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Agenda and minutes

Venue: Great Western Ambulance Service Offices - Jenner House, Langley Park, Chippenham SN15 1GG

Contact: Samuel Bath  (Democratic Services Officer)

No. Item




Apologies were received from Cllr Jane Burton, Cllr Desna Allen and Cllr Pip Ridout.  Cllr Niger Carter substituted for Cllr Burton and Cllr Judy Rooke substituted for Cllr Allen.


Minutes of the Previous Meeting

To approve and sign the minutes of the meeting held on 17 January 2013.

Supporting documents:


The Minutes for the meeting held on 17 January 2013 were signed and approved as a correct record.


Declarations of Interest

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


There were no declarations.


Chairman's Announcements


The chairman thanked Members and partners for their support over the past year, and particularly Phil Matthews, who was attending his last Committee meeting as chairman of WIN.  He welcomed Mike Franklin from the Fire and Rescue Service and thanked the Great Western Ambulance Service (GWAS) for their hospitality at Jenner House.


The chairman had attended an event at the Great Western Hospital organised by NICE, an open day at Chippenham Hospital for the launch of the new X-ray machine and kitchen, and the final public meeting of WIN.


The chairman announced the following appointments: Christine Graves, new chairman of Healthwatch, Iain Tulley, new Chief Executive of the Avon and Wiltshire Mental Health Partnership (AWP), Peter Hill, new Chief Executive of Salisbury Hospital.  He confirmed that GWAS had been acquired by the South Western Ambulance Service Foundation Trust (SWASFT).


Item 9 on the agenda was to move to item 7 and item 12 was to move to item 8.


Public Participation

The Council welcomes contributions from members of the public.




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 above for any further clarification.




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 above no later than 5pm on Thursday 7March 2013. Please contact the officer named on the first page 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 received.


Task Group and Rapid Scrutiny Group Reports

The Committee will receive the following reports and is asked to respond to any recommendations contained within;


1.    CCG Task Group Report

2.    Public Health Transition Task Group Report

3.    Transfers to Care Task Group Report

4.    Continence Services: Rapid Scrutiny Report

5.    Joint Air Quality Task Group Report (joint with Environment Select Committee).

Supporting documents:


The Committee received reports from Task Groups and Rapid Scrutiny Groups.


CCG Task Group Report 


The Committee agreed to the creation of the Task Group at its meeting on 15 November 2012 to consider the effective development of the CCG.


The Task Group report was presented by Cllr Peter Colmer.  It was noted that the CCG comprised three local groups: North East Wiltshire (NEW), West Wiltshire, Yatton Keynell and Devizes (WWYKD) and Sarum, covering the Salisbury area. 




To endorse the recommendations of the CCG Task Group as follows:


1.       The Health Select Committee, within the newly-elected Wiltshire Council, should establish a CCG Task Group to undertake the recommendations below.


2.       The Task Group should devise its own Terms of Reference.


3.       The Task Group should investigate what progress the CCG makes against the priorities identified in its Strategic Plan 2013/14.


4.       The performance of each of the three local groups of the CCG should be monitored, with a review requested from each area within their first year.


5.       The Task Group examines what mechanisms the CCG has in place to deal with conflicts of interest that could arise during the commissioning/procurement process.  


6.       The Task Group considers what arrangements the CCG is making to engage with patients and the public, and what mechanisms are in place to measure and monitor the effectiveness of these.


7.       The Health Select Committee considers identifying an individual service, commissioned by the CCG, with a view to establishing a further Task Group to investigate the ‘patient pathway’ within that service.



Public Health Transition Task Group Report


The Committee agreed to the creation of the Task Group at its meeting on 15 November 2012 to consider the transfer of Public Health from the NHS to the Council.


The Task Group report was presented by Cllr Peter Hutton.  He confirmed that the Task Group was satisfied that the transfer was progressing smoothly and, as a result the Task Group should be disbanded. 



To endorse the recommendations of the Public Health Transition Task Group as follows:


The Health Select Committee disbands the Public Health Transition Task Group.


That an update report on the transition is presented to the Health Select Committee at its meeting on 14 November 2013.



Transfers to Care Task Group Report


The Committee agreed to the creation of the Task Group at its meeting on 15 November 2012 to consider the systems which allow patients to leave hospital promptly and to go into the care facility of their choice.


The Task Group report was presented by Cllr Nigel Carter.


It was noted by Sue Geary that recommendation 4 in the report made reference to ‘the Partnership Group’; this should be more correctly referred to as ‘the Steering Group’.



