the Public Health Annual Report 2013-14.

Maggie Rae, Corporate Director, will be in attendance to present the report and respond to any questions. The Report will have been received by Cabinet on 16 September.

The item was agreed to be deferred to the next meeting.

At the last meeting, it was resolved that the Committee would receive a report on the long awaited Local Authority Health Scrutiny Guidance. A report by Paul Kelly, Scrutiny Manager is attached.

The Guidance has previously been circulated and can be found via the following link.

The Committee is asked to agree the recommendations in the report.

The item was agreed to be deferred to the next meeting.

Written updates on Health Select Committee Task Group activity are attached.

There were no comments on the task group updates.

To note and receive updates on the progress of items on the Forward Work

Programme.

The relevant extract from the Overview and Scrutiny Forward Work Programme is attached for reference.

Meetings with the Executive

A round of meetings are currently being held (based on those held following the Council election in 2013) between the Chairmen and Vice-Chairmen of the Select Committees and the relevant Cabinet members, Portfolio-holders and Associate Directors to review and develop Overview and Scrutiny’s Work Programme aligned to the Council’s Business Plan. As before, a focus on outcomes and invitations to develop policy with use of single-topic, time-limited Task Groups should feature significantly adding value to Council decision-making.

The following meetings have been scheduled with the Chair and Vice Chair:

7 October - Adult Care to include Mental Health with Cllrs Keith Humphries and Sheila Parker; and James Cawley.

14 October - Public Health with Cllr Keith Humphries and Deborah Haynes.

The outcomes of these meetings will be reported to the subsequent meeting.

The Committee noted 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 note that the next scheduled meeting of this Select Committee is due to be held on Tuesday 18 November 2014, starting at 10.30am at County Hall, Trowbridge.

The date of the next was confirmed as Tuesday 18 November 2014, at

10.30am and would be held in the Kennet Room at County Hall, Trowbridge, Wiltshire BA14 8JN.