Agenda and minutes

To elect a Chairman for the forthcoming year.

Councillor Johnny Kidney was elected as Chairman for the year 2023/24.

To elect a Vice-Chairman for the forthcoming year.

Councillor Gordon King was elected as Vice-Chairman for the year 2023/24.

To receive any apologies or substitutions for the meeting.

Apologies for absence were received from Cllr Mike Sankey, Cllr Mary Champion, and Cllr Tom Rounds.

To approve and sign the minutes of the meeting held on 28 February 2023.

Resolved:

To approve and sign the minutes of the meeting held on 28 February 2023 as a true and correct record.

To receive any declarations of disclosable interests or dispensations granted by the Standards Committee.

Cllr Clare Cape declared that she worked for NHS England in a national capacity, and the Chairman declared that he was Wiltshire Council’s Stakeholder Governor at the RUH.

To note any announcements through the Chairman.

The Chairman announced that since the last Committee meeting, Members had attended a briefing on the Good Lives Alliance retender, expressing that the contract was felt to allow for flexibility in being able to provide person-centred care. From an ongoing scrutiny perspective, there was interest in being able to carry out an independent review of providers, such as the Trusted Assessor Scheme run by the Wiltshire Care Partnership.

The Chairman announced that there had also been a Chair’s briefing for both Heath Select Committee and Children’s Select Committee on the Public Health Nursing Services Future Delivery model.

The Chairman announced that the Committee were due to be briefed on the Carers’ Support Strategy and retender, but that this was put on hold and so the Committee looked forward to receiving an update in due course.

Finally, the Chairman announced that both he and the Vice-Chairman had received and submitted a response to Quality Accounts from the South West Ambulance Service and the two providers in attendance: AWP and Wiltshire Health and Care.

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 Thursday 1 June 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 Monday 5 June 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.

To receive a presentation from Wiltshire Health and Care on how they have delivered services in the community over the previous 12 months. This update was requested by the committee in June 2022 and includes an update on how the long covid service has developed. 

Stephen Ladyman and Shirley-Ann Carvill of Wiltshire Health and Care provided an update to the Committee on their organisation’s services and challenges over the last year. They described the challenging times that healthcare had faced, both societal and financial. However, they also emphasised the successes they had achieved in that time, with progress being made towards the plans laid out last year, such as the response to Long Covid and the successful pilot of NHS@Home (Virtual Ward).

The Committee asked questions of the 2-hour urgent care response times, the potential for better promotion surrounding flow hubs and the possibility of initiatives to target long waiting lists.

Resolved:

To note the content of the report and to schedule an update next year to follow progress on any stand-out issues.

To receive a presentation on the progress that has been made in developing a Dementia Care Strategy for Wiltshire.

Robert Holman, the Commissioning Transformation Lead, reported to the Committee on the progress being made towards developing Wiltshire Council’s updated Dementia Care Strategy. He explained that they were currently co-producing the Strategy with hundreds of partners and individuals. He described the massive human cost involved in dementia care and the significant contribution from informal carers, as well as the need to consider carers as well as patients in the new strategy. Other points raised included the need to support younger people diagnosed with dementia and the need for more certainty surrounding care plans for those diagnosed.

The Committee sought further information on how the strategy proposed to engage with individuals reluctant to engage back, if the strategy accounted for gaps in effective provision across the county and if there was a plan to address recruitment issues in care homes. Enquiries were also raised about the possibility of taking specific steps to increase the rate of diagnosis, and the importance of making communities dementia-friendly. The committee discussed the successful work undertaken in Bradford-on-Avon to that end, linking it to the important role Area Boards can play in the strategy. The Committee also discussed if the conversation surrounding dementia was sufficiently prominent in communities. Attention was drawn to the sessions being run by Alzheimer’s Support and the possibility of greater promotion.

Councillor Tony Jackson asked if the strategy foresaw the utilisation of screening programmes and the possibility of using disease-modifying treatments, to which the Commissioning Transformation Lead agreed to feed back at a later date.

Resolved:

To note the progress that has been made with developing the dementia care strategy, to request an opportunity to review the strategy and an implementation plan if possible, to receive an update next year to understand the impact of the strategy once it is implemented, and to support the involvement of Area Boards in promoting dementia-friendly towns. 

To receive a presentation of the set of metrics used by Wiltshire Council and shared with Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board to evidence performance in Adult Social Care.  The committee is to consider whether these are the metrics it will use to scrutinise adult social care services andthe method for scrutiny. 

Tamsin Stone, Head of Performance, Outcomes and Quality, was then invited to talk the Committee through a presentation on the KPIs being used in Adult Social Care. The presentation gave an overview of the current KPIs being used to monitor Adult Social Care, highlighting the important role played by Performance Outcome Groups (POGs). The presentation also drew attention to the need to remain objective rather than being drawn into comparisons with other Local Authorities, and the need to carefully set targets to account for data variability.

The Committee asked questions on what data was held pertaining to staffing and referral. The Leader of the Council, Councillor Richard Clewer, suggested that the Committee considered the wider range of metrics that would soon be made available from the Integrated Care Partnership. Similarly, Councillor Cape reminded the Committee of their scheduled commitment to review these system metrics. The Committee discussed the best way to measure the KPIs until the Chairman suggested they receive an update in approximately six months and hold an inquiry session in the meantime.

