Meeting documents

Apologies were received from David Martin, Jean Teesdale and Julia Wassell.

There were no declarations of interest.

of the meeting held on Tuesday 16 September 2014 to be confirmed as a correct record.

The minutes of the meeting held on Tuesday 16 September 2014 were agreed as a correct record.

Matters arising

·         Still awaiting consultant figures but the policy officer will chase these and circulate once received.

Action: Policy officer

The following public questions have been received.

Mr Bill Russell has submitted the following questions.

Question 1

"I continue to be concerned that the voice of the patient & public remains fragmented and virtually unheard. Lots of different organisations and websites are collecting the experiences, comments and concerns of people but it seems that nobody is collating that data, pulling it all together and then analysing it so it is turned into useful information that can be used for the benefit of service users.

It is time that someone should take the lead and act as a single point of contact so that all the comments made by service users can be collated and turned into service improvements.  I would like the Local Authority, perhaps through the Health & Wellbeing Board, to take a lead and work with all the others to make this happen".

Question 2

"The word ‘discharge’ is commonly used by staff when patients leave hospital.  The use of this word is perceived by service users to mean that their care is at an end and they describe a feeling of being isolated and ‘falling off a cliff’.  The reality is that for many, especially for those with Long Term Conditions, their care needs continue 24/7/365 - for the whole of their life.

It would be much better to use the phrases ‘transfer of care’ or handover of care’.  It changes the whole nature of the process and would encourage the organisations to work together to make sure that care really is integrated and seamless".

The following public questions were submitted by Mr Bill Russell.

Question 1

"I continue to be concerned that the voice of the patient & public remains fragmented and virtually unheard. Lots of different organisations and websites are collecting the experiences, comments and concerns of people but it seems that nobody is collating that data, pulling it all together and then analysing it so it is turned into useful information that can be used for the benefit of service users.

It is time that someone should take the lead and act as a single point of contact so that all the comments made by service users can be collated and turned into service improvements.  I would like the Local Authority, perhaps through the Health & Wellbeing Board, to take a lead and work with all the others to make this happen".

The Cabinet Member responded by saying the Adults and Family Wellbeing service area fully recognises and agrees with the comments made by Mr Russell. Over the last two years, the service has been significantly strengthening its efforts to increase the patient voice and improve the patient experience through establishing partnership boards and working closely with organisations, such as SUCO.  The re-commissioning of carer services will help to increase feedback from carers.  HealthWatch has an important role in championing the needs of the consumer and inspecting the care homes.

The Chairman added that the public and patient voice on health services is undoubtedly fragmented and this matches the fragmented nature of the commissioner and provider system.  There are resource implications with this request and it could be very labour intensive to bring together a comprehensive list of all health and social care feedback.

The Health and Adult Social Care Select Committee uses whatever data is available when it has reason to look at an issue/service in depth but it does not routinely pull everything together for analysis.  Other agencies and providers/commissioners will also use the data available depending on their remits and purpose.

Question 2

"The word ‘discharge’ is commonly used by staff when patients leave hospital.  The use of this word is perceived by service users to mean that their care is at an end and they describe a feeling of being isolated and ‘falling off a cliff’.  The reality is that for many, especially for those with Long Term Conditions, their care needs continue 24/7/365 - for the whole of their life.

It would be much better to use the phrases ‘transfer of care’ or handover of care’.  It changes the whole nature of the process and would encourage the organisations to work together to make sure that care really is integrated and seamless".

The Chairman responded by saying that this is a fair comment but it would cause confusion and misunderstandings if the Select Committee in Buckinghamshire pushes to change what is nationally accepted terminology.  This would need to be led nationally by the NHS if it was felt to be worthwhile.

Discharge planning remains high on the agenda of  ...  view the full minutes text for item 4.

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

The Chairman updated Members on the following.

·         GP Services Inquiry update – 12 visits to various GP practices across the county have taken place and the final evidence session was held on Friday.  The visits covered a range of GP practices of varying size across the four districts.  The visits and evidence sessions were informed by public feedback on services which are received direct or via NHS Choices and patient experience surveys.  The report is being finalised for agreement by the Committee at the November meeting.

