Meeting documents

Apologies had been received from:

• Mr C Etholen
• Mrs L Clarke
• Ms C Jones
• Mr N Hussain

Mr Niknam Hussain had replaced Mr Majid Hussain on the Committee.

Ms Aston declared an interest as a Trustee of Carers Bucks and said she knew Thame Community Hospital very well (item 8).

The minutes of the meeting held on Tuesday 20^th March 2018 to be confirmed as a correct record.

The minutes of the meeting held on Tuesday 20 March 2018 were agreed as an accurate record and signed by the Chairman.

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/

The following public questions have been submitted.

Question received from District Councillor Robin Stuchbury relating to the present consultation on bringing care closer to home by Buckinghamshire Healthcare Trust

Q1. I understand that the community hubs pilot resulted in overnight bed closures of 20 beds in Marlow and Thame. Should this pilot be rolled out across the county, will this result in overnight bed closures in our other local hospitals (such as Buckingham, Amersham, Wycombe, Stoke Mandeville)?

This was a concern at the recent public meeting at Buckingham Community Centre where residents felt that the Trust was unable to give their assurance that the beds would not be closed. Please can Buckinghamshire Healthcare Trust confirm what is the timescale for a decision on whether to retain overnight beds at Buckingham hospital and how much money per annum do these beds cost the NHS Trust?   And how will that decision be taken and by whom?

Question received from Ozma Hafiz

Q2. Bed closures in Bucks are contributing to national patients being affected with operations delayed at NSIC.  We have less beds in Bucks compared to this time last year. Operations at Oxford have again been cancelled this week (http://www.bbc.co.uk/news/uk-england-oxfordshire-43470237) Would the Committee agree that it is time to reopen beds at Marlow, Thame and Wycombe Hospital and restore services to meet population needs. 

Question received from Andrew Clark

Q3. What impact will the potential closure of beds at community hospitals have on the health and wellbeing of disabled people living in the relevant localities, and when will the equality impact assessments of these changes be published?

These three questions have been sent to the Bucks Healthcare Trust for a response.

Question received from Linda Derrick

Given that: 

a) the report on "Developing out of hospital care: Community hubs pilot evaluation and next steps" is dated yesterday

b) the Trust refused to provide a copy earlier and referred me to BCC's website; and 

c) the deadline for questions from the public is 5pm today 

(i) precisely when did the report go on BCC's website?

(ii) how long does this give members of the public to read the report (which is 51 pages long) and prepare and submit questions; and 

(iii) does BCC or the Trust believe this is a transparent, open or democratic way of making and scrutinising  ...  view the full agenda text for item 4.

The following public questions had been submitted.

The following question had been received from District Councillor Robin Stuchbury relating to the present consultation on bringing care closer to home by Buckinghamshire Healthcare Trust (BHT).  The following question was read out by Mr R Stuchbury.

Q1. I understand that the community hubs pilot resulted in overnight bed closures of 20 beds in Marlow and Thame. Should this pilot be rolled out across the county, will this result in overnight bed closures in our other local hospitals (such as Buckingham, Amersham, Wycombe, Stoke Mandeville)?

This was a concern at the recent public meeting at Buckingham Community Centre where residents felt that the Trust was unable to give their assurance that the beds would not be closed. Please can BHT confirm the timescale for a decision on whether to retain overnight beds at Buckingham hospital and how much money per annum these beds cost the NHS Trust?   And how would that decision be taken and by whom?

The following question had been received from Ozma Hafiz and was read out by the Chairman.

Q2. Bed closures in Buckinghamshire were contributing to national patients being affected with operations delayed at NSIC.  We have less beds in Buckinghamshire compared to this time last year. Operations at Oxford had again been cancelled this week (http://www.bbc.co.uk/news/uk-england-oxfordshire-43470237) Would the Committee agree that it was time to reopen beds at Marlow, Thame and Wycombe Hospital and restore services to meet population needs. 

The Chairman asked BHT to note the question.

The following question had been received from Andrew Clark and was read out by the Chairman.

Q3. What impact would the potential closure of beds at community hospitals have on the health and wellbeing of disabled people living in the relevant localities, and when would the equality impact assessments of these changes be published?

These three questions had been sent to the BHT for a response.

The following question had been received from Linda Derrick and was read out by the Chairman.

