Agenda and minutes

To receive any apologies or substitutions for the meeting.

The Chairman referred to the recent sad death of Cllr Jerry Wickham and paid tribute to the important contributions he had made as Cabinet Member for Adult Social Care. 

He thereupon welcomed Cllr Laura Mayes, on her first attendance at a meeting of this Committee as Cabinet Member for Adult Social Care and also Joanne Burrows (SWAN Advocacy) and Sue Denmark (Wiltshire Centre for Independent Living).

The Chairman reported that Sarah MacLennan would be departing from the Wiltshire Clinical Commissioning Group shortly and, on behalf of the Committee, wished her well in her future endeavours.

There were no apologies for absence.

To approve and sign the minutes of the meeting held on 25 June 2019.

Resolved:

To approve and sign the minutes of the previous meeting held on 25 June 2019, subject to-

(1)          the inclusion of:

Sue Denmark representing Wiltshire Centre for Independent Living

Diane Gooch, representing Wiltshire & Swindon Users Network

Irene Kohler, representing Healthwatch Wiltshire

(2)          the removal of Cllr Clare Cape who did not attend the meeting.

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

There were no declarations of interest made at the meeting.

To note any announcements through the Chairman, including:

The Chairman made the following announcements:-

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 Tuesday 27 August 2019 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 30 August 2019. 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 were no members of the public present or councillors’ questions.

The committee is invited to consider its forward work programme and to take it into consideration when making recommendations on later items on the agenda.

The Committee was invited to consider its current forward work programme.

The Chairman reported that the forward work programme was already looking quite busy for the next meeting in November and therefore it might be necessary to consider deferring some of the items if anything further was to be added.

After some discussion,

Resolved:

(1)          To include the following items in the agenda for the next meeting in November 2019:- 

·         Intermediate Care Bed Service

·         Maternity Transformation Plan, which could be superseded by the outcome of a Rapid Scrutiny

·         Adult Social Care Quarterly Scorecard

(2)          To hold pre-meeting briefings as follows:-

·         Key performance Indicators and Adult Social Care Quality Scorecard – 5 November 2019 meeting  

·         NHS Long Term Plan – 14 January 2020 meeting

To receive an update on the Home from Hospital services delivered by Age UK Wiltshire.

The Committee received an update on the Home from Hospital Services delivered by Age UK Wiltshire.

The Home from Hospital Services provided short term support to Wiltshire residents, predominantly aged 60 plus for up to six weeks following a stay in hospital. It was at the discretion of the service provider whether to make exceptions for referrals for customers with support needs aged 50 to 59. The services included a mixture of both practical and emotional support that together enabled older people to transition back home and regain their confidence and independence, reducing the likelihood of people becoming socially isolated or lonely and being readmitted to hospital.  Services were aimed almost exclusively at individuals who were not otherwise eligible for a social care service or for NHS rehabilitation or HomeFirst.

It was noted that Age UK Wiltshire was contracted to deliver a Home from Hospital Service from Salisbury Hospital (SFT).  This service was jointly funded by Wiltshire Council and Wiltshire CCG and the contract was for a period of two years which was due to end in June 2020.  

In December 2018 two pilot Home from Hospital Services based out of Royal United Hospital (RUH), Bath and Great Western Hospital (GWH), Swindon were established. The priority was to maximise the impact of the service over the winter period and, on that basis, the agreement with Age UK was to start at the RUH (where a B&NES Home from Hospital Service already existed and the infrastructure was available) and to delay implementation at GWH until the service at the RUH was in place.  

The Joint Commissioning Board had considered the progress of the Home from Hospital Service earlier in the year and agreed to continue services at the RUH and the GWH to give them more time to embed and to continue to work with colleagues at SFT to improve take-up of the service. It was planned that Commissioners would then work to recommission a county-wide Home from Hospital Service that would ensure consistency, allow for an all-age service and allow for a more consistent contract management process which would take account of both the Home from Hospital provider and the different hospital referral processes.

