Agenda and minutes

To receive any apologies or substitutions for the meeting.

Apologies for absence were received from:

• Cllr Dr Monica Devendran (Cllr Tony Pickernell substitute)

• Cllr Mike Sankey (Cllr Tom Rounds substitute)

• Cllr Gavin Grant (Cllr Trevor Carbin substitute)

• Cllr Caroline Corbin (Cllr Ricky Rogers substitute)

• Cllr Richard Clewer

• Diane Gooch – Wiltshire Service Users Network

To approve and sign the minutes of the meeting held on 11 January 2022.

Resolved

To confirm the minutes of the meeting held on 11 January 2022 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 announced that the Vice-Chairman and he had met with BaNES, Swindon and Wiltshire (BSW) Clinical Commissioning Group’s (CCG’s) Director of Primary Care. The meeting, held on 24 January, had been arranged to discuss the Care Quality Commission’s assessment of the Patford House GP practice’s service as inadequate. The Vice-Chairman and he had been assured by the CCG that they were working closely with the practice to respond to areas of concern. He informed the committee that members of the CCG were in attendance and that there would be an opportunity to ask further questions as part of the Primary Care update later in the 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 9 March 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 onFriday 11 March 2022. 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.

Questions 22-03 and 22-04 were received from the following member of the public:

Mr Chris Caswill

The Chairman referred the committee to the questions and written responses included in Agenda Supplement 1. He also noted that he had received further communication from Mr Caswill.

The committee at its 11 January meeting received a presentation outlining the results of the public engagement exercise around the new health and care model being developed across the Bath and North East Somerset, Swindon and Wiltshire (BSW) region. The engagement ran from 2 November to 14 December 2021 and the formal report is now attached for information.

The project team will update the committee on the next steps for the programme as plans are developed ahead of the formal launch of the Integrated Care System in July 2022.

The Deputy Chief Operating Officer of BSW CCG explained that the draft health and care model provided a strategic overview across BSW and was a useful framework with which to go forward.

The officer then provided background information about how it was planned to progress the model beyond July 2022, as the CCG was replaced by the Integrated Care System (ICS). She noted that the plans would be developed at the ‘place’ level in the ICS through the Wiltshire Integrated Care Alliance, as well as its equivalents in BaNES and Swindon. Wiltshire Council would work with other partners in the Alliance, such as the NHS, voluntary and community providers, to influence the implementation of the health and care model. She reassured members that reports on the health and care plan would continue to be presented to the Health Select Committee and Health and Wellbeing Board.

Programme directors at Shaping a Healthier Future then introduced the final report about their six-week public engagement consultation, found between pages 17 and 62 of the agenda pack.

During the discussion key points included:

• Members thanked the officer for the background information about how the plan was to be taken forward, as well as the directors for their engagement report.

• It was asked if there were any demographic and geographical trends in the individual responses provided to the survey. The directors stated that they would consult with their colleagues who presented the data to find out further information.

• Members welcomed the recommendations made in the report and highlighted that they would need to be considered in a joined-up fashion, as part of a wider cultural change, so that the full benefits could be realised.

• The directors welcomed the point raised about coordinating change. They announced that a BSW Academy was being set up to consider workforce issues across the whole ICS, noting that it would include a Transformation and Change Centre.

• The importance of tying the implementation plan with the current demand was also commented on by members. They spoke about the need to measure outputs against the aspirations set out in the implementation plan, as well as existing services.   

• The idea of creating a database of the relevant individuals and organisations that had and had not participated in the consultations was welcomed. It was stressed that it was important to continue consulting with small and voluntary organisations to track the progress of the plans.

• The importance of continuing to engage with members of the public with limited internet access was highlighted by members. They welcomed the clarification around the digital by default language in the report and explained that they would like to see further examples of how digital services would be used in practice. They stated that digitalisation was about all processes within the NHS and not just about the patient interface.

• In response, the directors spoke about the need to make the best use of digital resources and to avoid the impression that services  ...  view the full minutes text for item 19.

The committee to receive an update from Clinical Commissioning Group (CCG) officers on current priorities and performance as the organisation transitions to the formal launch of the Integrated Care System in July 2022.

The Director of Primary Care at BSW CCG, explained that Primary Care included GP appointments and other services such as dentistry and pharmacies. She then provided an update on the current performance, including the progress of the vaccination programme, explaining that data was shared at the monthly Primary Commissioning Committee.

