Agenda and minutes

To receive any apologies or substitutions for the meeting.

Apologies for absence were received from Joanne Burrows, Cllr Christine Crisp, Cllr Andy Phillips and Cllr Fred Westmoreland.

Cllr Laura Mayes, Cabinet Member for Adult Social Care, Public Health & Public Protection also sent her apologies.

To approve and sign the minutes of the meeting held on 3 September 2019. (Copy attached)

Resolved:

To approve and sign the minutes of the previous meeting held on 3 September 2019, subject to the inclusion of apologies received from Cllr Howard Greenman.

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:

a) Maternity Services Redesign

b) Overview and Scrutiny task group – “how dementia friendly is Wiltshire?”

The Chairman made the following announcements:-

a) Maternity Services Redesign

A rapid scrutiny exercise took place on Monday 21 October with 3 members from our health select committee and 3 members from Bath and North East Somerset Council. There was a healthy challenge to the CCG on the process they had followed to lead to the recommendations they were now making regarding the redesign of the maternity service.

Following the announcement of the general elections to take place on 12 December 2019, the CCG had been advised to suspend its decision-making process. It was now expected that the recommendations from the CCG’s review would be made public in January 2020, at which point the CCG governing body would also hold a public meeting.

The report from the rapid scrutiny would also be circulated to members of this committee.

b) Forthcoming work priorities for the committee

As previously reported chairmen and vice-chairmen of overview and scrutiny committees hold annual meetings with Cabinet members, portfolio holders and directors to look at service priorities, developments, challenges and risks for the year ahead.

Two meetings were scheduled on Wednesday 13 November with the following topics:

Meeting 1 - Public Health & Public Protection

Meeting 2 - Adult Social Care & Transformation

If there were any areas of concerns Members had or any topics Members would like the committee to delve into, please do let the scrutiny officer know by Monday 11 November so these could be added to the discussions on the 13^th.

The outcome of these discussions would be shared with members of this committee and relevant items would be brought to the January meeting to consider including on the forward work programme.

c) Overview and Scrutiny task group – “how dementia friendly is Wiltshire?”

This committee agreed at its September meeting to form a task group to consider “how dementia friendly Wiltshire is”. This was endorsed by the Overview and Scrutiny Management Committee on 24 September 2019.

This was shaping up to be a very interesting piece of work but there was no time sensitivity attached to it. Bearing in mind that the overview and scrutiny and Executive meetings would be held the following week it would seem logical to hold off starting work on this task group until it was known how it would fit with any work priorities identified next week.

Invitation was sent to Wiltshire Councillors to take part in the task group and Cllr Carol King had expressed an interest. Some members of this Committee had previously expressed an interest and they were asked to email the Scrutiny Officer if still interested in taking part. It was noted that the following members had also expressed an interest in participating in the task group:-

Diane Gooch

Irene Koehler

Cllr Graham Wright

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 29 October 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 Thursday 31 October 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 asked to consider the work programme.

The Committee was invited to consider its forward work programme.

The Chairman reported that the forward work programme was looking busy for the next few meetings and it might be necessary to prioritise some of the items so as to make the agendas more manageable.  The Chairman also reported that a meeting was due to take place shortly with the Cabinet Member, Portfolio Holders and Directors to review the services’ priorities for the year ahead.

During discussion, it was suggested that at the June meeting consideration be given to a small group of members being established to undertake some research on the public’s view of the advocacy service, bearing in mind that the service was about to be re-commissioned.

Resolved:

To hold a workshop open to all committee members and substitutes with partners and stakeholders to consider their priorities, plans, expected challenges and risks for the year ahead. 

Following a review and analysis, the report recommends the procurement of intermediate care (IC) beds within the overall redesign of Wiltshire’s intermediate care services. 

To consider the report before it is presented to Cabinet on 19 November 2019.

Consideration was given to a report prepared by Dr Carlton Brand, Executive Director, for Cabinet on 19 November 2019 which, following a review and analysis, recommended the procurement of intermediate care (IC) beds within the overall design of Wiltshire’s intermediate care services.  It detailed progress in the review of IC services and explained how analysis had shown that many people remained in IC beds beyond the maximum optimum time.

The review had shown that there were many reasons for higher-than-expected lengths of stay and identified that some people currently in IC beds needed to be in bedded accommodation but not necessarily in the costlier, therapy-and-reablement-intensive IC beds. The review had been exploring how many IC bed places were needed within the system for pure IC needs and how many people could be placed in a new category of ‘system flow’ beds instead.

It was noted that although the full review of the process was underway, this could not be completed within the procurement timescale as the new contract needed to be in place by April 2020.   The proposed contracts would enable commissioners to work with providers to use the available beds flexibly when the need was more clearly understood and to ensure that the system could be developed for people with other bed-based needs.

It was therefore recommended that the new contracts should be for a period of three years, with an option to extend for a further two years. Furthermore, it would be written into the new contracts that providers would support the development of the new flexible system.