Cllr Colmer proposed an amendment to alter the wording of recommendation 4 from “...documents produced by the partnership group” TO “documents produced by the Steering Group”. This was seconded by Cllr Nina Phillips and unanimously agreed by the committee.



To endorse the  ...  view the full minutes text for item 49.


Older People's Accommodation Development Strategy

In January 2011, Wiltshire Council’s Cabinet approved a 10 year development strategy to modernise and improve the way that older people’s accommodation is provided, develop and adopt an integrated accommodation system, ensure the best use of increasingly scarce resources and respond to local needs in local communities.


Since the adoption of the strategy, significant progress has been made to advance the developments identified within the strategy.  An update report on the Older People’s Accommodation Development Strategy is provided.  The Committee is asked to note its content and comment as appropriate.

Supporting documents:


In January 2011, Wiltshire Council’s Cabinet approved a 10 year development strategy to modernise and improve the way that older people’s accommodation is provided.  Karen Jones, Senior Project Manager, provided an update on the progress of the Strategy.


It was stated that since the adoption of the strategy, significant progress has been made with advancements to developments within the various community areas.  Work was being undertaken on 23 developments across 15 community areas to improve and modernise older people’s accommodation. In addition some developments were also being progressed with flexible section 106 agreements. Developments were utilising council land, and were in line with financial projections.


The projected timescales of some developments had been brought forward whilst others have taken longer to come to fruition than was originally anticipated.


The Committee discussed the number of units that were being provided as a result of the developments and it was agreed that development, design and management would be crucial to the success of the Older Peoples Accommodation Development Strategy. It was agreed that the Strategy would be brought to the next meeting for consideration by the Committee.


The location of some developments was discussed and concerns were expressed that more rural sites could result in some older people being isolated. 

Karen Jones explained that the Strategy was not a one size fits all approach, that some older people wished to continue to live in rural locations, and that placing some units away from town centres provided greater choice.  She also confirmed that the project was well resourced despite the unsurety of funding over a two year cycle.




To note:

1.       The implementation progress of the Older People Accommodation Development Strategy.


2.       The funding application made to the Department of Health’s Care and Support Specialised Housing Fund to assist the delivery of extra care housing.


3.       The development and implementation proposals associated with Wiltshire’s Extra Care Housing Model. 


Joint Strategic Assessment (JSA)

The Joint Strategic Assessment (JSA) 2012/13 provides a summary of the current needs of people in Wiltshire.   In addition to the overall JSA, individual thematic chapters support the overall document providing detailed analysis of these issues and many more.  The functions of the JSA includes providing knowledge about Wiltshire for Wiltshire Council and other partners to enable evidenced based organisational planning, and timely commissioning decisions to build resilient communities for Wiltshire. 


The Committee is asked to note the production and publication of the JSA 2012-13 report and supporting documents and endorse its use in commissioning and strategy, ahead of its consideration by Cabinet on 19 March 2013.

Supporting documents:


An update on the JSA was presented by Aimee Stimpson. 


It was confirmed that a summary document was being produced for local community areas to provide information on local changes.


It was queried how the JSA reflected the strategic requirements of military personnel in the county, following the announcement by the Secretary of Defence that 4000+ troops would be relocating to Wiltshire.  It was confirmed that meetings had been held with military groups to identify the requirements of military groups.  It was noted that Wiltshire had been praised by the military for the services and arrangements in place for military personnel in the county.


The Committee questioned the use of the document if it would not be seen by the public.  It was confirmed that the JSA would be utilised as a strategic decision making tool, but that could be viewed and scrutinised by the public.


Cllr Chris Caswill acknowledged that there was a brief mention of child poverty in the JSA but believed that more attention should be paid to this important topic.  It was noted that changes in government policy surrounding benefits could exacerbate this problem in some of the most vulnerable areas, and that the Council would need to focus attention on this area.


Maggie Rae stated that extensive reports on child poverty in the county had been compiled and that the Council would continue to tackle the issue. It was stated that the issues of relating to child poverty were covered in a number of categories within the JSA.


Brian Warwick noted that the ‘issues matrix’ within the JSA contained many issues which related to older people, but there was no mention of older people, per se.  He would like to see a greater emphasis on ‘active ageing’, to enhance quality of life as people age.


Cllr Hutton noted the comments made to ensure that the Committee’s views on the JSA were made known at the Cabinet meeting on 19 March 2013.




The Committee noted the production and publication of the JSA 2012-13 report and its supporting documents and endorsed its use in commissioning and strategy.