She reported that an ‘evergreen offer’ was in place to encourage unvaccinated people to come forward for their first jab. Data was being used to identify individual streets with lower take up, allowing the vaccine bus to be deployed as effectively as possible. Community vaccine centres included local pubs and a Sikh temple. It was explained that plans were being put in place to roll out the fourth phase of the vaccine programme targeting higher risk groups, such as the over 75s. Primary Care staff would continue to play an important role in the vaccine programme but on a smaller scale than the last two years. Going forward there would be a focus on addressing the non-Covid needs of patients with plans to improve access to GPs outside of normal working hours. 

During the discussion key points included:

• Members thanked the director for the update and asked if further detail about the Covid-19 vaccine uptake could be shared.

• Cllr Howard Greenman, reported significant concerns, based on his own experience, those of residents and the local parish council about the GP Practice in Sutton Benger, part of the Patford House Partnership. He then stated that it was imperative that action was taken to improve the service at Patford House Surgery, Beversbrook Medical Centre and Sutton Benger Surgery.

• The director explained that the CCG had been working closely with the partnership over the past two years and agreed that tangible action was required. She reported that the CCG had an oversight board specifically looking at Patford House Partnership and discussions were ongoing about the implementation of the action plan to improve the quality of the service provided. The Care Quality Commission (CQC) were also shortly due to visit all three sites to assess compliance with warning notices.

• The director noted that the practice’s GP contract was under review. As there were approximately 15,000 patients registered at the practice, she explained that contingency plans would need to be in place should the practice have its registration removed.

• Members noted that the potential closure of the Patford House would impact the Primary Care infrastructure across the whole county and requested a further update on the imminent inspection.

• Cllr Tom Rounds, Chairman of Calne Area Board, noted that the Area Board had received an update from the practice manager of Patford House. He stated that services had deteriorated since the merger of the three sites. He then explained that there were staff shortages at the surgeries and that the management practice needed to be looked at forensically.

• Other members raised concerns about the number of doctors and access to appointments in their area. Cllr Pip Ridout highlighted that  ...  view the full minutes text for item 20.

A report is attached from the Director of Public Health updating the committee on the NHS Health Checks programme in Wiltshire, including how the programme is restarting following the impacts of the Covid-19 pandemic.

The committee is invited to input into the development of the community outreach element of NHS Health Checks and how this intends to address health inequalities across Wiltshire.

Cllr Ian Blair-Pilling, Cabinet Member for Public Health and Public Protection, Leisure, Libraries, Facilities Management and Operational Assets, introduced the report starting on page 63 of the agenda pack. The cabinet member was pleased to report that Wiltshire’s population was healthier than the English average. However, he stated that further work needed to be carried out to engage with harder to reach groups, highlighting a correlation between people not participating in the scheme and people not taking up a Covid-19 vaccination. Extending the reach of the programme to groups who had not previously received a check-up was predicted to yield the greatest results in reducing health inequalities. He reported that, in order to reach groups that might have been missing out on treatment, GPs had been asked to prioritise individuals with learning difficulties and to offer evening clinics.

Referencing a national report on health inequalities, published in December 2021, the cabinet member explained the need to focus on starting checks at a young age, mental health and reviewing digital services. He then opened the report up to the committee, wishing to draw upon their experience and ideas to help to enhance the proposals. 

During the discussion the following points were made:

• Members thanked officers and the cabinet member for the report, welcoming the focus on vulnerable communities.

• The cabinet member stressed the importance of supporting public health by using the full range of measures available to the council, such as by promoting physical activity in its leisure centres.

• The importance of communicating in plain English was highlighted by members, as they felt that this would help to promote uptake.

• It was also emphasised that encouraging peer-to-peer support in informal settings would be a productive approach, as formal learning settings could deter participation for some. Utilising existing groups would also mean that it would not be necessary to set up new bodies.

• The Director of Public Health noted that a large amount had been learnt through the pandemic and thanked the committee for their comments on peer- to-peer learning. 

• In response to a question about whether previous rapid scrutiny into health inequalities, carried out under the previous council, had been considered, the director confirmed that it had. She stated that they had taken onboard the comments of the committee that remained relevant and had also learnt a great deal during the pandemic.

• Members highlighted the importance of data in determining which interventions had been successful and asked about whether the information collected captured variation in individual wards.

