Agenda and minutes

Terence Herbert, Chief Executive Officer, gave an update on the Coronavirus outbreak noting that currently no cases had been reported within Wiltshire and a number of strategy and planning meetings with partners had taken place. Public Health England were providing frequent updates and service areas were updating their contingency plans. The immediate issue was to reassure and communicate with the public.

In response to a question asked about local media headlines causing panic and how the Council was responding to the panic, it was noted that the Council had written to all schools, updated information on social media and with local media sources, briefed all staff members and spoken to local press.

To receive any apologies or substitutions for the meeting.

Apologies were received from:

Joanne Burrows, SWAN, who was substituted by Lindsey Burke.

To approve and sign the minutes of the meeting held on 14 January 2020. (Copy attached)

Resolved

To approve and sign the minutes of the previous meeting held on 1 January 2020.

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 made the following announcements:

Dorothy House patient takes on incredible 125-mile canoe challenge

A Wiltshire resident and patient of Dorothy House, Kevin Dobson, was training to take part in the 125-mile Devizes-Westminster (DW) canoe race to raise funds for the Hospice. The race would take place on the river Thames in April 2020 and Kevin hoped he would be well enough to compete along with his son Edd Dobson. Kevin was currently being treated for terminal cancer and the race in April was outside his expected survival period.

Seminar and Networking Event on Financial Abuse Issues

The Democratic Service Officer had forwarded the seminar information onto the members which was due to take place on Tuesday 31st March and supported by Irene Kohler in her role as Salisbury’s Older People Champion. The seminar was now fully booked although if enough people were on the waiting list an additional session could be held.

“the state of children’s mental health services”

Anne Longfield, the Children’s Commissioner for England, recently published her report on 'The state of children's mental health services'. The report drew attention to the provision of services for children who need help, support and treatment. The briefing also looked ahead to assess whether current Government plans go far enough to meet demand.

This briefing showed that while the NHS had made progress in the provision of mental health services for children, the current system was still far away from adequately meeting the needs of all the children in England with mental health problems or the children who fell just below the threshold for clinical diagnosis.

Cabinet items

No HSC related items went to the February Cabinet meeting.

The Cabinet FWP was briefly discussed noting that Cabinet would be making a decision on the Virgin Health care contract to be extended, and to also agree the length of the contract extension. The Virgin Healthcare contract was commissioned jointly by the Wiltshire CCG and Wiltshire Council.

A briefing had been requested, following this it would be determined if a rapid scrutiny exercise was required.

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 25 February 2020 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 27 February 2020. 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.

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 forward work programme.

 After some discussion it was,

Resolved:

1.    To recommend that the following item be added to the Committee’s Forward Work Programme:-

A pre-meeting briefing to find out more about the work undertaken by Dorothy House.

2.    To note that the Forward Work Programme would be reviewed by the Chairman and Vice-Chairman and circulated to members of the Committee in due course.

To receive information on the Wiltshire Safeguarding Adult Board’s three-year strategy. A report will be circulated.

Mr Richard Crompton, Wiltshire Safeguarding Adult Board Chairman, introduced the Boards three year strategy noting that they had reached the end of the first year and key points included:

·         Safeguarding Adults Reviews (SAR) had taken which identified issues with self-harm, self-neglect, county lines, criminal and sexual exploitation. Although these represented a small percentage they were high risk.

·         A potential issue for Wiltshire was military rebasing to bring safeguarding issues.

·         Care homes had a duty to report any safeguarding concerns and incidents which showed a health culture of reporting.

·         There were three areas of strategic focus: quality assurance, voice and influence, and prevention.

·         Quality Assurance: The WSAB had supported the development of the Multi-Agency Safeguarding Hub for adults which had helped compile and interpret statistical results. The hub was beginning to meet their ambitions and reducing their volume of calls. A peer assessment audit had also taken place which noted improvements year on year. The results had been shared in the south west and other local authorities were interested.

·         Voice and influence: Meetings had taken place with service users and carers through reference groups to learn from their experience. The feedback was positive. Representatives also sat on the main Safeguarding Board and was working to embed and make improvements in the next year.

·         Prevention: Lessons learnt from case reviews and the development of relevant policies and procedures took place.

·         An alcohol learning event was held last year which had been well attended by agencies.

·         Outcomes of the SARs and the full report could be accessed via www.wiltshiresab.org.uk and thematic learning from case reviews via www.wiltshiresab.org.uk/wp-content/uploads/2019/06/SAR-Learning-Briefing-1.pdf

·         The review of adult E found that information had not been passed on to the hospital and domiciliary needs on discharge to the care agency. The Hospital Passport which should accompany a patient with learning difficulties had not been used.

In response to questions asked it was noted that:

·         The patient passport would not be incorporated in new ways of handling  electronic data.

