Meeting documents

Apologies were received from David Martin, David Carroll, Andy Huxley, Freda Roberts and Nigel Shepherd.

Avril Davies has replaced Julia Wassell on the Select Committee.

The Chairman announced that she is moving to Children’s Services with effect from 1 December.  She nominated a new chairman, Angela Macpherson, to take over from her.  Brian Roberts, Margaret Aston and Roger Reed seconded the appointment.

Avril Davies pointed out that Angela is not currently a Member of the Committee so asked whether this is viable.  Sara Turnbull, Scrutiny Team Leader, explained that Lin will be stepping down at the end of the meeting and Angela will be taking over from her at the close of the meeting.

Avril Davies felt that it would be better to appoint Angela as a provisional Chairman until it can be confirmed at the next meeting.

Members of the Committee agreed that Angela Macpherson would be the Chairman of the HASC on a provisional basis until the next meeting when it will be confirmed.  Angela Macpherson was co-opted onto the Committee for this meeting.

There were no declarations of interest.

The minutes of the meeting held on Tuesday 28 October 2014 to be confirmed as a correct record.

The minutes of the meeting held on Tuesday 28 October 2014 were confirmed as a correct record.

Matters arising

Item 6 – Committee Update – A letter has been sent to Frimley Park and to County Councillor Trevor Egleton.  Awaiting a response.

Item 7 – 15 Minute Domiciliary Care Appointments – A request for additional information has been sent to the Service and awaiting a response.  Once the information has been received, the Committee can then discuss what extra work it wants to do on the 15 minute call.

Avril Davies said that she would like to join the CAMHS Group with Margaret Aston and Noel Brown.  The policy officer said that he is currently waiting to hear from the Service as to how best to engage with them.

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.

There were no public questions.

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

The Chairman updated Members on the following.

·         The Chairman attended the first HealthWatch Board meeting which was in public on 18 November.  She said that she met the new Chief Executive of HealthWatch, Richard Cobbett.

·         The Committee has received a letter from the Thames Valley Police and Crime Panel on Female Genital Mutilation (FGM).  The letter requested that the Committee contact Clinical Commissioning Groups and Hospital Trusts to review what they are doing to identify FGM cases.  The Chairman has written to the CCGs in the first instance to find out, and has also requested that the public health team explain what is known about this issue locally.  The Chairman agreed to share the responses with the Committee.

·         An item on Children’s Health Commissioning is coming to the Education and Skills Committee on 9 December.  Responsibility for commissioning this service is transferring to the County Council’s Public Health Team, having previously been with NHS England.  Services include the Health Visiting Service and the Family Nurse Partnership Programme.  Funding for the new service will be around £6m and will present opportunities to link these activities up with our existing public health activity with children and expecting mothers.  Committee Members are encouraged to attend this meeting but papers will be circulated if Members are unable to attend with a link to the webcast.

Action: James Povey

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

Shade Adoh, the representative from HealthWatch, introduced Richard Corbett, the new Chief Executive of HealthWatch.  Mr Corbett said that he was the Director of Reading Voluntary Action and was responsible for setting up the HealthWatch in Reading.

For members to question the Health and Wellbeing Portfolio Cabinet Member and Service Director on current areas of risk and issues.  This will contribute to the committee’s work programming workshop in December, where they will agree committee agenda content and inquiries for 2015.

Contributors

Patricia Birchley – BCC Cabinet Member for Health and Wellbeing

Rachael Rothero – BCC Service Director Health and Wellbeing

Papers

Health and Wellbeing Portfolio Risk Report

The Chairman welcomed Patricia Birchley, Cabinet Member for Health and Wellbeing, Rachael Rothero, Service Director Health and Wellbeing, Susie Yapp, Interim Service Director and Adrian Isaac, Finance Business Partner.

The Cabinet Member started by saying that this is her 5^th year as Cabinet Member and the portfolio has delivered a balanced budget during this time.  Policy changes have meant that the service area is responding to unprecedented levels of change.

The following main points were made during the presentation.

·         The new business units provide a regular risk report to the Business Unit Board.

·         There are a number of key risks facing the service – these risks are significant not just to the portfolio but to the county council as a whole.  Having to think creatively about how to manage this risk.

·         Analysis has shown that projections for social care need in Buckinghamshire are likely to change over time.  Based on Planning4care estimates, the numbers aged 65+ with any level of social care needs in Buckinghamshire is projected to rise by 66% over the next 20 years.

·         The total number of people with dementia is projected to rise over the 20-year period by 87%.

·         Operate within a legal framework so a lack of resources is not a reason for the county council not meeting the needs. 

·         This is not a new challenge.  The service is already seeing an increase in demand for its services – 18% increase in people receiving nursing placements and 14% increase in home care services.

·         The Care Act is welcomed by Buckinghamshire County Council as it will produce some real benefits for users, carers and communities.

