Agenda and minutes

To receive any apologies or substitutions for the meeting.

Apologies for absence were received from the following:

• Cllr Mary Champion (substituted by Cllr Tom Rounds)

• Cllr Pip Ridout (who attended the hybrid meeting virtually)

• Irene Kohler - Healthwatch Wiltshire

• Diane Gooch – Wiltshire Service Users Network

• Mary Reed – Wiltshire Centre for Independent Living

The chairman took the opportunity to thank Cllr Antonia Piazza for his time sitting on the committee and welcomed his replacement, Cllr Pauline Church.

He reported that the Wiltshire Centre for Independent Living had notified the committee that they wished for their Chief Executive Officer, Mary Reed, to replace Sue Denmark as their stakeholder representative. The chairman thanked Sue for her time with the committee and proposed that they appoint Mary Reed as her replacement.

Resolved

To replace Sue Denmark with Mary Reed as Wiltshire Centre for Independent Living’s Stakeholder representative on Health Select Committee.

To approve and sign the minutes of the meeting held on 22 September 2022.

Resolved

To confirm the minutes of the meeting, held on 22 September 2022, as a true and correct record, subject to alterations noting the apologies of Cllr Ridout and recording that Cllr Rounds was substituting for her rather than Cllr Sankey.

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 reported that the vice-chairman, Cllr Ridout and he had received a briefing on the council’s plans to work with care providers to meet the demand for good quality home care. He explained that forming a new alliance called Wiltshire Living Well At Home would make the provision of care more geographically focussed, more flexible and provide the opportunity to pilot different concepts. It was noted that the three scrutiny members briefed were supportive of the proposal and would report their findings to Cabinet on 13 December.

The committee were informed that they could expect to receive proposals for their planned inquiry day, undertaking a system wide review of hospital and admissions discharges, at their January meeting. 

Cllr Corbin arrived at 10:35am.

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 25 October 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 on 27 October 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.

There was no public participation.

An update on the progress with the Living My Life Daytime and Evening Opportunities Alliance.

The Director of Procurement and Commissioning provided an update on the progress with the Living My Life Daytime and Evening Opportunities Alliance. She explained that this was a new approach to commissioning and procurement aimed at transforming how disabled young people, adults and older people access daytime and evenings activities. The director was pleased to report that since the Alliance started, on 1 August, 16 providers had been added to an open framework from which they could bid to provide activities. An evaluation would also take place later in the week to discuss options for how the number of providers could be increased.

The director then outlined plans intended to support the Alliance, including continuing to guide grant funded organisations to join the open framework. In addition, work would be carried out with providers to improve their understanding about the eligibility of potential customers. Since 1 August, two further customers had been assessed as having eligible needs and their care was now being purchased by the Alliance. The two new customers joined the 169 eligible customers already registered with the 16 providers, with more expected to follow.

During the discussion the following points were made:

• Members thanked the director for providing the report and praised the work being done to monitor service provision and expand the opportunities for eligible customers.

• The director noted that some smaller providers had faced challenges in accessing the external portal to register as a provider. However, she reassured the committee that the procurement team had produced a guide on how to access the portal and were also reviewing options for alternative portals. In addition, each provider was allocated a support officer to assist them with the registration process.

• In response to a question about why only three of the 31 grant funded luncheon clubs had joined the open framework, the director noted that a number of the clubs would be attending a review panel at the end of the week. She also highlighted that several clubs had sought alternative forms of funding.

• A question was asked about whether discretionary funding would be available to support luncheon clubs that provided services to older and vulnerable people but only had a limited number of, or no, eligible customers assessed under the Care Act. In response, the Cabinet Member for Adult Social Care, SEND, Transition and Inclusion noted that discretionary funding was available through Area Boards via the Older and Vulnerable People’s Grant Scheme and reported that five clubs had already received support through that route. She underlined that it was the council’s statutory responsibility to support people assessed under the Care Act and encouraged councillors to work with clubs in their areas to get assessments for potentially eligible customers.

• The Interim Head of Service for Whole Life Commissioning clarified that there were not specific criteria that clubs needed to meet in order to bid to join the open framework. However, clubs would be expected to provide costings, safeguarding assurances and outline the  ...  view the full minutes text for item 71.