On the basis that services were embedded and delivered the expected outcomes, a business case and specification for a county-wide Home from Hospital Service would be presented to the Joint Commissioning Board later in the year for approval.

However, should the service not demonstrate the outcomes expected, tWiltshire Council and the CCG’s Joint Commissioning Board would be asked to approve the decommissioning of all three current services from June 2020.

After some discussion,           

Resolved:

(1)          To note the report and decision of Joint Commissioning Board to extend service over winter 2019-2020

(2)          To receive confirmation after June 2020 of the decision made by Wiltshire Council and the CCG’s Joint Commissioning Board on the commissioning (or decommissioning) of all three current “Home from Hospital” services.

To receive a verbal update on Citizen’s Panels.

The Committee received a verbal update from Sarah MacLennan, Associate Director, Communications & Engagement, Wiltshire Clinical Commissioning Group on the outcome of its investigation of several options for procurement of a market research agency to support the development, recruitment and maintenance of the Citizen’s Panel.

Members were reminded that the Panel was being established to gain insight into how people accessed services.  It was considered that the Citizen’s Panel would provide a greater understanding and insight into the ways in which populations accessed health and care services, so that it would facilitate the creation of solutions, strategies and policies. The Panel’s thoughts and recommendations would allow for the strengthening of our health and care offer, based on the requirements, values and cultures of the communities within B&NES, Swindon and Wiltshire STP.

Sarah MacLennan reported that £40,000 was being funded by Health Care England for this project which was being run by B&NES, Swindon & Wiltshire Councils and which was available only until March 2020. She would report back to the Committee on progress at its January 2020 meeting.

Resolved:

To receive an update from Wiltshire CCG (acting on behalf of B&NES, Swindon and Wiltshire CCGs on this), on the outcome of its investigation of several options for procurement of a market research agency to support the development, recruitment and maintenance of the Citizen’s Panel at the Committee’s meeting in January 2020.

To receive an update on the merger of the Clinical Commissioning Groups merger.

A letter to stakeholders and a powerpoint presentation are attached.

The Committee received an update on the proposed merger of the Clinical Commissioning Groups.

Sarah MacLennan, Associate Director, Communications & Engagement, Wiltshire Clinical Commissioning Group, made a presentation during which she explained that the three CCGs had a shared history of working together effectively to deliver high quality care.  A single executive management structure had been established to provide more consistent leadership and direction to staff working across the three organisations, namely B&NES, Swindon and Wiltshire to form one new, single statutory CCG – (currently called BSW Commissioning Alliance).

Formal application would be made for approval via NHS England by 30 September 2019. An engagement programme had taken place during July and August and GP membership had been asked to vote on the proposal in early-mid September.

During discussion, it was noted that certain specialist services, such as some cancer services, would continue to be provided in Bristol and Southampton and these current services would continue to be provided as at present.

Resolved:

(1)          To inform the Committee, as a chairman’s announcement, at the November meeting, of the outcome of the vote from the GP membership of each CCG on a final decision to apply for a merger.

(2)          To receive an update after April 2020, on the implementation of the “single” CCG for Bath and North East Somerset, Swindon and Wiltshire, including recruitment and staffing.

Following the temporary closure of two units in February and March 2018, the committee received a number of updates on Places of Safety, the last one at its 25 June 2019 meeting where it was agreed to receive a further update on the analysis of the user feedback.

The Committee was reminded that the Avon & Wiltshire Mental Health Partnership NHS Trust (AWP) had been asked to make significant improvements to the provision of health based places of safety (HBPoS) at Sandalwood Court in Swindon and Fountain Way in Salisbury following two Care Quality Commission (CQC) inspections in 2016 and 2017 which rated these services as inadequate.

To address the concerns raised by the CQC, AWP, Swindon CCG and Wiltshire CCG recommended the temporary closure of the HBPoS suites in Swindon and Salisbury and the relocation of these services to a new, single, larger, purpose-built HBPoS at the Green Lane Hospital in Devizes for an interim period. NHS England had agreed this recommendation and the HBPoS at Swindon and Salisbury were temporarily closed on 19 February 2018 and 2 March 2018 respectively.       

