Meeting documents

Apologies were received from Mr B Roberts, Mrs J Blake and Ms S Adoh.

Mrs M Aston declared an interest in item 5 as she was involved in the pharmacy at the care home to which she was a Trustee.

Mr N Shepherd declared an interest in item 5 as his wife used to be the Chief Officer of the Pharmacy Committee.

Minutes of the meetings held on 22^nd March and 18^th April 2015 to be confirmed as a correct record

The minutes of the meeting held on 22^nd March and 18^th April 2015 were agreed as correct records.

Follow-up on actions from meeting held on 22 March

·         Item 4 – A letter had been sent to the Chiltern Clinical Commissioning Group in relation to the closure of Lynton House surgery and a response had been received from Dr Annet Gamell.

·         Item 5 – The Chairman read out the following response from Lee Jones, Assistant Director of Communications, in relation to Wycombe Hospital estates:

 "As previously indicated, our estates plans will be determined by the development of our clinical services.  Since our last update to the HASC we have launched a major piece of public engagement on developing community hubs and are working with partners on the county’s five year sustainability and transformation plan.  Both of these pieces of work, which won’t start to report until late June/July, will support the development of our clinical pathways and will heavily inform our estates plans."

·         Item 5 – Awaiting a response from Harlow House.

·         Item 5 – Awaiting a response from NHS England regarding dentistry provision.

·         Item 6 – Letter had been sent and a response received from Councillor Neil Blake, Leader of Aylesbury Vale District Council on affordable housing for healthcare workers.

·         Item 7 – Letter had been sent to Councillor Mike Appleyard and Mr T Boyd and they had been invited to attend the June meeting.

·         Item 7 – Members had received an invitation to the launch of the Social Work Academy on 16 June from 10am-12noon at Bucks New University.

·         Item 8 – Mr S Goldensmith would be preparing a report for the September meeting on travel time.

·         Item 9 – The Chairman had met with the Ambulance Trust and a briefing would be presented at the June meeting.

·         Item 9 – The following response had been received from Lee Jones, Assistant Director of Communications in relation to consultant/specialist waiting times:

"Our staffing and capacity for our specialities is based on us meeting our NHS constitutional standards (including referral to treatment waiting times – 18 weeks).  Overall the Trust is meeting its 18 week commitment, but there are some individual surgical specialities where we are not."

The Chairman asked Cllr N Shepherd to write directly to the Trust with his specific concerns.

ACTION: District Councillor Nigel Shepherd to write to Buckinghamshire Health Care Trust directly regarding specialist staffing levels.

·         Item 9 – A senior officer from Bucks Fire and Rescue Service had been invited to attend the June meeting.

The Chairman expressed disappointment in relation to the Lynton House surgery consultation process as the Committee felt it was not inclusive enough and the issue for residents where English was an Additional Language (EAL) was not addressed.  Dr Gamell explained that the final decision was currently with NHS England and she agreed to check the timelines for when the decision would be made.

ACTION: NHS England to provide HASC with a decision timetable regarding Lynton House Surgery.

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.  Members of the 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/getting-involved/

There were no public questions received in advance of the meeting.

Cllr Julia Wassell commented on behalf of a resident who had expressed concern about the Minor Injuries and Illness Unit at Wycombe Hospital where the X-ray machine regularly broke down. 

The Chairman asked that members of the public submit their questions in advance of the Committee meeting to enable an appropriate response to be prepared.

Members were asked to let the Chairman know by 31st May 2016 their views on moving the Committee meeting around the County.

ACTIONS:

·         Committee and Governance Advisor to write to Buckinghamshire Healthcare Trust to raise public concerns with X-ray machine at Wycombe Hospital

·         Chairman to write to Committee Members to seek views on holding HASC meetings at venues across the County.

This will include an update regarding Lynton House GP Surgery and an update on the response to the HASC recommendations regarding the draft workforce strategy.

A copy of the letter sent to Annet Gamell Chief Executive of Chiltern CCG, regarding Lynton House and Primary Care infrastructure funding is attached

A copy of the letter sent to Cllr Mike Appleyard and submitted to Cabinet on the 25th^th April regarding the draft workforce strategy is attached

The Chairman updated Members on the following:

·         Vascular services – briefing circulated to Members.  Mr Geoff Payne would be invited to a future meeting to discuss the issue in more detail if Members had further questions arising from the briefing note.

·         The Bedfordshire and Milton Keynes healthcare review would be coming to the 21^st June HASC meeting.

The Chairman welcomed representatives from the Pharmacy Committee to discuss the issue of the proposed 6% cuts to pharmacies which was currently under consultation. This had come to the attention of HASC member Mrs Margaret Aston who had requested a local investigation into the issue.

Areas raised during the discussion were as follows:

·         The Dept. of Health announced 6% cuts in December 2015, which if implemented would start from October 2016. An extended consultation regarding the proposals was due to close on 24^th May 2016.

·         Particular impacts on Buckinghamshire included:

o  Closures to small pharmacies in rural areas as their businesses become unviable.

o  Increased burden on GPs, Urgent Care Centres and Accident and Emergency Depts from patients who come to pharmacists for advice for minor ailments

o  Risk to vulnerable residents who never see a GP but visit pharmacists

o  An increase in wastage of medicines with cost implications

o  Delivery of medicines in the post compromising patients understanding of how to take their medicines.

o  Possible pharmacy closures based on national figures could be up to 25% which would translate locally into 20 pharmacies closing in Buckinghamshire.

Questions and comments were as follows:

·         The extent of national lobbying - Over 1 million signatures would be presented to the Dept of Health expressing concern over the cut.

