Agenda and minutes

Apologies were received from Cllrs Z Ahmed, M Bradford and A Macpherson.  Cllrs  S Jenkins and J Wassell had advised that they would be arriving late.

Cllr A Turner declared a non-pecuniary interest in Item 9 as a Trustee of an independent adult day care provider charity.

Cllr G Powell declared an interest in Item 7 as a European Special Consultant for the Center for Bioethics and Culture, California.

To confirm the minutes of the meeting held on Thursday 7^th January 2021.

The Chairman advised that the final report relating to the county-wide engagement exercise would be discussed at the next Health & Wellbeing Board meeting on 1 April 2021. The Select Committee would have a copy of the final report. 

RESOLVED: The minutes of the meeting held on 7 January 2021 were AGREED as an accurate record.

There were no public questions submitted for this meeting.

There were none.

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

The Chairman provided an update on the following items:

·         Cllr G Williams, Cabinet Member for Communities & Public Health, had confirmed that there would be local pharmacy representation at the Health & Wellbeing Board as part of a standing item on winter planning at meetings.

·         A new health and wellbeing centre was now being proposed in Long Crendon. This was as a result of meetings between the local action group, Unity Health and the Clinical Commissioning Group. The proposal, which had the support of Long Crendon Parish Council and was on the Parish’s land, was currently going through the planning process. Finances were being finalized but the project may be financed through a public works loan as the CCG did not fund capital builds. This project could be  a model of how primary care services are delivered in local areas as part of a wider community offer. The Chairman was proud of the Committee’s involvement in the project and would continue to monitor its progress.

·         Arrangements were progressing to set-up the Buckinghamshire, Oxfordshire and Berkshire West Joint Health Overview Scrutiny Committee across the Integrated Care System footprint. Meetings had taken place with elected Members across the councils to discuss their local scrutiny arrangements. It was hoped that the terms of reference would be on the next full Council agenda on 21 April for approval. The current scrutiny arrangements at each local authority would remain in place and the joint committee would look at specific issues that impacted the entire ICS area.

·         The Chairman advised that a productive session had been had with Oxford Health regarding mental health. It was recommended that an inquiry on mental health services be conducted by the Committee in future.

·         Additionally, the Government’s white paper on health and social care would be added to the work programme. The impact of the paper was scheduled to be discussed at the Health & Wellbeing Board in April 2021.

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

Presenter:

Ms Z McIntosh, Chief Executive, Healthwatch Bucks

Paper:

Update attached

The Chairman welcomed Ms Zoe McIntosh, Chief Executive, Healthwatch Bucks, and advised that information had been supplied in the agenda pack for noting. The paper summarised the recent work that Healthwatch Bucks had carried out in relation to health and social care services which aligned with the priorities of the Joint Health & Wellbeing Strategy. Ms McIntosh highlighted the two surveys that were in the report. The first survey was on the Ask NHS app to find out if it was meeting the needs of residents. The second survey sought feedback on the Covid-19 vaccination programme which was in response to the volume of feedback Healthwatch Bucks had received. The survey, which had opened on 3 February, focused on questions that would help improve the local rollout and had received 1,000 responses so far. Members were encouraged to circulate the links to the surveys.

In response to questions following the update, Ms McIntosh advised that:-

·         Feedback of Member experience during the vaccination rollout would be valued and could be included in the survey response.

·         Healthwatch Bucks had investigated the experiences of residents and staff in care homes in two separate reports that were available on the Healthwatch Bucks website. Overall the reports were positive with recommendations made to build on good practice.

The Chairman thanked Ms McIntosh for her update.

The Committee will receive a verbal update from Dr T Kenny, Medical Director on the current Covid situation at the Hospital and the recovery plans for bringing services back.

The Committee will then hear from Ms Heidi Beddall, Head of Midwifery at Buckinghamshire Healthcare NHS Trust following the publishing of the Ockenden Report in December 2020.

Background on the item:

In the summer of 2017, following a letter from bereaved families, raising concerns where babies and mothers died or potentially suffered significant harm whilst receiving maternity care at The Shrewsbury and Telford Hospital NHS Trust, the former Secretary of State for Health and Social Care, Jeremy Hunt, instructed NHS Improvement to commission a review assessing the quality of investigations relating to new-born, infant and maternal harm at The Shrewsbury and Telford Hospital NHS Trust.

Following the review of 250 cases, the emerging findings and recommendations from the independent review of maternity services at the Hospital were published in December 2020 and the report highlights the actions which the independent review believe need to be urgently implemented to improve the safety of maternity services at The Shrewsbury and Telford Hospital NHS Trust as well as learning that should be  shared and acted on by maternity services across England.

Presenters:

Dr T Kenny, Medical Director, Buckinghamshire Healthcare NHS Trust

Ms H Beddall, Head of Midwifery, Buckinghamshire Healthcare NHS Trust

Papers:

·       Link to Ockenden report below

OCKENDEN REPORT - MATERNITY SERVICES AT THE SHREWSBURY AND TELFORD HOSPITAL NHS TRUST (donnaockenden.com)

·       Buckinghamshire Healthcare NHS Trust’s response to Immediate and Essential Actions – December 2020

·       Buckinghamshire Healthcare NHS Trust’s response – February 2021

·       Assurance Assessment template – February 2021

The Chairman welcomed Dr Tina Kenny, Medical Director at Buckinghamshire Healthcare Trust, and Ms Heidi Beddall, Head of Midwifery at Buckinghamshire Healthcare Trust.

