Meeting documents

Apologies were received from Mr B Bendyshe-Brown, Mr C Etholen, Dr W Matthews, Ms C Jones and Ms S Jenkins.

Mr G Williams declared an interest as Deputy Cabinet Member for Children’s Services.

To confirm the minutes of the meeting held on Tuesday 20^th November 2018 as a correct record.

Additional papers:

Follow-up responses from Buckinghamshire Healthcare NHS Trust

Copy of revised Community hubs evaluation report (see link below to papers)

https://democracy.buckscc.gov.uk/ieListDocuments.aspx?CId=137&MId=11094&Ver=4

The minutes of the meeting held on Tuesday 20^th November 2018 were agreed as a correct record.

The Chairman referred to the updated report from Bucks Healthcare NHS Trust which was published as part of the agenda papers for the meeting.

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.

The Chairman updated the Committee about an outstanding question from a member of the public in relation to community hubs.  The response would be circulated once received.

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

The Chairman reported the following:

·         The next Bucks Healthcare NHS Trust Board meeting would take place on Wednesday 30^th January at 9am, Florence Nightingale, Walton Street in Aylesbury.

·         The NHS long term plan was published at the beginning of January.

·         The Adults residential short breaks consultation runs from 16^th January to 27^th February.  The Committee had set-up a task & finish group to review the proposals and prepare a response for the Cabinet Member.  The Chairman encouraged members of the public to make their own representations to the consultation – details on the Council’s website.

·         Planning permission had been granted to the Swan Practice in Buckingham for the Lace Hill development.  The Chairman would keep the Committee updated on progress with the project.

·         Awaiting publication of the Green Paper on Adult Social Care future funding.

·         The Chairman and Committee Member, Ralph Bagge attended a meeting with representatives from the Hospital Trust to discuss the key findings and recommendations in the Child Obesity report.

Julia Wassell reported that she had received a number of concerns from carers in relation to the current consultations around Seeleys and Thrift Farm.

Ms T Jervis, Chief Executive, Healthwatch Bucks provided an update on their key areas of work which included the following.

·         Urgent Care – use of 111 and urgent care.

·         Dignity and Self-Harm – access to support.

·         Reablement project

·         Maternity – birth plans (looking to cover a longer length of time)

·         Getting Bucks involved – at the December meeting, the terms of reference and the function of the engagement group were discussed.  The next meeting would be in February.

Purpose:

On behalf of the Committee, the Chairman and two Committee Members prepared a statement in response to the Buckinghamshire Healthcare NHS Trust’s (BHT) Quality Account for 2017/18.  The statement raised a number of concerns around the Trust’s quality priority targets although acknowledging that actions had been identified to improve the situation.  This item will review the areas mentioned and review the progress made to improve the situation.  The Committee will also hear about other improvement projects that the Trust is working on.

Attendees:

Carolyn Morrice, Chief Nurse, Buckinghamshire Healthcare NHS Trust

Tina Kenny, Medical Director, Buckinghamshire Healthcare NHS Trust

Papers:

Presentation from BHT attached

Intended outcome:

For the Committee to be reassured that the necessary improvements have been made in the areas highlighted in the Quality Account and that the targets will be met this year. 

The Chairman welcomed Ms C Morrice, Chief Nurse, Bucks Healthcare NHS Trust and Dr T Kenny, Medical Director, Bucks Healthcare NHS Trust.  He went on to explain that the Select Committee prepared a statement to the Trust’s Quality Account for 2017/18 and highlighted a few areas of concern.  This item would be an opportunity to hear from the Trust’s representatives about the improvements being made in these areas alongside other key improvement projects.

Ms Morrice confirmed that the Trust was committed to learning when things go well and replicating them and learning where things do not go well and making the necessary improvements.  2019/20 would focus on improving quality within the Hospital setting as well as looking at what quality in the home looks like.

During discussion, the following main points were made:

·         In response to a question around prevention, Dr Kenny explained that the CATS service (Community Assessment Treatment Service) was a standalone service within the hubs.  The purpose of the hubs was to keep people healthy and in their own homes for longer by providing care closer to home.  Part of this was about pro-actively going out to GP practices asking them to identify their most frail patients and putting preventative measures in place to avoid crisis situations. 

·         It was acknowledged that the use of the word "hub" can be confusing as it was being used across the system in slightly different ways.

·         In response to a question about the monitoring and reviewing of the services provided within the hub, Dr Kenny explained that there was a very active stakeholder group who were involved in developing the hubs and the technical steering group which looked at the key performance indicators and had general oversight of the piece of work.

·         In response to a question around how the five GP practices were identified, Dr Kenny explained that for the preventative piece of work, it was primarily around those nearest to the hubs but the services provided in the hubs were open to all practices across Bucks.

·         There was work currently underway to look at populations of around 30,000 and looking in more detail at the needs of each area.  It was acknowledged that the needs would be different, for example, in areas with more children there would be a focus on providing more services for children.

·         It was agreed that the development of the new models of care would come back to the Committee over the coming months.

Action: Committee & Governance Adviser

·         The Comprehensive Geriatric Assessment was a national tool used to identify frailty needs.  It was described as a well-developed "gold" star tool.

·         In response to a question about the vision for frailty cafes, Dr Kenny explained that people want to reduce duplication and have clear direction of where to go for services.  Discussions with patients and the voluntary sector had highlighted the need to be flexible and responsive to peoples’ needs.

·         On behalf of the Committee, the Chairman offered to review the draft frailty advice leaflet.  ...  view the full minutes text for item 7.

