Agenda and minutes

Apologies were received from Councillor S Adoh.  Cllr A Macpherson, Cabinet Member for Health and Wellbeing, sent apologies for item 7.

·       Cllr Chris Poll declared an interest in item 5 as South Central Ambulance Service were a dormant client.

·       Cllr Robin Stuchbury declared an interest in item 7 as a retired member of UNITE.

To confirm the minutes of the meeting held on Thursday 17^th November 2022 as a correct record.

The minutes of the meeting held on Thursday 17^th November 2022 were agreed as a correct record. In response to a Member question about the status of two queries raised in the previous meeting, a response has not yet been received but will be circulated in due course.

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 latest Care Quality Commission (CQC) report, published in August 2022, rated the South Central Ambulance Service (SCAS) as inadequate.  An improvement plan has been developed and the Committee will review this plan and evaluate the progress made to improving services to date.

Presenters

Will Hancock, Chief Executive

Steve Winfield, Clinical Operations Manager

Papers

Report attached

The Chairman welcomed Will Hancock, Chief Executive, South Central Ambulance Service.

During their presentation, the following key points were made:

·       In addition to the 999 emergency services and 111 service, South Central Ambulance Service (SCAS) also facilitated non-emergency transport services for vulnerable patients.

·       Many of the findings in the CQC inspection report related to concerns around safeguarding. In terms of the wider organisation and governance, there were concerns around managing safety within the organisation. Two factors identified as key risks leading to the inadequate rating were frontline delivery of emergency services and the safety domain for the organisation overall.

·       The ratings had considerably declined due to the pandemic. However, an extensive improvement programme had been launched to identify improvements to be made. Immediate concerns had been addressed, with a longer-term plan of quality improvement building on it. A wide range of stakeholders including safeguarding boards were involved in this process.

·       No further feedback had been received from the CQC, which was considered positive as any further concerns would have been addressed immediately.

During the discussion, Members raised the following questions:

·       In response to a Member question around the timeframe of the improvement plan, it was noted that SCAS were moving to business as usual. Due to the rating, SCAS had dropped from level two to four within the strategic oversight framework. A national oversight and scrutiny process had to be completed, starting with a meeting with NHS England in March to agree the exit criteria. There was an expectation that SCAS would move out of level 4 of the framework by September 2023 and remain on an improvement plan for the next 2-3 years.

·       In response to a question about the safeguarding issues raised in the CQC report, Mr Hancock explained that the safeguarding system had been completely overhauled in the past months and the team had been increased from three to nine.

·       There had also been issues with the 111 system as it had not being able to pass electronic referrals to local authorities but this had now been resolved.

·       A Member asked about workforce training and whether specific training around autism and learning disability was provided to staff. As an emergency service, there were occasions when training had to be cancelled due to extreme pressures. But level three safeguarding training was now protected, with 40 people a week being trained, and training was not cancelled even at the highest level of escalation. A response around specialised training for certain health conditions would be provided outside of the meeting.

ACTION: Will Hancock

·       In response to a question about staff appraisals, Mr Hancock confirmed that staff received appraisals and these were reported annually to the Board. The appraisals included a section on health and wellbeing which provided an opportunity to ensure mandatory training had been completed.

·       Mr Hancock went on to say that significant interventions to protect the wellbeing for frontline staff had been introduced, such as an end of shift policy outlining which types of patients can be seen  ...  view the full minutes text for item 5.

The Chairman updated Members on the following:

The first formal meeting of the Buckinghamshire, Oxfordshire and Berkshire West Joint Health Overview and Scrutiny Committee took place on Wednesday 25^th January, 2023. The Chairman reported that she had been elected as the Chairman, and Cllr J Hanna from Oxfordshire County Council had been elected as the Vice-Chairman for the ensuing two years. The draft Integrated Care Partnership strategy had been discussed and a formal response had been submitted to the ICP, outlining the key concerns and suggestions made by JHOSC Members.