Following the temporary closure of these two units in February and March 2018, the Committee had received a number of updates on Places of Safety, the last one being at its meeting on 25 June 2019 when it was agreed to receive a further update on the analysis of the user feedback.

The Chairman reported that a late supplement had been circulated to Members earlier that morning as soon as the report had been received. However, the Committee had previously received information on places of safety and it was suggested that the meeting focus on the user feedback and proposed plans.

The Committee thereupon received a presentation from Lucy Baker, Group Director, Wiltshire Clinical Commissioning Group. She reminded Members that, as reported at the last meeting, 185 surveys had been completed and 13 telephone interviews had taken place. 51% of take-up was out of area and the headline finding showed that feedback was positive. She reported that there would be a focus on the early prevention of a crisis and that from January 2020 there would be a single point of access out of normal working hours. In Salisbury there would be a place of calm which would be opening in January 2020 and this would be available throughout evenings and night time.    

It was noted that a second report appraising the options for future service provision would be presented to the Governing Bodies of Swindon and Wiltshire CCGs in September 2019. Arrangements would be made for Swindon Adults’ Health, Adults’ Care and Housing Committee and Wiltshire Health Select Committee to receive the second report.

During discussion, it was noted that there had been no instances where HBPoS had not been available to Wiltshire people and there were ongoing discussions with Bristol to look at ways of reducing the flow of Bristol residents into Wiltshire to avail themselves of the services available. 

After further discussion,

Resolved:

(1)          To set up a Rapid Scrutiny, possibly in association with Swindon, to examine the second report appraising the options for future service provision.

(2)          To receive the report provided and to direct any questions to the Senior Scrutiny Officer.

To receive an update on the progress of the implementation of the Wiltshire Dementia Strategy, as well as future ongoing work and priorities.

The Committee received an update report on the progress of the implementation of the Wiltshire Dementia Strategy and also details of future ongoing work and priorities in an action plan.

It was noted from the report that the number of people living with dementia in Wiltshire was rising. There were currently 4721 people with a formal diagnosis from an estimated 7192 people who were likely to be living with dementia. This equated to a Dementia Diagnosis rate for Wiltshire of 65.6% compared with the national target of 66.7%. These figures, taken from the July 2019 data provided by NHS England, referred only to people over the age of 65. When considering research carried out by the Alzheimer’s Society, which suggested that there were 15,000 people under 65 with dementia in the UK, it could be predicted that there was also a number of Wiltshire residents who were under 65 and living with dementia.

It was explained that the strategy would seek to develop more integration between health and care in providing services for people living with dementia in Wiltshire. There would be a joint focus on improving prevention and health and social care services and promoting dementia friendly communities within the county. It was anticipated that this approach would improve people’s awareness and understanding of dementia, how risk could be reduced, ongoing support and the role of services in ensuring that people could live well with dementia.

During discussion, it was noted that there were a number of organisations, such as Dementia Action Alliance, which brought together organisations across England committed to transforming health and social care outcomes for people affected by dementia.  Several Area Boards had been giving some consideration to dementia and had appointed Champions to look into the needs of the local populations in some depth.       

Resolved:

(1)          To review the summary of the action plan and reconfirm its commitment to the ongoing work and priorities of the Wiltshire Dementia Delivery Board flowing from the Dementia Strategy and its associated Action Plans.

(2)          To agree that the Wiltshire Dementia Delivery Board would continue to monitor progress against the implementation plan and approve developments and additions to deliver on the outcomes between now and 2021, reporting into future Health Select Committee meetings and the Health & Wellbeing Board on progress.

At its meeting on 25 July 2019 the Health and Wellbeing Board considered the attached report from Healthwatch Wiltshire reviewing the extent to which Wiltshire is dementia friendly.