• A public health consultant confirmed that data could be broken down into individual wards and practices. She also stated that lots had been learnt by sharing data between local authorities as it had enabled them to apply lessons for specific groups.

• The cabinet member spoke about the importance of identifying the granularity of delivery as well as the granularity of need and stressed that useful lessons had been learnt from the roll out of the  ...  view the full minutes text for item 21.

A report is attached from the Director of Procurement and Commissioning outlining the council’s intentions in relation to the transformation of day opportunities. The report will be considered formally by Cabinet at its 29 March meeting and the committee is invited to input in advance of this Executive decision.

Cllr Jane Davies, Cabinet Member for Adult Social Care, SEND, Transition and Inclusion, introduced the report, which she noted would be presented to Cabinet for approval on 29 March. She explained that the proposals set out a new approach to transform how adults, with varying needs, accessed daytime and evening activities. A wider range of activities would be offered than under the existing procurement system and would be better aligned to the aspirations of service users. She reported that the council expected to spend £1.9 million on commissioned day services in the forthcoming year. The new contracts were expected to last for up to eight years and were predicted to have an average annual cost of around £2.1 million over that period. The cabinet member stated that the proposals would modernise the service offer and set out an overarching commissioning strategy to achieve this.

It was noted that around 800 adults benefitted from the day opportunities supported by the council. However, the proposed changes would impact the services currently delivered to 277 customers whose services were procured via spot-contracts. The remainder had services purchased via block contracts with Alzheimer’s Support or Order of St John, which would not be affected by the proposals.

A Commissioning Manager in Transformation, Procurement and Commissioning, explained that under existing arrangements spot contracts were in place with around 40 providers. Under the proposed open framework an approved list of suppliers would be drawn up, which could be added to over time. The new system would have a greater focus on outcomes, improve transparency, and ensure that provision was more geographically even. He reported that a meeting had been held with day centre providers and a further meeting was due to be held the following week. Information about the application process of how to join the list of open framework providers had been given out and it was hoped to award the first contracts in July.

During the discussion the following points were made:

• Members thanked the cabinet member and commissioning manager for the report.

• Members asked if there were people with eligible needs whose demands were not being met. The commissioning manager explained that some of the people attending luncheon clubs may have eligible needs and would receive services if they had undergone a care act assessment. It was hoped that the implementation of the new system would help people to come forward for assessment.

• In response to a question about what would happen if an individual wanted to participate in activity that was not provided for under the framework, the commissioning manager explained that they would use a direct payment system so that a person could choose the services that they wished to participate in. He noted that the framework would offer a wider choice of services, giving control to customers. 

• To follow up on the commissioning manger’s point, the cabinet member explained that the majority of people accessing day centres were self-funders and that grants had previously subsidised costs  ...  view the full minutes text for item 22.

Full Council on 15 February 2022 invited Overview and Scrutiny (OS) to consider the transformation proposals for grant funded lunch and friendship clubs. 

In response a rapid scrutiny (RS) exercise took place on 2 March 2022, the report of which is attached for consideration by the committee. 

The Chairman reminded the committee that, on 15 February, Full Council had invited Overview and Scrutiny to consider the transformation proposals for council grant funded luncheon and friendship clubs. He then outlined the key points from the report about the rapid scrutiny exercise held on 2 March:

• The group established that the historic funding arrangements for the clubs were inconsistent in value and operated under a closed shop for new applicants.

• The new framework would provide an opportunity for providers to evolve to make themselves attractive to potential customers and the funding that will follow.

• The use of plain English was key when communicating with the clubs.

• The new framework would provide more certainty to customers, providers and the council.

• The proposals were not about replacing the community groups who provided luncheon clubs for people without a formal care need.

• The 50 percent grant funding for next financial year would act as a bridge for clubs before they have an opportunity to draw down from the framework.

• The group felt it was key for the Health Select Committee to continue to monitor the roll out of the framework.

The Director of Procurement and Commissioning took the opportunity to update the committee about an engagement session held with the clubs on 9 March. She explained that it was well attended, with 31 of the 34 groups in attendance. Lots of questions had been asked, with the session lasting 90, rather than the planned 60 minutes. Concerns were raised about the changes to the existing grants, as well as the additional steps required to comply with the new framework. However, some organisations did welcome the opportunity to join the open framework, feeling it would allow them to widen the number of people attending their clubs. The director stated that the council was keen to maintain their positive working relationship with the clubs and explained that a further meeting was planned to provide an update and allow additional questions to be answered.

