Meeting documents

Apologies were received from Mr B Bendyshe-Brown, Mrs L Clarke OBE, Dr W Matthews, Mr C Etholen, Mr G Williams, Ms C Jones, Mr S Lambert and Julia Wassell.

There were no declarations of interest.

To confirm the minutes of the meeting held on Tuesday 2^nd October 2018.

The minutes of the meeting held on Tuesday 2^nd October were agreed as a correct record.

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:

https://www.buckscc.gov.uk/services/council-and-democracy/getting-involved/how-to-get-involved/

Question submitted in advance by Mr B Russell

Q1. Can the HASC ask Buckinghamshire Healthcare NHS Trust what lessons they have learnt from the process of designing & evaluating the Thame & Marlow Community Hubs pilot project?

There have been a number of mistakes, omissions & changes made during the pilots. The objectives & KPIs appeared to change during the lifetime of the project & the evaluation was poorly managed with data missing and charts presented in a misleading way.

Future projects should be monitored & evaluated using the best methodology.

The following public question was submitted in advance of the meeting from Mr B Russell.

Question 1

"Can the HASC ask Buckinghamshire Healthcare NHS Trust what lessons they have learnt from the process of designing & evaluating the Thame & Marlow Community Hubs pilot project?

There have been a number of mistakes, omissions & changes made during the pilots. The objectives & KPIs appeared to change during the lifetime of the project & the evaluation was poorly managed with data missing and charts presented in a misleading way.

Future projects should be monitored & evaluated using the best methodology."

Response:

Representatives from Buckinghamshire Healthcare NHS Trust met with Mr Russell to discuss the issues and the relevant changes had been made to the report which had been uploaded on the Trust’s website.

A copy of the revised report is attached.

Community hubs would be discussed further at the meeting under item 7.

For the Chairman to update the Committee Members on health and social care activities since the last meeting.

The Chairman reported the following:

·         The Chairman attended a debrief meeting on the repeat medication ordering process.

·         A full day of evidence gathering had taken place to review the current support available for carers.  The key findings and recommendations would be discussed at the next Committee meeting.

·         Buckinghamshire Healthcare NHS Trust Board meeting takes place on Wednesday 28^th November at 9am in the Hampden Lecture theatre, Wycombe Hospital.

·         Clinical Commissioning Group Governing Body meeting takes place on Thursday 13^th December at 10.30am in the Jubilee Room, AVDC.

Ms T Jervis, Chief Executive, Healthwatch Bucks provided the following update on the organisation’s activity.

·         The Integrated Care System user engagement group would be meeting for the first time in December.

·         Healthwatch Bucks had produced a number of publications which were available on their website:

o   Crystal Clear – the report focussed on reviewing the publications of healthcare organisations to improve readability.  The effectiveness of the recommendations would be evaluated in 6-8 months’ time;

o   Access to Urgent Care – part of a street view project which talked to around 300 people across the County about their level of understanding around 111 and Urgent Care Centres;

o   Dignity and self-harm;

o   The 100^th care home visit had taken place and an interim report was available.

·         Healthwatch Bucks were involved in a number of specific projects around GP streaming, Reablement and a survey on Maternity services was currently running which runs across the whole Sustainability & Transformation Plan (STP) footprint.  So far, over 500 responses had been received.

Mr Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust reported that the CQC had issued a 12 week notification of an inspection so this would take place towards the end of January/beginning of February.  A follow-up unannounced visit would then take place after this.  The last inspection took place in 2016.

Purpose:

This item is for Committee Members to receive a progress report on the community hubs in Marlow and Thame and to hear how the plans are progressing with the other components of the Trust’s vision for developing care closer to home.

Attendees:

Carolyn Morrice, Chief Nurse, Bucks Healthcare Trust

Neil Macdonald, Chief Executive, Bucks Healthcare Trust

Lou Patten, Chief Officer, Clinical Commissioning Group

Papers:

Briefing paper attached

Intended outcome:

For Members to seek reassurance that the Marlow and Thame community hubs are working well and the plans for rolling out further care in the community are on track.

The Chairman welcomed Ms C Morrice, Chief Nurse, Bucks Healthcare NHS Trust, Mr N Macdonald, Chief Executive, Bucks Healthcare NHS Trust and Ms L Patten, Chief Executive, Clinical Commissioning Group.

