Agenda and minutes

To receive any apologies or substitutions for the meeting.

Apologies were received from:

·       Councillor David Bowler (substituted by Councillor Trevor Carbin)

·       Councillor Clare Cape

·       Councillor Mary Champion

To approve and sign the minutes of the meeting held on 1 November 2022.

Resolved

To confirm the minutes of the meeting held on 1 November 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 reminded Committee Members of the scheduled online meeting to review the Council’s proposed budget for 2022/23 and Medium-Term Financial Strategy 2022/23 to 2024/25 ahead of the next meeting of the Overview and Scrutiny Management Committee. The Chairman emphasised the importance of reading the reports and considering any questions or discussion points that they wished to be raised on behalf of the Health Select Committee.

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 11 January 2023 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 13 January 2023. 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.

The Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board (BSW ICB) will provide a presentation on the workforce challenges being experienced in Wiltshire in the primary care sector. This follows a request from the Committee in September (minutes here), when it received a more general update on primary care provision.

Jo Cullen, Director of Primary Care, and Fiona Slevin-Brown, Director of Place, delivered a presentation outlining the workforce pressures being experienced across the Primary Care System.

An overview was given with the main pressures experienced being: increased demand in GP Practices, high levels of same day demand, demand for antibiotics, high levels of staff sickness and significant vacancies, ongoing impact of seasonal vaccination programmes, and increasing support for services such as ambulances, hospitals and mental health.

It was highlighted that Bath and North East Somerset, Swindon and Wiltshire (BSW) were in a relatively good position in comparison to others in the South West for GPs, General Practice Nurses and Direct Patient Care roles and that NHS England had rated BSW green with no concerns raised in each area. This was shown through workforce summaries for each area up to November 2022 bar Direct Patient Care Roles which was up to September 2022. Data and analysis with regard to vacancies and recruitment for GPs, Nurses, Director Patient Care roles within Wiltshire was discussed with some of the main areas of concern being: high locum costs, providing supervision and mentoring time to new staff, stipulations in national specification for Mental Health Practitioners and an ageing workforce. The Additional Role Recruitment Scheme (ARRS) was then briefly discussed. It was noted that the October Workforce Submissions estimated a 105% spend against the ARRS fund based on aspirational recruitment plans, as such, the ICB review the ARRS spend monthly with the finance team and two new ARRS roles were introduced from 1 October 2022 with a number of PCNs adopting them. Finally, the Training Hub was discussed, and the key areas of focus were highlighted, examples of which being: leadership, upskilling and retention.

Members discussed the vacancy rates, the ability for PCNs to meet service and demand, and the workforce summaries provided. Concerns were expressed with regard to some of the statistics shown but the positivity of BSW being classified as green was noted. Officers acknowledged that despite the green classification, the situation was fragile and as such, officers were continuing to seek improvements and solutions to the challenges discussed. Members then discussed PCN phone system contracts and the challenges it placed on admin staff across the County. It was noted that some PCN systems were not fit for purpose, yet they were unable to switch systems due to contractual obligations and high exit costs. Officers explained that funding had become available to ease the burden of such costs in order to provide PCNs with updated phone systems that have the ability to meet increasing demand.

At the conclusion of the discussion, it was then:

Resolved

1)    To note the detailed presentation from the BSW Integrated Care Board on the workforce challenges being experienced in Primary Care in Wiltshire.

2)    To note that while Wiltshire is in a fairly good position relative to other areas in the South West region, there are still significant challenges in the County’s Primary Care workforce.

3)    To receive  ...  view the full minutes text for item 6.

A presentation will be provided on the transformation of local maternity services. This follows a rapid scrutiny exercise undertaken jointly with Bath and North East Somerset Council and Swindon Borough Council in January 2020, reviewing proposals for the midwifery service redesign.  Having endorsed the rapid scrutiny group’s report (here), the Committee resolved to receive further updates on the implementation of the transformation programme.

Lucy Baker, Director of Planning and Transformational Programmes delivered an update on the implementation of the transformation programme for local maternity services.

