Agenda and minutes

Apologies were received from Councillors J Wassell, H Mordue and G Sandy.

·       Cllr A Turner declared an interest as an independent trustee for an Adult Care Provider.

·       Cllr C Poll declared an interest as his wife and son were employed by the Buckinghamshire Healthcare NHS Trust.

·       Cllr M Walsh declared an interest as a member and director for an Adult Care Provider.

That the minutes of the meeting held on Thursday 22^nd September 2022 be confirmed as a correct record.

The minutes of the meeting held on Thursday 22^nd September 2022 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/getinvolved-with-council-decisions/select-committees/

There were no public questions submitted for this meeting.

The Chairman updated Members on the following:

·       The inquiry report into the development of Primary Care Networks was well-received at Cabinet. The inquiry group was commended for the report and the depth and breadth of the recommendations of which. 14 out of the 17 recommendations were directed at health partners and 3 were for the Council.  These recommendations were discussed in the Cabinet meeting and would  be reviewed by the Committee after 6 months and a year. The Cabinet response table would be circulated to the Committee.

Action: Principal Scrutiny Officer

·       A Member commented that the response to the recommendation relating to a named social worker was disappointing.  Concerns were raised that generic mailboxes were not always regularly monitored.

·       The Chairman suggested that the Adult Social Care team would be invited to attend the next meeting to provide an update around workforce challenges.

Action: Principal Scrutiny Officer

·       The Healthy Weight Event scheduled for November had been postponed and would take place later in the year.

The Director of Public Health Annual Report for 2022 is entitled “Hearts and Minds – Preventing Heart Disease and Stroke in Buckinghamshire”.  The report focuses on the importance of the prevention of cardiovascular disease for Buckinghamshire’s population.  The aim is to support a strategic approach for the Council and partners to address the cardiovascular health and risk factors for our population.

The report states that differences in cardiovascular between different groups are a significant driver of health inequalities across Buckinghamshire.  As well as hearing from the Director of Public Health, Members will also hear from a number of key health partners on their programmes aimed at reducing the risks of cardiovascular disease and how they are tackling health inequalities.

Presenters:

Dr Jane O’Grady, Director of Public Health

Dr Toby Gillman, Aylesbury GP

Mr Andrew McLaren, Chief Medical Officer, Buckinghamshire Healthcare NHS Trust

Ms Rose Hombo, Deputy Director of Quality, Oxford Health NHS Foundation Trust

Ms Philippa Baker, Place Director, Buckinghamshire

Papers:

Cover report

Director of Public Health Annual Report (full version)

Director of Public Health Annual Report (short version)

The Chairman welcomed the following presenters to the meeting - Dr Jane O’Grady, Director of Public Health; Dr Toby Gillman, Aylesbury GP; Mr Andrew McLaren, Chief Medical Officer, Buckinghamshire Healthcare NHS Trust; Ms Rose Hombo, Deputy Director of Quality, Oxford Health NHS Foundation Trust and Ms Philippa Baker, Place Director, Buckinghamshire.

During their presentation, the following key points were made:

·       The death rates from cardiovascular disease had decreased over the last 20 years, but have started to increase again, especially in men and in the most deprived areas. Evidence had emerged that having Covid, even without pre-existing cardiovascular disease, increased the risk of having cardiovascular events. The indirect impacts of the COVID pandemic could also increase cardiovascular disease and events.  This could be due to a more unhealthy diet, less physical activity, an increase in smoking and missed opportunities to manage blood pressure during the pandemic. It was estimated that around 47,000 people in Buckinghamshire were unaware that they had high blood pressure, and 10,000 unaware of diabetes.

·       Although smoking rates were decreasing, there was an increase in unhealthy weight and diabetes. A systematic approach across all partners was needed to address environmental, social, behavioural and clinical risk factors.

·       It was noted that the cost of living crisis would worsen people's cardiovascular risk factors. People living in the 10 % most deprived areas needed to spend 75% of their disposable income on food to follow recommended guidelines on healthy eating. A system-wide response was needed to address this. This included improving data collection around ethnic coding in the NHS, and monitoring the most at-risk communities, such as African groups for high blood pressure and stroke, and South Asian groups for high blood pressure, diabetes and heart disease.