During the discussion the following points were made:

• Members thanked the rapid scrutiny group for the report, as well as the director for providing an update about the meeting held on 9 March.

• Cllr Vigar welcomed the changes to help learning disability groups but reiterated his concerns, raised in the previous item, about luncheon club provision for older people. He highlighted that the report expected approximately two thirds of the 32 clubs currently receiving grants to join the open framework and noted that they would be competing for funding to support no more than 35 individuals over the age of 65, the number of customers currently using spot purchased contracts in that age group. He also noted that 14 of the 277 customers currently supported using spot purchasing arrangements had support with memory and cognition as their primary need, so the clubs might actually be competing for funding for fewer than 35 individuals over the age of 65 if it was not  ...  view the full minutes text for item 23.

On 13 October 2021 a RS was undertaken where members concluded that they were satisfied with the council’s preferred position to end the Housing Related Support (HRS) service on 31st March 2022. As part of the exercise members agreed to meet in early 2022 to ensure that alternative support would be in place for residents up to and beyond 1 April 2022.

The second RS exercise took place on 11 February 2022, the report of which is attached for consideration by the committee.

Cllr Ruth Hopkinson, lead member of the rapid scrutiny exercise, presented the findings of the group following their meeting on 11 February. She reminded the committee that Housing Related Support (HRS), as originally designed, duplicated statutory services provided by landlords. However, the group had found that the service had evolved to the point where it was estimated that it could be masking the social care needs of 140 individuals who would otherwise have been in receipt of a social care assessment. Cllr Hopkinson explained that 12, rather than the estimated 140 people had come forward for assessment, so the rapid scrutiny group had concerns that elements of the work being carried out by the HRS were not being replaced.

The councillor reported that the group had found the reasons for removing the service were sound but did feel that there were ongoing risks and that the engagement with housing associations could have been improved. However, the group did welcome the signposting of residents to the Prevention and Wellbeing Team and Community Engagement Managers. The group felt that the Health Select Committee should continue to constructively monitor the withdrawal of the service to minimise risks.

The Director of Procurement and Commissioning reassured the committee that the 63 residents who had opted into an active care package had now had their care reviewed. The 63 individuals had received information about social and leisure opportunities, but none wished to receive onward referrals to address social isolation needs. She reported that a number of families had contacted landlords directly and had chosen not to be signposted elsewhere. Since the last committee meeting 25 referrals had been received from care providers into Adult Social Care, the majority of which related to hoarding. All bar four of the 25 referrals were due to receive a complete review of their needs by the end of the week. The director then offered to share additional information about advice and contact referrals.

Resolved

1.    That a written update is given to the Chairman and Vice-Chairman of the Health Select Committee on 31st March 2022 confirming the status of the HRS related care assessments.

2.    That the Prevention and Wellbeing Team prioritise its focus on sheltered housing schemes particularly during the transition period up to and beyond 1st April; and any associated delivery plan is shared with the members of the rapid scrutiny group.

3.    That the Health Select Committee incorporates into its work programme how the council’s Adult Social Care transformation intends to collaborate with the voluntary sector in relation to the proposed open framework for day care opportunities.

The committee is invited to consider the forward work programme.

The Chairman referred the committee to the Forward Work Plan outlined on page 105 of the agenda pack and invited suggestions from members. He stated that he would like to open up the briefings on Cabinet reports that sat outside of the formal committee meetings, normally only attended by the Chairman and Vice-Chairman, up to all members of the committee.

Members welcomed the proposed update from the South West Ambulance Service, at their June meeting, and requested that their performance data was broken down to a local level.

It was noted that a paper on the Care Home Tender was due to be presented to Cabinet in April. It was also noted that the date that the Forward Work Plan was last updated was listed as 1 April 2022.

The Cabinet Member for Adult Social Care, SEND, Transition and Inclusion reported that in a radio interview care home residents had given very positive feedback about the services that they were receiving. She then took the opportunity to thank staff for all of their hard work in supporting residents.

Resolved

1.    To note the Forward Work Plan.

2.    To extend, where appropriate, invitations to the wider committee for future briefings on cabinet reports.

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 ordinary meeting as Tuesday 7 June, at 10:30am.

The date of the next ordinary meeting was confirmed as Tuesday 7 June, at 10:30am.