An outline of the BSW Local Maternity and Neonatal System was provided alongside statistics and context for BSW mothers and babies, ethnic minority babies in the UK as a whole, deprivation, pregnant mothers who continue to smoke, and pre-term births. The 2018 Maternity Transformation Road Map was then displayed in conjunction with the initial Service Redesign plan. The current position of the programme and community hubs were then explored with the impacts of COVID on the project explained, and finally the long term plan for health projects.

The national initiative Continuity of Carer model of care was explained and the importance of informed choice and personalised care for mothers was emphasised. Within this, reducing inequalities in outcomes in regard to the Equity and Equality Action Plan was discussed and the four main areas of focus explored, namely: improving data collection to better understand local needs, language and communication, accessibility to maternity services, and race equality among maternity and neonatal staff. Finally, the safety and quality in maternity and neonatal services in BSW was discussed.

Members then considered the presentation and sought further details on the freestanding maternity units and how BSW fared in comparison with the rest of the South West and/or UK regarding quality of care. Officers confirmed that they would circulate a detailed quality report with Members, but that BSW compared well. The Ockenden Review was then raised, and officers noted that there were concerns regarding midwifery staffing but that a lot of work had invested into retention and recruitment. Furthermore, site visits had been conducted alongside informal interviews with mothers and staff members, and it was stated that unannounced spot checks by the Maternity Voice Partnership were also conducted.

Members then sought clarification as to the statistics regarding mothers from BAME (Black, Asian and Minority Ethnic) backgrounds, specifically around UK stillbirth and neonatal death rates. It was suggested that Members discuss the topic with the Lead Midwife outside of the meeting, however it was noted that there were a variety of factors leading to the statistics such as health complications and access to care. It was further emphasised that a huge amount of work had been undertaken to understand and overcome said issues. National and local home birth rates were then discussed, and it was explained that more women were choosing to give birth in hospital environments as they felt safer and more comfortable due to the close proximity of medical intervention if needed.

At the conclusion of the debate, it was then:

Resolved

To note the detailed update from the BSW Integrated Care Board on the transformation of maternity services following the rapid scrutiny exercise undertaken by the Committee in 2019-20.

A report is provided updating on the business planning process for the council, the link to the activity of ageing and living well and whole life pathway and the progress against that activity. The Committee is asked to note the update and use the information contained to help focus future scrutiny activity.

Cllr Jane Davies, Cabinet Member for Adult Social Care, SEND, Transition and Inclusion, Emma Legg, Director of Ageing and Living Well, and Daniel Wilkins, Head of Service for Learning Disability and Autism, briefly presented a report to the Committee on how the Council’s activity would meet the priorities of the Business Plan around ageing and living well following a more detailed briefing occurring the week prior.

As such, it was reiterated that within the report there were 13 planned series of activities across 7 services areas within Adult Social Care as a whole and the objectives of such directly address 6 of the 10 Business Plan Mission Statements, therefore demonstrating the scope of the work being undertaken and its impact across the corporate Business Plan. Officers highlighted that there were already KPIs in place against the activities being undertaken or if there were not then they were under development in order to measure the impacts and outcomes for residents. Prevention was noted as being a key theme across the Plan with the creation and development of a new Prevention and Wellbeing Team alongside an Intensive Enablement Service, both of which striving to continue supporting residents of all ages to maximise their independence, safety and wellbeing.

Cllr Richard Clewer, Leader of the Council, commended the work made by officers and assured Members on the extent to which the Business Plan was being utilised, put into action and delivered through the different Service Delivery Plans in a cohesive manner.

During the discussion, Members considered workforce and staffing issues for Adult Social Care both in the public and private spheres, and how officers were proposing to attract potential candidates and retain existing staff. The reduction in day services such as lunch clubs was raised, and Members queried the impact of this on providing support to vulnerable adults. Officers explained that the new Prevention and Wellbeing Team and other support officers would look to focus on people new to social care and to work on managing long term universal, innovative and, at times, bespoke methods of care that wouldn’t lead to a reliance on paid for services. It was further noted that under the new change in grant conditions, groups were being encouraged to apply for the new open framework as this would provide assurance for residents on concerns such as safeguarding and would work to empower groups to be proactive, have conversations with residents and to seek cohesive advice in order to ensure that people who need care had the ability to access provisions in the right place at the right time. Officers further emphasised that they were working to ensure that residents had the information and support necessary to make informed choices and that there was still a lot of work to be done to achieve the goals set out in the plan.

