Agenda and minutes

The chairman apologised for the delayed start of the webcast which was due to technical issues.  Apologies had been received from Cllr Lawrence Wood but were not known until after the meeting.

Cllr Alan Turner declared a non-pecuniary interest as a trustee of an independent adult day care provider charity.

Cllr Guy Hollis declared that he worked as a Community First Responder for the South Central Ambulance Service.

To confirm the minutes of the meeting held on Thursday 5^th November 2020.

Cllr Patricia Birchley referred to the action under item 8, [Pharmacy Services] on page 17.  Cllr Jane MacBean, the Chairman, confirmed she had contacted Cllr Gareth Williams, Chairman of the Health and Wellbeing Board (HWB), regarding pharmacy representatives being invited to attend the HWB meetings. Cllr Williams had advised it would be difficult as it would mean also inviting several other organisations.  The Chairman stated she would continue to work with the HWB to ensure pharmacy representation at relevant HWB meetings as it was vital that they had an integral part of any planning for key services. 

RESOLVED:  The minutes of the meeting held on 5 November 2020 were AGREED as an accurate record.

The following public questions have been submitted for this meeting.

Question submitted by Buckingham Town Council

Q1. "Buckingham Town Council notes that "Two community hubs are being piloted in Marlow and Thame to help patients take greater control over their care and treatment and avoid hospital admissions" as part of plans to establish an ICS across Bucks

https://www.england.nhs.uk/integratedcare/integratedcaresystems/buckinghamshire-ics/our-current-projects/

Please can the ICS Leads explain whether it will be one of the ICS priorities to establish something similar with the Buckingham Community Hospital within the next 5 years? And moreover, how will the introduction of the ICS across Bucks noticeably affect the lives of Buckingham people? And how will Buckingham people be able to have a say about all this?"    

Question submitted by Ozma, Save Wycombe Hospital Campaign

Q2. How were the Marlow and Thame hospital buildings used during the first wave of the pandemic? Would it be sensible to prepare to use them as step down wards for Covid patients now that numbers in Bucks of Covid cases are on the increase again?

A written response has been sent to Ozma in relation to the other questions – response attached. 

Councillor Jon Harvey from Buckingham Town Council read out the following question:

"Buckingham Town Council notes that "Two community hubs are being piloted in Marlow and Thame to help patients take greater control over their care and treatment and avoid hospital admissions" as part of plans to establish an ICS across Bucks.

https://www.england.nhs.uk/integratedcare/integratedcaresystems/buckinghamshire-ics/our-current-projects/

Please can the ICS Leads explain whether it will be one of the ICS priorities to establish something similar with the Buckingham Community Hospital within the next 5 years? And moreover, how will the introduction of the ICS across Bucks noticeably affect the lives of Buckingham people? And how will Buckingham people be able to have a say about all this?"    

Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust (BHT), advised that the community hub provision was a Place-based decision and BHT would publish a Strategy towards the end of this financial year which would include a roadmap for the establishment of community provision.  N Macdonald added that it was slightly more complicated in Buckingham as the links to hospital services were with Milton Keynes.

Dr James Kent, Accountable Officer, Integrated Care System (ICS,) explained that the ICS consisted of three Places [Buckinghamshire, Oxfordshire and Berkshire West] and Dr Kent referred to paragraph 1.15 [page 35 of the agenda pack] which listed the aims of integrated care which would be achieved at Place through strong partnership working.  Residents would notice greater joined up care, particularly in primary care.  There would be less duplication, greater collaboration across providers and shared best practice.  Patients and residents would have their say through the normal channels including Patient Participation Groups.  If any service changes were planned the normal consultation process would be undertaken.

Cllr Harvey encouraged further public engagement on the issue of health care in Buckingham and advised he was interested in how the ICP would affect people across the whole county and hoped that residents would be involved in systematic changes.  The Chairman assured that the Health and Adult Social Care (HASC) Select Committee would be reviewing and challenging the ongoing development plans of the ICP.

The Chairman read out the question below which had been submitted by Ozma, Save Wycombe Hospital Campaign:

How were the Marlow and Thame hospital buildings used during the first wave of the pandemic? Would it be sensible to prepare to use them as step down wards for Covid patients now that numbers in Bucks of Covid cases were on the increase again?

N Macdonald stated that the hospital buildings were used to support the physical location of the community teams, particularly for frail, older people.  It would not be sensible or practical to re-establish them as wards as the ability to staff the wards would be more acute than before. 

The Chairman advised that three further questions had been received from Ozma and written responses were included in the agenda pack for this meeting.  Cllr Khalil Ahmed expressed concern over the substance and brevity of the responses provided.  The Chairman suggested Cllr  ...  view the full minutes text for item 4.

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

The Chairman advised that a draft response to the NHS consultation document was being prepared on behalf of the HASC Select Committee and would be finalised and circulated to the committee members after today’s meeting.  The deadline for submission was Friday 8 January 2021. 

The Committee will receive an update from Zoe McIntosh, Chief Executive of Healthwatch Bucks.