Dr Kenny provided Members with an update on the current Covid-19 situation at the Hospital and the recovery plans that were in place. The general trend was that Covid-19 cases were decreasing locally which was credited to the national vaccination programme. At its peak, there had been 232 patients being treated for Covid-19 at the Hospital and this was now under 80. The Trust was participating in public health Covid-19 studies and was recruiting staff and patients for these. The Recovery Restore Board, which was multi-organisation and involved GPs, the CCG and the Trust, had been meeting to consider Covid recovery as well. One of the elements of recovery was being mindful of staff mental health and support their wellbeing. Patient referrals to the Hospital had continued and the Trust encouraged the public to raise health concerns with their GP as normal. The Hospital had taken steps to be a Covid safe environment so patients referred to the Hospital were encouraged to keep their appointments and follow medical advice issued to them. During the pandemic, some services, such as chemotherapy, had been moved away from Stoke Mandeville; these were now returning to the Hospital.

The Trust had developed ‘virtual’ wards with patients based at home and equipped with pulse oximeters to measure their oxygen levels. The patient would then have telephone contact with medical experts. This had meant patients could stay at home if this was appropriate for their care. There had also been an innovative partial booking pilot which booked patients in no more than six weeks in advance for outpatient clinics. As a result of the pilot, disrupted appointments had fallen and cancelled appointments had reduced by 30%. The Trust’s cataract service had opened a Covid safe cataract surgery separate from the Hospital site, and carried out nearly 3,000 operations since May 2020. This innovation had generated national interest and a video of the set-up was on the Trust’s website to reassure cataract patients.

Following this, Ms Beddall outlined the Hospital’s response to the immediate actions that had been requested by the NHS as part of the key findings from the Ockenden report. The report had transferrable learning and action points that applied across the UK, and the service was ensuring that they worked towards any recommendations that were not in place. The service was compliant of the first seven immediate actions in December 2020 and at the time of the meeting, nearly 100% of the Ockenden recommendations were in place. This was credited to the Trust developing a culture of learning and being proactive following the Morecambe Bay report and the East Kent inquiry.

Members raised the following points during discussion:-

·         The Ockenden report recommended all serious maternity incidents are reviewed internally monthly at Trust panel level; this already took place at the Hospital. The service worked with the patient safety team to  ...  view the full minutes text for item 7.

The Committee will hear from representatives from the NHS Dental Services Commissioning team and the Local Dental Committee on how dental services are currently commissioned in Buckinghamshire, how services have been accessed during the pandemic and some of the challenges faced by dentists over the last few months.

Presenters:

Mr H O’Keeffe, Senior Commissioning Manager Dental, NHS England and NHS Improvement – South East

Mr S Moonga, Clinical Director, Senior Dentist, Local Dental Committee

Papers:

·       Cover report

·       Profiles – information to health systems

·       Dental profiles for Buckinghamshire, Oxfordshire and Berkshire West

·       Delivery of Urgent Dental Care briefing paper – November 2020

·       Delivery of Urgent Dental Care briefing paper – December 2020

The Chairman welcomed Mr Hugh O’Keeffe, Senior Dental Commissioning Manager,

NHS England and NHS Improvement (South East) and Mr Satnam Moonga, Clinical Director and Senior Dentist from the Local Dental Committee. Mr O’Keeffe outlined that NHS England were responsible for commissioning all dental services. 70% of its investment was in primary care services (high street dentists) and 30% was in referrals to other services. Primary dental care services were commissioned under the General Dental Services and Personal Dental Services Regulations 2005 which meant that the dental practices had the same contractual relationship as the GPs to deliver NHS services. Patients were not registered to a single practice and could attend any practice of their choice. Across Buckinghamshire, Oxfordshire and Berkshire West, 52% of the population normally attended a dental practice in a two year period. The frequency of dental attendance was often governed by each individual’s oral health and clinical need. There were 71 dental practices in Buckinghamshire, 28 of which provided only NHS services for children and charge exempt adults.

Dental practices had to cease routine dentistry and orthodontics on 25 March 2020 due to the pandemic. Practices could only offer dental advice, analgaesia and antibiotics at this time. There had initially been two urgent care dental hubs set-up in Buckinghamshire to support priority care during the lockdown. There had been a high threshold to access these hubs and between March – June 2020, 808 referrals had been made to them. Dental practices were able to re-open from 8 June 2020 for all treatments and had been open ever since. Operating capacity in June 2020 was around one fifth compared to normal due to Covid-19 restraints. There was also a national operating procedure that focussed on high needs which limited patient access to practices. Dental practices had also been required to adapt their surgeries to operate in a safe Covid environment as well as source PPE.

