Agenda and minutes

To receive any apologies or substitutions for the meeting.

Apologies for absence were received from:

·       Cllr Clare Cape

·       Cllr David Vigar

·       Cllr Mike Sankey

·       Cllr Pip Ridout (substituted by Cllr Tom Rounds)

To approve and sign the minutes of the meeting held on 5 July 2022.

Resolved

The minutes of the previous meeting, held on 5 July 2022, were approved as a true and correct record.

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

There were no declarations of interest.

To note any announcements through the Chairman.

The chairman reminded the committee that new guidance had been published by the Department of Health and Social Care (DHSC), setting out the principles of how health overview and scrutiny committees should work with Integrated Care Systems to ensure they are locally accountable to their communities. He reassured members that Health Select Committee would retain its legal duties to review and scrutinise matters relating to the planning, provision and operation of the health service in Wiltshire.

It was reported that the committee would receive an information briefing in October or November, on the recent Learning Disabilities Mortality Review, an investigation into the reasons behind premature deaths amongst people with learning disabilities. The committee were also informed that the final version of Wiltshire’s Independent Living Strategy would be presented to Cabinet for approval on 27 September.

Furthermore, the chairman was pleased to report that the Scrutiny Team would be contacting partners to discuss the arrangements for the committee’s inquiry day, a system-wide review of hospital admissions and discharges, and the factors behind the delayed patient admission from ambulances. A report outlining the approach to the inquiry would be presented to the committee for approval at the next meeting.

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 on the front of the agenda 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 on the front of this agenda no later than 5pm on Wednesday 14 September 2022 in order to be guaranteed of a written response. In order to receive a verbal response, questions must be submitted no later than 5pm on Friday 16 September. Please contact the officer named on the front 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 was no public participation.

To receive an update on the delivery of Primary Care in Wiltshire following the update received in March 2022 (minutes here).

The Director of Primary Care at the Integrated Care Board provided background information about patient access to appointments and outlined plans for enhanced access from 1 October. She also took the opportunity to report on the progress of the Covid-19 vaccination programme.

The director noted that the Primary Care Network (PCN) was facing significant workforce pressures, but, despite this, had delivered appointments 233,000 in July 2022, out of a Wiltshire population of 497,000. She reported that the proportion of patients receiving face-to-face appointments had increased in August, so that at least 65 percent were seen in person during the month. Further details were then given about plans to extend the hours available to patients, which would mean that a range of appointments would be available between 6:30pm to 8pm Monday to Friday and between 9am and 5pm on Saturdays. The director explained that Primary Care had been working closely with Healthwatch Wiltshire to plan the delivery of the extended service.

It was announced by the director that the focus of the autumn vaccine programme would be on the most vulnerable patients, with a particular focus on care homes and social care staff. She explained that large vaccination sites were running in Salisbury and at Bath Racecourse, but vaccinations were also available at smaller sites throughout Wiltshire’s PCNs. She also praised the communications teams who had been working alongside PCNs and their partners to improve the programme.

During the discussion key points included:

• Members thanked the director for the update.

• It was confirmed that plans for enhanced access were in place across all 13 PCNs in Wiltshire, covering the entire population. A panel, including representatives from Healthwatch Wiltshire, had met to review the plans of all of the PCNs to ensure that they were well coordinated and met required standards. The plans had also received NHS sign off at a national level.

• The director highlighted that the number of appointments across the whole of BaNES, Swindon and Wiltshire (BSW) had increased to 427,000 in August.

• In response to questions from members about the reasons why such a high proportion of the population required an appointment, the director explained that they were analysing the data about different types of appointments to gain a better understanding of the increase and would be happy to share their findings with the committee.  She also offered anecdotal evidence that much of the demand was from people with longer term conditions that were reticent to come forward during the hight of the pandemic.

• When asked about how the level of demand was communicated to patients, the director stated that there was a video available on the King’s Fund website, but that they could also review their communication at a local level, including through area boards.

• It was noted that there was one GP practice, in Calne that was not part of a PCN but that the ICB was working closely with the practice to ensure that it delivered demand.

