Meeting documents

Apologies were received from Mr Brown and Mr Hunter-Watts.

There were no declarations of interest.

Minutes of the meeting held on 20^th October 2015 to be confirmed as a correct record

The minutes of the meeting on 20^th October 2015 were confirmed as an accurate record.

The following public questions have been received:

Mr Bill Russell has submitted the following questions:

1.    Better Care Fund: How does the Friends and Family Test for patients in the acute hospital relate to the patient experience of those receiving services (funded by the BCF) designed to keep them out of hospital? We need a proper measure of the patient experience not the FFT.

2.     GP services: What can to Council do to help recruit Drs and Nurses to work in Bucks GP surgeries where there is a crisis happening now? Can you help with cheap housing for young Drs & nurses, e.g. better facilities to improve working conditions?

The Chairman read out Mr Bill Russell’s questions and the response received from Lesley Perkins (Programme Director for Integrated Care) in regard to the Better Care Fund:

Q1. Better Care Fund: How does the Friends and Family Test for patients in the acute hospital relate to the patient experience of those receiving services

(funded by the BCF) designed to keep them out of hospital? We need a proper measure of the patient experience not the FFT.

Response from Lesley Perkin ‘Mr Russell is quite right that the existing, national metrics on patient experience are not relevant if we want to understand the experience of an integrated journey.  This was discussed at the last Health and Wellbeing Board and all members agreed that it would be good to develop a local metric that aims to improve this situation.  This wouldn’t just be the patient experience of individual services funded by the BCF but rather a joined up measure across the pathway. I’m afraid I don’t have details of how this will be done at this stage but as a first step intelligence is being gathered from other parts of the country who have already made some progress on this complicated topic.’

The Chairman added that there was an item on the BCF on the agenda and that Lesley Perkin may wish to elaborate further as part of her presentation.

Q2. ‘GP services: What can the Council do to help recruit Doctors and Nurses to work in Bucks GP surgeries where there is a crisis happening now? Can you help with cheap housing for young Doctors & nurses, e.g. better facilities to improve working conditions?’

The Chairman stated that she had been advised that this was outside the scope of this Committee. It was a District Council issue around housing. The CCGs had also been asked to comment about recruitment for doctors and nurses.

The Vice Chairman agreed and added that this was a timely question as District Councils were due to consult on their Local Plans. Suggested that HASC write to the Leaders of all fours District Councils in Buckinghamshire and ask that key worker housing is included in the Local Plan.

HASC debated the issue further and the following points were raised:

• Employers have a responsibility to provide suitable housing and this used to happen in the NHS.
• The Housing Act is quite specific on the employees they have to provide housing for and Government advises on what constitutes a key worker.
• HASC should write to NHS England regarding the expansion housing of provision and the need for more GP surgeries as some GPs are presently at full capacity. NHS England need to make better links to allow for S106 monies to be utilised for healthcare development.

Actions:

• HASC write to the Leaders of all four District Councils in Buckinghamshire and ask that significant consideration is given to key worker housing
• HASC write to NHS England to highlight the need for the provision of primary healthcare infrastructure investment linked to  ...  view the full minutes text for item 4.

This will include an update on NHS dentistry in Buckinghamshire in response to concerns raised by Members at the 20th October meeting.

The Chairman highlighted the following:

·         The Committee’s concern regarding NHS dentistry funding and future funding – Members have been circulated with a brief report regarding this. There is no evidence of under-provision but are issues of accessibility. However where there is under performance money in a dental practice is clawed back at a regional level by NHS England and this is not necessarily re-invested in Buckinghamshire. NHS England would like more accurate information around housing expansion so they can plan for more NHS Dentistry provision and ensure investment is targeted in the right areas.

Actions:

·         To add NHS Dentistry to HASC work programme discussion on 8^th December. Specifically looking at:

o   Community Dentistry Service provision for elderly and vulnerable people.

o   Quality of NHS dentistry provision

o   Provision of dentistry in hospital settings and the pressures faced.

o   Provision of NHS Dentistry in the south of the county

·         Milton Keynes Hospital and its future – The Chairman stated she would be attending a scrutiny meeting in Bedfordshire regarding the Healthcare Review and will update the Committee on this.

• Mrs Aston updated the Committee on the progression of the Learning Disability Inquiry in her role as chair of the inquiry group.
• Mr Shepherd met with the Chair of Chiltern CCG Board to discuss performance data and how this can best presented to HASC and this will be included in the work programmes discussions on 8^th December.
• Julia Wassell attended a seminar by ‘Healthy Minds’

i.)       Update on Wycombe Hospital – For Members to receive an update in response to the following question raised by Julia Wassell at HASC on 20^th October.

‘It has appeared as an item in the Trust Board Minutes that there is to be re-provision of the older building at Wycombe General Hospital.  I would be grateful for a full explanation of what will be occurring 2016-2018.  Any plans need to be explicit so that the public do not become further concerned following major changes previously.’

ii.)      Update on progress against Improvement Plan – For Members to receive an update on the Trust’s improvement planning post the Care Quality Commission’s Inspection. The focus will be on the findings from the community health services inspection.

Contributors: Neil Dardis, Chief Executive of Buckinghamshire Healthcare NHS Trust

 Neil Dardis (Chief Executive) Carolyn Morrice (Chief Nurse), Dr Tina Kenny (Medical Director) and Neil MacDonald (Chief Operating Officer) updated the Committee on the Buckinghamshire Healthcare Trust Improvement planning process post the Care Quality Commission’s Inspection. SEE PAPERS AND WEBCAST FOR FULL DETAIL

During the discussion the following areas were covered:

·         An update on the CQC Inspection report findings from March 2015 on Community Services and the unannounced inspection covering urgent care and end of life services.