·         The short-sighted nature of the cut which risked increasing the burden on higher cost healthcare

·         Concerns regarding on-line services, leading to increasing wastage of medicines and risks of patients not taking medicines appropriately.

Actions:

·         The Chairman to send a letter to the Department of Health expressing concerns about the proposed cuts.

·         A press statement to be issued outlining the proposed cuts and the Committee’s concerns. Committee and Governance Advisor to action

·         Set-up a small working group of Members to meet with pharmacists after the meeting. Committee and Governance Advisor to action

SEE WEBSITE FOR FULL CONTENT

An opportunity to update the Committee on relevant information and report on any meetings of external organisations attended since the last meeting of the Committee.  This is particularly pertinent to Members who act in a liaison capacity with NHS Boards and for District Representatives.

No updates were reported at the meeting.

To provide Members with an overview of the local Sustainability and Transformation Plan including: the footprint, governance arrangements, priorities and next steps.

Paper to follow.

Contributors: Lou Patten – Chief Executive – Aylesbury Vale Clinical Commissioning Group, Ann Donkin, Programme Director, Communities Health and Adult Social Care Directorate

The Chairman welcomed Dr Annet Gamell, Chief Clinical Officer, Chiltern Clinical Commissioning Group and Ms Ann Donkin, Programme Director, Communities Health and Adult Social Care Directorate.

During the presentation and discussion, the following main points were made.

·         44 Sustainability and Transformation Plans had been defined across England largely based on patient flows into tertiary acute centres.

·         STPs must address strategic issues that transcend more than one local system.

·         Each footprint had a named ‘system leader’ to drive development of plans.  David Smith, Chief Executive, Oxfordshire Clinical Commissioning Group, was named as the system leader.

·         Buckinghamshire was part of a Buckinghamshire, Oxfordshire, Berkshire West ‘footprint’.

·         STPs would be the single application & approval process for ‘growth’ funding for 2017/18 onwards.

·         The focus for Buckinghamshire would be on reducing spend on bed-based care into prevention and care at home.

·         Next steps would be around refining the planning assumptions, setting parameters for modelling different service changes in the local system, considering options for delivering Vanguard models relevant to Buckinghamshire and agreeing the communications and engagement plan.

SEE WEBSITE FOR FULL CONTENT

For Members to note the work programme

Members noted the work programme.

The Committee is looking at the issue of the Care Market to understand the current and future challenges Adult Social Care Services face.

The Committee will receive:

·         A presentation of the current and future demand for adult social care services

·         An overview of the models and types of support needed to meet future demand more effectively and efficiently

·         An understanding of the growing role of assistive technology

Contributors: Rachel Rothero – Director for Joint Commissioning, Firas Sarhan, Director the Centre of Excellence of Telehealth and Assisted Living (CETAL), Buckinghamshire New University.

The Chairman welcomed Mr Mike Appleyard, Cabinet Member for Health and Wellbeing, Ms Rachael Rothero, Director for Joint Commissioning, Mr Graeme Finch, Contracts Manager and Mr Firas Sarhan, Director, Centre of Excellence of Telehealth and Assisted Living (CETAL) at Bucks New University.   Members were referred to the report entitled ‘The Care and Support Market Place’.

The Chairman welcomed Mr Firas Sirhan who provided Members with an update on assistive technology.  He stressed that there was evidence that more patients have long-term conditions which highlighted the need for more technology to assist them. 

During their presentation, the following main points were made.

·         The NHS and Community Care Act 1990 recommended the development of a range of private and not for profit providers to deliver social care services.  This had previously been delivered by Local Authorities directly.

·         Local Authorities had moved from being direct providers of care to increasingly purchasers-only of care.

·         Due to means testing, some individuals would be required to pay the full cost of their services and many people in these circumstances purchased directly from the market place rather than the Local Authority.

·         The County Council currently spent 89% of its current budget on providers in the market place, with the remainder spent on assessments, the social work function and the occupational therapy function.

·         59% of the overall social care budget was spent on placements in residential care.

·         The Council did not provide any directly provided services apart from assessment, care management and occupational therapy.  Bucks Care was the last remaining in-house service provision.  MTP savings were linked to the supply chain.

·         The County Council, in partnership with the County Council Network (CCN), commissioned a study across a consortium of 12 Councils to undertake a detailed evaluation of the care home market place and to understand the market implications of what was then phase two of the Care Act.

·         There were challenges around how to stimulate demand and the Council had worked with an organisation called Housing LIN looking for older people housing needs over the next 25-30 years.  The Council was working with the District Councils and Clinical Commissioning Groups on this project.  District Council representatives to be invited to future workshops.

·         The service area was remodelling the Council’s block contracts to ensure what was on offer was fit for purpose.

·         Buckinghamshire was seen as an attractive place for developers of care homes but the care home sector was targeting self-funders which was pushing up Local Authority rates.

·         Mr Firas Sirhan circulated an information pack for Members and said that he would be happy to arrange visits to the Living Lab to demonstrate the technology and equipment

ACTIONS:

CHASC Business Unit to circulate to District Councillors the dates of future housing workshops involving Public Health and District Housing Teams

SEE WEBSITE FOR FULL CONTENT

To discuss confidential aspects of the Care Market paper

The Chairman referred Members to the confidential appendix which was circulated to Members in advance of the meeting.

The next meeting will take place on Tuesday 21^st June at 100am in Mezzanine Room 2. There will be a pre-meeting for Committee Members at 9.30am

The next meeting will take place on Tuesday 21^st June at 10am in Mezz Room 2, County Hall, Aylesbury.