The Chairman asked Members to consider which organisations and people the report should be sent to.

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

District Councillor Wendy Matthews updated Members that Wexham Park Hospital has been taken over by Frimley Park (as from 1 October 2014). It is now known as Frimley Health Trust.  As of this time, the Governors of Wexham Park has been dissolved and, for the interim, the Hospital at Wexham will be run by the Governors at Frimley with no input from Buckinghamshire.  A Shadow Trust was supposed to be formed but there has been no further information on this.

The Cabinet Member said that Frimley Hospital has had an outstanding rating and she felt optimistic that the standard of care will be better at Wexham park now.  There is a Governor on the Board from Bucks County Council.

The Chairman said that she is expecting to hear from Frimley Park in relation to the direction of travel.  The Chairman suggested that she writes to Frimley on behalf of the Committee to congratulate them on the takeover and to ask for an update on the direction of travel.

Action: Chairman

The Chairman went on to say that she thought the Bucks County Council Governor is County Councillor Trevor Egleton and she suggested that she writes to him to ask him to attend future Committee meetings to provide an update on this.

Action : Chairman   

Shade Adoh, HealthWatch representative, provided Members with the following update.

"The Dignity in Care enter view project has now started its programme of visits.  By the 28^th October, they will have visited two care homes using volunteers to meet, observe and discuss with residents how they feel about the way they are cared for.  Feedback will be provided to the manager on the day with a written report to follow.  It is intended to visit sixteen homes before the end of March 2015 as well as with users of two domiciliary care providers.

There were two visits intended to help volunteers see what good looked like, I participated in the first visit which was educational and led to some adjustments of the questionnaire.

As for partner projects, we have a draft report from SEAP (Support, Empower, Advocate, Promote) on gypsies & travellers and one from Carers Trust Thames on their work trying to gather views from BME carers.  There is ongoing work to get the key messages pulled out so that they can be finalised and put on our website.  Our report on discharge for a Hospital setting is online.

Chiltern Music Therapy have started their project on collecting voices on mental health and the SUCO (Service Users and Carers Organisations for Bucks) project on collecting evidence of behaviour that challenges care provision starts this month of October.

The Transport project report is expected this month whilst the Urgent Care project is expected early December."

Further to the item on Domiciliary Care Services commissioned by the County Council at the June committee meeting, members will question the adult social service on the policy regarding 15 minute care visits.

Contributors

Patricia Birchley – Cabinet Member for Health and Wellbeing

Rachael Rothero – Service Director, Health and Wellbeing

Papers

Delivering Dignified Domiciliary Care

The Chairman welcomed Patricia Birchley, Cabinet Member for Health and Wellbeing, Susie Yapp, Interim Service Director (Commissioning and Service Improvement) and Graeme Finch, Contracts Manager.

The Cabinet Member started by saying that there has been national concern in relation to the 15 minute calls, it is not an isolated problem in Buckinghamshire.  The main aim is to make sure people have their care needs met in a dignified manner.  There are no residents in Buckinghamshire who only receive one 15 minute call a day – the majority of people receive a 15 minute call which is part of a bigger care package involving longer visits during a day.  The aim is to try and reduce the number of 15 minute calls from 42% down to 25% of all commissioned calls.  The volatile nature of the provider market has meant that more investment has been put into domiciliary care.  Buckinghamshire is marginally ahead of the industry in terms of rates of pay for care.

Mr Finch went on to say that a lot of work has been undertaken with the four main providers and as a result of this, more trust has been placed with the provider base.  Any change requests to a person’s care package can be actioned very quickly.  Front-line staff pay being above minimum wage is monitored as part of the contract which the county council has with its providers.  Relationships have improved and there are more sub-contractors which has increased the scope and the geographical spread of services is better now than before.  There has been a lot of work undertaken to identify what is appropriate and acceptable activity to be included in a 15 minute call.  The service is confident that the mechanisms are in place to monitor and evidence that the 15 minute call is sufficient for those people who receive it.  In Buckinghamshire, the service delivers around 20,000 domiciliary care visits every week and the service receives around one complaint for every 10,000 visits.

