Agenda and minutes

To receive any apologies or substitutions for the meeting.

Apologies for absence were received from Cllr David Vigar and Cllr Jack Oatley, who were substituted by Cllr Liz Alstrom and Cllr Ernie Clark respectively. Sue Denmark, Elizabeth Disney, Chief Operating Officer BANES, Swindon and Wiltshire Clinical Commissioning Group and Jo Cullen also offered their apologies. 

To approve and sign the minutes of the meeting held on 6 July 2021.

Resolved:

To confirm the minutes of the meeting held on 6 July 2021 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 of their decision to hold a rapid scrutiny exercise around the issue of Housing Related Support and asked any members that wanted to be involved with this exercise, to be held on 13 October, to contact the Senior Scrutiny Officer.

The Chairman then announced that the Vice-Chairman and he had met with the Cabinet Member for Public Health and the Director of Public Health in the first week of September. The purpose of the meeting was to understand the key priorities for Public Health over the next 12 months, which, in turn, would help the Committee to further shape its own scrutiny work programme. The Chairman also announced that the Vice-Chairman and he were due to meet the Cabinet Member for Social Care, SEND, Transition and Inclusion later in the month.

He then referred to the Prime Minister’s statement on Tuesday 7 September announcing to changes to National Insurance in order to provide an extra £36 billion over the next three years for frontline health and care. The Chairman reported that he had invited the Executive to update the Committee about the implications of the announcement for Wiltshire.

Statements

Members of the public who wish to submit a statement in relation to an item on this agenda should submit this is electronically to the officer named on this agenda no later than 5pm on Monday 6 September 2021.

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 1 September 2021 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 3 September 2021.

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.

No questions were submitted by the public.

On 19 October 2021, Full Council will discuss the adoption of a new 10-year Business Plan for Wiltshire Council. This will follow its consideration by Cabinet on 27 September 2021.

The Business Plan sets the council’s overarching strategy and its purpose is to enable Chief Officers to lead and manage the organisation to achieve the priorities and objectives set by elected members. In September, each select committee will be invited to comment on Business Plan priorities relevant to their remits, with comments being referred to Cabinet to consider at its meeting on 27 September 2021.

The final Business Plan will be an influential document when OS is developing its forward work programme, with experience showing that OS is most impactful when it focuses on the council’s key priorities. Alongside select committee engagement on the Business Plan, the chairs and vice-chairs will be meeting with their Executive counterparts and directors during September to gain a more informed understanding of plans and projects and to discuss how OS can engage most constructively. These two processes should lead to a well-developed OS forward work programme that reflects the key priorities of the council.

The Chairman informed the Committee that Full Council would discuss the adoption of a new 10-year Business Plan for Wiltshire, after prior consideration by both the Overview and Scrutiny (O&S) Management Committee and Cabinet.

He explained that the Business Plan was a key document for the Health Select Committee as it would set the health and care priorities for the Council and in turn the work programme of the Committee.

As the Vice-Chairman and he were both members of the O&S Management Committee, the Chairman stated that they would have the opportunity to ask health and care related questions at their next meeting. However, as the plan had yet to be published at the time of the Health Select Committee meeting, the Chairman asked members if they would welcome the opportunity to meet informally before the meeting of the O&S Management Committee to scrutinise the Business Plan.

Cllr Laura Mayes, Deputy Leader and Cabinet Member for Children’s Services and Skills, outlined the four key priorities identified in the plan:

• Empowered people.

• A resilient society.

• A thriving economy.

• A sustainable environment.

The Deputy Leader explained that the final document would be written thematically, rather than having a chapter for each department, so health and care issues were woven throughout.

Given the limited time available for Health Select to scrutinise the Business Plan before it was submitted to the O&S Management Committee, she welcomed the suggestion by the Chairman to hold an informal meeting. Furthermore, she invited members of the Committee to make suggestions about what they would like to be included.

During the discussion the following points were made:

• Members did indicate that they would appreciate the opportunity to hold an informal meeting.

