Meeting documents

Apologies were received from Roger Reed, Brian Roberts, Jean Teesdale, Julia Wassell, David Carroll, Freda Roberts and Shade Adoh.

Margaret Aston declared that she is a Trustee of Carers Bucks.  She is also the Chairman of Abbeyfield House.

of the meeting held on Tuesday 20 May 2014 to be confirmed as a correct record.

The minutes of the meeting held on Tuesday 20 May 2014 were agreed as a correct record.

Matters arising

Item 8 – Mr Macdonald has produced a presentation in response to his outstanding actions which has been circulated to members and is attached for information.

This is an opportunity for members of the public to put a question or raise an issue of concern, related to health.   Where possible, the relevant organisation to which the question/issue is directed will be present to give a verbal response.  The member of public will be invited to speak for up to four minutes on their issue.  A maximum of 30 minutes is set aside for the Public Questions slot in total (including responses and any Committee discussion). This may be extended with the Chairman’s discretion. 

For full guidance on Public Questions, including how to register a request to speak during this slot, please follow this link:

http://www.buckscc.gov.uk/about-your-council/scrutiny/get-involved/

No public questions have been received for this meeting.

The Chairman reiterated that a public question needs to be received in writing 7 days prior to the date of the meeting.  This is to allow time for a response to be prepared or for the appropriate representative to be invited to the meeting.  The full guidance for public questions can be found on the website – http://www.buckscc.gov.uk/about-your-council/scrutiny/get/involved/

For the Chairman of the Committee to provide an update on recent scrutiny related activity.

The Chairman updated Members on the following:

·         A recent statement from Buckinghamshire Healthcare NHS Trust stated that "Buckinghamshire Healthcare NHS Trust was today removed from special measures after demonstrating that it had made significant improvements to the quality of care it provides…..Overall the Trust was rated as ‘requires improvement’, although it received a ‘good’ rating for having caring staff….The inspection team found that the Trust had made ‘significant progress’ with ‘real differences being made in a relatively short time to improve quality and the patient experience."  They also praised staff for being ‘caring and compassionate and treated patients with dignity and respect.’

·         At the Committee meeting in April, Members raised concerns with Buckinghamshire Healthcare Trust regarding discharge papers being illegible and going missing.  Lee Jones from the Trust has since provided assurance that their Chief Nurse and Medical Director are working in partnership with GP colleagues and Clinical Commissioning Group partners to improve discharge planning and process as part of their Quality Improvement Plan.

·         Some Committee Members visited the Whiteleaf Centre on Thursday 29^th May.  The Whiteleaf Centre is the new Mental Health Hospital in Aylesbury which is operated by Oxford Health NHS Foundation Trust.  It houses services which were previously run from the Tindal Centre.  It also provides office space for some of the mental health community teams.  It was agreed to send a letter of thanks to the staff at the Whiteleaf Centre. 

Action: James Povey

·         County Councillor Noel Brown is the council’s representative on Oxford Health and it was agreed that he would provide updates for the Committee on the developments at the Whiteleaf Centre and Oxford Health in general.

Action: Noel Brown

·         The Centre for Public Scrutiny – Good Scrutiny Awards 2014.  Buckinghamshire County Council was shortlisted for its budget scrutiny conducted in early 2014.  Although the County Council did not win an award, it was highly commended under the ‘Improving Transparency’ category and the council was runner-up in the ‘Scrutineer’s Choice’ award.

For Members of the Committee to provide any updates on health and social care topics or providers.

The Chairman referred Members to the report which was produced by Shade Adoh, the Healthwatch representative on the Committee.  The report was circulated to Members prior to the meeting and is attached to the minutes.

District Councillor Wendy Matthews updated members on an issue which was raised at the last meeting in terms of a lack of clinics in the Iver area.  Iver is now being used as a pilot site for both Adult Mental Health Services and Adult Social Care.

County Councillor David Martin reported that Mulberry Court has just re-opened which is a place for patients with the early on-set on dementia.  It was a 37 bed unit but it has now re-opened with 24 beds.  He commented on the good quality of staff who work there.  The Chairman added that mental health was always the poor relation and it is good to see that it is now being given priority.

The Care Bill legislation will come into force in 2015/16.  This will have significant impacts on how adult social care is delivered and funded.  Members will hear more details on the impacts of the Bill, and scrutinise Adult Social Care preparedness.

Contributors

Patricia Birchley, Cabinet Member, Adults and Family Wellbeing, BCC

Rachael Rothero, Service Director, Adults and Family Wellbeing, BCC

Papers

The Care Act Implications and the Blueprint for Adult Social Care, June 2014

The Chairman welcomed Patricia Birchley, Cabinet Member for Adults and Family Wellbeing and Rachael Rothero, Service Director, Adults and Family Wellbeing.  The Chairman started by saying that the Care Bill legislation will come into force in 2015/16 and will have significant impacts on how social care is delivered and funded.

The Cabinet Member started by saying that the County Council is prioritising on two aspects of the Care Bill – Self-funders (the number of self-funders is considerably higher in Buckinghamshire) and Market Equalisation.  More people will be reaching the cap of £72k and will be asking the County Council to fund their care costs. 

In 2016, people will want to open a care account so that their contribution towards the cap will be clear and about 72% of self-funders will continue to be self-funders and they will not reach the point where the County Council will be expected to foot their care bill.  There will be a smaller cohort of self-funders who will reach the cap of £72k for their care costs and then those who would currently pay for their own care costs but will be asking the County Council to pay for their care as they have reached the gap of £72k. The estimate is £10.5m of extra funding each year which is new money that the County Council has got to find.   It is hoped that the Government will find this new money. 