During discussion, Members asked the following questions.

·         What data or evidence can be supplied that can provide reassurance to the Committee that the process of the supplier notifying the client that longer visit lengths are required is being utilised where required and front line staff and providers feel confident using this?  Mr Finch confirmed that he can provide statistical evidence.  He went on to say that the main provider is responsible for monitoring the sub-contractors to ensure they are providing the quality of service required.

Action: Graeme Finch

·         Given the new policy still includes provision for "assisting with minor element of washing" in any 15 minute visit, is the council still considered to be among 8% minority of councils that use 15 minute visits to undertake washing or bathing tasks?  Mr Finch responded by saying that there are some tasks which are still undertaken in the 15 minute call which includes washing but not bathing.  Providers and professional social workers have confirmed that this appropriate.  There are no national standards  ...  view the full minutes text for item 7.

The 2014/15 Budget Scrutiny Report by the Finance, Performance and Resources Select Committee raised concerns over the proposed £750k cut to the Supporting People item in the Health and Wellbeing budget.  Members will scrutinise the potential impacts of this budget reduction.

Contributors

Patricia Birchley – Cabinet Member for Health and Wellbeing

Rachael Rothero – Service Director, Health and Wellbeing

Papers

Supporting People

The Chairman explained that the Budget Scrutiny report 2014/15 requested that the Health and Adult Social Care Select Committee consider looking at the impacts of the £750k cut in the Supporting People budget for 2015/16.  This was due to concerns on the impact on vulnerable people and on local voluntary and community organisations which depend on funding.

The Chairman welcomed Patricia Birchley, Cabinet Member for Adults and Wellbeing, Susie Yapp, Interim Service Director, Ainsley MacDonnell, Service Manager for Commissioning within Adults and Family Wellbeing and Steve GoldenSmith, Senior Joint Commissioner.

The Cabinet Member explained that the Supporting People Services (SP) provide housing related support to some of the most disadvantaged and vulnerable residents in Buckinghamshire who are not eligible for adult social care.  The county council needs to change the way it delivers these services but she expressed concern that by the end of the budget process, 50% of the budget will have been taken out.  The Cabinet Member went on to say that she felt there should not be any more cuts to this service as it could have a major impact on adult social care services in the long term and end up costing more money.  The Government places high importance on this service.

Ms MacDonnell went on to say that this service is a key component of preventative services in Buckinghamshire.  The typical tasks carried out by the service includes helping people with benefits, paying their rent and essential life skills and hygiene.  The aim is to support people to live in their own home.  Supporting People services in Buckinghamshire are currently delivered by 30 providers through 39 contracts.  

Funding attached to Supporting People services had previously been ring fenced by central government.  This ceased following the Spending Review in 2010 when funding was rolled into the local authority Formula Grant with spending decisions made by individual councils.  £1.2 million of savings have already been made through re-negotiation with the providers.  The service has to find £250,000 this year and another £750,000 the following year.  These are significant amounts of money being taken out the services.

During discussion, Members asked the following questions.

·         The report provides no detail on where the cost savings of £750k will come from across the range of Supporting People services provided.  When will these details be made available to the Committee and Public?  Ms MacDonnell said that the team has looked at all the different component parts and has started re-negotiating the contracts with providers.  The service is looking at opportunities to link with other services, for example, using Prevention Matters to support people in a different way.  It is also working with partner providers to make savings through efficiencies.  The overall aim is about looking at how to support people through different mechanisms rather than removing the support entirely.

·         A number of service elements are to be incorporated into the Prevention Matters Programme.  Can you expand on how the Prevention Matters Programme will change to accommodate these?  Mr GoldenSmith responded  ...  view the full minutes text for item 8.