Resolved:

To scrutinise the Key Performance Indicators on a six-monthly basis with timing to be guided by officers and for the Chairman and Vice-Chairman to identify and propose a broader range of health and wellbeing KPIs for approval by the Committee.

To receive a presentation from Avon and Wiltshire Health Partnership Trust on the progress it has made over the previous 12 months in developing anddelivering its transformation programme. 

The Chairman welcomed Alison Smith, Deputy Chief Executive of Avon and Wiltshire Mental Health Partnership Trust (AWP) and Alexandra Luke and invited them to give an overview of their work in providing healthcare to people with mental illnesses, learning disabilities and autism and an update on their transformation programme.

The Deputy Chief Executive expressed her apologies for not getting the report to the Committee in time for the meeting and explained that as a result she would speak to the data more broadly and ensure the report was sent out as soon as possible.

Alexandra Luke described AWP’s work on delivering advice and guidance to those with mental illness, explaining that they were the first area to offer this guidance on mental health after the pilot scheme in Bath and North East Somerset.

The Committee sought clarity on if there was any distinction in the data between different types of mental illnesses and on the scope of training for nurses, referring to the rarity of recruiting internationally for mental health practitioners and nurses. The Deputy Chief Executive explained that as a secondary provider, AWP did not have different data sets for different mental illnesses, and stated that recruitment was not as relevant a challenge for mental health treatment, noting an ongoing training programme with a national recruiter. She concluded by stating that regardless of the outcome of an upcoming report from the Care Quality Commission (CQC), a review was desirable to ensure the continuation of their improvement plan and that they were aware of several areas to improve upon already.

Resolved:

To circulate the report from AWP to the Committee and forward any questions from the Committee to AWP for a response, and to invite AWP back next year.

To report the findings and recommendations of a Rapid Scrutiny Exercise reviewing the provision of NHS Dental Services in Wiltshire. 

Introducing the next item, the Chairman reminded the Committee of their agreement in February to carry out a rapid scrutiny of NHS dental services before responsibility for commissioning was transferred from NHS England to the Integrated Care Board (ICB). He then referred the Committee to the report from the scrutiny carried out on 29 March, thanking the input of Jo Lawton of NHS England and Jo Cullen from the ICB. He summarised the main findings as being that Wiltshire residents need greater access to NHS dental services, the ICB would face significant challenges in improving services, ongoing scrutiny was needed and that more information was desired on the work being done to improve access to health services in disadvantaged communities.

The Chairman then called on the Cabinet Member for Public Health, Councillor Ian Blair-Pilling, to speak to the item.

Councillor Blair-Pilling summarised the rapid scrutiny session as sitting in the foothills of a mountain of a learning curve, explaining that dental care was remarkably different and distinct from other forms of healthcare. He emphasised that while it was important for scrutiny to make its own choices, this work could benefit from being conducted as a joint enterprise with the ICB, with updates coming from both.

The Director of Public Health, Kate Blackburn, suggested the recommendation that the Public Health team bring a report on inequality back to Committee covering public health and dental care was of such a scale so as to necessitate collaboration with the ICB as part of a system approach. The Director suggested that rather than a massive report, a focus on dental provision and access would be more suitable and achievable, as well as bringing in the work being done by the Wiltshire Health Inequalities Group’s work.

The Chairman noted The Director’s point and invited the Leader of the Council’s input.

Councillor Clewer noted the new structure of the Integrated Care System involving the ICB and the Integrated Care Partnership. He advised that it could prove unproductive for too many Councils to be trying to assess the issues processes of the Integrated Care System before it was on its own two feet. He suggested that the work would be better suited to the Integrated Care Partnership as one of their statutory requirements.

The Committee discussed the issue further, with Councillor David Vigar highlighting that unnecessary reports were to be avoided and that instead, regular updates were all that was required. Councillor Cape noted that one of her key takeaways from the report was that the root cause of issues with dental provision was the way in which the payment system for dentists operated. She suggested that until that systemic issue was properly addressed at a national level, the Committee were unlikely to make any significant progress in improving dental service provision. The Director of Public Health agreed that while there was work they could undertake to address issues surrounding inequality, the fundamental problems they faced were national ones. Councillor Clewer added that the area was essentially  ...  view the full minutes text for item 40.

The committee is invited to comment on the quality accounts submitted by the hospital trusts.  A formal response will be completed by the Chair and Vice Chair by 16th June.

The Chairman presented to the Committee the Quality Accounts published by the RUH in Bath and the Salisbury NHS Foundation Trust for questions or comments.

Councillor Vigar stated that generally, the accounts were brilliant, expressing praise for the way the report was structured. He expressed confusion regarding the apparent lack of correlation between certain objectives and outcomes but was otherwise impressed. Councillor Cape similarly praised the layout of the reports and the use of charts.

The Chairman explained that he and the Vice-Chairman would construct their own feedback outside the meeting but would be sure to include the comments of the Committee.

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

Cllr Vigar suggested adding the data discussed by the Committee to the Forward Work Plan, to which the Chairman agreed subject to a discussion to decide how best to work them in.

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 4 July 2023.

The date of the next meeting was confirmed as 4 July 2023 at 10:30am.