Given that: 

a) The report on "Developing out of hospital care: Community hubs pilot evaluation and next steps" was dated yesterday (11 April 2018)

b) The Trust refused to provide a copy earlier and referred me to BCC's website; and 

c) The deadline for questions from the public was 5pm today ( (12 April 2018)

(i) Precisely when did the report go on BCC's website?

(ii) How long does this give members of the public to read the report (which was 51 pages long) and prepare and submit questions; and 

(iii) Does BCC or the Trust believe this was a transparent, open or democratic way of making and scrutinising decisions on what is an important healthcare issue for residents in Buckinghamshire?

A written response would be sent after the meeting.

For the Chairman to update the Committee on issues arising since the last meeting.

The Chairman reported that the RAG status in the previous minutes for this inquiry had been updated and a copy of the recommendation monitoring report would be attached to the minutes.

There were no updates from members of the Committee.

Purpose:

In February 2017, the Committee received a presentation on the Buckinghamshire, Oxfordshire and Berkshire West (BOBW) Sustainability and Transformation Plans.  Buckinghamshire is one of the first waves of Accountable Care Systems, now known as Integrated Care Systems. 

This item is an opportunity for the Committee to review the progress being made on the work of the BOBW STP, as well as reviewing the work which is being carried out locally as part of the Integrated Care System.

Attendees:

Lin Hazell, Cabinet Member for Health & Wellbeing

Ms L Patten, Accountable Officer, Bucks Clinical Commissioning Groups

Ms L Watson, Managing Director, Bucks Integrated Care System

Ms G Quinton, Executive Director, Communities, Health and Adult Social Care, Bucks County Council

Mr N Macdonald, Chief Executive, Bucks Healthcare Trust

Papers:

Power point presentation attached

Intended outcomes:

For Members to seek assurance that progress is being made in delivering the plans set-out in the BOBW STP as well as the progress of the Integrated Care System in delivering the local plans.

The Chairman welcomed Lin Hazell, Cabinet Member for Health and Wellbeing; Ms L Patten, Accountable Officer, Bucks Clinical Commissioning Groups (CCGs); Ms L Watson, Managing Director, Bucks Integrated Care System; Ms G Quinton, Executive Director, Communities, Health and Adult Social Care, Bucks County Council (BCC) and Mr N Macdonald, Chief Executive, BHT to provide an update on the Buckinghamshire, Oxfordshire and Berkshire West (BOBW) Sustainability and Transformation Plans (STP).

Ms Patten referred to the presentation in the agenda pack and made the following main points:

• Anything that made sense to do at scale in terms of commissioning would be undertaken at scale and the following facts and figures were provided as an example of how it was working:

v  Total population of 1.8 million

v  £2.5 billion place-based allocation

v  Three Clinical Commissioning Groups

v  Six Foundation Trust and NHS Trust providers

v  14 Local Authorities

• Ms Patten was now Interim Chief Executive Officer of Oxfordshire CCG as well as leading the Buckinghamshire CCGs.
• Fiona Wise was the STP Executive Lead from 5 March 18.
• The programmes led by the STP included cancer alliance, prevention, population health management, estates and workforce.
• Best practice was being shared in urgent and emergency care, mental health, primary care and maternity.

Ms Watson said she had been in post for 3 months to support the Buckinghamshire Integrated Care System and emphasised that she was not aligned to any particular organisation; her post was to support and challenge the system to ensure the best outcomes for the population of Buckinghamshire. 

Ms Watson then highlighted the following points with regard to the Buckinghamshire Integrated Care System:

• The vision and objectives of the Integrated Care System.
• The transformation journey so far.
• The work with BCC on the emerging care model to target services for those most at need and make the best use of resources.
• The significant amount of engagement with the public and stakeholders over the last year and highlighted that engagement would continue during 2018.

Ms Quinton mentioned the following points concerning the  integration and transformation of social care:

• Adult Social Care had recently launched its new strategy called The Better Lives Strategy and within this was the context of the transformation programme.

• The aims – to help people live independently; to help people regain control of their independence; help for people to live with support but as independently as possible.
• The Strategy was underpinned by a new social work approach model which focussed on what people could do rather than what they could not do.
• £161m was spent on adult social care; it was a very complex system supporting over 8,000 clients with a myriad of providers.
• There were approximately 10,000 new contacts into adult social care each year, of which 2281 resulted in an ongoing care package i.e. 22%, a ratio of 5:1; best practice was 22:1. 
• At the moment, 59% of people were helped to live independently but this should be much higher at approximately 80%.
• The average length of stay in  ...  view the full minutes text for item 7.