Housing was discussed and it was suggested that officers liaise with Planning Officers with regard to proposing that certain conditions be included within development plans for provisions such as  ...  view the full minutes text for item 8.

A report is provided on the work of the Learning Disabilities Knowledge café and the Autism Partnership as vital forums for ensuring that learning disabled people and autistic people are involved in shaping services that impact on their lives.

Daniel Wilkins, Head of Service for Learning Disability and Autism, Emma Legg, Director of Ageing and Living Well, and Cllr Jane Davies, Cabinet Member for Adult Social Care, SEND, Transition and Inclusion, presented a report on the role of the Learning Disability Café and Autism Partnership in providing a forum to shape services that impact on the lives of people with learning disabilities and autism.

The presentation provided an introduction to the café and its principles alongside the key priorities and different areas of work, namely: changing services, advising businesses, developing training and campaigns. It was highlighted that the implementation of the café had changed approach in recent years to engage more people and greater capture the voices of learning disabled and autistic people to improve inclusivity and representation. It was explained that the events were hosted by the Wiltshire Centre for Independent Living (CIL) and as such they, alongside a Facebook group and communications from the Council themselves, promote each event. It was noted that approximately 10-20 people attend each café and although this number was low in comparison to the number of learning disabled and autistic people within Wiltshire, this was a huge improvement since the previous incarnation and officers were pleased with the process made. Despite this, officers stressed that they were continuing to strive for broader engagement and encouraged Members to share links and/or information on the cafes to residents or organisations that they felt could benefit from the service. Officers confirmed that with regard to the running on the event, they deferred to CIL as CIL was led by people with lived experience of disability and as such, they understand how best to organise the events to maximise comfort and engagement.

The key aims of the Autism Partnership were then shared and it was noted that as Members had not had sight of the Autism Strategy, a copy would be circulated post meeting. Following from this, the key priorities of the Strategy were shown, and it was noted that these were derived directly from the National Strategy to ensure cohesion across the plans. A rough timeframe was then detailed in which the six priorities of the Strategy would be explored during the next three meetings of the Autism Partnership in order to develop an Action Plan.

During the discussions, Members explored the role of carers and the support provided for them in order to aid the achievement of the Strategy aims. Furthermore, it was noted that officers had liaised with Wiltshire Police to deliver training sessions with new constables and that the recruitment of a person with autism to sit on one of their Boards was being pursued.

Following which, it was:

Resolved

1)    To note the information provided on the work of the Learning Disability Knowledge Café and the Autism Partnership as forums for ensuring that learning disabled people and people with autism are involved with shaping services that impact on their lives.

2)    To note that Wiltshire Council’s Autism Strategy 2022-27 will be  ...  view the full minutes text for item 9.

A report will be provided proposing an approach for a committee inquiry session into the challenges being experienced with patient flow through hospitals used by Wiltshire residents.

The Chair reminded Members that the Committee had proposed to look at patient flow through hospitals and the systemic factors that present barriers to said flow. As such, a report had been brought to Committee outlining an inquiry session into the issue which could aid Members in identifying any further areas for scrutiny. It was noted that to address the factors contributing to the extreme pressures being experienced and reported in Urgent Care and the systemic challenges impacting on patient flow through hospitals in Wiltshire, a broader look at the predicaments faced across the whole system was needed.

The Chair thanked the Scrutiny Team for producing the report and Mel Nicolaou, Head of Resources Commissioning, for her input. It was stated that once the Committee agreed the methodology to be used, a date for the inquiry session would be found, and the Chair and Vice-Chair would on the details and an update would be brought to the next meeting of the Committee.

Members wondered whether half a day would be sufficient time to fully discuss the issues and it was noted that it was important that the Committee had the flexibility to lengthen the meeting should it be required. The Chair requested that Members submit any questions ahead of the session to ensure that the various stakeholder groups in attendance could prepare any necessary responses or information for Members. Given the current position of the NHS and the interconnected relationships with the care system, the issue surrounding capacity of services such as domiciliary care and the impact on Urgent Care was raised. The Chair acknowledged the issue and confirmed that it would be included as a point of discussion in the session.