A report outlining the key challenges faced across health and care services this Winter and the preparations being made to meet these.

The Director for Living and Aging Well gave an overview of the pressures on and risks to the delivery of health services through the Wiltshire Care Alliance. She noted that there was an urgent care improvement plan for Wiltshire, before providing further detail about specific areas of focus such as emergency departments and sourcing home care. She stated that the plan, built collaboratively by partners across the Alliance, focussed on year-round pressures and delivering services in the community. The plan contained fewer projects than in previous years to concentrate efforts where the biggest impact could be made and to provide greater clarity about their anticipated impact. She then highlighted the eight key plans identified on page seven of the agenda supplement.

The Director of Locality Commissioning at the Bath and North East Somerset, Swindon and Wiltshire (BSW) Integrated Care Board (ICB) updated the committee about key risks to the delivery of plans. She reassured the members that the ICB reviewed the risks on a weekly basis, listing a range of mitigation measures in place, such as developing a resource base to combat the increased cost of locum staff.

The Director of Locality Commissioning at BSW ICB then gave details about three winter schemes being implemented across the whole of the integrated care system. A local control room had been set up in Chippenham to coordinate information and free up ambulance capacity by reducing the number of patients being admitted to hospital, when it was not the most appropriate setting for their treatment.  She then went into further detail about areas identified by the Chief Executive of NHS England to build extra capacity, and improve resilience, through the winter, before outlining how these were being applied in Wiltshire. One example was an increased focus on falls, with greater emphasis on prevention and delivering a two-hour emergency response to these incidents.  

During the conversation the following points were made:

• Members thanked the directors for the update and welcomed the schemes being put in place over the winter. Noting that many of the schemes were non-recurrent, they sought further clarity about the level of provision that would be in place post winter and for following winters. 

• The Director for Living and Aging Well acknowledged that most schemes in the winter plan were non-recurrent but stated that options for extending the programmes would be considered if these initiates proved to be successful. She explained that there was a large degree of autonomy about how the Better Care Fund could be spent, so reassured the committee that decisions for future years could be taken at a local level. She emphasised that a large proportion of current spending was used to purchase additional care home beds, and it was hoped that other measures, such as investment in funding for different patient pathways, would reduce this proportion over time.

• It was confirmed that virtual wards were due to be rolled out in Wiltshire, following similar initiatives in Bath and North East Somerset (BaNES  ...  view the full minutes text for item 72.

A presentation on the development of Wiltshire Neighbourhood Collaboratives, led by the BSW Integrated Care System.

The Wiltshire Integrated Care Alliance Programme and Delivery Lead explained that neighbourhood collaboratives would be community led network of partners, including area boards, the voluntary sector, emergency services and health and care providers, aiming to shape the delivery of services at a local level. The neighbourhood collaboratives would be a community-based asset within the Integrated Care System (ICS), having the opportunity to share ideas and best practice through a forum called Wiltshire Collaborative. She stressed that neighbourhood collaboratives would have a clear structure but would not replicate the work of existing bodies or be performance managed.

She reported that the aim was to create three neighbourhood collaboratives by April 2023, by which time a clear governance framework would have been developed. A steering group would be set up, with task and finishing groups to oversee the implementation of the plans, with the intention of establishing a neighbourhood collaborative in each of Wiltshire’s 13 Primary Care Networks (PCNs) by 2024.

During the discussion points included:

• Members thanked the delivery lead for her very detailed presentation and welcomed the principle of local decision making.

• Questions were asked about how the implementation and success of the neighbourhood collaboratives would be measured and how they would improve patient care. In response, the delivery lead explained that she thought the neighbourhood collaboratives would help to identify gaps in existing service provision. Local communities would have the ability to interrogate and add to data provided nationally through a body called Optum. Wiltshire wide key performance indicators (KPIs) would be developed, and neighbourhood collaboratives would also be able to establish their own KPIs to measure how services were provided.