• The  ...  view the full minutes text for item 59.

To consider the allocation of grant funding from the Department for Levelling Up, Housing and Communities (DLUHC) to support victims and their families experiencing domestic abuse in Wiltshire.

Report to follow.

The Cabinet Member for Public Health and Public Protection, Leisure, Libraries, Facilities Management and Operational Assets introduced the report outlining how Wiltshire Council intended to spend a grant allocation of £832,348, from the Department for Levelling Up, Housing and Communities in 2022-23. He explained that it was anticipated that funding would also be in place for 2023-24 but had not yet been confirmed. A Public Health specialist in the Vulnerable Communities Team and a Public Health consultant then provided background information about the demand for domestic abuse support services and how the council had spent the grant for 2021-22. They then elaborated on proposals to spend the money allocated for 2022-23. Key points included:

• Wiltshire Council has a statutory responsibility for the provision of support to victims of domestic abuse and their children residing in safe accommodation.

• The Institute for Public Care at Oxford Brookes University had undertaken a needs analysis in June 2021 which helped to inform Wiltshire Council’s strategy for the procurement and commissioning of services. The study identified that some groups, such as men and people from ethnic minority backgrounds were more likely to be hidden victims of domestic abuse.

• A perpetrator strategy was being developed to work with individuals committing abuse to make them less likely to reoffend.

• Grants were awarded by central government on an annual basis and had to be spent in accordance with strict timeframes and guidelines. To make the best use of the available funding within these parameters there was a strong emphasis on different agencies working together and contract variations were agreed with existing suppliers.

• Local authorities received the grant funding simultaneously, so the recruitment of specialists was highly competitive. Due to the challenges in recruiting additional staff, training was provided to upskill the existing workforce.

• There was a strong focus on prevention and making people feel safe in their own homes, so the use of safe accommodation was seen as a last resort.

• As funding was awarded on an annual basis, it was not possible to commission services over the longer term. However, staff were able to build upon the experience of the first year of the project and there was anecdotal evidence of better outcomes for people using the service.

• Outcome data showing the impact of the 2021-22 funding would be available towards the end of 2022.

The committee were then invited to consider the outline proposals for the spending of the funding allocated for 2022-23 ahead of the final report being sent to Cabinet for approval on 11 October. During the discussion the following points were raised:

• Members thanked the cabinet member and Public Health officers for the update.

• Given the short-term nature of the funding, members asked whether lessons could be taken from the project to improve service delivery even if the grants were not renewed in future. In response, the Public Health consultant explained that there were lessons that could be taken forward, such as improving  ...  view the full minutes text for item 60.

To review the proposals for the use of the grant funding presented to Cabinet on 13 September.

The Cabinet Member for Public Health and Public Protection, Leisure, Libraries, Facilities Management and Operational Assets introduced the report outlining how Wiltshire Council intended to spend a supplementary grant allocation to tackle illicit drug use, including through enforcement, diversion, and treatment and recovery interventions. He explained that £351,756 had been awarded for 2022/23, with indicative funding also in place for the following two years, rising to £630,000 in 2024/25. He highlighted that Wiltshire Council’s Public Health Team spent approximately £2.5 million into this area with additional funding coming from the office of the Police and Crime Commissioner for Swindon and Wiltshire.

The Public Health Principal at Wiltshire Council then went on to provide further detail about the new interventions to be funded by the grant, including enhanced provision of Naloxone, a medication that reverses the effects of opioids. The health principal emphasised the importance of education in tackling substance abuse and balancing investment between prevention and recovery. She also took the opportunity to stress the importance of working alongside other agencies, such as those in the criminal justice system, to ensure that the correct support was put in place for individuals throughout their recovery. A number the new roles funded by the supplementary funding including a part time transition worker to help support young people into adulthood as they continue their recovery.

During the discussion the following points were made:

• The cabinet member noted that it was important to look at statistics relating to vulnerable groups but also to look at the wider statistics in order to develop a strategic overview.

• In response to a question about the Shout system, the Public Health principle explained that it was a confidential text messaging support service, for individuals struggling with mental health to support individuals who are at crisis point.

