Meeting documents

Venue: Mezzanine Room 1, County Hall, Aylesbury. View directions

Contact: Liz Wheaton 

Note: Please note that this meeting will be webcast - please use the "Webcasts" menu link 


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Note No. Item



Apologies for Absence / Changes in Membership

Additional documents:


Apologies had been received from:


  • Mr B Bendyshe-Brown
  • Ms L  Clarke OBE
  • Mr C Etholen
  • Mr S Lambert
  • Julia  Wassell
  • Ms J Cook
  • Dr  W Matthews



Declarations of Interest

To disclose any Personal or Disclosable Pecuniary Interests

Additional documents:


Ms M Aston declared an interest as she was Chairman of the Executive Committee of Abbeyfield Residential Home in Haddenham.



Minutes pdf icon PDF 216 KB

To confirm the minutes of the meeting held on Tuesday 28 November 2017 as a correct record.

Additional documents:


The minutes of the meeting held on 28 November 2017 were agreed as an accurate record and signed by the Chairman.


Public Questions

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:

Additional documents:


There were no public questions.

The Chairman referred to the response the Select Committee had received from the CCGs regarding the question raised by District Councillor Robin Stuchbury on the proposed changes to GP provision in Buckingham at the last meeting.  The Members had received a copy of the letter by email and a copy of the response would be attached to the minutes of this meeting.  Ms L Patten would provide an update in May.



Cabinet Member Question Time

An opportunity for Committee Members to ask questions of the Cabinet Member for Health & Wellbeing and the Cabinet Member for Community Engagement and Public Health.

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Lin Hazell, Cabinet Member for Health and Wellbeing, reported that the budget was under constant focus. In December, £2.8 million had been released from the contingency fund reducing the year end overspend forecast to £1.3 million.  Since then the department had found £700,000 of efficiencies resulting in a projected overspend of approximately £700,000.  The Cabinet Member acknowledged that demand fluctuated and the budget situation was volatile.  More controls would be put in place and a more robust transformation programme had been devised which would be closely monitored through weekly meetings. 


The following questions/points were raised:


  • In response to a question on how well the service had coped under the recent winter pressures, L Hazell informed the Committee that the number of Delayed Transfers of Care (DToC) had been good.  However, some of the Hospitals outside of the county, with patients from Buckinghamshire, were struggling.  The Buckinghamshire County Council (BCC) Adult Social Care service had also been doing well, particularly the Re-ablement service, which provided packages to enable people to live independently in their homes after leaving hospital.  L Hazell offered to provide an update report if required.  The Chairman added that Buckinghamshire Healthcare Trust (BHT) had planned well and coped better than some other areas.  A lot of A & E staff had been off sick which had increased the pressure but the situation was improving.


  • A member of the Committee asked what was being done to help people in their 60’s become more resilient as the care packages provided now were not sustainable in the future.   L Hazell explained that the Adult Social Care Service was working with Public Health and was confident that changes would be seen.


It was asked whether L Hazell could provide assurance that domiciliary care providers would not undertake the practice of "clipping", i.e. reducing the time spent with the client.  L Hazell had not heard of the term and had not received any feedback that this was happening and agreed to find out.


Ms J Bowie, Director of Joint Commissioning, had provided the following update after the meeting. 


Post Meeting Note


Locally, BCC referred to a practice called "call cramming" and work had been taking place with our providers to stop this occurring. BCC commissioned domiciliary care with our main providers on a time and task basis with allocated hours for this work.  The actual hours of care delivered were reconciled with the commissioned hours over 4 week periods. Any complaints received that visits had been significantly shorter than planned were investigated.  Care workers were generally paid for the hours of care they delivered so there was no personal incentive to shorten the visit times. 


  • L Hazell did not know how many older people were readmitted to hospital and agreed to report back.   Ms Bowie had provided the following update after the meeting. 


Post meeting note:


Readmissions to hospital after 30 days stopped being routinely monitored nearly 5 years ago so there were no current national comparisons of rates.  ...  view the full minutes text for item 5.



Chairman's update

Additional documents:


The Chairman updated that following the last meeting, he had assigned a RAG status to the recommendations made in the Adults with learning disabilities inquiry and met with the officers to raise some of the concerns about some of the recommendations.  An update had been attached under the information item.