Henry Powell, Democracy & Complaints Manager, explained that an inquiry session, as proposed, had not been undertaken before and as such, officers were anticipating that it would mitigate previous difficulties faced by having all stakeholders, Members and officers present at one meeting to minimise duplication and confusion and to encourage an open discussion. It was noted that the outcomes of the meeting were expected to emerge through the conversations and that it would work towards reassuring residents that the Committee were alive to the concerns reported in the media around the pressures experienced in the care system. 

Following which, it was:

Resolved

For the Committee to hold an inquiry session as proposed in the report, with more detailed arrangements to be developed further by the Scrutiny team in consultation with the Chair and Vice-Chair of the Committee and reported back to the next meeting of the Committee.

A presentation will be provided setting out the process for designing and adopting the BSW Integrated Care Strategy.

Richard Smale, Director of Strategy and Transformation for the Integrated Care Board presented an update to the Committee setting out the process for designing and adopting the BSW Integrated Care Strategy.

It was emphasised that the Integrated Care Board were statutorily required to produce the Integrated Care Strategy by 31 March 2023 and as such, officers were in the first stages of the process. It was further noted that officers were meeting with the Health and Wellbeing Board the following week to engage with colleagues and private stakeholders for the development of the strategy, therefore the presentation would be focussed on explaining the process itself to Members.

The three products that officers would produce were explained, namely: the Integrated Care Strategy, the Integrated Care Implementation Plan, and the Operating Plan 2023/24 and then the importance of the relationship between the Integrated Care Strategy, which sets the direction, and the Joint Forward Plan, which defines how the elements of the strategy will be delivered, was highlighted. Officers then described an engagement event that was held on 16 December 2022 to inform the development of the strategy, feedback from which derived key areas of importance such as: tackling inequality, focussing on the individual, considering all ages, focussing on prevention and wellbeing, and wider determinants on health examples being housing conditions, diet and employment. Further areas were listed as focussing on a holistic view of all of the factors impacting on health and wellbeing rather than on the literal delivery of the services themselves and drawing on the strength and development of local communities.

Details were then given on the content required for the strategy and the desire to change the way the system operates with regard to areas such as greater diagnostic capabilities, recruitment and retention of staff, developing workforces, investment into apprenticeships and considering how to get the best from your resources. It was noted that the first draft would be circulated for comments during the time in which the local teams would be producing their specific Health and Wellbeing Strategies to ensure that there would be no duplications between engagement and to retrieve feedback that could be used in the development process.

Cllr Richard Clewer, Leader of the Council and Chair of the Integrated Care Partnership, emphasised the difficulties in combining all of the local strategies into the Integrated Care Strategy for the whole of BSW. The importance of undertaking a thematic approach akin to the Wiltshire Business Plan was noted and it was highlighted that both the development and implementation of the Strategy would be expected to evolve continuously over the course of the first year but that the potential benefits of a cohesive plan and vision across BSW would overcome the expected difficulties. Officers confirmed that a rough draft could be presented to the Committee for feedback ahead of the next planned meeting.

Cllrs sought clarification as to whether any information would be fed to Central Government and it was confirmed that it would not as there  ...  view the full minutes text for item 11.

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

The Chairman thanked all Cabinet Members, Directors and other partners that had joined both he and the Vice-Chair in meetings before Christmas where potential work areas for the Committee to consider over the next 12 months were discussed. As a result of which, several items had been added to the Forward Work Programme such as: domestic abuse support, substance abuse support, and health coaches.

Members suggested the inclusion of challenges faced by dentists working for the NHS, the steps taken to combat the difficulties in obtaining dental appointments within Wiltshire and ensuring that the Dementia Care Strategy be brought forth to Committee during the draft phase so that Members could provide meaningful input.

Following which, it was:

Resolved

To note the Committee Forward Work Programme with the addition of a future item on dental services in Wiltshire and on the forthcoming draft Dementia Care Strategy.

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 10.30am on 28 February 2023.

The date of the next meeting was confirmed as 28 February 2023, at 10:30am.