Agenda and minutes

The Chair welcomed all to the meeting.

Apologies were received from Cara Charles-Barks, Angus Macpherson, Dr Andrew Girdher, Tony Fox, Nick Marsden, Nerissa Vaughan, Andy Hyett, Dr Catrinel Wright, Dr Toby Davies, James Scott and Cllr Ian Thorn.

To confirm the minutes of the meeting held on 14^th December 2018.

The minutes of the previous meeting held on 14^th December 2018, previously circulated, were considered.

Resolved

To approve the minutes as correct.

To declare any personal or prejudicial interests or dispensations granted by the Standards Committee.

There were no declarations of interest.

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 31^st January 2019 in order to be guaranteed of a written response. In order to receive a verbal response questions must be submitted no later than 5pm on4^th February 2019 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 were no questions from the public.

·       Maternity Transformation Consultation

The Chairman drew the meeting’s attention to the following information as set out in the agenda pack:

A reminder to everyone that the Transforming Maternity Services together public consultation closes on 24 February, so just over two weeks left to provide feedback on the proposals. You can provide your feedback by going to the website: www.transformingmaternity.org.uk or by a hard copy which is available from Wiltshire CCG comms team or Wiltshire Council comms team.

A Health Overview and Scrutiny Joint Committee carried out a rapid scrutiny of the consultation process before the consultation started on 12 November, and an update will be taken to the March Wiltshire Health Select Committee. We expect independent analysis by Bath University to be finalised by the end of April, and depending on the outcome of the consultation, that transformational work can begin in the summer of 2019.

The Chairman also drew the meeting’s attention to an update paper on the Trowbridge Integrated Care Centre presented at the meeting and included in the minutes.

To confirm the future working arrangements for safeguarding vulnerable people given the removal of the statutory basis for the safeguarding children board in April 2019. 

Responsible Officers: Mark Gurrey (Independent Chair)

It was agreed to consider this item as the last item to enable the presenter to attend.

Mark Gurrey presented a report on future working arrangements for safeguarding vulnerable people given the removal of the statutory basis for local safeguarding children’s boards.

Matters raised during the presentation and discussion included: that the new arrangements are designed to offer the chance to work more effectively and with joint purpose with a wider agenda. The Safeguarding Vulnerable People Partnership (SVPP) Plan sets out how it will work with relevant agencies including schools, colleges and educational providers; quality, impact and independent scrutiny; child safeguarding practice reviews; workforce development and funding and support.

It was noted that discussions are ongoing about funding support for the SVPP and that as the plan is based on an equal partnership between Wiltshire Council, the NHS and Wiltshire Police, a rebalancing of financial arrangements will be necessary.

Independent scrutiny will be sourced in order to meet specific purposes and needs. It will not rely on one individual and scrutiny methods will be sourced to meet the need. The SVPP will help to hold other partnerships to account for delivery

In response to an issue raised by the Board, it was noted that the membership of the SVVP had not yet been finalised. While Board membership is likely to be small, all membership possibilities would be considered alongside appropriate political oversight arrangements. 

It was noted that the SVPP wanted to engage with parents, young people, carers and service users to make better uses of their experience on the system so that they can they help change future arrangements.

Resolved

1.    To note the progress to date.

2.    To provide an update on the development of the Safeguarding Vulnerable People Partnership forward agenda at the next meeting.

To note the performance and progress of the Better Care Plan and the review of the impact of funding streams in the BCP.

Responsible Officers: Linda Prosser, Carlton Brand

Report author: Tony Marvell

Helen Jones and Jeremy Hooper gave an update on the performance and progress of the Better Care Plan (BCP) and the review of the impact of funding streams in the BCP.

Matters raised during the presentation and discussion included: non-elective admissions; delayed transfer of care; Permanent Admissions to Care; changes to the service and the data collection process Wiltshire Health and Care HomeFirst; Immediate Care Beds; Urgent Care at Home; Community Hospital beds; the revised Help to Live at Home Alliance; the latest performance of the local schemes delivered through the BCF and the work underway to rationalise reporting and review each funding stream.

It was noted that there was still a lot of pressure in the system and that work is underway to align BCF funding to achieve maximum impact and to ensure there were efficiencies at every point of intervention. 

In response to an issue raised by the Board, it was noted that patients must continue to be placed in the best environments for their needs.

Resolved

1)    To note the performance levels contained in the Integration and Better Care Dashboard.

2)    Note the progress being made to further improve our whole system governance and leadership for Wiltshire residents.

3)    Note the intention to review the impact of each funding stream within BCF.

4)    To approve the proposal to delegate authority for technical quarterly returns to the Director of Commissioning (Wiltshire Council), and the Director of Commissioning (Clinical Commissioning Group) who will approve on behalf of the Health and Wellbeing Board.

A verbal update and presentation on progress tackling winter pressures.

Responsible officers: Linda Prosser/ Carlton Brand

Report authors: Emma Legg/ Ted Wilson

Emma Legg, Helen Jones and Ted Wilson gave a verbal update and presentation on the progress being made in tackling winter pressures.

Matters raised during the presentation and discussion included: the Help to Live at Home Alliance; block contracts for additional winter capacity for domiciliary care and reablement; Step Down Social Care and a purchasing plan under development; the expansion of Age UK Home from Hospital Services; the HomeFirst Integrated Reablement Pathway and HomeFirst Plus Recruitment Phasing.

In answer to a question from the Board, it was noted that efforts were being made to secure key worker accommodation, especially in the south of the county. 

A copy of the presentation is attached.

Resolved

To note the progress to date.

To assess progress in delivering the action plan developed in response to the CQC system review of health and wellbeing in Wiltshire.