Following discussions at the last meeting, the Chairman advised he had also assigned a RAG status to the recommendations in the Hospital Discharge Inquiry and this had also been attached under the information item.


Forthcoming events:


·         There would be a BHT Board meeting in Aylesbury on 31 January 2018.  Mr N Dardis, Chief Executive of BHT, would be leaving on 16 March due to a move to Frimley Park Hospital and Mr N Macdonald would be taking over as interim Chief Executive.

·         Evidence gathering for the Child Obesity Inquiry would start on 6 February 2018.  A private briefing was taking place after the HASC meeting today with the Inquiry Group and members of the Public Health team.




Committee Update

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.

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Committee members provided the following updates:


  • Mr M Hussain had recently visited the dementia tour bus in High Wycombe.  The process was two hours in total and he had spent five minutes on the bus wearing headphones, glasses and special shoes to enable him to experience how someone with dementia felt; Mr Hussain said he found it extremely enlightening.


  • Ms T Jervis, Healthwatch Bucks, updated that Healthwatch Bucks would be attending all the BHT engagement events on community hubs.  The Chairman asked that the information be circulated to the Committee Members.

Action:  Ms Wheaton 




Public Health pdf icon PDF 343 KB

At the Committee’s July meeting, Members undertook an Inquiry looking at how well the council is prepared for the planned future growth.  This was a piece of work across all the Select Committees.  The purpose of this item is for the Committee to evaluate how well public health is embedded across the County and review the strength of key stakeholder relationships.



Mr N Brown, Cabinet Member for Community Engagement & Public Health

Dr J O’Grady, Director of Public Health



Presentation attached


Intended outcome:

For Members to be reassured that Public Health services are embedded across the Council and that Public Health is at the heart of all discussions, particularly around future growth plans for the County.

Additional documents:


The Chairman welcomed Mr N Brown, Cabinet Member for Community Engagement and Public Health and Dr J O’Grady, Director of Public Health. 


Mr Brown declared an interest as his daughter was a nurse at Frimley Park Hospital and confirmed the nurses were working extra shifts to cope with the winter pressures. 


Mr Brown reported that the Public Health team was leading the work stream on the social care transformation plan.  Mr Brown stressed the importance of engaging with older people before their situation became a crisis.  The Public Health team were very involved in prevention and the prevention at scale pilot to try to keep people healthy for longer. 


Dr O’Grady provided a brief overview of the presentation in the agenda pack and made the following points: 


  • A core value for Public Health was to improve the wellbeing of the population and narrow the gap in healthy life expectancy between different residents in the community.


  • 25% of health was due to health care received, the rest was due to wider determinants of health.


  • What happens before you were born affected your life as a child and an adult.  It affected education prospects, health and chances of success. Public Health worked across the life course and looked for opportunities everywhere to improve people’s health and wellbeing.


The following comments were made in response to questions from the Committee.


  • In response to a query on how people were helped to maintain their wellbeing and resilience, Dr O’Grady replied that the main drivers for health were the environment, personal resilience, good mental wellbeing and physical health.  The critical group was the 40-65 year olds.  If someone was healthy in mid-life there was an increased chance of ageing without frailty and dementia.  Dr O’Grady advised that NHS Health checks were available for everyone eligible in that age range (a person was eligible if they did not already have a condition such as high blood pressure or diabetes as they would already be being looked after).  The rate of take up for the NHS Health checks was approximately 45-48% which was similar to other counties.  The GP surgeries called people in on a five year rolling basis and Health checks were also available in outreach services.  There was also the lifestyle service which provided a range of services such as  smoking cessation and weight management.


  • Public Health was one of 15 local authorities taking part in a national pilot called "Prevention at Scale".  The aim was to get the message out to people in the community.


  • Dr O’Grady agreed it was important to maintain the activity groups and make them sustainable as they were often in areas where they were most needed.


  • Teaching school children about healthy eating and ensuring healthy options were available at food outlets would help prevent childhood obesity.   Mr Brown added that the High Wycombe foodbank wanted to include fresh food but realised they would have to teach cooking and that was now in place. 




Dementia services pdf icon PDF 197 KB

The Health & Adult Social Care Select Committee carried out a review of Dementia Services in 2012 with recommendations being presented to Cabinet.  This item is an opportunity for Members to hear from representatives about the progress being made in Dementia Services.