·         The spread and reach of the user groups was not as extensive as would like although they were well attended, they were looking at how to better utilise the people that did attend to ensure better representation and disseminate information.

·         Geographically the groups were well represented, although there were transport issues and better ways to communicate were being explored.

·         There was a family approach to safeguarding although the statutory nature of the WASB was that vulnerable adults were safeguarded.

RESOLVED

To note the outcome of the Safeguarding Adults Review relating to Adult E

That the next annual update from the Wiltshire Safeguarding Adult Board include confirmation that the board ensured the recommendations of the Safeguarding Adult Review for adult E and thematic learning from case reviews were shared and effected change across local organisations.

To support the work the board is doing and encourage working with Local Area Coordinators, Social Prescribers and others to ensure a cohesive overview of services.

To acknowledge the aims of the board’s Strategic Plan 2019 – 2021 and  ...  view the full minutes text for item 23.

As agreed at the 5 November 2019 meeting, to receive an update on progress in the recent procurement of Wiltshire Council’s intermediate care beds.

James Corrigan, Better Care Fund Lead in Joint Commissioning, updated the committee on progress for the procurement of intermediate care beds, the key points were:

·         A procurement tendering exercise had been complete and was now in a stage of standstill which was a two week period to consider legal issues if challenges were made regarding the process.

·         Intermediate care beds (ICB) operated in three areas in Wiltshire – North, West and South with most ICB located in the south due to not having community hospitals in the south.

·         There were currently 65 beds – 55 step down and 10 step up beds which could be used flexibly.

·         The procurement exercise was being carried out to change how the beds were used as the beds were often not used for their purpose.

·         The new contract aimed to create a new category of system flow beds for those who needed to be looked after but did not need an ICB.

In response to questions asked it was noted that:

·         The aim was not to buy more beds but to use the ICB’s more flexibly. The most suitable model would be identified during the first 2 quarters.

·         Cost would be monitored throughout and both fixed and variable costs would be looked at.

RESOLVED

To note the update provided in the report.

To receive further information on the review of Intermediate Care Services at a pre-meeting briefing once the service review is nearing completion and on the definition of system flow beds.

Following consideration of the 2018 Quality Accounts at the Health Select Committee meeting on 25 June 2019 to receive an update from Salisbury NHS Foundation Trust.

The Salisbury NHS Foundation Trust Quality Accounts 2018-19 can be accessed here. The comments from the Health Select Committee are included on pages 178 and 179 and the specific points highlighted by the committee for an update are listed below for ease of referral: 

1. progress achieved to date for the five quality priorities identified by the trust for 2019/20, with particular interest in:

a)    Improving patient flow through the hospital, including measurements of the impact of the SAFER care bundle (Priority 3) and measurements of emergency re-admissions within 28 days of discharge as this has been slightly increasing for patients aged 16 and over since 2016;

b)    Increasing the number of patients who are able to de discharged to their preferred place of care at the end of their life, including working collaboratively with the community and social care partners to develop an older persons’ pathway (Priority 3);

c)    Organisational development strategy with regards to improving staff health and wellbeing;

2. Progress on expanding parking provision for both staff and visitors.

3. An update on the following areas from the priorities identified for 2018/19:

a)    Continued efforts to reduce the number of patients who fall and injure themselves;

b)    Identify patients with delirium;

c)    Ensure a rapid discharge for patients at the end of their life who wish to die at home;

d)    Outcome of the audit of the delirium care bundle;

e)    Performance of the frailty pathway against the discharged within 72 hours measure;

f)     Maintaining 90% standard of patients receiving hip fracture surgery within 36 hours;

g)    Monitoring of improvements (education and training) in understanding whether a patient meets the eligibility criteria for fast track Continuing Health Care funding (NB - Please note this is of particular interest);

h)    Navigator performance with regards to patients being seen within 15 minutes of arrival in the emergency department, as well as any additional development of skills offered to navigators;

i)     Trusted assessors, development of the concept and impact on speeding up discharges.

Lorna Wilkinson, Director of Nursing, and Claire Gorzanski, Head of Clinical Effectiveness for the Salisbury NHS Foundation Trust gave a presentation on Salisbury NHS Foundation Trust - quality priorities 2019/20. The key points of the presentation were:

·         Work with partners to prevent avoidable ill health and reduce health inequalities had improved. A Treat Me Well campaign was launched in 2019 and more work was being done to embed learning disability standards.

·         Exceeded c-diff infection targets – 18 infections were picked up, 8 within the hospital and 10 outside of the hospital. The hospital had the lowest gram negative blood stream infections in the region.

·         Sepsis screening and escalation to doctors had improved. Sepsis treatment - administering antibiotics within one hour had decreased which would be monitored.

·         Patients over 65 now received three fall prevention measures: mobility and medication assessments and lying / standing blood pressure checks.

