Agenda and draft minutes

To receive any apologies or substitutions for the meeting.

Apologies were received from Committee Members: Cllrs Tony Pickernell, Monica Devendran, Tom Rounds and Howard Greenman.

Cabinet Members: Cllrs Jane Davies, Ian Blair-Pilling and Richard Clewer.

To approve and sign the minutes of the meeting held on 22 January 2025.

The minutes of the meeting held on 22 January 2025 were presented for consideration.

The Chairman noted that at that meeting, the committee resolved to receive a briefing from ICB on the new community health contract, following questions raised by the public at that meeting. Furthermore, the minutes included a written response to the public questions as well as a report provided for members by the ICB ahead of the briefing which took place on 14 February.

The proposals coming out of that briefing were:

• Further scrutiny of the contract, which is included in the Forward Work Programme and would be considered under item 10.
• Writing to the Secretary of State for Health to be satisfied that all procurement guidelines had been complied with when commissioning for the provision of community health services in Wiltshire.

The Chairman also noted that ahead of the meeting a statement had been received from Unison, which reiterated points raised during the meeting held on 22 January 2025. The Chairman outlined that the respective matter had already received a call in, and Members reiterated that it would be positive to have a response from the government minister that could then be shared with Committee Members.

After which, it was;

Resolved: 

To confirm and sign the minutes of the meeting held on 22 January 2025 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 made the following announcements: 

This would be the last meeting of the Committee this Council and the report on item 10 on the agenda was highlighted as an opportunity to reflect on what the committee had achieved as well as to plan ahead.

The Chairman noted that this would be his last meeting as Chairman of the Committee as he would not be standing in the upcoming election. The Chairman thanked Cllr Gordon King (Vice-Chairman) for his wisdom over previous years, the Committee for their impact and to Julie Bielby and Democratic Services for the support they had provided. 

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 5 March 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 7 March 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 Chairman noted that Cllr David Vigar had submitted questions to the committee relating to the recent budget proposals around adult social care. The questions were raised previously as part of the scrutiny process. 

The Chairman also noted that in terms of the wider issue of Select Committee involvement in the budgetary process, the Overview and Scrutiny Management Committee would be considering the arrangements for financial scrutiny on 13 March 2025.

As the Cabinet member for adult social care, Cllr Jane Davies was not in attendance, it was;

Resolved:

That the Health Select Committee request a briefing from Cllr Davies to address these questions.

Appendix 1 to these minutes is the response prepared in relation to Cllr David Vigar’s questions prior to an informal briefing with the Cabinet Member.

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.

There were no Cabinet Member updates to be received.

The report seeks to provide the Committee with an overview of the Care Quality Commission (CQC) Local Authority Assurance Assessment of Adult Social Care Services within Wiltshire Council, to offer insights into the current assessment of services and inform of the opportunities for further development to enhance the quality of care and support provided to residents.

The Chairman noted that Wiltshire’s Adult Social Care Services had recently received a ‘Good’ rating from CQC and that this was the first opportunity the committee had to review the findings in more detail. It was outlined that in the agenda pack was a report outlining the findings of the inspection, which also contained a link to the full inspection report which could be found on page 68, para 12.

Cllr Elizabeth Threlfall, Portfolio Holder for Adult Social Care Transformation introduced the report, with it noted that this was a complicated process which had resulted in the publication of a “Good” rating from CQC following a huge amount of preparation from the service involved. This included practitioners, managers, partners and providers who had worked hard in order for CQC to see the quality of service provided and the commitment of staff to deliver. Overall, it was stated that the Adult Social Care team should be proud of the result that they had achieved and for having a commitment to continuous improvement with surveys being used to develop improvement plans.

The Chairman invited Mary Harvey (Principal OT) and Kaylie Chapman (Principal Social Worker) to provide a brief presentation on the findings of the inspection:

• It was outlined that the “Good” result published in January had been a fantastic achievement, with an opportunity taken to thank everyone involved in the result, including the people in Wiltshire with lived experience.
• A timeline of the journey up until the publication of the report was provided, which included looking at strengths and weaknesses, working with partner organisations for an LGA peer review and the completion of a comprehensive staff self-assessment. Focus was also given to ensuring that staff wellbeing and readiness was addressed as this was a new process to some of the staff group involved. The inspection itself took place over three days in September with CQC meeting a variety of Adult Social Care Staff.
• An overview of the 9 CWC quality statements across 4 themes was provided, which covered:
  • Theme 1 – Working with people
  • Theme 2 – Providing support
  • Theme 3 – How the Local Authority ensures safety within the system
  • Theme 4 – Leadership
• Attention was drawn to some of the highlights which had been included within the CQC report, with specific reference given to the feedback provided from people that the team had worked with, as well as the prevention strategy and transformation activity.
• Next steps and the development of an improvement action plan was discussed with attention drawn to the ability to enable people to have more choice on how they have their services provided, direct payments and self-directed support and how technology enabled care could be used to prevent and reduce care needs.
• It was summarised that the team were grateful for the positive result., which reflected the impact made by staff and that the team was aware of areas they wanted to develop and improve upon.