·       Dr Gillman commented that space was a challenge in some practices, such as Whitehill, Poplar Grove and many of the practices in High Wycombe.

·       Practices were working with Live Well Stay Well on a smoking prevention and cessation programme.

·       High rates of obesity were another multifactorial problem requiring different approaches such as engagement through Weight Watchers, Slimming World and Weigh Forward Bucks.  Some PCNs had recruited Health Coaches and Aylesbury Central PCN were using different approaches, such as a low carbohydrate diet, which had yielded positive results in some cases.

·       People were also supported by social prescriber link workers.

·       The Hospital Trust had started a health check service for staff, including blood pressure monitoring, cholesterol checking and mental health services. Furthermore, the Trust had engaged with the Heart of Bucks Community Foundation and provided funding for cancer awareness programmes, targeted in the most deprived areas.

·       The challenges around primary care data were highlighted. Over the last two years, the trust had moved towards an electronic patient record.  Improvements in data collection was a key priority across the system.

·       Buckinghamshire’s drug and alcohol draft strategy would be published in early 2023 and would be refreshed in light of the new Harm to Hope Strategy.

During the discussion, Members raised the following questions.

·       A Member  ...  view the full minutes text for item 6.

The Committee reviewed Buckinghamshire Healthcare NHS Trust’s Clinical Strategy in its early stages in February 2022.  Five themes are identified in the strategy and this item provides an opportunity for Members to hear more about how the plans are developing under each theme.  This item also includes an update on their Estates Strategy.

Presenters:

Mr Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust

Ms Ali Williams, Chief Commercial Officer

Mr Andrew McLaren, Chief Medical Officer

Mr Owen Sullivan, Interim Director of Strategy

Papers:

Report attached

The Chairman welcomed Mr Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust, Ms Ali Williams, Chief Commercial Officer and Mr Andrew McLaren, Chief Medical Officer, to the meeting.

During the discussion, Members raised the following questions:

·       A Member commented that the Urgent Care Treatment Centre in High Wycombe no longer operated on a 24/7 basis and asked what services were provided at that site. Mr Macdonald explained that part of the centre was subcontracted to FedBucks, who provided the GPs. It was noted that information around the operating hours of the centre were available on the website but Members felt that more communications to the public needed to be undertaken to increase awareness.  Mr Macdonald said that he would take Member’s feedback on board and release more communications to the public to promote the service and enable them to differentiate between urgent and emergency treatment.

Action: Neil Macdonald

·       The use of the 111 service was being encouraged to ensure people would be signposted to the right treatment at the right place.

·       The impact of technological advancements on service delivery and wait times was discussed. 20% of outpatient contacts were now being dealt with in a virtual space, either over the phone or via video calls. An electronic patient record was also being established over the next two years, with a large number of processes moving into this space. The need for follow-up appointments had been greatly reduced through the use of electronic forms, saving spaces for further appointments. Robotic surgery had also become a mainstream procedure, with over £1m having been invested into new equipment. A progress report on virtual wards would be published in Spring 2023.

·       An estates strategy had been set out to address some of the challenges faced by Buckinghamshire Healthcare NHS Trust and priorities were being developed in utilising space in the best possible way. A survey had been conducted and showed that there was a backlog of £200m in maintenance issues.  A bid had been submitted to the Government’s Hospital infrastructure programme to which a decision was awaiting.

The Chairman thanked the presenters for attending the meeting.

At its February 2022 meeting, the Committee reviewed the progress in the development of the community hubs in Marlow and Thame.  As part of this review, Members remain concerned about the provision of services for people who are fit to be discharged from Hospital but need further support services.  The Committee will hear more about the progress being made in supporting intermediate care.

Presenters:

Mr Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust

Ms Jo Bashnonga, Health & Care Integration Programme Director

Ms Elaina Quesada, Service Director, Adult Social Care (Operations), Buckinghamshire Council

Papers:

Report attached

The Chairman welcomed Ms Jo Baschnonga, Health & Care Integration Programme Director and Ms Elaina Quesada, Service Director, Adult Social Care (Operations), to the meeting.  Mr Neil Macdonald also presented this item.