·         Achieved 79% of hip fracture best practice (target was 80%), there was sometimes a struggle with carrying out operations within 36 hours and work was being done to look at lessons learnt.

·         Work with partners to improve patient flow through the hospital was being worked on. The target of 90% of consultant review within 14 hrs of admission was being met, although only 18% of patients were being discharged before midday where the target was 33%.

·         The OPAL had increased to a 7 day service.

·         Readmissions had increased. There was no clear reason for the increase and it was being looked into.

·         Targets for delayed discharge had all been missed, this was due to how the hospital worked with partners and internal patient flow. The Local Delivery Board held a workshop looking at figures and priorities. Also an

internal expert panel was held each week which was multi agency to look at patients stays over 7 days and specifically look at complex discharges to identify lessons to learn. 

Issues such as not having medicines ready and transport were areas being explored.

If a patient was being discharged after noon, the patients circumstances were taken into account on whether they would be kept for another day or discharged.

·         Attend Anywhere was a new technology “digital” appointment via phone, tablet, etc. The system had been trialled with speech and language therapist at school which enabled the child to stay in school and not miss class time and the therapist was able to demonstrate techniques for the teachers. Feedback so far had been positive.

Consultant Connect was currently being used at Bath hospital, which enabled consultants to receive specialist advice very quickly and reduced the amount of further appointments required. The next stage was to get clinicians on board with the programme and conversations were taking place.

·         Work was ongoing to Improve the health and wellbeing of staff.

RESOLVED

To thank officers attending and for the quality of their presentation.

To note the Salisbury NHS Foundation Trust quality priorities for 2019/20.

To welcome a similar update from the Salisbury NHS Foundation Trust on its quality priorities  ...  view the full minutes text for item 25.

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

a) Social Prescribing – to receive a presentation on how the Primary Care Networks in Wiltshire have been using (or are planning to use) the Directed Enhanced Service funding (including Social Prescribers)

b) Citizen’s Panel – to receive an update on the outcome of the CCG’s investigation of several options for procurement of a market research agency to support the development, recruitment and maintenance of the Citizen’s Panel.

c) Maternity Service Redesign – to receive a response to the rapid scrutiny report considered at the last meeting of the committee (attached for ease of reference) and update.

f) Mental Health transformation – to receive a presentation on progress to date.

Maternity Service Redesign

Lucy Baker, Director of Service Delivery for Banes, Swindon and Wiltshire CCG, gave an update on the maternity redesign rapid scrutiny (RS) exercise. The RS looked at the process followed and found that the CCG’s decision-making process was based on information that was available to them. The report was then taken to a CCG meeting in January, where the feedback of the RS was valuable to ensure the correct information was presented in an improved format. The recommendations were supported and the project was now moving into the implementation stage.

The RS suggested that clear information should be provided to mothers, in response to that, visits to communities had taken place to provide workshops to listen and provide information on what was happening next.

The first community hub was live in Salisbury which had received good feedback especially response to the breast feeding group. The next community pilot hub would be running in Trowbridge by the end of April 2020.

10 community of care pilots would be up and running to support mothers through pregnancy. The first pilot running in Salisbury had been working to support and make a difference to mums who had experienced trauma during a pregnancy and had received very good feedback.

In response to questions asked it was noted that:

The funding for the Salisbury unit had been secured and due to open in December. Bath RUH had a £6M funding gap and a fundraising campaign would be launched. The next grant funding tranche was in April / May. The RUH unit was not expected to open until 2022/23 and the capacity would not be needed until then. Capital funding had been secured and a plan B was in place for fundraising if required.

Mental Health

The mental health project is about doing things differently. The project has involved talking to service users, families, carers and partners to understand what wasn’t working, what was working and what could be better. The feedback from those conversations was used to develop a draft strategy which was now being updated. Thrive MH Programme Board were responsible for the governance and provided oversight for all of the mental health transformation programmes. There were six strategic work streams and each was delivering a key priority.

A key priority action and risk within the service was having a strong workforce and work was being done to design the workforce of tomorrow today. The committee were also informed about the Daisy unit in Devizes which supported people with learning disabilities and had some positive results. Work was also being done to commission a personality disorder service. Mental Health AWP had reviewed 111 calls as part of an investigation looking at how early intervention and prevention could be used to reduce emergency calls. Mental health professionals would also be available on the 111 service with band 7 nurses supporting band 5 nurses in crisis management. A single point of contact service would open on 20th March to provide a place of  ...  view the full minutes text for item 26.

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 Chair noted that the Child and Adolescent Mental Health (CAMHS) Task Group was due to present its final report at the committee’s meeting on 23 June 2020.

There were no further updates.

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 Tuesday 23 June 2020 starting at 10.30am at County Hall, Trowbridge.

The date of the next meeting was Tuesday 23 June 2020 starting at 10.30am at County Hall, Trowbridge.