Purpose:

In February 2017, the Committee first reviewed the Hospital Trust’s plans for developing care closer to home which included developing community hubs.  Since April 2017, Marlow and Thame Community Hospitals have been piloting the hub model by providing day health services in a community setting.  The pilot was initially for 6 months but it was extended to 12 months to allow more services to be introduced.  The Committee set-up a Task & Finish Group after the 6 month report was presented to the Committee in September.  The Task & Finish Group put forward a number of recommendations for the Trust to consider as part of its final report.

The Committee will now review the community hubs in light of the paper submitted by Bucks Healthcare Trust.

Attendees:

Dr T Kenny, Medical Director, Bucks Healthcare Trust

Dr M Thornton, GP Partner Unity Health and Clinical Lead, FedBucks

Mr N Macdonald, Chief Executive, Bucks Healthcare Trust

Ms L Patten, Accountable Officer, Bucks Clinical Commissioning Groups

Papers:

Report attached

Intended outcome:

For Members to evaluate the community hubs pilot and to consider the future plans put forward by Bucks Healthcare Trust.

The Chairman welcomed Ms C Morrice, BHT;

Dr M Thornton, GP Partner Unity Health and Clinical Lead, FedBucks; Mr N Macdonald, Chief Executive, BHT and Ms L Patten, Accountable Officer, Bucks CCGs.

Mr Macdonald advised it was important to review the pilot as part of the jigsaw of the STP and ICS in trying to pull together to solve the growing issue of effectively managing emergency demand and dealing with some of the issues of an increasingly frail and elderly population   Mr Macdonald also thanked the members of the Thame and Marlow stakeholder groups.

Ms Morrice said the purpose of the presentation was to provide an overview of the full paper contained in the agenda pack.  The aim of the presentation was to share the results, explain how the pilot fitted into the wider communications strategy and outline the next steps.  The following points were highlighted:

• 600,000 contacts cared for outside of hospital annually.
• Working with partners to ensure safe services were provided.
• Invested over £1m to expand community services.
• Delivering what patients and clinicians had asked for.
• Creating a health and social care environment to reduce pressure on the GPs and hospitals.
• Developing locality teams, rapid response intermediate care teams and community care co-ordinators.
• There had been a 12 month pilot at Marlow and Thame hospitals which had provided a new community assessment and treatment service (CATS), more outpatient clinics and more diagnostic services.
• The pilot was run with a strong governance structure by an operational group. 
• Dr Thornton advised that The Clinical Innovation Group had been looking at how to develop the service further.  Frailty was an emerging area and clinicians had been looking at the next steps of development to try to predict who may need to use the service. 
• Ms Morrice said she worked with the Stakeholder Engagement Group and had received a lot of challenge on the key performance indicators.  Stakeholders had provided a wealth of information on the population.
• Over 300% more patients had been seen in CATS than in the inpatient service in 2016/17 at Marlow and Thame.
• 92 people were followed up on in their own homes.
• Less than 1% of patients seen by CATS were subsequently referred to A&E.
• The number of Community Care Co-ordinator referrals of 6,063 included families.
• Patients felt the clinicians had the time to listen and understand care needs. 
• Patients thought the new model should have been better communicated.
• Transport was a consistent issue; there had been some progress with looking at using transport hubs and having staggered appointment times.
• Stakeholder views on the hubs were obtained by a variety of means.
• Recommendations from the stakeholders were to raise awareness, increase the service to five days a week, consider expanding the process to self-referral, more outpatients and voluntary sector involvement.
• Dr Thornton showed an example of what the model of care might look like which showed input onto self-management with more support.  GPs had started to work together and were empowering people to look after themselves.  ...  view the full minutes text for item 8.

For Members to note the work programme.  There will be a private work programming session after the meeting to discuss future items.

Papers:

Work programme attached

The Chairman thanked everyone for attending the meeting.  Mr Martin thanked Ms Wheaton for the preparation documents.

The next meeting is due to take place on Tuesday 22 May 2018 at 10am in Mezz Room 1, County Hall.

Tuesday 22 May 2018 at 10.00 am in Mezz room 1, County Hall.