During their presentation, the following key points were made:

·       The health and care integration programme launched in June 2022 to deliver a new model of hospital discharge and intermediate care in Buckinghamshire.

·       Whilst the Committee was supportive of the development plans but remained concerned about the capacity in the system following the removal of inpatient beds in the community setting.

·       Mr Macdonald explained that one of the key challenges facing the health and care system was that people should receive their ongoing care more quickly and whilst this was a national issue, due to workforce availability and funding, the local integration programme was designed to help address these issues.

During the discussion, Members asked the following questions:

·       Members raised concerns around the reduction in discharge to assess beds which were mentioned in the report.  The Service Director explained that the discharge to assess beds still existed but the pathway had changed.  Ms Baschnonga explained that she was developing a model of care around intermediate care, which was still in progress.

·       A Member explored the strength of partnership between the Hospital discharge team and the Council’s adult social care discharge team.  Mr Macdonald explained that the working relationship between the Hospital and the Council were good. However, the pressures across the system were recognised, particularly in terms of social worker capacity.

·       A future intermediate care offer needed to be supported by therapists and other healthcare professionals to ensure people could live as independently as possible.

·       In response to a question around the lack of a single IT system for managing patient information, Mr Macdonald explained that developing the right care system was complex and required input from a lot of different partners but a digital strategy was being developed.

·       A new model of assessment to improve the quality of information and increase assessment capacity within the acute setting was also being established. This work was being carried out collaboratively with staff across the partnership. Involvement from patients and carers would follow around February 2023.

·       A specific piece of work had been carried out with the community group at the Gerrard’s Cross Community Hospital, facilitated by the League of Friends. This did not follow the same model as the Thame and Marlow Community Hubs.

The Chairman thanked all the presenters for their attendance and asked that the progress with implementing this programme of work be brought back to a future meeting.

Action: Principal Scrutiny Officer

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

Presenter:

Ms Zoe McIntosh, Chief Executive, Healthwatch Bucks

Papers:

Update attached

Ms Z McIntosh, Chief Executive, Healthwatch Bucks updated the Committee on the  latest activities and made the following main points:

·       The ICB had responded to the report on social prescribing. The Committee had received a copy of this response, which included timeframes to the recommendations presented. These centred around the provision of support after social prescribing and lack of transport provision.  A second report on people’s experience of social prescribing was due to be published later in November, and the responses had been positive regarding the benefits of social prescribing.

·       Healthwatch Bucks was currently working on a project around early onset dementia (diagnosis before the age of 65). They were keen to hear from patients and their carers, and Members were encouraged to inform Healthwatch of any potential participants. Cllr Susan Morgan mentioned that Aylesbury Town Council had a dementia officer and she agreed to pass their details to Ms McIntosh.

Action: Cllr Morgan

The Chairman thanked Ms McIntosh for her update.

For Committee Members to discuss the items for the forthcoming meetings.

Presenters:

All Committee Members

Papers:

Work Programme

Members discussed the work programme and agreed the following items for the February meeting:

·       South Central Ambulance Service – Ms Quesada mentioned concerns around the process for referring safeguarding issues and agree to share a report with the Committee;

Action: Elaina Quesada

·       Maternity services;

·       An review of the social worker academy and the workforce challenges withing adult social care.

Potential items for future meetings:

·       Dementia services;

·       Future healthcare planning – a scoping document had been developed but the Principal Scrutiny Officer had been made aware of some work being undertaken which could have an impact on this piece of work so it had been put on hold for the time being.

The next meeting is due to take place on Thursday 9^th February 2023 at 10am.

Thursday 9^th February 2023 at 10am.

The Chairman asked Philippa Baker to provide a very brief verbal update on the development of the Integrated Care Board.

·       Local Government and NHS providers had been asked to develop a place-based partnership within Buckinghamshire.  This was currently being developed and was expected to be in place by April 2023.

·       The Integrated Care strategy was being developed by the key health and social care partners on the Integrated Care Partnership.  An engagement document would be published in the next few weeks, with the final draft being approved in February 2023.