Responsible Officers: Linda Prosser, Carlton Brand

Report author: Tony Marvell

Carlton Brand presented a report on the progress being made in delivering the action plan developed in response to the CQC system review of health and wellbeing in Wiltshire.

Matters raised during the presentation and discussion included: the hard work and effort already being made by staff and partners to improve care and support for Wiltshire residents and the 16 areas of improvement as highlighted in the report.

In answer to a question from the Board, it was noted that delayed transfers of care had been a key area of improvement in the past, and while improvements have been made in this area, the system acknowledges where it is in terms of ranking and continues to look for ways to improve.

It was noted that more support from providers and organisations, as well as the third or voluntary sector, was needed in order to make system improvements. The importance of involving patients’ views in the improvement process was also noted.

Resolved

To note the progress taken to respond to the CQC review.

To agree a new workforce strategy for health and social care in Wiltshire

Responsible Officers: Linda Prosser, Carlton Brand

Report author: Maureen Holas

Linda Prosser presented a report on the new workforce strategy for health and social care in Wiltshire.

Matters raised during the presentation and discussion included: the need to ensure that high quality, evidence based workforce transformation activity is planned and implemented to support the delivery of the care and clinical models for Wiltshire; the emphasis placed on partnership working – aligning challenges, ambitions, resources and identifying enablers; the desire to ensure health and social care in Wiltshire is a fulfilling and rewarding place to work and train and ensuring all staff resource is deployed and used as effectively and efficiently as possible.

In answer to a question from the Board, it was noted that effort would be made to ensure that cross-referencing of the collaborative work being done with B&NES and Swindon through the Sustainability and Transformation Partnership (STP) was more explicit.

In response to an issue raised by the Board, it was noted that there needed to be more of a holistic view of why people would want to work in Wiltshire, with reference to blockages in housing availability across the county.

Resolved

1)    To note the progress to date.

2)    To review the proposed objectives and approach to the development of the Wiltshire workforce strategy.

To outline NHS preparations for Army Basing in 2019/20.

Responsible Officers: Linda Prosser

Report author: Jo Cullen

Linda Prosser presented a report outlining the NHS preparations for Army Basing in 2019-20.

Matters raised during the presentation and discussion included: that the local health community was continuing to work closely with the Army to ensure health services for the current military personnel and their families; the impact the increase in civilian patients might have on local services; primary and secondary care considerations and the impact on community services.

In answer to a question from the Board, it was noted that workarounds were already being implemented to ensure the notes of patients go into NHS holding blocks.

In response to an issue raised by the Board, it was noted that there needed to be a more specific plan for the immediate transfer of care, especially in the case of maternity services.

Resolved

To note the progress to date.

To receive the findings from the recent campervan and comments tour.

Responsible Officers: Stacey Plumb (Healthwatch Wiltshire)

Stacey Plumb presented a report on the recent HealthWatch campervan and comments tour.

Matters raised during the presentation and discussion included: overall, there were more positive comments than negative ones; most of those spoken to wanted to talk about their local GP; waiting times to see GPs were highlighted as a concern; comments about hospital staff attitude and approach were positive; comments about social care were mixed and experiences of using them seemed inconsistent; accessing mental health services was reported to be an issue; collaboration with the GP Alliance to look at the improved access service and to hear patient views; prioritising mental health as an area of work going forward and working with Wiltshire Council’s new adult social care advice and contact team. The long-term plan and expectation is that mental health services are invested in and improved year on year, especially in regard to counselling, early intervention, and community engagement.

it was noted that a new provider had taken over the service since the Campervan and Comments Tour and this had led to a delay in providing feedback to the Board.

In response to an issue raised by the Chairman it was noted that comments must be differentiated from general satisfaction in service areas. In some areas the comments were not precise enough, and this raises difficulties in using this data to find areas of improvement (e.g. social care – do comments relate to private providers or council services?).

It was noted more work could be done to ensure the priorities of Healthwatch aligned with that of commissioners where appropriate and it would be helpful if there could be further engagement on Healthwatch’s work plans for the coming year (whilst respecting Healthwatch Wiltshire’s responsibilities as an independent organisation).

Resolved

1)    To note the engagement that took place during the tour.

2)    To note the key messages from the Campervan and Comments tour report.

3)    To confirm its commitment to listening to the voice of local people to influence commissioning and service provision.  

To receive an update on progress with the implementation of the Sexual Health and Blood Borne Virus Strategy

Responsible Officers: Tracy Daszkiewicz

Report author: Steve Maddern

Vicky Lofts gave an update on progress with the implementation of the Sexual Health and Blood Borne Virus Strategy.

Matters raised during the presentation and discussion included: that to be successful the strategy must rely on a partnership approach between commissioners and providers and wider partner organisations and that underpinning the strategy was an implementation plan split into three strategic priorities: prevention and diagnoses and treatment.

In answer to a question from the Board, it was noted that the strategy was where it was expected to be in regard to fulfilling its objectives, and was working hard to stick to its ambitious targets.

Resolved

1.    To note the Sexual Health and Blood Borne Virus strategy implementation update.

2.    To update the Board of its progress in the future.

The next meeting will be held on Thursday 21^st March 2019 at 10.00am.

The Chairman drew the meetings attention to the appointment of Tracy Cox as shared Accountable Officer from 1 March and thanked Interim Accountable Officer Linda Prosser for all her hard work for Wiltshire.

It was also noted that the NHS Long Term Plan had been released and can be viewed via https://www.longtermplan.nhs.uk/.

The next meeting is due to be held on 21^st March 2019 at 10.00am.

There were no urgent items.