• She noted that plans for neighbourhood collaboratives built upon the learning from population health management pilot study conducted in Trowbridge, which had shared data to help identify that around 80 people in the area that were likely to become housebound within the next two years. As a result of the work being undertaken, preventative measures were now being put in place to try to mitigate the risk to those individuals

• The delivery lead reassured the committee that the collaboratives had been designed not to duplicate the work of existing organisations and stated that she would welcome information from members if there were areas in which duplication was taking place. 

• Observations were made that many of the partners anticipated to take part in the 13 neighbourhood collaboratives were groups already attending Wiltshire’s 18 Area Boards. It was suggested that there would be opportunity to share contacts and discuss how the Older and Vulnerable People Grant Scheme could be targeted most effectively. The delivery lead agreed that it would be productive to work closely with Area Boards and explained that PCNs would speak to local groups to establish stakeholders within each neighbourhood collaborative.

• It was also suggested that there would be scope for engagement with the Warminster Health and Wellbeing Social Care Forum.

Resolved

To note the comprehensive update on the implementation of the  ...  view the full minutes text for item 73.

The Associate Director of Mental Health Transformation at BSW ICS provided an information briefing about the implementation of the Community Mental Health Framework (CMHF) across BSW as well as the impact of, and plans for, the service. She explained that a national framework had been put in place in 2019 designed to enable people to make positive decisions, make the best use of community service and adopt a preventative model to mental health.  

During the briefing points included:

• CMHF focussed on improving services for specific groups of people, including those with eating disorders and complex emotional needs.

• A key aim was to get the input of people who had experienced mental health issues themselves when deciding how services were to be delivered in the community, including by gathering their views through Healthwatch Wiltshire. Close work was also being done with partners in the voluntary sector, Alabare and Rethink Mental Illness, to support patients throughout their treatment.

• Two new mental health practitioners had been employed to work directly with seven PCNs.

• Annual health checks were being introduced for people with severe mental illness, as they had a life expectancy between 10 and 20 years below the general population.

• A single point of access had been developed for Children and Adolescent Mental Health Services and work was going on to improve transition into adult services.

• The programme would be implemented at a BSW level by using the Thrive Strategy, which considered service provision across all aspects of mental health. 

• A gap analysis was being undertaken to look at services for adults over the age of 65 with a functional mental illness.

• It was noted that there was a move away from a purely target based culture to one focusing more on the impact services to patients. This approach was reflected in a new outcomes framework, co-developed with the ICS covering Bristol, North Somerset and South Gloucestershire, which would consider both quantitative and qualitative data. 

• It was emphasised that the services could be adapted to reflect findings about their impact.

• The CMHF was intended as a five-year transformation programme and, as such, additional transformation funding would cease at the end of 2023/24. However, the associate director was keen to stress that the programme should be seen in the context of longer-term changes to the delivery of mental health services in the community and emphasised that it would help to develop a BSW’s system wide mental health strategy.

Resolved

To note the report and the overview of the community mental health framework across BSW, summarising the key features of the plan and the anticipated impact for service users, carers, and stakeholders.

To report on a recent review into the reasons behind premature deaths amongst people with learning disabilities.

The Director for the Whole-life Pathway at Wiltshire Council gave a presentation about a recent review conducted into the reasons behind premature deaths amongst autistic people and people with learning disabilities. She explained that there was a local area co-ordinator reporting into committees across BSW to develop a better understanding of how health inequalities could be reduced for people with learning disabilities or autism.

It was highlighted that Wiltshire Council undertook reviews upon the death of individuals with autism or learning disabilities to learn more about the underlying causes. Although this was not a statutory responsibility it was felt that these reviews could enhance understanding and drive service improvement. On average someone with a learning disability dies 22 years younger than the general population and, although these premature deaths are often related to an underlying condition, some deaths are avoidable. It was reported that the leading cause of avoidable premature death in BSW for this group was choking issues related to aspiration pneumonia. During the pandemic in 2021 the rate of excess deaths for people with learning disabilities was twice as high as in the general population, so work was going on to promote the vaccination programme.

During the discussion points included:

• Members thanked the director for the presentation.

• It was noted that people with learning disabilities often got diagnosed with dementia far earlier than the general population and were more likely to face challenges in maintaining a healthy bodyweight.

• The median age of people going through the review programme was 51-70.