During discussion, members fully supported the flexibility of beds as proposed, recognising the importance of placing people in the correct beds by regularly checking demand against capacity.

Resolved:

(1)          That the outcome of the overall redesign of Wiltshire’s intermediate care services be brought to the Health Select Committee when available (later in Q4 – Feb/March 2020).

(2)          That Cabinet be informed that this report was also considered by the Health Select Committee on Tuesday 5 November 2019 and there were no issues raised by the committee.

To receive an update on Adult Social Services performance and consider the balanced performance scorecard.

This is the first time the scorecard is being considered by the committee and members are encouraged to question the format and development of the scorecard and also the performance improvement themes emerging.

The Committee received an update on Adult Social Services performance and received the new Adult Social Services scorecard for consideration.

This was the first time the scorecard was being considered by the Committee and members were encouraged to question the format and development of the scorecard and also the performance improvement themes emerging.

The scorecard contained a balance of four elements or types of measure, namely:-

·         Outcome measures related to service users.

·         Output or measures of process.

·         People measures relating to staff.

·         Financial measures relating to budget.

It was necessary to maintain a close watch on all four types of measure to ensure reliable and robust performance management.

During discussion, members noted that there were 13 areas identified for improvement and these were being actively investigated.  Wiltshire’s statistics were being benchmarked against those nationally, which were generally in respect of more urban areas and members suggested that it would be more meaningful to compare them with those of other authorities in the South West Region.  

The Chairman reminded the Committee that adult social services represented the Council’s largest area of spend.  

Resolved:

To note the report and request an update in three months.

As agreed at the September 2018 meeting to receive an update on the implementation of the agreed recommendations following the June 2018 rapid scrutiny on NHS Health Checks.

The Committee received a report which provided an update on progress against the agreed recommendations from the Health Select Committee rapid scrutiny of the NHS Health Check programme that took place in June 2018. The report also provided the annual update on programme performance for 2018-19. It was shown that growth in the uptake of NHS Checks programme which was the highest uptake since 2011.

Although some good work had been undertaken to complete the actions agreed by this Committee and to improve programme quality and uptake of the programme, further work was being done and a plan for development work during 2019-20 was in place.

It was noted that national data had recently been received which would provide further information.

During discussion, it was suggested that local networking with local organisations could well prove useful, especially in publicising the benefits of immunisation.

Resolved:

To thank Cabinet Members and officers for their work on the recommendations from the 2018 Rapid Scrutiny.

To receive the annual update on programme performance for 2019-20 for NHS Health Checks at the 23 June 2020 meeting.

To receive updates from CCG officers on recent, current and upcoming work, projects and changes, including:

a)    Progress on the CCG merger (including outcome of the vote from the GP membership of each CCG on a final decision to apply for a merger)

b)    Mental health bed-base review (work to date and next steps)

Based on the information provided the committee is invited to consider if it wishes to receive further information at another meeting or any other form of scrutiny it considers appropriate for the topic.

The Committee received an update from CCG officers on recent, current and upcoming work, projects and changes, including:

(a)          Progress on the CCG merger (including outcome of the vote from the GP membership of each CCG on a final decision to apply for a merger), and

(b)          Mental health bed-base review (work to date and next steps).

It was noted that the redesign of the Maternity Services was being presented to the CCG governing body on 16 January 2020.

Members noted that plans were progressing well to achieve a CCG merger by 1 April 2020.  There had been a total GP turnout of 78% and 80% of which had voted for the decision to merge.  In Wiltshire there had been a 83% turnout with  67% voting in favour of the merge. The senior management team was already in place and the post of Clinical Lead was currently being advertised after which GP lead roles would be considered.

Resolved:

(1)          To note the update on the CCG merger and receive further information at the next meeting in January 2020 and regular updates on the CCG merger leading up to April 2020.

(2)          To bring forward an update on the Mental Health bed-base review to the next meeting in January 2020, but acknowledging that this might be delayed as there was more work to be undertaken.

Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) was 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.

The attached report appraises the options for future service provision and was presented to the Swindon and Wiltshire CCG Governing Bodies in September 2019 for ratification and approval.

The recommendation from both Governing Bodies are being presented to Swindon Adults’ Health, Adults’ Care and Housing Committee and Wiltshire Health Select Committee.

The Committee received an Options Appraisal Report on the temporary closures of health based places of safety in Swindon and Salisbury from Sheila Baxter, Mental Health Commissioner and Ruth Atkins, Head of Communications & Engagement, Swindon CCG. 

Members were informed that 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.

The report appraised the options for future service provision and had been presented to the Swindon & Wiltshire CCG governing bodies in September 2019 for ratification and approval.

The options considered for the appraisal were:-

Option A – To make permanent the Bluebell Unit arrangements based in Devizes, with no health based places of safety at Sandalwood Court, Swindon and Fountain Way, Salisbury.  This would provide four HBPoS beds for the Sustainability and transformation Partnership (STP) area and this was enough based on data.