Resolved

1.    To note that the Supplementary Substance Misuse Treatment and Recovery Grant has been awarded to Wiltshire Council as part of a three-year scheme to support investment in a whole system approach to tackling illicit drug use

2.    To note the proposals to use the Supplementary Substance Misuse Treatment and Recovery Grant, to be determined by Cabinet on 27 September 2022.

The Committee will compare performance against the stated heath related goals in the Council’s Business Plan 2022-32, its strategic risks and proposed future developments. It will note the following relevant indicators and consider future arrangements for more detailed scrutiny of performance:

• Percentage of children who are physically active.

• Percentage of adults who are physically active.

• Referrals into the reablement service.

The chairman referred the committee to the report in the agenda pack providing an update on the progress that the council had made against the stated missions in its business plan. He then highlighted the relevant health related indicators in the report:

• The percentage of children who are physically active.

• The percentage of adults who are physically active.

• Referrals into the reablement service.

The chairman explained that he felt that the plan would be a useful reference point in developing more detailed scrutiny of performance indicators for health and wellbeing outcomes. Noting that the market capacity and cost of social care were both highlighted in the Strategic Risk Register, he reported that Cabinet was due to discuss its market sustainability plan for social care at its meeting on 29 November. In order to allow the committee to input into the plans before that date, he proposed that the vice-chairman and he should hold discussions with officers and cabinet members. The options for scrutiny engagement were to bring a report to the committee’s next meeting on 1 November or hold a rapid scrutiny exercise.

The leader explained that the intention was that the business plan would grow over time and that there would be opportunities to review indicators to ensure that they remained relevant. Whilst the plan provided an overview, the committee would be able to help identify areas which it felt it would benefit from more in-depth analysis. He highlighted that the NHS produced vast quantities of data and although many health indicators were not fully under the control of the council, it would be important to monitor this information on an ongoing basis. The leader also urged members to look in detail at the Strategic Risk Register as it gave a good insight into the potential likelihood and impact of different risks to the council.

Resolved

1. To note the relevant updates and outturns:

a) Against the measures and activities ascribed against the council’s priorities;

b) To the Strategic Risk Register, issues and emerging risks.

2. To ask the chairman and vice-chairman to explore options for ongoing monitoring of key performance metrics and risks regarding Wiltshire’s health and wellbeing, with proposals reported back to the committee.

3. In light of the risks identified around capacity and costs within the adult social care market, to ask the chairman and vice-chairman to make arrangements for appropriate pre-Cabinet scrutiny engagement on the forthcoming Social Care Market Sustainability Plan.

The Committee is invited to review its forward work programme in light of the decisions it has made throughout the meeting.

The chairman explained that he felt that it was important for both the committee to understand the implications of new DHSC guidance about the principles of how health overview and scrutiny committees should work with Integrated Care Systems. As such, he proposed a rapid scrutiny exercise be set up to establish the implications for the committee’s work.

In addition, the chairman proposed that the committee received an update on the implementation of Wiltshire’s Independent Living Strategy, which would be sent to Cabinet for approval on 27 September.

Referencing the annual nature of the grant funding awarded to the council for Domestic Abuse and Substance Misuse services, members were keen to investigate the potential impact of the withdrawal of grants on service users.

Resolved

1.    To note the Forward Work Programme, as amended at the meeting today;

2.    To establish a rapid scrutiny group to review the new guidance for Health Overview and Scrutiny Committees and report any implications for the committee’s approach back to a future meeting;

3.    To receive an item on Wiltshire Neighbourhood Collaboratives on 1 November 2022.

4.    To note that, in September and November, the chairman and vice-chairman will meet with the relevant cabinet members and directors to discuss work priorities for the coming 12 months, and to invite committee members to suggest any issues that they believe should be discussed.

5.    To add consideration of the impact of the potential future cessation of external grant funding for Domestic Abuse and Substance Misuse services, as discussed under previous agenda items.

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

There were no urgent items.

To confirm the date of the next meeting as 1 November 2022, at 10:30am.

The date of the next meeting was confirmed as 1 November, at 10:30am.