The situation had eased since January 2021 with dental practices operating safely and able to access appropriate PPE however operating capacity was at nearly 50%. Further guidance was expected in April 2021 but it was recognised that there was no quick way to work through the backlog. Additionally, the NHS England dental budget was based on dental attendance so may be problematic in future due to the reduced capacity. Mr Moonga highlighted the difficulties that the lower capacity created and gave the example that Aerosol Generating Procedures (AGPs) needed considerable planning due to the current regulations.

Following the update, Members had further questions and were advised that:-

·         The geographical coverage of dental practices in Buckinghamshire was considered good. The Dental Access Programme had expanded access to dentistry in more densely populated areas such as High Wycombe and Aylesbury.

·         Capacity for NHS dentistry provision had increased by 30% since 2009. Due to a decrease in NHS access at the time, the Government’s response had focussed on increasing uptake and ring fenced funding.

·         Charges for patients was based on a national fee. There was  ...  view the full minutes text for item 8.

The Committee will review the key issues facing Adult Social Care, including the service area’s response to Covid, pressures on the workforce, support to carers over the last few months, vaccinations in care homes, support to care providers and an update on the Better Lives Transformation programme.

Presenters:

Ms A Macpherson, Cabinet Member for Adult Social Care

Ms G Quinton, Corporate Director, Adult Social Care and Housing

Papers:

Report attached

Ms Gill Quinton, Corporate Director for Adults, Health & Housing, was in attendance for this item and provided the Committee with an update on the following:

·         how the service had responded to the pandemic;

·         what the current pressures were on the workforce;

·         support in place for carers and young carers over the last few months;

·         vaccinations in care homes;

·         support to care providers;

·         the Better Lives Transformation programme.

Covid response

The service had been at the forefront of the pandemic and staff had been reallocated in order to meet the statutory demands. The Chartridge Ward in Amersham had been for people who were medically fit to be discharged from the Hospital setting but had tested positive for Covid. Since the beginning of January 2021, adult social care had focused on hospital discharges and the safety of the most vulnerable clients.

Workforce

There was a total of 118 social worker posts with most being covered by employees of the Council. There were 37 social worker vacancies; 15 were currently covered by agency workers and 22 were vacant. The Council was committed to supporting the health and wellbeing of staff and encouraged the workforce to take up a range of support and advice that was available.

Carers and young carers

Carers Bucks was commissioned to support carers in Buckinghamshire and at the end of Quarter 3 2020-21, there were 12,786 registered carers with the service. During the pandemic, Carers Bucks secured funds of £150,000 from the infection control grant which enabled applicants to access PPE and support carers who needed to attend vaccinations or testing. The service continued to provide prompt information, advice and support, and had its delivery reorganized between April – June 2020. From July 2020, the service started delivering monthly virtual support groups for adult carers. Additionally, the carers discretionary budget had been used to fund therapies to assist carers with their own health and wellbeing needs.

Carers Bucks had contacted all of the 1,043 young carers multiple times during the first lockdown and offered support. Assessments were held in a safe environment (schools and colleges) or alternatively via Zoom where this was not possible. Over 40 young carers attended two activity days held during the summer which had been aimed at those most socially isolated. Support had been offered as part of the Reaching Out project to support young carers feeling anxious about returning to society post-lockdown.

Vaccinations in care homes

All care home settings had been contacted regularly to offer vaccinations to residents and staff. Staff had access to the vaccination through care homes, the national portal or hospital hubs. Encouragement of accepting the vaccination was ongoing. At the time of the meeting, 94% of residents and 70% of staff had been vaccinated. Reasons why some had not been vaccinated included vaccination hesitancy and staff themselves having to self-isolate.  

Support to care providers

Care providers faced increased pressures including increased operational costs and a reduction in self-funder clients. The Council had supported providers in a number  ...  view the full minutes text for item 9.

This item will provide Committee Members with an opportunity to reflect on the work of the Select Committee over the last few months and propose work programming ideas for the new Committee to consider after the Election.  Attached is a “HASC highlights document” which has been produced to capture the work of the HASC over the last few months and to aid the HASC Select Committee in the new council.

Presenters:

All Committee Members

Papers:

HASC Highlights document

The Committee considered the work that had been carried out this year and felt that the following issues should be added to the future work programme:-

·         An inquiry into mental health services in Buckinghamshire.

·         Monitoring of the Long Crendon health and well being centre plans.

·         The implications of the health and social care white paper.

·         Review of Buckinghamshire dental services. A Member commented it would also be useful to hear more about the outcome of the April 2021 contract negotiations and UDA pilots.

·         Continued delivery of the Better Lives Strategy.

·         A deep dive into the lessons learnt from Covid-19.

·         Eating disorders and self-harm amongst young people; this item could be in conjunction with the Children’s and Education Select Committee.

Due to the Elections taking place on 6^th May 2021, this is the last Select Committee meeting before the new Council.  Dates of future meetings to be advised.

This was the last meeting of the Committee before local elections in May. The Chairman thanked all healthcare partners for their participation at the meetings and thanked the officers for their ongoing support. The Chairman also thanked all the Members of the Committee for their work.