The Committee asked the following questions, with clarity sought on what  ...  view the full minutes text for item 21.

The report seeks to update the Committee on the Adult Social Care Service Plan and its performance against the Business Plan targets.

The Chairman noted that there was a strong overlap between this item and the previous one with progress on the business plan objectives reflected in the positive findings of the CQC inspectors. It was stated that it was helpful for the Committee to receive a performance report and consider whether there

were subjects that could be picked up in the forward work plan.

Cllr Elizabeth Threlfall, Portfolio Holder for Adult Social Care Transformation introduced the report, with it noted that the Business Plan targets outcomes, relating to the Adult Social Care priorities have a focus on building communities and ensuring the safety and wellbeing of residents. It was outlined that the report updated on several service areas aligned within the Business Plan and was a summary of work undertaken with everything conducted on an evidence base with outcomes assessed financially and from a resident satisfaction perspective.

The Chairman invited Emma Legg (Director Adult Social Care (DASS) to speak on the report, which included, but was not limited to:

• There were ten services working towards Business Plan objectives, with the majority working in the area of keeping people safe with safeguarding a key statutory responsibility.
• The following key themes were highlighted with specific examples of work provided within the report:
  • Prevention
  • Choice and Control/Promoting Independence
  • Transitions
  • Partnership Working
• Prevention was highlighted as a golden threat which ran through the report and had been included in a lot of Adult Social Care work with it suggested that preventing deterioration was important to maintaining independence.
• Next steps were outlined and would focus on prioritizing direct feedback from service users, enhancing the use of data and reviewing service priorities based on CQC feedback and transformation activity.

The Committee asked the following questions which included but were not  

limited to how an adult social care plan was defined, with clarity provided that this was a high-level summary of work being conducted rather than a totality of the work. A point was raised regarding how it would be positive to understand how improvements were being made over time with it suggested that the Forward Work Plan could potentially have some KPIs next to priorities to demonstrate progress.

A question was asked about potential savings being made due to more people living independently, to which it was noted that purchasing properties tends to lead to savings through prevention however it is difficult to ascertain long-term. The Chairman noted that an annual report on the impact of the prevention and wellbeing strategy could potentially be added to the Forward Work Programme. Reference was also made to Caring Steps Together, to which it was noted that the Council was aware of Caring Steps Together and it was happy to promote it following conversations with ICB colleagues outside of the meeting.

Resolved: 

That the Health Select Committee: 

• Receive an annual update on the Business Plan.
• Receive a report on the impact of the Prevention and Wellbeing Strategy.

The report seeks to provide an update to the Committee on the progress of the delivery of a new Integrated Care Centre in Trowbridge which will replace the Trowbridge Hospital and to provide assurance on the engagement approach being taken by the Integrated Care Board (ICB) on designing the future model, and how this aligns with the aspirations set out within the new Integrated Community Base Care Contract.

The Chairman outlined that Members had received a report introducing what was planned in the next 12 months in preparation of the Trowbridge Integrated Care Centre opening.

The Chairman invited Caroline Holmes (ICB Interim Executive Director for Wiltshire) to present an overview of the current situation:

• Trowbridge Integrated Care Centre would be a £16million development to replace the outdated Trowbridge Community Hospital and that many services would transfer to the new centre with the full list to be finalised. £3million of the budget had been provided by Wiltshire Council’s community infrastructure levy with completion set to be late 2025.
• The new centre would focus on supporting the integrated model of care, doing more for patients in the community and closer to their homes.
• It was noted that the new centre would help to address local inequalities with three of Wiltshire’s ten most deprived areas located in Trowbridge. The centre also aimed to make health care easier for residents with the population of Trowbridge set to increase over future years.
• The ambitions of the project were outlined, with the centre potentially set to act as a hub for multiple health organisations, employ the latest green technology and also to reduce travel times and relieve pressure on other health and care services.
• It was outlined that the Trowbridge Integrated Care Centre would be developed to align with the three key shifts expected within the NHS 10-year plan:
  • Making better use of technology
  • Moving more care from hospitals to communities
  • Preventing sickness, not just treating it
• The new approach to integrated community-based care was outlined with it noted that that a single provider, HCRG Care Group, had been appointed to take on the NHS community portfolio.
• The operational objectives of the centre were outlined which included but was not limited to:
  • To provide sufficient physical capacity to deliver core primary care services for a projected population of circa 62,000 in the Trowbridge Primary Care Network.
  • To improve access to same day urgent care for circa 30,500 patients per annum within Trowbridge through the development of additional capacity.
  • To provide capacity to enable delivery of an integrated and increased range/volume of activity of community health, acute outreach, mental health and social care services within the WWCHC locality/neighbourhood in order to reduce A&E and non-elective admissions.
• A list of potential services that would be provided as operational model
• development was outlined as well as a roadmap for the operational model.
• The next steps for the project were outlined with the core structure of the building set to begin to take shape in coming weeks and for community work to take place to enable the centre to be patient friendly.

The Committee asked the following questions which included but were not  

limited to whether the minor injury unit would be retained to which it was noted that there would be urgent care services located within the centre, however the exact make up of this was to be confirmed with it acknowledged that footfall into such  ...  view the full minutes text for item 23.

The report seeks to highlight key aspects of the work undertaken by the Health Select Committee during the 2021-25 council and to recommend topics to the Management Committee for possible inclusion in a new overview and scrutiny work programme after the elections in May 2025.

The Chairman outlined that this was the last meeting of Health Select Committee this council.  Included within the agenda pack, the review summarised the work of the committee in the past four years and was an opportunity to reflect on how the committee had operated, its achievements and challenges and recommendations for the work of the next committee. The Chairman thanked Members who responded to the survey.

The Chairman discussed the report with attention drawn to the Learning and Improvement sections as well as asking if there was anything additional which the Committee believed should be taken to the Overview and Scrutiny Management Committee meeting that was set to take place the subsequent morning.

A discussion the took place regarding the NHS contract which had been awarded to HCRG, with it suggested that the ICB had innocently not recognised that the Health Select Committee was the democratic vehicle for scrutiny. It was therefore suggested that the ICB could include within its Terms of Reference to alert the Health Select Committee of any major changes set to affect services in Wiltshire. It was further suggested that this proposal include not only changes to health services but to also include changes to major contracts.

Caroline Holmes (ICB Interim Executive Director for Wiltshire) provided clarity that there was no planned or proposed reconfiguration for the ICB contract and that it had been reflected that though parts of the procurement process had been confidential there had been some opportunities to provide the Health Select Committee with updates. It was clarified that a service reconfiguration was not the same as a contract award.

It was therefore suggested that it would be reasonable for the Wiltshire Council to request that the ICB was to notify the Health Select Committee of any big contract changes in advance and that future confusion could be avoided with briefings in advance of any potential changes.

Resolved: 

That the Health Select Committee: 

• Approve Appendix 1 as a list of the Health Select Committee’s key activities and achievements
• Approve Appendix 2 to recommend to the Overview and Scrutiny Management Committee as topics requiring further work to the new Council including reasons. 
• To approve the recommendations made to improve the working of the select committee regarding
  • Prioritising discussion
  • Scrutiny of service delivery
  • Continued use of task groups and rapid scrutiny
  • Maintaining a focus on key outcomes
  • The use of briefings to keep members informed
  • Further involvement of people impacted by service

• To note the next steps in paragraph 13 of the report

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

It was raised that NHS England was set to experience disruption as it was suggested that central roles in the NHS could be reduced by 50%. Caroline Holmes (ICB Interim Executive Director for Wiltshire) suggested that a number of changes had been announced over previous weeks with senior team members having stepped down with it likely that NHS England would play a smaller role with much more direct management in central and regional areas. It was suggested that there was not expected to be any announcements of changes to ICBs as these had previously undergone a 30% reduction in costs and budget a year ago.

To confirm the date of the next meeting as Thursday 5 June 2025 at 10.30am.

Future meetings are as follows:

9 July 2025

9 September 2025

12 November 2025.

The date of the next meeting was confirmed as Wednesday 5 June 2025 at 10.30am.

Future meetings were noted as follows:

9 July 2025

9 September 2025

12 November 2025

The Committee gave out-going Chairman, Cllr Johnny Kidney a round of applause.