The full report can be accessed on the Healthwatch Wiltshire website (here).

This is included as background information for the committee prior to considering information from both Alzheimer’s Support and Alzheimer’s Society on their respective work over the past year and areas of focus for the future.

Stacey Plumb, Manager of Healthwatch Wiltshire, made a presentation entitled How dementia friendly is Wiltshire? (a copy of which is circulated separately in a supplementary agenda). 

Reference was also made to a report which was considered by the Health & Wellbeing Board at its meeting on 25 July 2019 which reviewed the extent to which Wiltshire was dementia friendly. The report was available to view on the Healthwatch Wiltshire website at https://www.healthwatchwiltshire.co.uk/sites/healthwatchwiltshire.co.uk/files/Working%20Together%20to%20Improve%20Dementia%20Services%20in%20Wiltshire.pdf

During discussion, it was pointed out that there were some staff who had not completed their training. Some had signed up to attend but hadn’t actually participated. This was something that needed attention as it was most important that all staff were adequately trained.

Resolved:

 To thank Stacey Plumb for her presentation, the contents of which were noted. 

To receive information from Alzheimer’s Support on its recent work and areas of focus for the future.

The Committee received a presentation by Babs Harris, Chief Executive Officer of Alzheimer’s Support on its recent work and areas of focus for the future. (a copy of which is circulated separately in a supplementary agenda). 

The Committee also received an information sheet from Alzheimer’s Support. (a copy of which is circulated separately in a supplementary agenda). 

On behalf of the Committee, the Chairman thanked Babs Harris for her presentation.

To receive information from Alzheimer’s Support on its recent work and areas of focus for the future.

A briefing note is attached.

The Chairman welcomed Matt Whittley (Regional Public Affairs and Campaigns Officer, Alzheimer’s Society), Tom Redfearn (Regional Public Affairs and Campaigns Manager) and Kelly Inwood (Area Manager) who attended to provide information on its recent work and areas of focus for the future.

The Committee received a briefing note from the Alzheimer’s Society which included suggested themes for a review to explore as follows:-

·         Quality of care

·         Accessing care

·         Cost to people with dementia

Matt Whittley made a presentation explaining the work of the Society. (a copy of which is circulated separately in a supplementary agenda). 

During discussion, Members acknowledged that there were insufficient appropriate care facilities which resulted in some inappropriate admissions to hospital.

The Chairman thanked the officers from the Alzheimer’s Society for their attendance and the presentation.

Resolved:

To establish a task group to further explore how dementia friendly Wiltshire is, in terms of

1)       Quality of care for people with dementia (ensuring understanding of dementia among the social care workforce and adequate training, clear pathways of care, improved communication between professionals in the health and social care sector)

2)       Accessing care (delayed transfer of care and inappropriate hospital admissions, accessing information, advice and support, and diagnosis rate)

3)       Cost (state funded support / self funders, financial support, including passported benefits and forward planning for the authority)

4)       Working with Alzheimer’s Society, Alzheimer’s Support and Healthwatch, as well as any other groups or organisations that will be identified when the task group scopes its work, to identify strengths in Wiltshire that can be used as best practice in other authorities (as both rural and urban Wiltshire could offer learning in both)

To receive any updates on recent activity for active task groups and from members of the Health Select Committee who have been appointed as overview and scrutiny representatives on programme boards.

The Committee received updates on the activities of the following task group:-

·         Child and Adolescent Mental Health (CAMHS) Task Group – this Task Group was about to resume work.

Resolved:

To note the updates on the activities on task group activity provided.

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

The Committee received a document showing the relevant items from the

Overview & Scrutiny Forward Work Programme.

Resolved:

To note the Forward Work Programme for this Committee.

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

There were no urgent items of business.

To confirm the date of the next meeting as Tuesday 5 November (starting at 10.30am).

Resolved:

To confirm that the next meeting of the Committee would be held on Tuesday 5 November 2019, at County Hall, Trowbridge, starting at 10.30am.