• In response to a question about whether the lessons from the programme could be applied widely, the director reported that a multi-agency training programme was due to take place on 1 December for the voluntary and community sector.

• Amongst the lessons learnt was the need for people with a learning disability or autism to be given a medical passport when they were admitted into a hospital or rehabilitation units. Attempts were also made to ensure that patients were given packages of care that were not more restrictive than necessary.

• It was acknowledged that there were challenges in providing care, such a dental treatment or cancer screening, for patients with challenging behaviour. The approach of NHS England was to avoid going down the route of specialist services in favour of a model of providing reasonable adjustments. However, the director noted that a national debate was taking place to analyse the merits of different approaches.

Resolved

To note the work underway to improve care and reduce health inequalities for people with a learning disability and/or autism and to prevent people with those needs dying prematurely.

To report the findings and recommendations of a Rapid Scrutiny Exercise reviewing the implications of a new Health Overview and Scrutiny Principles document published by the Department for Health and Social Care (DHSC).

The chairman introduced a report from a rapid scrutiny exercise undertaken to review the new health scrutiny principles document published by the Department for Health and Social Care, and to consider any implications for health scrutiny in Wiltshire. The chairman explained that whilst the new principals did not significantly change health scrutiny’s essential role, it did provide the committee with an opportunity to review its approach in the context of the new integrated system. He highlighted that the group had agreed eight recommendations focusing on the monitoring of the implementation of the ICS alongside counterparts in BaNES and Swindon. There would be a stronger emphasis on information sharing with local colleagues, such as Healthwatch Wiltshire, and greater public engagement when undertaking scrutiny into specific topics.

During the discussion, members welcomed the improved connections with bodies scrutinising the NHS is different ways, including their counterparts in BaNES and Swindon. They also endorsed an approach placing a greater emphasis on public engagement, highlighting the issues regarding the PCN in Calne as an example of when this might have provided additional insight.

Resolved

To endorse and implement the following recommendations of the rapid scrutiny exercise, with updates being bought back to the committee when appropriate:

1. Health Select Committee (HSC) to receive regular updates on the transition to integration, including its implications in practice such as the funding, commissioning and delivery of services at both place-and system level.

2. HSC to engage in the development of the system-level Integrated Care Strategy, placing particular focus on its objectives and how their delivery will be measured.

3. HSC to receive the next Joint Strategic Needs Assessment (JSNA) being developed by Wiltshire’s Health and Wellbeing Board and understand how it informs the design of services at place-level.

4. The chairman and vice-chairman to meet with their counterparts from BaNES Council and Swindon Borough Councils to discuss the programme of integration and opportunities for collaboration.

5. The chairman and vice-chairman to review and update the HSC work programme with Cabinet Members and directors at the meetings scheduled in November, ensuring appropriate balance between proactive scrutiny and retaining capacity for scrutiny of issues of concern to local communities, reporting back to Committee.

6. The chairman and vice-chairman to meet with representatives from the Integrated Care System to discuss the following and report back to HSC:

A) How they can work together to achieve efficient and effective HSC engagement on system-level proposals and performance.

B) HSC’s forward work programme, ensuring key integration milestones and system level service proposals are reflected;

C) How the ICB will be proactive, open and transparent in sharing information, involving HSC early in contentious matters and building scrutiny into the cycle of planning, commissioning, delivery and evaluation;

D) How the ICB can engage in the HSC’s performance data monitoring arrangements, currently being developed;

7. The chairman and vice-chairman to invite regular liaison with Healthwatch Wiltshire to discuss work priorities, share information and reports and ensure people’s needs and experiences are reflected in HSC’s work.

8.  ...  view the full minutes text for item 76.

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

The chairman invited suggestions from members about what they would like to see added to their forward work programme and noted that addition of an item regarding South West Ambulance Service Foundation Trust earlier in the meeting. He also reported that discussions would be held with the relevant cabinet members about the forward work plan.

Resolved

To note the forward work programme as amended at the meeting, including the addition of the item agreed regarding pressures on the ambulance service.

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 18 January 2023, at 10:30am.

The date of the next meeting was confirmed as 18 January 2023, at 10:30am.