·         Buckinghamshire Healthcare Trust (BHT) were rated as good for caring overall and had made significant improvements from the year before in urgent care services. Community end of life services were rated as good.

·         Improvement work and planning has looked to address culture and leadership issues particularly in Children’s Community Services and challenges regarding recruitment and retention of staff.

·         The Public Health Team are conducting Needs Assessments around 0-5 and 5-19 Services, finding out what the need is and how it differs across the county. Have launched a survey to capture views of Reception, Year 6 and Year 9 children to inform the strategic approach to Healthy Schools.

·         BHT has incorporated the inspection findings into their overall improvement plan. The overall improvement strategy priorities are: reducing mortality, improving the patient experience and reducing harm. BHT has seen significant reductions in harm from falls, incidents and has an A rated stroke service.

·         The CCGs outlined the integrated prevention work to reduce hospital admissions and further work needed with social care around speeding up discharges for those who are medically stable.

Wycombe Hospital

·         BHT continues to invest in services at the site and is in the process of developing clinical strategies. BHT is keen to engage HASC and the community but have no definitive plans at this point in time. Probably looking at spring next year for any strategic plans.

Other Issues raised by Members and discussed:

·         The use of agency staff to maintain safe services.

·         The quality of discharge papers and ensuring coordinated IT systems and care pathways across partners and geographical areas.

·         Winter pressures, learning from the year before and how this will be managed this year.

·         Patient experiences and learning from the challenges people face with multiple complex needs.

·         Understand how BHT working with Children’s Services and Public Health to drive improvements in Children’s Community Health.

·         Likely cuts to public health funding and implications.

·         Contingency plans if a junior doctors strike goes ahead, communication to the public and impact on budgets.

Action

To have RAG rating on the Improvement Report and for HASC to be sent an exception report

Action: BHT

For Members to receive an update on the Better Care Fund, particularly the progression of key projects and the identification and management of risk.

Contributors: Lesley Perkins, Programme Director for Integrated Care.

Lesley Perkin provided members with an update on the Better Care Fund (BCF) key projects, performance outcomes and risk management. SEE WEBCAST AND PAPERS FOR FULL DETAIL.

During discussion the following areas were discussed:

• BCF is a national mandate and involves integration of existing funds.
• Buckinghamshire BCF is a combined budget of £28.8 million and this is the minimum amount under the terms of the programme. The maximum was £100 million.
• Identification of services in Bucks covered under the BCF.
• National metrics attached to the BCF are not just impacted on by BCF services. Bucks BCF is not hitting targets on non-elective admissions and re-ablement targets although internal monitoring shows the re-ablement areas are improving.
• BRAVO is an example of the positive work around integration.
• Integration work being taken forward is locality working led by GPs working with partners across health and social care at a ground level.
• BCF will continue into next year and details will be outlined in the comprehensive spending review.
• The need to ensure providers are working in an integrated way in addition to commissioners.
• Systems resilience work operationally includes contact line for care homes to contact GP. Strategically there is a county –wide Care Home Strategy programme working with providers looking at different ways of ways.
• There is a need for Health and Social Care to work with closer Care Homes and a further consideration of applying conditions on providers.

In response to questions from Members the following issues were also discussed:

The Integration of Community Health Teams and likelihood of this happening.

·        The Picture of what’s happening with Care Homes and how commissioners  manage this.

·        The Need for new models of Care Homes.

·        Clarification on why the risk register provided has no actions listed.

Actions

·      HASC add Care Home market and new models of provision to 8^th December work programme discussions.

Action: Committee & Governance Adviser

·      CCGs and Adult Social Care to report back to HASC on the BCF risk register and the inclusion of actions against red and amber residual risk.

Action: CCGs and Adult Social Care

For Members to receive an update on the Cancer Screening figures for Chiltern and Aylesbury Vale CCG’s. In particular to consider the early stage (1 and 2) diagnosis figures which in 2013 were significantly below the England average.

Contributors: Dr Annet Gamell, Chief Clinical Officer, Chiltern Clinical Commissioning Group.

HASC took collective decision to have this item deferred and to have a simpler, clearly laid out paper submitted by the CCGs in the New Year.

Annet Gamell briefly updated the Committee on the following:

·         There seems to be an issue with an issue with recording

·         Cancer survival rates and mortality rates shows the local CCGs are above or are at least in-line with national averages

·         The Cancer Outcome survey data to be rolled out nationally and CCGs are looking at 70% recording.

Action

·         CCGs to compile Cancer Screening paper which covers cancer diagnosis, flows through the system to treatment.

For Members to note updates on the progression of GP inquiry recommendations.

Contributors: Dr Annet Gamell, Chief Clinical Officer, Chiltern CCG,   Louise Patten, Chief Officer, Aylesbury Vale CCG,  Richard Corbett, Chief Executive, Healthwatch Buckinghamshire.  

Members noted the update report provided. The RAG  status report is attached

For Members to note the work programme

The work programme was noted.

There was a reminder to members that there is a work programme workshop on 8^th December.

The next meeting will take place on Tuesday 2^nd February 2016, at 10.00am in Mezzanine Room 2. There will be a pre-meeting for Committee Members at 9.30am.

The next full webcast committee meeting will be on 2^nd February 2016 at 10am.