• As the government’s white paper on health and social care had yet to be published, members asked if there was scope for potential adjustments to the Council’s Business Plan to reflect changes in government policy. Jane Davies Cabinet Member for Adult Social Care, SEND, Transition and Inclusion noted that there would be an annual review process of the Business Plan so it could be adapted.

• Members stated that they would like that they would like the Shared Lives programme to feature prominently in the document.

• Members noted that early intervention, prevention and the need to create a healthier population were features of the current business plan and expressed a desire that they also feature strongly on the forthcoming plan.

• Given the growing reliance on digital services, members also noted that they would like the role of technology to feature prominently.

Resolved:

1.    To thank the Deputy Leader and Cabinet Member for Adult Social Care, SEND, Transition and Inclusion for the update on the Business Plan.

2.    To invite Health Select Committee members to attend an informal meeting upon the publication of the Business Plan, but prior to the meeting of the O&S Management Committee on 21 September. This meeting would provide an opportunity to  ...  view the full minutes text for item 29.

A report is attached from the Director of Public Health that outlines proposals for allocating the £830,051 MHCLG 2021-22 grant funding to support victims of domestic abuse and their children residing in safe accommodation.

Members are invited to comment in advance of consideration by Cabinet.

Cllr Simon Jacobs, Cabinet Member for Public Health, provided background information about the proposals, explaining that Wiltshire Council was already spending roughly £1 million per year on domestic abuse support and currently provided 37 refuge bed spaces. £830,051, roughly quadruple the expected amount, had been granted to Wiltshire Council by the Ministry for Housing, Communities and Local Government (MHCLG) for the provision of support to victims of domestic abuse, and their children, in 2021-22.

The cabinet member saw the funding as an opportunity to break the cycle of abuse but stressed that it had to be spent quickly. Although a large grant had been made available for 2021-22 further information about future funding had not been made available. He then referred the Committee to the report attached to the agenda pack, which provided a breakdown of how it was intended for the money to be spent, as well as the recommendations to be put to Cabinet for approval on 14 September. Given the short-term nature of the funding, he felt that it was not possible to source additional refuge accommodation. Instead, the money would be used to improve and expand existing services.

During the discussion the following points were made:

• Members welcomed the extra investment given that the expected grant was around a quarter of the figure actually provided.

• It was asked if a report would be made available part way through the year to provide an update on the progress made.

• Questions arose about how many people were currently being supported. The cabinet member noted that the provider, Splitz, had reported a 30 percent increase in numbers between March 2020 and March 2021. He also contextualised that there had been a steady increase in demand nationally across the last four years, which he expected to continue. However, he did not necessarily see this as a negative and explained that it could be a sign that people now had the confidence to come forward when that may not have previously been the case.

• Members enquired about the level of advocacy support currently being provided by Splitz. Hayley Mortimer Public Health Consultant clarified that Splitz do employ independent advocates for domestic abuse workers and there is an accreditation that those support workers will provide. However, she also offered to provide further information and to look at future opportunities.

• In response to queries about whether there were enough beds to meet demand, it was explained that they were currently operating at around 90 percent occupancy, so there was capacity and flexibility available to meet increased demand. If, in the longer-term, demand continued to increase then the possibility of supplying additional beds would be explored.

• It was noted that additional staff would be employed on 12-month fixed contracts given the timeframe in which the additional funding had to be spent and that they would be employed directly by Splitz.

• It was asked how Splitz’s spending on new roles would be monitored to ensure that staff were  ...  view the full minutes text for item 30.

RUH Programme managers Simon Cook and Geoff Underwood will brief the committee on the health and care vison/support model being developed and how this will shape any potential business case bids to invest in the RUH infrastructure.

The committee is invited to comment on the proposals and consider how it may wish to scrutinise going forward.

RUH Programme Managers Simon Cook and Geoff Underwood gave a very detailed presentation about the health and care support model being developed across the BANES, Swindon and Wiltshire (BSW) System and how they felt this would shape any potential business case bids to invest in the RUH infrastructure.