Presenter:

Ms Z McIntosh, Chief Executive, Healthwatch Bucks

Paper:

Report attached

The Chairman welcomed Ms Zoe McIntosh, Chief Executive, Healthwatch Bucks, and advised that information had been supplied in the agenda pack for noting; any follow up questions could be provided to Ms McIntosh outside of the meeting.  The Chairman added that she was pleased to have Ms McIntosh on the HASC Select Committee in order to gain a better understanding of residents’ views of the healthcare services and ensure that the committee work dovetailed with the work carried out by Healthwatch Bucks.

Before moving on to the next item the Chairman stated she had made the decision, due to lack of time, to stand down Cllr Angela Macpherson, Cabinet Member for Adult Social Care; Cllr Gareth Williams, Cabinet Member for Communities and Public Health; Mrs Gillian Quinton, Corporate Director, Adults, Health and Housing and Dr Jane O’Grady, Director of Public Health, for Item 9, Winter Provision and Covid Update as other items needed to be considered in greater detail.

The Committee will hear from Dr James Kent, the newly appointed Accountable Officer for the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System.

Presenter:

Dr J Kent, Accountable Officer, Integrated Care System

Papers:

Cover report attached

NHS “Integrating Care – next steps for integrating care systems”

The Chairman welcomed Dr James Kent, Accountable Officer, ICS.  Dr Kent explained that the ICS was a system of three Places; Buckinghamshire, Oxfordshire and Berkshire West, and within each Place there were partnership arrangements which were called ICPs.  The change had occurred approximately two years ago.

Dr Kent stated that the Integrated Care document, included in the agenda pack, was published by NHS England (NHSE) in November 2020; it outlined the way forward for the ICS and included two options on how to put each ICS onto a statutory footing.  NHSE’s preferred option was Option 2, whereby the Clinical Commissioning Groups (CCGs) would be subsumed into the statutory ICS.  The purpose of the ICS was to drive forward all elements of the long term plan and Dr Kent emphasised that the Integrated Care document was a managerial and organisational document rather than a strategic document in terms of services and the majority of the paper was in line with the current direction of travel.  Systems started from strong Places and the paper clarified the role of Place, which centred around local services and urgent care services and indicated the services which were likely to be commissioned at a system level; these tended to be some of the more specialised services.  Several areas needed more detail, such the scrutiny process and the governance; these would be worked on between now and March 2022.  If the second option was agreed it would also need to be decided how the voice of Primary Care was heard.  The document provided clarity on the leadership roles to be recruited to in the ICS. 

The following points were raised in discussion with Committee members

• The Chairman requested the timescale for when further information would be provided.   Dr Kent advised that there was a large amount of work to be carried out before September 2021 but the ICS was currently working in the direction of travel and his personal view was that plans would need to be broadly configured by January 2022; however the timeline of March 2022 was dependent on the operational challenges of the pandemic being over by March/April 2021; if not, the date could slip.
• It was noted that there was little mention of social care within the report.  In response, Dr Kent agreed that the document was overly health focussed; it started with the need for strong Places in order to ensure good integration between health and social care.  The health and social care services would be commissioned at a local level and would build on work already underway in terms of joint commissioning and governance arrangements.
• A Member commented that social care was provided by Buckinghamshire Council (BC) and the report discussed pooled funding of resources. When asked if this would also apply to social care; Dr Kent stated that he had no information on social care funding flows but had not seen anything to suggest that it would change.
• A Member requested an update on how the establishment of the Primary  ...  view the full minutes text for item 7.

At its last meeting, the Committee received an update on Buckinghamshire Integrated Care Partnership’s comprehensive programme of public engagement.  The programme and survey launched on 24^th August 2020 and the survey closed on 19^th October.  Further engagement work has taken place during December.

The Committee will receive a presentation on the latest results of the survey and some of the key findings from the focus groups.

Presenter:

Mr D Williams, Director of Strategy, Buckinghamshire Healthcare NHS Trust

Papers:

Report attached

The Chairman welcomed Mr David Williams, Director of Strategy, Buckinghamshire Healthcare Trust, and referred to the paper in the agenda pack.  D Williams recapped that Mr Dan Leveson, Deputy Director of Strategy had presented a verbal update at the last meeting.  The engagement exercise had been developed around the following four themes - reducing health inequalities, community services, keeping people safe and digital appointments.  Phase two had been completed in order to obtain richer data, particularly from Black and Minority Ethnic (BAME) groups, carers and patients with disabilities and long-term conditions (LTCs).  83 members of the public were part of the second phase; 25% were from the BAME community, 27% were carers and 33% had a disability or LTC.    D Williams highlighted the following points:

• Digital appointments were working well but residents were concerned that face to face appointments may not be available in the future.  More communication was required to reassure residents that face to face appointments would continue where necessary. 
• Keeping people safe - further communication was required regarding NHS 111 services to ensure efficient use of A & E resources.
• Residents were willing to travel further for a one-off appointment if it resulted in being seen earlier but not for regular appointments; particularly older people and if the journey was on public transport. 
• BHT was committed as a partnership and needed to work harder with communities on how to change and deliver services.  D Williams emphasised that BHT would work with the HASC Select Committee and the community if any changes were to be made which would impact on the residents.  
• Community services – many people had experienced integrated care and the idea of community hubs and joined up care was well received.  Recovering at home was preferable, if possible. 
• Information on beds in the community hospitals would be provided in the report. 
• Residents were receptive to information on lifestyle choices but did not like being preached to about what was good or bad.  It was noted that work should be carried out with children and families to change habits.
• BHT acknowledged the need to improve communications regarding changes to services and the ‘tone’ of communications was important. 

