Agenda and minutes

Apologies were received from Councillors Turner, Collins and Birchley.

Mr Macdonald declared an interest in item 6 as his wife was the Accountable Clinical Director for the Arc Primary Care Network (which includes Marlow Medical Group).

To confirm the minutes of the meeting held on Thursday 25^th November 2021.

The minutes of the meeting held on Thursday 25th November 2021 were agreed as a correct record.

Public questions is an opportunity for people who live, work or study in Buckinghamshire to put a question to a Select Committee.

The Committee will hear from members of the public who have submitted questions in advance relating to items on the agenda. The Cabinet Member, relevant key partners and responsible officers will be invited to respond.

Further information on how to register can be found here: https://www.buckinghamshire.gov.uk/your-council/get-involved-with-council-decisions/select-committees/

The following public question had been submitted from Kirsty Shanahan, who attended and read out her question:

Question 1 - Given that the Council has decided to include actions to reduce carbon emissions in all its areas of influence, could there be a part of the Better Lives Strategy that provides for the Council to support people to save energy at home, advise or help them to make their homes warmer by taking measures to insulate or draught-proof them, and therefore also help vulnerable or elderly people save money and live more healthily in order to live independently for longer?

Cllr Angela Macpherson, Cabinet Member for Health and Wellbeing provided the following response:

Response - In implementing the Better Lives strategy, we have adopted a ‘no wrong front door’ principle. This means that if someone contacted the Council with an adult social care issue, they would have an initial conversation with someone in our adult social care multi-agency hub.  If during the conversation, should any issues be raised about quality of housing or fuel poverty, social care workers would make the appropriate referrals or signposting to resolve the concerns. This may include resources such as the Bucks Online Directory for example, which has information on the local Affordable Warmth Network and is accessible to both staff and the public.

Additionally, adult social care is keen to link up initiatives across the Council and provide an holistic approach to helping people and their families. As part of this, in relation to housing energy efficiency improvements, social care workers may make referrals to the Council’s Better Housing Better Health scheme.  The scheme, co-ordinated by the National Energy Foundation on behalf of the Council, pulls in available funding to carry out energy efficiency improvements to people’s homes. The latest annual report confirms that over 210 referrals of vulnerable households were made to the scheme from health and social care agencies.

Health professionals can also refer vulnerable people to the Council for a Healthy Homes on Prescription grant of up to £5,000 to provide small scale adaptations to their homes to avoid admission to hospital or enable discharge from hospital.  These grants can be used for a range of adaptations including home efficiency measures such as cavity wall insulation or new windows and doors. 

In December, the Government published its long-awaited White Paper, People at the Heart of Care, setting out reforms to social care.  In addition to key elements relating to a new care cap and capital limits, the White Paper also raised the importance of housing in social care and work will be taking place to embed housing within local health and social care strategies.  In light of the White Paper, the Better Lives strategy will be amended to ensure it reflects the focus on housing.

The Chairman updated Members on the following:

·       Future healthcare provision, Lace Hill, Buckingham - The HASC Select Committee had submitted a response to the consultation proposals and the Chairman had recently received a detailed response from the Executive Partner at the Swan Practice.  This response would be circulated to Committee Members in due course.

·       The inquiry into the development of Primary Care Networks was progressing well.  Further evidence gathering meetings were due to take place during February and March.  

Committee Members will hear from Buckinghamshire Healthcare Trust’s representatives on the Trust’s proposal to continue to operate Marlow and Thame as community hubs on a permanent basis, as part of the Trust’s strategy to develop care closer to home.

Presenters

Ms K Bonner, Chief Nurse

Mr D Williams, Director of Strategy

Papers

Report attached

Equality Impact Assessment Community Hubs, April 2018

Early Supported Discharge Orthopaedic Service (ESDOS)

Patient leaflet (ESDOS)

Stroke Patient Pathway

The Chairman welcomed Mr N Macdonald, Chief Executive, Mr D Williams, Director of Strategy, and Ms K Bonner, Chief Nurse from Buckinghamshire Healthcare NHS Trust (BHT).

