Agenda and draft minutes

To receive any apologies or substitutions for the meeting.

Apologies were received from Cllr David Bowler, Cllr Nick Dye and Cllr Howard Greenman and from Irene Kohler, Older Person’s Champion representative, and from Fiona Slevin Brown, Cllr Caroline Thomas, and Cllr Richard Clewer.

There were no substitutions.

To approve and sign the minutes of the meeting held on 20 November 2024.

Resolved: 

To confirm and sign the minutes of the meeting held on 20 November 2024 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, including:

The Chairman made the following announcements: 

Legacy - Having an opportunity for Overview and Scrutiny (OS) to look back on its activity during the outgoing council is an important part of its improvement journey. Doing so allows the Committee to consider our successes and challenges, including the key activities undertaken. The Committee can then submit suggestions for further scrutiny under the next Council and maximise the impact of its future activity. 

At the next meeting on 12 March 2025, the Committee would receive a report outlining its key activities during 2021-24 and also proposing some future work priorities for the successor committee after the elections in May 2025.  

To feed into this process, members of the Committee would soon receive an email from the Senior Scrutiny Officer asking them to submit their ideas on what scrutiny should be looking at under the next Council. The Chairman would be very grateful if they could all give this attention and reply with a few ideas. These would then be used to form a report to the next meeting and ultimately to the first meeting of Overview and Scrutiny Management Committee after the elections. 

Reminder about budget meeting On Friday (24 January 2025) Members have an opportunity to review the budget as it relates to the remit of the committee. Invites had been sent to the Teams meeting and attendance was encouraged. 

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 15 January 2025 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 17 January 2025. 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.

The Committee had received 26 questions from 8 individuals all relating to one subject, the new BaNES, Swindon and Wiltshire (BSW) Integrated Care Board (ICB) community health contract.   Those questions were published as agenda supplement 2 on 21 January 2025. 

The Chairman repeated the statement that he had provided in response to the questions:

‘It is in the remit of the Health Select Committee to scrutinise how local health services are meeting the needs of Wiltshire residents, and that they are effective and safe. 

The questions that have been submitted to the Committee require a level of knowledge about the commissioning process of the new contract and transition of services that the Committee does not have.  Many contain a request for the Committee to seek a pause in the transfer of services and this is not in our power.

The ICB as commissioners of the service have been asked to provide a response’

Caroline Holmes (Interim Executive Director of Place – Wiltshire BSW ICB) and Laura Ambler (Executive Place Director of Place – BaNES BSW ICB) and Allison Elliott (Director – Commissioning) were present at the meeting. 

Caroline Holmes gave the following statement:

‘Chair, thank you for confirming the role and remit of this committee and for sharing the questions that have been submitted about the award of the BSW community services contract.  

The contract has been commissioned by five organisations; BSW ICB, Somerset ICB, BaNES Council, Wiltshire Council and Swindon Council. 

We understand that people have further, detailed questions and queries about the process we undertook and how we are working together with our partners to mobilise for 1 April 2025. Mindful of the committee’s time today, we will supply full, comprehensive answers to the questions raised to this committee as soon as possible and will provide a dedicated briefing to the Select Committee as agreed.  These will also be published on our website alongside all the information that we have already shared about our work on integrated community-based care. 

We are confident that our innovative new community-based care partnership with HCRG Care Group, the NHS, local authorities and charities will transform the care and support that people get for their health and wellbeing at every stage of their lives.  

The decision to appoint HCRG Care Group as our lead partner followed a robust, detailed and legally mandated procurement process, to ensure fair competition and best value for money.  

The mobilisation process has been underway since October and follows a detailed mobilisation plan with full risk assessment.  The assurance of mobilisation is provided through the ICB. 

Our focus continues to be on working closely with colleagues across BSW and all organisations involved to ensure a safe transfer of services for patients. We know that it can be unsettling for some affected staff and are working hard to ensure they have all the right support in place to help them make the transition to the new arrangements. 

There will be opportunities to help shape the future of  ...  view the full minutes text for item 5.

To receive a brief verbal update from attending Cabinet Members (or Portfolio Holders on their behalf) highlighting any news, successes or milestones in their respective areas since the last meeting of the committee, not covered elsewhere on the agenda.

The Chairman reminded that this was a new item for the Committee and was an opportunity for Cabinet Members (or Portfolio Holders on their behalf) to give them a brief verbal update on any news, successes or milestones in their respective areas since the last meeting of the committee, not covered elsewhere on the agenda. 