The managers highlighted long term pressures facing health and care, such as an aging population and spoke about technological innovations changing the way that services are delivered. Against this background they developed seven priority areas had been identified, based on the RUH’s plans for the future of the hospital as well as principles put forward by the BSW group:

1. Provide holistic and flexible care seamlessly as one system with embedded innovation and continual improvement.

2. Care is preventative, proactive and anticipatory, focuses on wellbeing and addresses health inequalities through the lens of wider determinants of health.

3. Provide person centred care and empowerment to put the person in control of their health and well being, and ensuring that each interaction adds value to the person.

4. Provide care at home or in the community wherever appropriate, coordinated through strong primary care networks and multidisciplinary teams, and supported by sufficient emergency and specialist capacity in hospitals.

5. Lead with digital and data to support seamless care for our patients and drive more effective decision making.

6. Support an agile workforce, champion innovative roles and provide opportunities for training, research and development.

7. Deliver an efficient way of working to ensure financial sustainability of the system and value for money of services.

A potential model for the future was outlined, comprising a coordinated system making it easy to access health care services. There would be an emphasis on prevention to reduce demand for health care. The managers emphasised that the hospital itself was only a single part of the patient pathway, indeed, it was hoped to provide more care in the community to allow hospitals to focus on care that could only be delivered in a hospital setting.

When summing up, the managers spoke about the importance of involving the public in developing the care model. Similar models were being developed by the Wiltshire Integrated Care Alliance and their equivalent in Swindon, so it was planned to coordinate all three plans to cover the whole of BSW. Whilst the focus of their presentation had been on BANES and West Wiltshire, the catchment area of the RUH, they stated that a version covering the whole of BSW would be bought to a consultation event on 7 October. Further consultation events would then be held up until the end of November 2021.

During the discussion the following points were made:

• Engagement would be undertaken with all doctors including GPs and those in mental health teams.

• It was felt that a lack of community doctors, particularly in less urban areas, would drive people to hospital when it may have been more efficient to treat them elsewhere.

• Questions were raised about how diagnosis  ...  view the full minutes text for item 31.

The committee invited an update on the work of Wiltshire’s Reablement Service at its last meeting.  The Director of Access and Reablement will brief the committee on the impact of the pandemic and the opportunities and challenges faced as the service prepares for winter demand.

Emma Legg, Director Adult Care Operations; Access and Reablement, provided a presentation to the Committee about demand for reablement services as well as their future plans. She informed the Committee that they provided a wide range of services and had seen increased demand for care and support. Although the number of contacts coming to the Contact Team had fallen at the start of the pandemic, numbers had now risen, so were now averaging 6,000 per month. Similarly, Section 42 safeguarding enquiries had increased in 2021, with particular spikes in the number of reported cases of physical abuse and neglect.

It was noted that the number of patients being discharged back to their homes (Pathway 1) had increased and was being managed through further integration. The director explained that this type of reablement reduces the need for long term care. She reported that Pathway 2, those patients unable to return home immediately so requiring a bed, had also increased, although less markedly than those through Pathway 1.

Looking ahead to the winter, the reablement service were working with partners to develop demand and capacity modelling in order to identify gaps in provision. Prevention of hospital admissions was a key focus, with a new crisis response service being established. There was an emphasis on working with people at an early stage to delay their social care needs, such as through identifying the support equipment and home adaptions needed. Work was also underway with the voluntary sector to support discharge and improve planning for long term care, to ensure that it is outside a hospital setting. She noted that over the past few years there had been a significant increase in the number of people being supported in their own homes, with the number of people starting in domiciliary care rising from 79 percent in 2019-20 to 87 percent in 2021.

During the discussion the following points were made:

• In response to questions about whether targets were being met, the director stated that figures compared well with other local authorities. Further analysis was also being undertaken around the placements made and how those compared with other authorities.

• It was reported that the summer had not relieved the pressure on services as much as usual. Planning for the winter was well advanced and modelling had taken account of potential spikes in Covid-19 or Flu.

Resolved:

To thank the director for the update and to note the work taking place to ensure the Access and Reablement Service is prepared for the winter.