The following points were raised in discussion with Committee members

• A Member requested that the final report be written in ‘plain’ English; D Williams agreed and suggested that some of the committee members could help with the terminology for future reports.
• It was suggested that the focus groups be asked why they had not completed the survey when it was first released.
• A Member referred to one of the public questions [question one on page 21 of the agenda pack].  D Williams acknowledged that the survey was carried out digitally which precluded some residents from taking part and this was the reason phase two of the survey was undertaken.  The Community Boards were now established and would be an excellent way in which to engage with residents.  The Chairman highlighted that 20,000 free text survey responses had been received and  ...  view the full minutes text for item 8.

The Committee will hear from the leads within the Buckinghamshire Integrated Care Partnership on the delivery of the winter plan, in particular how residents have accessed services over the last few months, the flu and Covid vaccination programmes, the impact of the second wave on services, staff wellbeing and an update on the recovery plans.

Members will also hear about the Discharge2Assess model and explore the impact of early discharge on health and social care, particularly during the Winter months.

Presenters:

Mr N Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust

Mr D Gibbs, Chief Operating Officer, Buckinghamshire Healthcare NHS Trust

Mr R Majilton, Deputy Accountable Officer, Clinical Commissioning Group

Cllr A Macpherson, Cabinet Member for Adult Social Care

Cllr G Williams, Cabinet Member for Communities and Public Health

Mrs G Quinton, Corporate Director, Adults, Health and Housing

Dr J O’Grady, Director of Public Health

Papers:

Report attached

Mr N Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust, advised that the infection rate was still very high in Buckinghamshire and the new variant of Covid was the driving cause of the pressure on the NHS. 

During November, the new variant accounted for 5% of Covid cases; last week it had risen to 72%.  Firstly, the critical care units were operating at 150-200% above normal capacity and there were other patients who were less unwell but still required hospital treatment and was almost double the number of the peak on 7 April 2020.  There were currently 6-7 in-patient adult Covid wards at Stoke Mandeville Hospital.  There had been a lower than expected demand for patients with flu, but the pressure far exceeded what was normally seen in the winter.

The second challenge was to safely manage people in hospitals which had implications in terms of the number of patients seen.  The third challenge was the workforce as health care workers were 30% more likely to contract the virus and approximately 10% of nursing rosters were affected.  There was significant pressure on the ability to maintain the level of activity.  The medium and long-term mental health impact of working in such an environment would cause staff to become exhausted.  The pressures were replicated in the ambulance service, community nursing, primary care and the care sector.  The largest flu vaccination programme had been completed and the NHS was now being asked to establish the largest ever vaccine programme. 

The Chairman asked N Macdonald to pass on the Committee’s thanks to all the frontline workers and his team.  The following points were raised and discussed by members of the HASC

• The Chairman asked what led to the major incident being declared by the Leader of the Council in December 2020, what assistance could be expected and what were the ramifications.  N Macdonald advised that the NHS had been working in national major incident mode since November/December 2020.  The Council’s decision followed triggers set out by the Council’s own measures and would enable the Council to pull on further mutual aid support, redeploy staff, maximise safe capacity in the adult social care sector and reduce non-urgent pressures.
• In response to being asked whether a facility such as the Olympic Lodge would be set up to ease capacity in the hospitals; N Macdonald acknowledged that there was increasing pressure on the nursing and care home market and stressed that patients needed to be discharged safely.  All available options were being considered.
• A Member requested the data on the number of Buckinghamshire residents who were in phase one of the vaccination programme and the timeframe of the delivery of the vaccine for the first two groups in phase one.  Dr Kent stated that first vaccine was carried out in primary care in Buckinghamshire on 14 December 2020 and that the programme was now in week 4.  There were approximately 65,000 residents in the initial two cohorts; and a further 50,000 in the other four cohorts making  ...  view the full minutes text for item 9.

Members have raised during earlier discussions, the potential issues around access to dentists during the Covid pandemic.  As a result, the work programme has been slightly amended to reflect this important issue and Members are asked to consider and agree the items proposed for the March meeting.

Presenters:

All Committee Members

Papers:

Work Programme attached

The Chairman advised that the next meeting on 4 March 2021 would be the final one.  It was agreed that the following items would be included on the agenda:

·       Access to Dentists and the impact of Covid-19 on dental services.

·       Support for Carers and Staff wellbeing.

An update on the vaccination programme.

The next meeting is due to take place on Thursday 4^th March 2021 at 10am.

Thursday 4 March 2021 at 10.00 am.