To review the JSA annually as part of the Committee’s ongoing monitoring arrangements.



Avon & Wiltshire Mental Health Partnership (AWP) - Charter House

In January 2013 Wiltshire Council was informed that the Avon and Wiltshire Mental Health Partnership (AWP) had taken the decision to stop admitting patients to Charter House on a temporary basis due to a number of issues including low occupancy, environmental problems and the stand alone nature of the site.  This coincides with a series of meetings being held by AWP to seek the views on proposals to refresh their strategic objectives, vision and values.


A briefing note from Iain Tully, Chief Executive of AWP, is attached for the Committee’s consideration and comment.

Supporting documents:


Denise Clayton, Avon & Wiltshire Mental Health Partnership (AWP), provided an update to the Committee on the temporary closure of Charter House in Trowbridge.


Ms Clayton stated that, as a facility for persons with advanced stages of dementia, Charter House had recently seen a reduction in its admissions. There had been difficulties recruiting adequately trained staff to provide the level of care that would be expected and the facility has also fallen into a bad state of repair.  As a result of all of these factors, it was agreed to suspend any further admissions to Charter House while a review of it is conducted. All patients being treated at Charter House have now been relocated to other centres including;

·         Fountain Way (Salisbury);

·         The Victoria Centre (Swindon); and,

·         Ward 4 at St Martin’s Hospital (Bath).


It was noted that some centres were a considerable distance away from Charter House, and therefore were in conflict with the access to care expressed in the JSA and various other strategic documents. Though Members expressed some reservations, it was agreed that access to good quality care in the region would be preferable to less favourable care locally, and that the arrangements were not contrary to strategic practice.


It was confirmed that additional funding had been sourced and passed to care homes and community hospitals in the region to manage increased demand. Ms Clayton stated that the temporary closure of Charter House was part of a wider review into the service across the region which was looking at local requirements for older people.


The Chairman thanked Ms Clayton for the update.  It was unfortunate that the Committee had not heard of AWP’s plans from them directly.  The chairman expressed the wish to work closely with AWP and hoped that they would bring any future plans to the Committee for early consideration.  Ms Clayton confirmed that AWP would be working closely with the Committee and stakeholders. 


The Chairman stated that two public meetings were being held by AWP in Wiltshire to invite comments on their plans to refresh their strategic objectives, vision and values.  These would be on 18 April at the Town Hall, Devizes between 2-4pm and 6-8pm. Individuals are advised to Contact 0800 694 9990 to reserve a place. For more information and to provide feedback, go to: www.awp.nhs.uk/strategicobjectives.




To note the update provided.


To agree the creation of a Task Group to consider the review being undertaken by AWP on care provision for people with dementia in Wiltshire.


Update from Great Western Ambulance Service (GWAS) Joint Health Overview & Scrutiny Committee

The GWAS Joint Health Overview and Scrutiny Committee met on Friday 22 February 2013.  Cllr Peter Colmer was in attendance and will be invited to provide an update on the outcome of the meeting.  This will include:


i)             Briefing on the future of the Ambulance Headquarters.

ii)            Following the acquisition of GWAS by the South Western Ambulance Service Foundation Trust (SWASFT), members’ views are sought on the future arrangements of the Joint Committee.

Supporting documents:


Cllr Peter Colmer had attended the meeting of the joint Committee on 22 February 2013 and gave a verbal report to the Committee.


GWAS was acquired by the South Western Ambulance Service Foundation Trust (SWASFT) in February 2013.


Service performance is measured against three categories.  It was noted that there was a significant deterioration against the 19 minute measure.  GWAS agreed this was a cause for concern, commenting their resources were stretched due to lack of ambulances.  It was agreed that close monitoring of this issue was required.


Handover times at hospitals were still an issue.  It was noted that fines of £1 million had been levied on the PCTs this year.  Based on the revised formula, this would equate to £4 million if the same level of performance occurred.  There were concerns that one part of the health system was paying large sums to another part of the system.  It was suggested that a scrutiny committee could look at ‘pathways’ associated with the new GP commissioning arrangements.


Following the acquisition of GWAS, their headquarters at Chippenham will close.  SWASFT, whose headquarters are in Exeter, prepared a report for the Committee to update them on staffing plans in relation to the former GWAS headquarters. 


The joint Committee discussed the future of scrutiny of SWASFT.  It was agreed that the chairman of the joint Committee would prepare a paper which will be circulated to individual Health Select Committees for discussion and comment.