·         Over the last 4 years there has been a modest increase in the Adult Social Care budget (2.5%).  Spend on Older People has increased by 30% and spend on Learning Development has increased by 4% so the numbers are very different to the budget.  Possible due to the savings made by the service.  If Bucks County Council was an average authority, when looking at comparator spend information, the council would be spending £7m more per year which is a significant difference.

·         Managing the demographic changes is the greatest risk for the service and the county council as a whole.  Been looking at ways of managing risk differently.

·         There will be a point when the service cannot reconcile its legal duties against the growth in demand for services.

·         The service is responding to the reform around the legal framework for delivering social care.  Single piece of legislation which will include a new national eligibility criteria and meeting care needs of people in prison.  Responding to the assessment needs and care planning needs for people who have not come into contact with the service in the past.

·         The service is working collaboratively with other authorities to start to understand the financial impacts and the service is projecting the risk to be in the region of £30m which is a huge cost.

·         There will be a cap on care costs which could cost  ...  view the full minutes text for item 7.

For members to scrutinise the detailed spending proposals for this integrated health and social care fund.

Contributors

Patricia Birchley – BCC Cabinet Member for Health and Wellbeing

Rachael Rothero – BCC Service Director Health and Wellbeing

Lesley Perkin - Programme Director, Integrated Care (BCC/CCG)

Papers

HASC BCF update presentation

The Chairman welcomed Patricia Birchley, Cabinet Member for Health and Wellbeing, Rachael Rothero, Service Director Health and Wellbeing and Lesley Perkin, Programme Director, Integrated Care (BCC/CGG).  The Health and Adult Social Care Select Committee’s sub-group has met three times in the past 9 months to keep updated on how the Better Care Fund is progressing.  The sub-group comprises Margaret Aston, Brian Adams and Lin Hazell.

Lesley Perkin took Members through her presentation and made the following main points.

·         The integration journey began a few years ago.  There were several large workshops and a commitment was made by all the Leaders.

·         The Better Care Fund (BCF) is due to commence in April 2015.

·         The outline business case was completed in June 2014 which describes the new models of service for older people.

·         The case for change is aimed at improving outcomes and delivering a better user experience in a more financially sustainable way.

·         Buckinghamshire’s BCF Plan is aligned to Buckinghamshire’s Health & Wellbeing strategy and will aim to deliver the vision of "promoting healthier lives for everyone in Buckinghamshire".

·         "Whole system" integrated care puts the individual at the heart of the system.

·         Buckinghamshire has been using the Kings Fund model of integration to help design the outcomes.

·         The BCF is not new money.  It brings together health and social care funds to support integrated commissioning and provision.

·         The minimum size of the fund in Buckinghamshire is £28.8m with the flexibility to increase.

·         The outline business case has been agreed for a 4 tier model and further work has been commissioned to develop the full business case.

·         The full business case is due to be signed off by Cabinet and CCGs prior to establishment of s75 in April 2015.

During discussion, Members asked the following questions.

·         What key indicators will be agreed either locally or nationally to judge whether the Better Care Fund is successful in the short and medium term.  Ms Perkin said that there is a list of indicators which are being looked at including acute admission to hospital, long-term care admission, bed occupancy in acute admissions and patient experience and getting people back to their home setting as soon as possible.  The Cabinet Member said that keeping someone in their own home for as long as possible so that they can lead an independent life is very important.

·         What form will the public engagement referred to in the papers take, given there will be uncertainty over how the new services will be implemented.  Ms Perkin responded by saying that public engagement takes a variety of forms.  The questions we are asking will impact on the work we are currently undertaking.  At this stage we are bringing together services which already exist.

·         With the advent of more people going out to work, social isolation is going to increase.  Ms Perkin said that the Prevention Matters initiative is about engaging fully with the voluntary sector and have to work hard to make sure this continues.  The Cabinet Member said that  ...  view the full minutes text for item 8.

For members to scrutinise the performance and operation of the local ambulance service provider. 

Contributors

Vicky Holliday – Area Manager Aylesbury Vale, SCAS

Andy Battye – Area Manager Chiltern, SCAS

Steve West – Operations Director, SCAS

Papers

SCAS Annual Health Scrutiny Committee Report: Buckinghamshire November 2014

The Chairman welcomed Steve West, Operations Director, Vicky Holliday, Area Manager, Aylesbury Vale and Andrew Battye, Area Manager, Chiltern from South Central Ambulance Service (SCAS).

The following main points were made during their presentation.

·         It has been a very challenging few months.

·         In 2013/14, SCAS was contracted to perform at 75% against the Red 1, 8 minute and Red 2, 8 minute standards and at 95% for the Red 19 minute standard across the Thames Valley.

·         The current contract with SCAS for 2014/15 has been agreed Thames Valley wide (Oxfordshire, Buckinghamshire and Berkshire).  This is the area defined for the purposes of performance management and is measured on an annual basis in accordance with the national NHS contract.