Of even more concern is the issue of market equalisation.  From 1 April 2016, people can ask the County Council to buy their residential care for them at the County Council’s cost of approximately £600 per week as opposed to the price that around 62% of self-funders are paying of £900 per week.  So if everyone can purchase their care at a cost of £600 per week, the cost to care home providers is around £22million and it makes the market unsustainable. 

During the presentation, they made the following main points.

·         The Cabinet Member has recently been elected as Chairman of the South East Councils Adult Social Care Committee and she said that she will use this appointment as a platform to do all she can for the residents of Buckinghamshire.

·         The Portfolio faces continued pressure on budgets due to demographics factors which increase demand for services and through pressures on prices in the market.

·         There are real concerns at a national and local level around self-funders and the potential impact on the local care market.

·         The additional costs to the council will be around £30million a year.

·         The Government has not recognised market equalisation.

·         This is one of the biggest pieces of legislation in Social Care that the County Council has had to respond to.  It is a profound change to the way social care has historically been funded and has profound implications in terms of how services are commissioned in future.

·         The timetable for responding to the consultation is very tight.

·         From 2015/16, the service will need to respond to the way  ...  view the full minutes text for item 7.

For Members to scrutinise this area of council service delivery.

Contributors

Rachael Rothero, Service Director, Adults and Family Wellbeing, BCC

Patricia Birchley, Cabinet Member, Adults and Family Wellbeing, BCC

Papers

Overview of the Domiciliary Care Market Place for June 2014 HASC Meeting

The Chairman started by acknowledging that the policy on the 15 minute care visits is currently being reviewed by the Adult Social Care team and this issue will be discussed in more detail at a future meeting.

The Cabinet Member introduced Graeme Finch who is a contract manager within the Adult Social Care team and she went on to stress the importance of domiciliary care both locally and nationally.

Ms Rothero went on to say that domiciliary care is a critical market for the county council.  The challenge is to ensure that every transaction is dignified and provides high quality care.  It consumes a lot of time in terms of intense contract management.   One of the biggest challenges is to ensure that the domiciliary care market place that is able to respond to the increased demand in social care as a result of the Care Bill.  This is seen as the biggest Public Health crisis which local authorities are facing.

During discussion, Members asked the following questions.

·         The National Adult Social Care Intelligence Service (NASCIS) 2012/13 data shows a lower weekly spend per person for home care and meals in Bucks compared to the average for England (home care - £170 vs £214; meals - £16 vs £34).  Does the service have data from service users which can reassure the Committee that this cost difference indicates an efficient and value for money service rather than an inferior service to that offered elsewhere in the country?  Ms Rothero explained that the unit costs are based on the 2012/13 data and are based on the average cost per person, per week receiving 10 hours of home care which represents around 40% of the County Council’s overall market place.  She went on to say that nationally, some places include supported living in their figures but in Buckinghamshire, supported living is not included.  The Government has recognised this and are no longer using this measure of unit cost in future – they are proposing to use a standard cost of care per hour for the external market place.  The 2014/15 data will be based on the new unit cost measure.  Mr Finch added that in 2010/11 the trend from £190 to £170 is also against a background of average of 8 hours of care but it is now around 9 hours of care.  The cost difference is for more hourly care.  The county council currently pays around £17.85 per hour against a national average of £15.19 per hour.  It is known that some authorities pay around £11-£13 per hour which is not sustainable in Buckinghamshire.

·         A member commented that evening care can start around 5pm which seems very early to be putting people to bed.  Would you have to pay more if you asked the providers to put people to bed later and is there capacity within the teams to do this?  Some providers have a rate between 7am-7pm and they have different rates for weekends and bank holidays.  With the main providers there  ...  view the full minutes text for item 8.

At their last meeting the committee agreed to commence an inquiry into local GP service provision, with a second inquiry to follow later in the year on a different topic (at this stage this may potentially be on either Adult Social Care outcomes performance, or palliative care in the community).

During this item members will agree the composition of the inquiry group.

Paper

HASC Inquiry Proposal 2014/15

The Chairman confirmed that the next inquiry will be on local GP services and specifically the variability in patient satisfaction with their local GP services.  Members interested in being part of this inquiry were noted and they were asked to provide their availability from mid-July onwards so that the initial meetings can be arranged.

Contributors

Andrew Brown, Scrutiny Policy Officer

Papers

The Health & Adult Social Care Select Committee Work Programme

The Chairman referred Members to the work programme and stated that the September meeting will focus on the results of the CQC inspection report with input from the Buckinghamshire Healthcare NHS Trust.

The Chairman mentioned the budget scrutiny and the impacts on the proposed cut to the Supporting People budget which includes support for vulnerable adults.

A member asked about the current Ofsted report on Children’s Services as it is on services in care as she felt there was some cross-over with the Committee.  The Chairman asked the policy officer to look into this and confirm where it will be looked at and when.

Action: James Povey

A member commented that the Health & Wellbeing Board is a joint partnership which relies on input from different partners and the Committee needs to get feedback from the partners to see how effective it is and the ongoing funding of this.  The Chairman said that the Committee has not yet scrutinised the work of the Health & Wellbeing Board and its performance.  The Chairman said that she would speak to the policy officer about how much detail can be given to this item in October.

Action: James Povey

The next meeting is due to take place on Tuesday 16 September 2014 at 10am in Mezzanine Room 2, County Hall, Aylesbury.

The next meeting is due to take place on Tuesday 16 September 2014 at 10am in Mezzanine Room 2, County Hall, Aylesbury.

Future dates in 2014

Tuesday 28 October

Tuesday 25 November

Proposed dates in 2015

Tuesday 10 February

Tuesday 24 March

Tuesday 28 April

Tuesday 26 May

Tuesday 30 June

Tuesday 15 September

Tuesday 20 October

Tuesday 24 November