The Chairman started by reiterating that one of the main roles of the HASC Select Committee was to be a critical friend to the health and social care system and to independently review and challenge health and social care service developments.  The Chairman requested that future reports were clear about this.

During their presentation, the following main points were made:

·       Community hubs were established, as a pilot, in Thame and Marlow in 2017 as part of BHT’s strategy of developing care closer to home.  The inpatient community beds were closed to enable the new model of care to be delivered.

·       The report outlined BHT’s proposal to permanently remove the inpatient beds at Thame and Marlow Community Hospital and to continue investing in the community hubs model.

·       The inpatient community wards at Thame and Marlow were no longer suitable to provide high quality care, due to challenges around sustainable staffing, the age of the facilities and enhanced infection control standards.

·       The report provided evidence of additional services introduced as part of the community hubs, as well as the support of the home first model of care. It also outlined plans to further develop this model.

·       A community assessment treatment service to provide multidisciplinary assessments, especially for frail adults, had been implemented which had led to a reduction in Hospital admissions.

·       Patients had responded positively to this service and support from some key stakeholders had been included in the paperwork.

·       Some services provided at the community hubs had had to be suspended during the pandemic but were restarted in March 2021.

·       The number of outpatient services, diagnostic services and x-ray services had increased.

·       The community hubs do not work in isolation and a number of other services had been developed to support the system.  For example, the Home First model had been developed since 2017 which was safer and more effective for patients who were medically fit to be discharged from the Hospital.  Investments had been made in the Ageing Well service and the patient stroke pathways had been strengthened. 

·       The evidence showed that the number of patients maintaining their independence had improved since 2017.

·       It was acknowledged that challenges were still being faced due to Covid-19, particularly staffing pressures (8% of the workforce was currently off sick).

·       A full demand and capacity model was being developed for discharge pathways into community beds, which was forming the basis of a business case to develop a single integrated pathway for Buckinghamshire residents. A proposal had been made for further provision of bedded capacity on all sites.

During discussion, Members made the following comments and asked the following questions:

·       In response to a Member’s concern about the lack of feedback following a public meeting in Buckingham in 2017 to discuss the roll-out of community hubs, Mr Macdonald explained that no decisions had been made in relation to Buckingham.  ...  view the full minutes text for item 6.

Buckinghamshire Council’s Better Lives Strategy 2022-25 reiterates the direction of travel set out in the original Better Lives Strategy 2018-21.  Committee Members will examine the progress made through the first strategy and the scope of the second phase of the transformation programme.

Presenters

Cllr A Macpherson, Cabinet Member for Health and Wellbeing

Ms G Quinton, Corporate Director, Adults and Health

Papers

Covering report

Appendix 1 - Better Lives Strategy 2022-25

Appendix 2 – case studies

The Chairman welcomed Cllr Angela Macpherson, Cabinet Member for Health and Wellbeing, and Ms Gill Quinton, Corporate Director, Adult and Health, to the meeting.

During their presentation, the following main points were made:

·       The Council’s refreshed Better Lives Strategy (BLS) for 2022 – 2025 was published on 19^th January 2022. The strategy focuses on how services would be delivered to help people to achieve independence at home.

·       The BLS strategy had already achieved £10 million in savings and a further £6.9 million of savings were forecast over the next budget period.

·       Case studies to highlight the impact of the strategy on people’s lives had been included in the agenda pack. 

·       The report sets out key areas of priority in terms of transformation projects, most of which were currently in the early stages.

During discussion, Members made the following comments and raised the following questions:  

·       A Member asked whether the strategy delivers the correct balance in terms of independent living and the provision of care. Concerns were also raised around costs in terms of domiciliary care and residential/nursing care. The report compared the costs which were estimated at an average of £285 per week for domiciliary care and £1000 per week for residential and nursing care.