Cllr Jane Davies (Cabinet Member for Adult Social Care, SEND and Inclusion) gave the following update: 

·            The report following the CQC Inspection of Adult Social Care would be published next week and this would be shared with the Committee at the next meeting;

·            There was work on the Homecare First contract for 2026 and would like to offer to bring that to the committee for some scrutiny.  Alison Elliot explained that currently Wiltshire Council purchase homecare services for people to remain in own homes and be as independent as possible – the contract the Cabinet Member was referred to was in relation to that.  The Homecare first service would be coming into the Council and joined with the reablement service to provide one service; and

·            The Council are talking to the Department for Health and Social Care around the pressures that have come into the system, particularly for providers who will have for example much higher National Insurance bills that are not covered by the Government grants directly to the Council and so they are representing those concerns on a national stage.

Resolved: 

That the Health Select Committee note the update provided by the Cabinet Member. 

The Committee will receive an overview of the draft Older Person’s Accommodation Strategy 2025-2030 at the meeting.

The Chairman welcomed Allison Elliott (Director of Commissioning) who was in attendance to present an overview of the draft Older Person’s Accommodation Strategy for 2025-30 (slides attached as appendix 1 to the minutes) and the following was highlighted:

·            This was an early draft of the strategy being shared to indicate the direction of travel being taken from a commissioning perspective;

·            Voice it Hear it were commissioned to speak residents (over a range of ages) as to what they think they might need later in life and what their accommodation needs might be.  The majority of older residents reported that they wanted to stay in their own home for as long as possible but may need adaptations and practical support to achieve that;

·            People want accessible information about housing choices and options locally and equitable access to support;

·            Whilst most residents would like to stay in their own homes there was the recognition that they may need to downsize their home – there was a preference for a bungalow with a small garden and living in a care home was the least desirable option;

·            We know that people are living longer healthier lives which was a real positive however, Wiltshire’s population was projected to increase by 7% over the next 20 years and the most significant growth is expected to be among older adults.  By 2030 8.3% of the population (around 44,000 residents will be aged 80 or over and there will be an increase in those with dementia as people live longer the risks of getting dementia are greater and those with complex dementia may well require care home facilities;

·            The draft strategy being prepared will take on board what residents have told us and Officers were engaging with providers and health colleagues around this, but ultimately residents will need the right homes in the right place with the right support so that they can stay independent and in their own homes;

·            The four desired outcomes were a) easy access to information and services on housing choices and options, b) increased involvement of older people planning their future accommodation needs, c) sustainable housing options that meet the current and future needs and aspirations of older people and d) support to enable older people to live independently across all housing tenures, enhancing the availability of technology and preventative services;

·            The commitment was to invest in community services which support independent living, expand the use of digital technology, engage more with older residents in order to assess and fully understand their future housing needs, look to increase supported accommodation options with specialist designs for complex needs, enhance availability of accessible housing through developer contributions for those 55 and over, develop specialist residential facilities and boost the provision of nursing and specialist dementia care homes as the market doesn’t currently support those with complex dementia;

·            Officers were looking to develop additional housing options and at what other Local Authorities do, for example some older people rent out space in their homes  ...  view the full minutes text for item 7.

The Committee will receive an update on the aims and benefits of Continuing Health Care (CHC) funding and this will address the queries raised when this was last presented to the Committee in June 2024.  The report is to follow.

The Chairman noted that the Committee received an introduction to the Continuing Health Care (CHC) funding in June 2024 and at that time they requested that an update include Wiltshire specific data.  Sarah-Jane Peffers (Associate Director for Patient Safety and Quality and All Age Continuing Care – BSW ICB) was in attendance to provide the update.

Summarising the more detailed presentation included in the agenda pack, the following was highlighted: 

·            ICBs have a statutory responsibility for assessing individuals for eligibility for NHS Continuing Healthcare funding. The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care sets out the principles and processes to be followed by ICBs;

·            CHC funding is a package of care provided to individuals who have been assessed as having a primary health need which is funded by the NHS to support individuals with significant and ongoing healthcare needs and to enable care to be delivered in the most appropriate setting, whether at home or in a care facility;

·            Diagrams within the presentation showed that BSW was within the confidence levels of individuals assessed as eligible for CHC per 50k nationally and the comparative positions with BSW’s nearest neighbours based on demographics;

·            The regional data shows that BSW ICB has the joint highest referral conversion to eligibility rate in the southwest and the second highest assessment conversion to eligibility rate in the southwest with the ICB exceeding the 80% target of assessments being completed within 28 days of notification;

·            The Wiltshire specific data showed that there was a 22% conversion rate to eligibility for Wiltshire residents and there had been a sustained increase in positive checklists over the past year in all three localities;

·            Wiltshire locality CHC patient spend equated to 52.5% of BSW ICB expenditure at £36.76 million from a total of £70.07 million to date and the adult spend in comparison to the nearest neighbour based on demographic similarities reflected the second lowest annual budget; and

·            The transformation work was continuing, and BSW ICS is working to together to empower people to live their best life.  Areas of focus were commissioning, contracting, Personal Health Budgets, digitisation, brokerage, shared polices and workforce development.