For members to question representatives from the Milton Keynes Clinical Commissioning Group on the review of healthcare provision in Milton Keynes, and the implications for residents who use Milton Keynes Hospital

Contributors

Wayne Rabin - Milton Keynes Clinical Commissioning Group

Papers

Presentation attached

The Chairman welcomed Wayne Rabin, Interim Communications & Engagement Lead on the Healthcare Review, Milton Keynes.

He made the following main points during his presentation.

·         The aim of the Healthcare Review is for Hospital services to be delivered more effectively and networked better with other specialist hospitals (such as the John Radcliffe) already providing care for people in Milton Keynes.

·         Care closer to home will be better, proactive and successfully integrated with other services in the community.

·         The needs of the patient will be put first to ensure the co-ordinated and integrated delivery of health and social care.

·         Any proposed models must be clinically and financially sustainable.

·         Although funding is set to increase, if MK CCG does not change the way services are commissioned, then a £25 million deficit is forecast in 2018/19.

·         Services need to be remodelled to effectively meet predicted demand.

·         The Review will be carrying out further work with clinicians, providers and the public for developing an efficient, modern district general hospital in Milton Keynes and to understand the difficult choices they still have to make to ensure services remain safe and financially viable.

·         The Review is also looking at the ways in which the existing model of general practice in Milton Keynes could be configured and integrated into a new model that could better serve patients.

·         The progress report will be published tomorrow (29 October 2014).  The Chairman will be receiving an email version of the report tomorrow.  From October to December 2015, there will be a formal public consultation process.

During discussion, Members asked the following questions.

·         In the letter to the Committee dated 5 September 2014 from Milton Keynes CCG, it states that "work carried out so far during the Review has sought to understand patient needs and their preferences including geographic origins (patient flow activity between Hospital sites and from other areas outside of Milton Keynes)".  Can you confirm that this took account of the flow of patients from North Bucks, both within and outside the MK CCG boundary?  How are the needs and preferences of these people being captured to date?  Was this an oversight?  Mr Rabin explained that stakeholder engagement is still in the early stages.  The report which is due to be published tomorrow is a progress report.  The residents of North Bucks have always been part of the consultation and are included in the strategic plan.  He stressed that consultation has not yet started with residents – this will start around October 2015.

·         When are more detailed options going to be published and realistically, what are the likely implications for Milton Keynes Hospital?  Mr Rabin responded by saying that further models will be published in the progress report and the analysis will continue.  The aim for Milton Keynes Hospital is around existing reconfiguring services – no services will be lost at Milton Keynes.  Services need to be more efficient.

·         Will Milton Keynes Hospital be specialising in certain areas?  Mr Rabin said that patient flows between the Hospitals (Milton Keynes and  ...  view the full minutes text for item 9.

Members to discuss paper received concerning the re-commissioning of CAMHS due in 2015.  This will be in advance of an item later in the 2015 (possibly April) on the service changes proposed by the new provider.

Papers

CAMHS Briefing for Health & Adult Social Care Select Committee

The Chairman updated members that the specification for the new service is being finalised and invitations for tendering the new service will be advertised from November with a view to awarding the new contract in April 2015 with a six month mobilisation before the new service starts.

The Chairman explained that the paper is for information at this stage but asked whether the Committee would like to set up a sub-Committee to look into this.  It was agreed that County Councillors Margaret Aston and Noel Brown would engage with the commissioners and feedback to the Committee.

A member felt that the core principles should be re-ordered.

Contributors

James Povey – Scrutiny officer

Papers

The Health & Adult Social Care Select Committee Work Programme

Members were asked to note that the Buckinghamshire Care item will be rescheduled for a future meeting in 2015.

The meeting in February currently has one item so Members will be asked at the November meeting to submit possible items and inquiry topics.

The next meeting will take place on Tuesday 25 November 2014 at 10am in Mezzanine Room 2, County Hall.

Meeting 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

The next meeting is due to take place on Tuesday 25 November 2014 at 10am in Mezzanine Room 2, County Hall.

Meeting 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