It was intended that the full NHS 111 service should go live on 10 March.  The Committee was concerned to hear that the implementation of the service to date had resulted in significant problems, with reports of ambulances being despatched to none emergencies.


The Committee was concerned about the possible impact on ‘genuine’ emergencies if they had to wait for an ambulance which was attending a patient with a minor condition. It was agreed that the Committee should undertake a rapid scrutiny exercise into the 111 Service.


It was confirmed that the future scrutiny of GWAS would now be undertaken as SWASFT and currently SWASFT were in the process of identifying how best to work with Councils across the region to scrutinise services in these areas. The Chairman will be contacting Wiltshire Council in future to discuss these arrangements.




To note the report from SWASFT.


To undertake a rapid scrutiny exercise into the NHS 111 service.


Update on Continuing Healthcare (CHC)

Under previous working arrangements, the Health and Adult Social Care Select Committee resolved to establish a non-executive working group (between Wiltshire Council and NHS Wiltshire) to review NHS Continuing Healthcare (CHC) and the Council’s partnership working arrangements for both CHC and joint packages of care.


A report detailing the work undertaken by the Group, its findings and ensuing recommendations was presented to the newly formed Health Select Committee at its first meeting held in July 2012, together with a joint response to the recommendations proposed from Wiltshire Council and NHS Wiltshire.


The Committee endorsed the recommendations contained within the report which included that an update on the agreed Action Plan would be represented.  This is now attached and the Committee is asked to consider its content and response as appropriate.

Supporting documents:


The Committee received the final report from the CHC Task Group on 12 July 2012 and requested an update report on the action plan at its meeting in January 2013.  This was subsequently deferred until March 2013. 


Deborah Gray, Deputy Director of Nursing and Patient Safety, NHS Wiltshire and Sue Geary, Head of Performance, Health and Workforce, gave an update on Continuing Healthcare arrangements.


It was stated that the pathway had been improved, although some actions were still to be completed.  It was confirmed that the responsibility for CHC now fell to Jacqui Chidgey-Clark, Director of Quality and Patient Safety at Wiltshire CCG.




The Committee noted the update on Continuing Healthcare


To receive an update on the progress of the action plan at the Committee’s meeting in September.


Update on cardiovascular services prior to transfer to specialist commissioning

The Committee received an update from the CCG at its previous meeting held in January in relation to the Southern Vascular Network’s proposed model of a single site model based at Bournemouth hospital.


Neither the CCG nor the Committee were able to support the proposal and it was agreed that a letter of objection would be sent accordingly.


An update report is now provided by the CCG for the Committee’s consideration and comment.

Supporting documents:


At the Committee meeting on the 17 January 2013, Wiltshire CCG presented a paper on the national review of vascular services and the implications to the population of Wiltshire.  The Committee expressed grave concerns about review and requested an update prior to the service transferring to specialist commissioning.


Beatrix Maynard, Wiltshire CCG, and John Goodall presented the update.

The CCG remained concerned about the proposed service and confirmed that a Steering Group for vascular services for Wiltshire had been set up to ensure a clear and shared understanding of the implications for the population of Wiltshire for each area’s network plans for vascular surgery. The first meeting of the steering group was confirmed as April 8 2013.




To note the report.


To receive an update from the CCG on the work of the steering group at its meeting in November 2013.


Emergency Falls Admissions in Salisbury Community Area

One of the aims of the Wiltshire Falls and Bone Health Strategy is to halt the rising number of falls and related injuries experience by older people each year.  Noting that local falls data show Salisbury Community Area as significantly higher for falls emergency admissions compared to the Wiltshire average, Zoe Clifford, Public Health Speciality Registrar, will be in attendance to present a report exploring the possible reasons behind the data.


The Committee is asked to note the results highlighted in the report and consider whether it wishes to support the key areas identified for action.

Supporting documents:


The Wiltshire Falls and Bone Health Strategy 2012-14 and consultation results were presented to the Committee in November 2012. The high rate of emergency admissions from the Salisbury Community Area for falls was questioned. A report exploring the data further was requested.


Zoe Clifford presented the report, detailing the data for the areas in question. It was suggested that the greater number of falls in the south, and in Salisbury in particular, could have been a result of a greater proportion of elderly people.


It was confirmed that the data was tested further, examining demographics (age, gender), types of fall (in care, in public), and comparative data for over 65’s in general.


The Committee questioned some of the figures to ascertain the integrity of the data, and agreed with the extensive findings of the report.  It was agreed that the data was not representative or inclusive of persons on medication, re-admissions or non reported falls.