The Committee asked the following questions which included but were not  

limited to: 

·            How we convert people into service eligibility is not addressed, how do you ensure fairness for those deemed to be eligible across a cross section so that no particular type of person is left behind and the CHC funding is ethically distributed.  It was noted that BSW ICB have to ensure that there is equity and fairness for all and whilst that information was not shared with the Committee today it could be at a future meeting.   It was important to be able to clearly articulate fairness and equity and BSW ICB worked with all partners across health and care to ensure that the right people have access to CHC funding.  The threshold for a positive CHC checklist is low, so that a CHC assessment can be offered to  ...  view the full minutes text for item 8.

The report seeks to update the Committee on the progress of Neighbourhood Collaboratives across Wiltshire during the past year.  These collaboratives are integral to achieving the objectives of the Wiltshire Joint Local Health and Wellbeing Strategy and the Integrated Care System (ICS) Strategy. 

The Chairman welcomed Emma Higgins (Head of Combined Place – BSW ICB) who was in attendance to provide an update on the progress of Neighbourhood collaboratives across Wiltshire. 

Summarising the key points of the report included in the agenda pack, the following was highlighted: 

·            The neighbourhood collaboratives represent a community-led, partnership based approach to addressing health inequalities, improving health outcomes and fostering a culture of prevention and early intervention;

·            There had been strides in several areas – for the CCB (Chippenham, Corsham and Box) collaborative they were focusing on a targeted cohort of non-hypertensive residents aged 30-49 with obesity and smoking behaviours focusing on preventing long-term conditions such as diabetes and cardiovascular disease and engagement sessions were planned for January 2025;

·            In Salisbury there had been an innovative approach by engaging the farmers at the Livestock Market and the development of health and wellbeing work in the market directly.  This had been particularly successful and there were ongoing discussions around transferring that learning to other settings;

·            In terms of county wide progress despite some delays to reach the April 2025 target there had been recent developments in Warminster, Calne, Trowbridge and Devizes and were on track to establishing collaboratives in those areas and across Wiltshire in 2025;

·            Colleagues in the Community Conversations team at the Council were embedded in the collaboratives work and their ongoing dialogue with communities had been crucial in shaping priorities and ensuring the work remains responsive to local needs;

·            Key learning, particularly around the Livestock market had provided valuable insights by offering health promotion and some services directly into the market and they had successfully reached usually hard to reach populations and supported them with needs identified at the market.  The pilot highlighted the importance of delivering services in a familiar environment and demonstrated the value of preventative care.  A full evaluation report and presentation was available for viewing;

·            The aims for 2025 were to embed the learning and approach from the collaboratives across the work and the full Steering Group meeting February will focus on lesson learned from the work to date and celebrate success to inform future developments.  They were also exploring opportunities to integrate the work with the new ICB provider in HCRG when that into effect in April 2025; and

·            The Neighbourhood Collaborative programme had made significant progress towards the objectives and demonstrates the potential of community-led partnership driven approaches to improving health outcomes and tackling health inequalities across Wiltshire.  It was not a unique programme and they were drawing on learning from a lot of work being done in a number of areas including Community Conversations and they look forward to further discussions on how they can build on and address challenges together.

The Committee asked the following questions which included but were not  

limited to: 

·            Aware that there are already some services in the community for example for trips and falls/hypertension and diabetes etc – how can a collaborative prove to be a success for measure its worth?  It was  ...  view the full minutes text for item 9.

The Committee will receive an overview of the Wiltshire Pioneers project.  Case studies and further details of the project are attached.

The Chairman welcomed Mary Reed and Abbie-Jo Lawrence (Wiltshire Centre for Independent Living) and Daniel Wilkins (Head of Transformation and Quality) who were in attendance to provide an overview of the Wiltshire Pioneers project as requested by members following the discussion of the service user contract at the last meeting.

Summarising the more detailed presentation included in the agenda pack, the following was highlighted: 

·            The aim of the work of the pioneers was to ensure that the people who use social care are key engineers in its transformation, working in equal partnership with Wiltshire Council staff.  The project went live last year and there are 6 core pioneers that work closely with the Council and a wider network of 100 pioneers.  The 35 staff from Adult Social Care who are involved are called Innovators;

·            Best practice for doing co-production is where they are trying to get to and that is ‘doing with’ as opposed to ‘doing to’ or ‘doing for’;

·            Wiltshire CIL had designed the Pioneers Project, with a lot of thought going into the mechanisms and processes needed to affect change and develop meaningful partnerships.  They had drawn on a range of evidence and theories in the development of the work including business change models and techniques used in strengths based practice.  It was acknowledged that not all is perfect in systems and there was consideration as to what could be co-created in the future.  It was lots of small actions leading to bigger changes in the system.  They were not looking to change Adult Social Care overnight but they wanted people to see change happening, have fun and feel energised to make progress;