During the discussion, the following main points were made:

·         In response to a question about GP engagement and how well the services available at the hubs were communicated and embedded in GP surgeries, Mr Macdonald explained that behaviours and awareness of the hubs would increase as the number of GPs referring increased and thereby over time, the services would be embedded in the surgeries.  Over the coming months, there were plans to introduce patient self-referral to the hubs.  Mr Macdonald went on to explain about the development of a communications App which would allow GPs to select from a list of options and communicate directly with consultants in the Hospital and Community settlement.  This would be mandated and the only way patients could come into the Trust.  Technical testing was currently taking place and it was hoped that the project would go live during Q4 (January to March 2019).

·         Ms Morrice went on to say that as well as developing the technical side, the relationship between GPs and the health professionals working in the hubs was key so a new "connector" role had be established to build on the relationship side. 

·         The important work of the Patient Participation Groups was acknowledged and the key role of the Practice Managers, in terms of communicating with GPs and spreading information about the hubs.  Ms Patten reported that there were a number of networks for Practice Managers but stressed that the job roles for Practice Manager varies from place to place.  The Clinical Commissioning Group supports Practice Managers, particularly in terms of training.  Ms Morrice added that locality meetings took place and provided a good opportunity to share best practice and learning but agreed that these networks could be developed further.

·         In response to a question about whether GPs across the county were referring to the hubs and not just Marlow and Thame residents, Mr Macdonald explained that access is county-wide.  A GP would call the "Silver phone", manned Monday to Friday between 9-5pm by a geriatrician who would make a decision with the GP as to where the patient should be seen, for example, MuDAS (Multi-disciplinary Day Assessment Service), A&E at Stoke Mandeville or at one of the community hubs.  Mr Macdonald explained that the challenges were around providing services which were "locality based".

·         Transport continued to be a challenge but lessons had been learnt in terms of appointment times and delays in waiting for transport had improved.  The voluntary services were continuing to help and support the hubs.  Consideration was being given to developing tele-meds and how to minimise hospital transport in light of the major transport infrastructure projects across the county.

·         There were no parking fees at the hubs but there were plans to review this to deter general parking at the hubs.

·         A Member asked about the  ...  view the full minutes text for item 7.

Purpose:

For the Committee to hear from representatives across the health and social care system about the progress being made on its journey to being an integrated care system by 2020.

Attendees:

Lin Hazell, Cabinet Member for Health & Wellbeing

Gill Quinton, Executive Director, Communities, Health & Adult Social Care

Neil Macdonald, Chief Executive, Bucks Healthcare Trust

Lou Patten, Chief Officer, Clinical Commissioning Group

Papers:

Briefing paper attached

Intended outcome:

For Members to understand the progress being made on the integration of the health and social care system and what more needs to happen before 2020.

The Chairman welcomed Ms G Quinton, Executive Director, Communities, Health & Adult Social Care, Ms L Patten, Chief Executive, Clinical Commissioning Group and Mr N Macdonald, Chief Executive, Bucks Healthcare NHS Trust.

During discussion, the following key points were made and questions asked.

·         Ms Patten provided details around Population Health Management and explained that there was growing evidence to support the need to look at the projected needs of the population now and in the future when planning health service.  It could not be based on assumptions of where patients had received their care in the past but a wider review of the type of people living within the county and establishing their level of need was important.

·         This approach also required taking a wider look at planning and involved closer working with the County and District Councils. A framework would be developed by the Integrated Care System and owned by the Health & Wellbeing Board.

·         Ms Patten stressed that this approach was about services not buildings and provides opportunities for groups of clinicians to come together to provide services at scale.  This summed up the hub concept.

·         A new on-line community asset mapping tool was due to be launched soon which would allow people to search for activities by location and type. 

·         GPs were embracing and endorsing prevention methods and the importance of GPs, as part of the Integrated Care System, was acknowledged.

·         Health data was used to target communications to specific groups with key relevant messages based on their needs.

·         Making every contact count was still important and it was acknowledged that more could be done.