Option B – To maintain the Bluebell Unit in Devizes as a dedicated unit but to re-open the place of safety suites at Sandalwood Court and Fountain Way.  This would provide six beds for the Sustainability and Transformation Partnership (STP) area and this was above requirements based on data.

Option C – To roll out the additional Bluebell Unit clinical model in Swindon and Salisbury. This would provide 12 beds for the Sustainability and Transformation Partnership (STP) area and is above requirements based on data.

It was noted that a clinical led panel consisting of a GP from Swindon, a GP from Wiltshire and the secondary care doctor on Swindon CCG’s Governing Body had considered each option against the criteria. The panel had expressed some concern relating to the ability to staff three units, value for money, estate costs and travel. In addition to the clinical panel, the managers of Healthcare Swindon also carried out the scoring, considering each option against the following criteria:-

·         Quality

·         Environment for staff and detainees

·         Workforce sustainability

·         Travel distances

·         Cost effectiveness

The recommendation from both of these governing bodies was to support and endorse Option A, namely to retain a health-based place of safety at the Bluebell Unit in Devizes, with the closure of the health-based place of safety suites at Sandalwood Court, Swindon and Fountain Way, Salisbury.

The recommendations from both governing bodies were being presented to Swindon Adults’ Health, Adults’ Care & Housing Committee and this Select Committee.

During discussion, Members questioned the view that four HBPoS beds would be sufficient for the needs of Wiltshire residents and were reassured that should the need arise, Bristol residents would be catered for outside of Wiltshire.

The Committee recognised the financial and practical reality of the option chosen by the Swindon and Wiltshire CCG Governing Bodies, namely to retain a dedicated health-based place of safety (Bluebell Unit) in Devizes, with the closure of the health-based place of safety suites  ...  view the full minutes text for item 73.

As agreed at the 11 July 2018 Health Select Committee meeting, the attached report provides an update on activities relating to the transformation programme of Avon and Wiltshire Mental Health Partnership Trust over the last year, since the last report.

Consideration was given to a report by the Clinical Director, Avon & Wiltshire Mental Health Partnership Trust (AWP) which provided an update on activities relating to the transformation programme of this Partnership Trust over the past year, since the last report.

It was noted that this Trust provided community and inpatient mental health services for the people of Bristol, North Somerset, South Gloucestershire, Bath & North East Somerset, Swindon and Wiltshire. The Trust treated people with a wide range of disabling mental health problems.

The Trust was last inspected by the Care Quality Commission in 2018 and their assessment was as follows:-

·         Safe                Requires improvement

·         Effective        Good

·         Caring            Good

·         Responsive   Requires improvement

·         Well-led         Requires improvement

The Trust had six executive led, dedicated programmes of work to improve its services and support the achievement of the objectives, which were as follows:-

·         CQC and Regulatory Improvement

·         Embedding a Culture of Quality Improvement

·         Getting the Basics Right

·          Infrastructure

·         Operational Effectiveness

·         Workforce

A brief summary of each programme and achievements to date was set out in the report. 

The Clinical Director, Avon & Wiltshire Mental Health Partnership Trust went on to explain that arising from this the CQChad now confirmed the following three priorities:-

·         Ageing well

·         Mental health

·         Learning Disabilities and Autism

During discussion, mention was made of the success of a number of projects which were being undertaken including crisis cafes and an out of hours service which would be available from January 2020.  There was a need for an emergency assessment service away from hospital Accident & Emergency departments.  It was considered that safeguarding should be a priority for everyone, both clients and carers.

Resolved:

(1)          To note the update report and to request an annual update in November 2020 with a specific interest in the following:

-       The development of the roles / career pathway for AWP employees (to help retention of staff)

-       the associate psychologist apprenticeship pilot (being piloted from January 2020) and other apprenticeship opportunities

-       the Out of hours service (being piloted with Medvivo)

-       engagement programme with carers (and families) and overall recognition of carers (possibly with information on the Making Families Count charity and its programme of work)

(2)          To ask AWP to engage with the Council to ensure it is fully aware of the Single View programme.

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 an update from the following task group:-

·         Child & Adolescent Mental Health (CAMHS) Task Group

Resolved:

To endorse the CAMHS Task Group’s recommendation:

For Wiltshire Council’s Commissioners to work with their counterparts in BANES and Swindon to resolve the issues around data reporting on ‘Access Rates’, so that this data can be of a high quality and relied upon to represent an accurate picture of accessibility to mental health services.

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

There were non urgent items of business.

To note that the next meeting is due to take place on Tuesday 14 January 2020, starting at 2.30pm at County Hall, Trowbridge.

Resolved:

To note that the next meeting of the Committee would take place on Tuesday 14 January 2020 at County Hall, Trowbridge, starting at 2.30pm.