In July the committee requested updates on the wellbeing of health and social care staff following media coverage suggesting many workers were facing extreme challenges after 18 months of working intensively. The committee has already received an update from health partners; this second report updates on the work taking place within the council to support its staff and in consequence ensure ongoing service delivery continues to be effective.

The Director Adult Care Operations; Access and Reablement referred the Committee to the report contained in the agenda pack and gave an overview of the key findings. Recruitment was identified as a key challenge, particularly in certain teams where the vacancy rate is up to 31 percent. Whilst the council was successful in recruiting newly qualified staff there were issues with retaining experienced staff and turnover was higher than the national average. Challenges had also been identified in providing peer support given that many staff were working remotely during Covid-19. An overarching workforce strategy was being developed in order to address the issues identified. The strategy would include a range of measures to improve recruitment, such as further engagement with universities over placements and supporting degree apprenticeships. Other measures would focus on allowing staff time for recovery and building a supportive working environment.

During the course of the discussion the following points were made:

• Concerns were raised about feedback from a staff survey identifying the drawbacks of remote working, such as creating social isolation and making communication more difficult. Given that some staff may prefer the chance to return to the office, questions were asked about the ratio of staff to available desk spaces and whether staff, who wanted to, had been given the chance to return to work. The director noted that there had been a variety of feedback and work was underway with different teams to provide support for individuals. Due to the varying requirements of different teams some teams needed more of a presence in County Hall whilst others were able to carry out more work remotely.

• Members noted that a reduced level of staff sickness had been reported over the past year and the director explained that they would monitor this to see if levels increased once staff were attending the office on a frequent basis.

• It was noted that experienced staff numbers were the greatest area of focus and concern. A range of measures were being considered to address this issue, such as encouraging those who had left the profession to return to work and allowing more flexible working.

• Questions were asked about whether information was available about where staff went after they left their roles, such as whether the left the profession or took a similar job with a different employer. It was noted that they left for a variety of reasons but that exit interviews were being undertaken.

• The Director of People was also present and noted that senior managers met with a staff reference group, representing all adult social care teams, to discuss the workforce strategy.

• Officers were unable to confirm whether members of a supported graduate scheme were expected to stay with the council for a minimum period of time upon qualification. However, they did note that staff had to have worked for the council for a certain period on order to be applicable for an apprenticeship.

Resolved:

1)    To thank officers for the update.  ...  view the full minutes text for item 33.

A report is attached which provides an update on the Wiltshire/place-based governance arrangements being developed in response to the Health and Care Bill 2021-22.

The committee is asked:

a) To agree to bring the draft Cabinet report on the ICS ‘place-based’ governance framework for Wiltshire to its 2 November meeting.

b) To agree to the chair and vice chair representing the committee at the proposed September and October workshops listed within the report.

The Chairman referred the Committee to the information included in the agenda pack. He explained that Cabinet would be asked to approve the new governance arrangements for Wiltshire emerging from the Social Care Bill and that the draft proposals would be bought to the November meeting of Health Select Committee. He also explained that the Vice-Chairman and he had been invited to a development workshop. The Chairman reiterated that the proposals would directly impact the Committee and welcomed the opportunity to help shape the arrangements.

Lucy Townsend, Corporate Director People, noted that the work of the Committee would be focused primarily on Wiltshire as the ‘place’ level. Work was also underway through the Integrated Care Alliance (ICA) to look at the ‘neighbourhood’ level. Officers across different partners, including the CCG and local authorities had discussed their preferred options for governance arrangements and these would be bought to the workshop due to be attended by the Chairman and Vice-Chairman. If approved by Cabinet in November, the new governance structure would be implemented from April 2022.

Resolved:

1.    To agree to bring the draft Cabinet report on the ICS place-based governance framework for Wiltshire to its 2 November meeting.

2.    To agree to the Chairman and Vice-Chairman representing the Committee at the proposed September and October workshops.

To consider the forward work programme for the Health Select Committee.

As a result of interest from the Committee the Chairman proposed to have a focus on carers at the November meeting. There were no objections from the Committee.

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 2 November at 10:30am.

The date of the next ordinary meeting of the Health select Committee was confirmed as 2 November 2021, at 10:30am.