The Committee suggested that the report could link in with the Older Peoples Accommodation Strategy, and also with Highways and Town Planning.




To note the report on Emergency Falls Admissions in Salisbury.


Recommendations for O&S Management Committee

The Overview & Scrutiny Management Committee at its meeting held on 28 February agreed that each Select Committee should prepare a report at its last meeting identifying key items that they feel should be kept on the Forward Work Programme for consideration by Councillors post election in May.


Due to the limited timeframe between the Management Committee and the Health Select Committee, it is proposed that the items identified at the meeting be compiled into an appropriate report that will be approved by the Chairman and Vice Chairman and subsequently circulated to the Health Select Committee members before it is submitted to the Management Committee at its final meeting to be held on 11 April 2013.


The Committee was required to identify items for inclusion in the legacy report to be submitted to the Overview and Scrutiny Management Committee; the suggested items to form the basis of the Committee’s work programme in the new Council.




The following topics to be recommended as legacy items to the O & S Management Committee for possible inclusion in the Overview and Scrutiny work programme in the new Council:


The following Task Groups are re-established:

         Clinical Commissioning Group

         Transfers to care

         Joint Air Quality (with Environment)


Two new Task Groups are formed:

         Continence Services

         Review of Services by AWP


A rapid scrutiny is undertaken:

·       NHS 111 service


Update reports are received in respect of:

         Cardiovascular services (November)

         CHC (September)

         JSA  (annually)


Partner Organisations Update

Partner organisations will be given the opportunity to provide an update where appropriate.

Supporting documents:


Great Western Hospital (GWH)

The Committee noted the report from the Chief Executive of GWH on key issues relating to GWH and community services across Wiltshire. Kevin McNamara updated the committee and stated that the Trust was pleased to confirm that over £1m will be invested in additional nurses this year with recruitment underway in a number of areas following detailed skill reviews.


Mr McNamara confirmed that GWH would develop action plans against all outcomes of CQC inspections, and that the CQC would return in future to evaluate the concerned areas.


The Committee raised some of the issues detailed in the Francis Report that outlines problems with care quality and, in particular, patient respect. Mr McNamara confirmed that the new lead nurse at GWH was committed to the values of respect and compassion.


Royal United Hospital Bath NHS Trust (RUH)


Francesca Thompson, Chief Operating Officer, RUH to provide an update.


It was confirmed that RUH had entered a 5 year patient safety arrangement with the Strategic Health Authority. RUH had also bid for and been awarded a hosting arrangement that aims to reduce the mortality rate at the Hospital by 15%.


RUH also hosted the Wiltshire Carers event on March 6 2012, which was a success.


RUH had also recently elected its first Council of Governors. This involved 11 public governors and five staff Governors who will represent the views of members and sit on the Council of Governors with five stakeholder Governors. Nearly 3000 people voted with a turnout of around 32%.


RUH also highlighted its current challenges including the extraordinary demand on emergency care that it was receiving, and the plans to discharge patients within the agreed limits.


The Committee discussed emergency data collection, and noted that reports include a breakdown of admissions to emergencies would be useful.



Christine Graves, the new Chairman of Healthwatch, provided an update.


Healthwatch will come into effect from 1 April 2013.  The remit of Healthwatch would be similar to that of WIN, but had some enhancements.


Healthwatch has a duty to engage with the Health Minister, whilst championing health and social care and its delivery. In addition, Healthwatch Wiltshire will make recommendations to Healthwatch England, and advise the Care Quality Commission to carry out special reviews or investigations into areas of concern. Healthwatch will also act as a signposting service, providing advice and direction to the public on matters of healthcare. It was stated that Healthwatch hoped to build on the legacy of information that WIN had built, and was pleased to inherit its active support.


The Chairman welcomed Healthwatch and Christine Graves to the Committee and stated that it was hoped that the relationship would be as successful as it has been with predecessors WIN. Healthwatch would act as a critical friend, providing a check and balance on Healthcare providers across the region.


The Committee queried how information or concerns would feed into Healthwatch. Information would arrive through various channels, including the Committee, from the public and also via user  ...  view the full minutes text for item 58.


Urgent Items

To consider any other items of business that the Chairman agrees to consider as a matter of urgency.


There were no urgent items raised at the meeting.


Date of Next Meeting

The next meeting of the Health Select Committee will be on the 30May 2013 and will be held in the Committee Rooms at Monkton Park, Chippenham


30 May 2013




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