·         Performance measures are commissioned and reviewed at Thames Valley contract level which SCAS have been achieving, but have experienced some challenge to achieve the Red 2 performance standard over the past month.

·         The Clinical Commissioning Groups work collaboratively with SCAS to seek continuous improvement in performance measures by reviewing these measures at County level.

·         SCAS also provides the 111 service in Buckinghamshire and through greater integration of the two services is amongst the lowest providers in the country for calls transferred from 111 to 999 now at 8%.

·         SCAS has worked with commissioners to gain winter funding to support extra vehicles to assist with Health Care Professional bookings over the winter months.  This will free up a proportion of frontline ambulance time to respond to Red category calls.

·         The rural aspect to large parts of Buckinghamshire can make journey times a challenge.

·         In response to Sir Bruce Keogh’s review of Urgent and Emergency Care in England, where it was suggested that by supporting and developing Paramedics, 50% of patients calling 999 could be treated at the scene, SCAS is currently undertaking a review of how it could develop our vision of a "paramedic at home".

During discussion, Members asked the following questions.

·         There remains significant substandard response times in Chiltern District and to a lesser extent in South Bucks.  Whilst across the region, SCAS meets the performance targets and the report states the CCGs are reviewing instances of long waiting times in Buckinghamshire.  Are you confident this substandard performance can be addressed or do more vehicles need to be commissioned?  Mr West explained that the area where the service has seen the greatest impact as a result of the reconfiguration is around Wycombe.  SCAS is working hard to increase the workforce – the current headcount is 152 and now trying to increase it to 201.  The fleet is improving significantly.  The major challenge is around recruitment and retention.  Buckinghamshire is an expensive place to live.  There is a shortfall of around 2,000 paramedics nationally and there are not enough paramedics being produced through higher education – around 600 a year.  In 2017, there will not be any paramedics coming out of higher education.  SCAS is having to look at alternative models with the workforce and different strategies of recruitment and there  ...  view the full minutes text for item 9.

For committee members to agree the draft report by the committee inquiry sub-group, of which Roger Reed was the chairman.

Papers

HASC GP Services Inquiry Draft Final Report

The Chairman asked Roger Reed, Chairman of the Inquiry Group, to provide an update for Members on the recent inquiry.  He made the following key points.

·         He thanked the Committee Members who were involved in the inquiry and the 12 GP practices who were visited as part of the inquiry, who made the Members feel very welcome.

·         Eight recommendations have been made in the report.

·         The inquiry was set up as a result of concerns about access to GP appointments.

·         The visits to the GPs were spread across the county – some in rural areas and some in urban areas.

·         There is a clear imbalance between GP capacity and demand for services.  It is a national issue.

·         The report has called for greater transparency on GP funding and more to be done on managing GP demand – more education of patients so that we can ensure everyone gets the most possible service from GPs.

·         Non-emergency waiting times can be the result of patients putting constraints on certain things – such as only seeing a certain GP at a certain time.

·         The CQC monitors GP practices using 38 indicators – it is not a judgement on the quality of the GP.

·         GPs would like the District Nurses to be placed back in the surgeries.

·         Better communication must be enhanced.

·         Post Hospital Discharge – GPs were not always aware of this.  The report recommends that more process should be put in place so that GPs are notified in a timely way when patients are discharged.

·         The Chairman thanked James Povey, Scrutiny Officer, for the superb support he gave to the inquiry group.

A Member said that they would like to see the comment about District Nurses being placed back in the GP surgeries as a recommendation in the report.

A Member commented that they heard from one GP surgery about the discharge paperwork which followed 1-2 weeks after the patient had gone home and very little information came with it.

The Chairman asked Dr Gamell to respond to the report.  She said that the report is very useful and helpful to have the information collated in one place.  GPs are good at absorbing services but the workforce is at critical point and it has never been so bad.  Being a GP is not seen as an attractive career.  The Primary Care Strategy will look at the healthcare needs of a local community.  The District Nurses were removed from the GPs surgeries as different surgeries had different needs.  From 1 November, every GP surgery will be getting a daily email on patient discharges which will enable proactive visiting by the GPs.  Ms Patten said that the skill set for the District Nurses is aligned to a specialist nurse practitioner and they need to be used sensibly.  She said that it is about understanding the needs of the population and supporting as many people as possible.

The report was agreed and the Chairman explained that it will be going to Cabinet in December.

Contributors

James Povey – Scrutiny officer

Papers

The Health & Adult Social Care Select Committee Work Programme

Members were asked to note the Committee Work Programme and to email James Povey (jpovey@buckscc.gov.uk) with any issues or suggestions.

The next meeting is due to take place on Tuesday 10 February 2015 at 10am in Mezzanine Room 2, County Hall.

Future dates

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 10 February 2014 at 10am in Mezzanine Room 2, County Hall.