Purpose:

Following a letter from the Local Pharmaceutical Committee (LPC) to the Committee’s Chairman, in relation to the planning of local medicines supplies, this item is for Committee Members to receive an overview from the LPC and to seek reassurance that robust plans are in place for local pharmacists over the coming months.

Attendees:

Pankaj Shah, Chairman, Local Pharmaceutical Committee

Ronak Patel, Vice-Chairman, Local Pharmaceutical Committee

Papers:

Copy letter sent from PSNC (Pharmaceutical Services Negotiating Committee) to the Government Health Select Committee

Medicines factsheet – information on medicines supply for patients

Key actions for pharmacy contractors

Intended outcome:

For Members to be reassured that the contingency plans surrounding local medicine supplies are robust and minimise any adverse effects on residents over the coming months.

The Chairman welcomed Mr P Shah, Chairman of the Local Pharmaceutical Committee and Mr R Patel, Vice-Chairman of the Local Pharmaceutical Committee.  The Chairman also introduced Mr M Dias, Policy Officer, Bucks County Council.

During discussion, the following main points were made:

·         Planning was underway for a smooth transition of medicine supplies to ensure minimal impact on patient healthcare.

·         Pharmacists had always dealt with shortages very well and this was an ongoing scenario in community pharmacy.

·         Community Pharmacists would always make the right clinical decision for the patient and would consult with the GP if all sources of any particular medicines had run out.

·         Government had advised pharmacists not to stockpile medicines in light of Brexit and the Local Pharmaceutical Committee were working with community pharmacists to manage the process.

·         The Pharmaceutical Services Negotiating Committee were working with the Department of Health on issues and working groups had been set-up to develop a number of protocols, for example, a Serious Shortage Protocol (SSP).

·         Networking between community pharmacists had improved.

·         Locally, the Bucks LPC was working with all relevant health providers to ensure minimal impact.  One person co-ordinating any shortages.

·         Mr Shah confirmed that there were 97 pharmacists, including those providing online services.  Pharmaceutical Needs Analysis looked at the concentration of pharmacists and at present, the number in Buckinghamshire was satisfactory and all were running efficiently.

·         A response had not yet been received from the letter sent by the Pharmaceutical Services Negotiating Committee to the Government Health and Social Care Select Committee.  The letter requested measures to be put in place to ensure that community pharmacists had quicker and clearer reimbursement and stock availability information.

·         As well as pharmacists holding 4-6 weeks of stock, wholesalers were also holding the same amount of stock to ensure a good 12 week supply.

·         Mr Shah acknowledged that there had been problems with the supplier of the flu vaccine last year and a miscommunication also led to problems but lessons had been learnt.  A flu Committee had been set-up locally to ensure the same issues did not happen this year.

·         In response to a question about the morale of community pharmacists, Mr Shah explained that the role of the community pharmacist had changed and become more service orientated rather than just a dispensing role.

·         Mr Shah reassured the Committee that key partners were constantly communicating with each other and planning both locally and nationally in relation to shortages.

·         In response to a question about online repeat prescriptions and some patients being unable to do this, Mr Shah explained that there were exceptions if patients are unable to do this, then the pharmacist would help.

·         Healthwatch Bucks had undertaken a piece of work around pharmacists which looked at key trends.  The report could be viewed on Healthwatch Bucks website – www.healthwatchbucks.co.uk

·         Community pharmacists work collaboratively and share supplies and this would continue over the coming months.

·         A Member suggested sending a press release to the media to reassure people about medicine supplies.

The Chairman thanked the  ...  view the full minutes text for item 8.

Purpose:

A day of evidence gathering was held on 30^th October 2018 where Members of the Review Group heard from various representatives in relation to the current support available for carers.  A report has been drafted which contains the key findings and areas of recommendation which the Committee will discuss.

Attendees:

Brian Roberts, Chairman of the Review Group

Anita Cranmer, Member of the Review Group

Lesley Clarke OBE, Member of the Review Group

David Martin, Member of the Review Group

Papers:

Draft Support for Carers report attached

Intended outcome:

For the Committee to discuss and agree the content of the draft report which will then be presented to Cabinet in March 2019.

The Chairman explained that a day of evidence gathering was held in October and the draft report reflects the key findings and areas of recommendation coming out of this day.

A Member stressed the importance in providing a consistent approach from managers in their support for carers, effectiveness of signposting services and the consistency of high quality support given to carers.

A Member was concerned about the lack of support for employees who are carers and felt that recommendations 6, 7 and 8 were particularly important.

A Member highlighted the role of the Select Committee and the importance of their work programme and felt the report should be re-titled to reflect that it was an inquiry rather than a review.

It was suggested that there should be a differentiation between services for young carers and adult carers in terms of the single point of access.  A Member also felt that there were not as many recommendations specifically for young carers and suggested that this could be reflected in the report. 

A Member suggested broadening the recommendation around developing a corporate training programme to include other partners within the ICS.

The Committee & Governance Adviser was thanked for her work in supporting the Inquiry Group and preparation of the draft report.

The Chairman confirmed that the report would be presented to Cabinet on Monday 25^th March.

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

Papers:

Work programme attached

Members noted the work programme.

The Chairman confirmed that the Chief Executive of Frimley Hospital Trust would be invited to attend a future meeting to discuss Wexham Park Hospital.

The next meeting is due to take place on Tuesday 19^th March 2019 at 10am in Mezzanine Room 1, County Hall, Aylesbury.

The next meeting is due to take place on Tuesday 19^th March 2019 at 10am in Mezz 1, County Hall, Aylesbury.