·       The refreshed strategy builds on the tiered approach.  Tier 1 focussed on living independently, with services provided through referrals and signposting to universal services (around 70% of adult social care clients). The second tier focussed on reablement, where many short-term packages were provided to enable people to return to their home environment (e.g. disabled facilities grants), (around 20 % of clients). The refreshed strategy aimed to reduce this number. Tier 3 focussed on long-term support for clients, which tended to be the high-cost services (around 10 % of clients were in this tier).

·       A Member pointed out that although savings have been achieved, the adult social care budget had increased.   The Cabinet Member explained that this was due to an increase in demand for services, particularly from younger people with disabilities.

·       A Member commented that the Care Advice Buckinghamshire website was not well publicised. The Cabinet Member acknowledged that this was the case and agreed to review this.  She went on to say that the website does provide many useful resources and signposting to other services.

·       The report stated that 3 % of people were dissatisfied with the service they had received. A Member asked how this issue was being addressed. The Cabinet Member advised that Cabinet was continually monitoring this issue through performance indicators. A monthly report was in place which records compliments and complaints, and it was noted that more compliments were now being recorded.

·       A Member asked whether there had been any progress with developing services for people with dementia. The Cabinet Member explained that this project would be a co-ordinated one across many areas, including health care providers, housing and the voluntary sector.

·       A Member raised an issue around future proofing houses to minimise potential changes later in life, for  ...  view the full minutes text for item 7.

The Committee will receive an update on recent key projects for Healthwatch Bucks.

Presenter

Ms Z McIntosh, Chief Executive, Healthwatch Bucks

Paper

Update attached

Ms Z McIntosh, Chief Executive, Healthwatch Bucks updated the Committee on their latest activities.

·       The Enter and View programme has restarted following the pandemic and three reports had recently been published.  Thrift Farm, a day opportunity centre, had been visited.

·       Healthwatch Bucks continued to support Buckinghamshire’s Patient Participation Groups (PPGs).  Additional funding was received from the Clinical Commissioning Group (CCG) to undertake this work. The results of a recent survey had been published on Healthwatch Buck’s website.

·       A network event for PPGs had recently been held where the CCG advised attendees about changes in health and social care and the options to work together to support the Primary Care Networks. A report detailing the key findings was currently being produced.

·       Feedback from signposting services for resident’s had been collected and Healthwatch Bucks had provided a summary of the results, which could be found on their website.

During discussion, the following questions were asked:

·       A member asked whether there were any trends in terms of the quality of both GPs and Dentists.  It was noted that the issue with Dentists was mainly due to not being able to get an appointment, so it was difficult to get any robust data on specific Dentists.

·       A member expressed concern about the negative feedback in relation to the mental health services provided by Oxford Health.  Ms McIntosh advised that, both the CCG and Oxford Health were aware of the feedback. The Chairman advised the Committee that access to mental health services was on the work programme.

The Chairman thanked Ms McIntosh for her update.

For Committee Members to discuss the items for the March meeting and to discuss ideas for the work programme for future meetings.

Presenters

Committee Members

Papers

Work programme attached

Members discussed the work programme and agreed the following items for the March meeting.

·       South Central Ambulance Service;

·       Support for Carers.

Members made the following suggestions for future meetings:

·       Access to mental health services;

·       End of Life Care (Hospice Care provided by the community palliative team);

·       Transitions (Children to Adult Services);

·       Healthcare planning;

·       Dementia services (part of the refreshed Better Lives Strategy).

The Chairman explained that she had produced a report which brought together various issues that came to the attention of the HASC in the preceeding 18 months around the future identification of healthcare need and progression of adequate provision.  The report was shared with the Corporate Management Team but she believed there would be value in circulating it to Members to absorb, with a view to further discussion around how to enhance and expand it, prior to discussing it with key partners.

Action: Chairman

The next meeting is due to take place on Thursday 24^th March 2022 at 10am.

Thursday 24th March 2022 at 10am.