Lin Hazell, Cabinet Member for Health & Wellbeing

Ms J Bowie, Director of Joint Commissioning, Adult Social Care


Report attached


Intended outcome:

For Members to gain a greater understanding of the current services available for patients with dementia and their carers and to seek reassurance that patients are receiving the best possible care and that future demand on services can be met.



Additional documents:


The Chairman welcomed L Hazell, Cabinet Member for Health and Wellbeing and Jane Bowie, Director of Joint Commissioning, Adult Social Care and Maxine Foster, Commissioning Manager, CCG.


L Hazell advised that due to increased numbers of people diagnosed with dementia, working together with the CCGs and Public Health was essential.


Ms J Bowie reiterated that there had been joint working between the CCGs and public health and social care.  There was a three year dementia strategy with five key themes:


  • Improved Diagnostic Pathway and Diagnostic Rate
  • Dementia Awareness
  • Personalised Support and Independent Living
  • Pre –Crisis Support
  • Young Onset Dementia


There was a joint dementia board overseeing the implementation of the strategy and looking at an all aged mental health strategy to build on the work on dementia services.


The following points were made in response to questions from the Committee:


  • Ms Bowie was asked what was meant by one of the challenges being around "Changing prioritisation of the importance of an early diagnosis".  Ms Bowie said there were two aspects:
    • The residual view of what was the value if there was no cure.  However, it was important to be diagnosed in order for interventions to be put in place and for family and friends to be able to make adjustments.
    • Focussing on the GP practices to improve and maintain their diagnosis rate.  Work had also taken place with Oxford Health Trust to provide capacity.
  • One of the barriers to early diagnosis was identifying onset of dementia in young people.  For people in their 40’s the condition affected a different part of their brain and it was difficult for clinicians to formally diagnose dementia.  It could take up to five years for someone to receive a diagnosis of young onset dementia.
  • For older people there was the stigma attached to the fear of having dementia diagnosed which could result in the loss of their driving licence and higher travel insurance costs.
  • Ms Bowie confirmed the aim was for people to tell their story once but said that it was not always everyone’s experience.  Feedback was that professionals were not joined up in every case or shared best practice.  Ms Bowie agreed this needed to be addressed and improved.  There were some blockers on sharing information but there were  mechanisms which could be used to overcome the blockers.
  • Ms Bowie said she was happy that the adult social care assessment dovetailed with the mental health trust and a structured and legally compliant process was followed to determine when a person should have their liberty denied due to dementia.
  • Ms Foster provided an explanation on why all the GP practices in Chiltern CCG were dementia friendly but not all of Aylesbury Vale CCG was dementia friendly.  The difference was because there was a Quality Improvement Scheme in Chiltern CCG in 2016 to promote dementia and early diagnosis.  There were currently six practices working towards becoming dementia friendly within the Aylesbury Vale CCG.
  • Ms Bowie confirmed that there was an overarching strategy board with  ...  view the full minutes text for item 9.



Committee Work Programme pdf icon PDF 97 KB

For Committee Members to note the work programme.



Work programme attached

Additional documents:


The Chairman asked the Members to note the following items on the work programme for the meeting in March:-


·         Mental Health

  • Direct payments – to be confirmed


The Chairman asked for any other suggestions to be fedback to Ms Wheaton.


Information items pdf icon PDF 176 KB

1.    BOBW STP interim report - attached;

2.    Adults with Learning Disabilities (12 month recommendation monitoring RAG status) update from the Service following the last meeting - attached;

3.    Hospital Discharge (6 month recommendation RAG status) – following the last meeting, the Chairman has assigned the RAG to the recommendations – updated table attached

Additional documents:


The Chairman advised on the following items for information:


·         BOBW STP – The Chairman and Ms Wheaton would be attending a meeting in Reading in March to gain an update.

·         Adults with Learning Disabilities – update from the Service following the 12 month recommendation monitoring exercise

Hospital Discharge – table showing the 6 month RAG status assigned following the last meeting.



Date and Time of Next Meeting

The next meeting is due to take place on Tuesday 20 March 2018 at 10am in Mezzanine Room 1, County Hall, Aylesbury.

Additional documents:


Tuesday 20 March 2018 at 10.00 am.