·         In the last 10 years, the number of people with diabetes had doubled.  There were good clinical measures around diabetes which link to the effectiveness and the support patients were getting, for example, blood sugar levels.  GP practices in Buckinghamshire were the best in the country for diabetes outcomes and 7^th in the world for care and support planning for patients with diabetes.

·         Nationally, 30% of children would be leaving primary school obese of which 70% would go on to develop health issues related to obesity, including diabetes.

·         In response to a question about prevention and providing health checks, Ms Patten explained that there was an annual health check programme but this was aimed at those identified at potential risk and limited funding meant that it could not be available to everyone.  There was a need to provide opportunities for wider conversations across the system.

·         The funding for next year had yet to be announced but the health budget for Buckinghamshire remained under-funded as the Government top-sliced some of the budget based on the assumption that Buckinghamshire was a healthy county, even though there were significant inequalities across the county.

·         Social care funding affects health funding, particularly around community services and length of stay in Hospital - the two were interchangeable.

·         In response to a question about governance of the ICS, Mr Macdonald explained that the ICS was not a statutory body and  ...  view the full minutes text for item 8.

Purpose:

For the Committee to hear about the health and social care winter plans and to seek reassurance that lessons from previous years have helped shape and inform the plans for this year.

Attendees:

Karen Jackson, Director of Operations, Bucks County Council

Natalie Fox, Chief Operating Officer, Bucks Healthcare Trust

Debbie Richards, Director of Commissioning and Delivery, Clinical Commissioning Group

Papers:

Presentation attached

Intended outcome:

For Members to be reassured that the system has prepared as much as possible for winter and the pressures it brings.

The Chairman welcomed Ms N Fox, Chief Operating Officer, Bucks Healthcare NHS Trust and Ms K Jackson, Service Director of ASC Operations.

The presenters referred to the presentation which was included in the agenda pack and the following main points were made during the discussion.

·         All systems across the country, including Buckinghamshire were preparing for a challenging winter and had been working hard to prepare for the increased pressure on services.

·         A number of schemes across the system had been set-up to reduce unnecessary admittance to A&E which included use of GP services, community hubs, prevention measures, improving communications with the public and working with care homes to help reduce Hospital admissions.

·         Work was underway to improve Hospital discharges and a robust plan had been developed across the system to reduce length of stay.  A discharge to assess model had been developed which reinforces the "Home First" philosophy across the system.  Closer working with the voluntary sector, particularly the Red Cross who would be providing an enhanced care service to help stabilise people in their own home.

·         A winter Director had been appointed and would be starting on 10^th December.

·         A regular winter Director telephone call took place across the system where issues were discussed, in particular looking at how the system could work differently to alleviate pressure and what else would be needed to manage demand. 

·         Lessons had been learnt about pressure on staff so more focus had been placed on how best to support staff during the winter months.

·         In response to a question about the lack of detail around pharmacy services in the plan, Ms Jackson explained that it was a system plan and she agreed to discuss the key public messages around pharmacists at the next A&E Board, particularly opening times of local pharmacies over the festive period.  The key role that pharmacists play in providing services to take the pressure off GPs was acknowledged.

·         The additional hours provided by GPs to help improve access to appointments had recently been launched and so far, the service had not been fully utilised to date and had only been up and running for the last 6 weeks.  It was acknowledged that more publicity was needed to support this.

·         The skill mix of the workforce had been reviewed.  Paramedics had been brought into A&E, for example.  The Trust had also looked at how unregistered staff could cover certain tasks to release registered staff to carry out other clinical tasks.  There was still a high vacancy rate and the Trust was continuing to work on recruitment and skill mix across the organisation and the system.

·         In response to a question about the flexibility around the GP streaming service in the Hospital setting, Ms Fox explained that this was a robust system but she agreed to look into whether more could be done to increase GP provision across the system, particularly where the additional GP hours were not being utilised by specific surgeries.

·         It was agreed that  ...  view the full minutes text for item 9.

For Members to discuss and agree the items for future meetings.

Papers:

Work programme attached

Members noted the work programme.

The next meeting will take place on Tuesday 29^th January 2019 in Mezz Room 1, County Hall, Aylesbury at 10am.

The next meeting is due to take place on Tuesday 29^th January 2019 in Mezz Room 1, County Hall, Aylesbury at 10am.