·            There had been events held across the county, but it was recognised that not all want to attend events so there was also WhatsApp groups, emails and surveys.  Open communication was important and the WhatsApp group had opened up great conversations and the sharing of stories of what was going well.  Wiltshire CIL staff facilitate interactive meet ups between innovators and pioneers, which were as far away from traditional meetings as possible, encouraging everyone to come together as equals and collaborate;

·            There had been great progress since they had got started in February 2024 – there were 6 work streams and growing.  Teams had come to them to ask the pioneers to look at their work to see what could be improved.  The pioneers had worked closely with the Financial Assessment and Benefits (FAB) and designed a new form.  There had been great feedback from those using the new form;

·            There had been feedback from innovators saying that it helped remind them of why they became a Social Worker in the first place and that engagement with the pioneers had led to so many good ideas, and some very simple changes that it would make all the difference;

·            Some feedback from a pioneer was that they now feel they have a chance for their voice to be finally heard and to make small but important  ...  view the full minutes text for item 10.

The report seeks to present the options available to the Committee with regards to the appointment of non-elected non voting co-opted members.

The Chairman highlighted that the Committee had had a preliminary discussion on this subject in September 2024 and that the insight and expertise that is brought by the co-opted members is valued.  The aim of the report was to formalise the role of non-elected and non-voting co-opted members on the Committee.  The report and draft protocol was for the Committee approve or amend and the intention would be to introduce the new approach from May 2025.

The Committee asked the following question: 

·            The report is recommending that there be a maximum of 5 co-opted members to be appointed by the committee, we currently have 3.  Are the other 2 representatives earmarked or how would the committee decide on who the representatives should be?  It was noted that it was planned for the co-opted membership to be reviewed annually by the committee and suitable representatives be considered as appropriate.  It a groups representation was felt to be needed then there would be flexibility to be able to add them to the committee.

Resolved: 

1.           That the Health Select Committee agree the following: 

a)         That a maximum of 5 co-opted members are to be appointed to the Committee.

b)         That the terms of office of 1 municipal year to be reviewed at the first meeting of each municipal year, supported by a report from the Scrutiny team (paragraph 22 of report refers).

c)         That the Voluntary and Community Sector organisations who should retain their current seat as co-opted committee members are:

•         Healthwatch Wiltshire

•         Wiltshire Service Users’ Network (WSUN)

•    Wiltshire Centre for Independent Living (CIL)

d)          To adopt the following approaches to support inclusion of co-opted members:

•     Annual consultation of co-opted members and their respective groups and organisations when developing the forward work plan for the Health Select Committee

•           Annual informal presentations delivered by co-opted members, and / or other representatives of their respective organisations and groups on the role and work of the organisations and groups, their key successes and challenges in the previous year as well as priorities for the year ahead.

•           Ensure that co-opted members are aware of all opportunities to engage with Task Groups and Rapid Scrutiny exercises.

2.     That the Health Select Committee delegates to the Chair and Vice-Chair to report the above decisions to the next available meeting of the Overview and Scrutiny Management Committee.

3.     That the Health Select Committee recommends to the Overview and Scrutiny Management Committee that a protocol for non-statutory Co-opted members be included with the relevant protocol for overview and scrutiny to offer clarity on the role of co-opted members, their appointment, and the expectations and support linked to it.

To review and approve the attached Committee forward work programme in light of the decisions it has made throughout the meeting.

The Committee’s noted the Forward Work Programme (FWP) as circulated with the agenda and agreed that an informal committee briefing from the ICB should be arranged for HCRG contract following the questions raised to the committee for February 2025 and any necessary scrutiny work following that briefing be added to the work programme.

A committee member questioned whether they could now proceed with the panned Rapid Scrutiny on urgent care which was agreed at the meeting on 20 November 2024.  The plan would be to make a recommendation to the next Health Select Committee.  Cllr Clare Cape and Cllr Gordon King were happy to join that Rapid Scrutiny and any others were asked to contact the Senior Scrutiny Officer (Julie Bielby).

Resolved: 

That the Health Select Committee: 

1.          Approve the Forward Work Programme with the additions agreed at the meeting. 

2.          Commence the Rapid Scrutiny Exercise to understand the data collected with regards to Urgent Care (in particular response time and to include a range of response times and hospital handovers) and develop a report for the next Health Select Committee.

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 Wednesday 12 March 2025 at 1pm.

Future meetings are as follows:

5 June 2025

9 July 2025

9 September 2025

12 November 2025.

The date of the next meeting was confirmed as Wednesday 12 March 2025 at 1pm.

Future meetings were noted as follows:

5 June 2025

9 July 2025

9 September 2025

12 November 2025.