Three questions had been submitted to the Cabinet Member for Health and Wellbeing, Cllr Angela Macpherson in advance of the meeting.  These questions are detailed below along with the written responses received. 

Funding – What has the impact of the recent Government announcement, in relation to the use of care home beds to support Hospital Discharge, had on ASC and the development of the new model for Hospital Discharge?

With respect to the recent announcement of funding for hospital discharge, this additional government funding is being used to fund additional social work capacity for the social work assessments and working with the person and their family members to support them through the process. Additional discharge beds within care homes are also being sourced alongside provision for patients waiting to be discharged who are unable to return home because they are homeless or their house is in a state of disrepair.

A Health and Care and Integration Programme is already in place which we briefed HASC on at the last committee. This is developing a new discharge model for Buckinghamshire. At the moment, programme capacity has been diverted to manage current winter pressures (drawing on new national funding streams) - this has slowed the development of our new model for hospital discharge. It was agreed in January that the pace on this would be slower across the Winter period and pick up again afterwards with external support.

Capacity – During December and January, how many people have been discharged to Olympic Lodge and other facilities across the county?  How does this compare to the same period last year?  What has been done differently this time to improve the discharge process at times of significant winter pressure.

By mid-January, Olympic Lodge had been operating for 14 weeks. As at the week ending 15th January, (week 14), Olympic Lodge had admitted 219 patients, compared to 150 in week 14 in 2022.

The key difference to last year is that the focus of the Olympic Lodge facility is patients who are most likely to be able to respond to therapeutic intervention and regain much or all of their former independence.   People with highly complex needs such as dementia are being discharged directly into a care setting which is able to support their specialist complex needs – this may be at home with home care or into a care home.

Workforce – At the budget scrutiny session, you mentioned that there are 19  ...  view the full minutes text for item 6.

This item provides Committee Members with an opportunity to explore in more detail the current adult social care workforce, particularly within the social worker teams.

Presenters

Cllr Angela Macpherson, Cabinet Member for Health & Wellbeing

Jenny McAteer, Director of Quality, Performance and Standards

Papers

Report with three appendices

Appendix 1 – ASC Training Brochure

Appendix 2 – ASC Specialist Training Programme

Appendix 3 – ASC Progression Framework

The Chairman welcomed Jenny McAteer, Director of Quality, Performance and Standards and Elaina Quesada, Service Director, Adult Social Care (Operations), to the meeting.

The Chairman started by explaining that the recent Primary Care Network (PCN) inquiry raised concerns around staff recruitment and retention within the adult social care service One of the recommendations within the inquiry report was in relation to having named social workers to work alongside PCNs The response from adult social care said that it was not possible to have a named social worker due to team capacity and locality mailboxes were currently being used. 

During the discussion, Members raised the following questions.

·       A Member emphasised the importance of rostering, particularly when dealing with staff shortages. It was noted that staff performance was on track to be the best in the last three years. The team had gone through a restructure in June 2021, which created additional social work and occupational therapy capacity. Despite the challenges in wait times, people contacting the department were offered face-to-face appointments at community cafes, which were joined by other partners for more complex cases. The community cafes were located across the county to ensure residents could visit them locally.

·       A Member raised concerns around staff retention once they had obtained their qualifications. . Although some people had left following the service e restructure, there had been significant improvements in the service over the past two years, with some staff returning to the authority. Staff surveys had also had very positive responses. It was further noted that Buckinghamshire Council had a good multimedia presence.  Members suggested that contracts could be amended to ensure people who received their qualifications through the Council would remain in the authority for a certain period of time. It was noted that in the past two months, a memorandum of understanding had been signed by local authorities in the Southeast region that social workers leaving a local authority could not be employed by an agency for 6 months.

·       Members raised concerns about the number of agency staff, which made up around 50% of social workers overall. Ms Quesada explained that out of the 50 agency workers, 19 were not paid for by the Council but by the NHS. Compared to the workforce in the department overall, which equated to around 415 staff, 50 agency workers was a relatively small number. It was noted that there would always be a need for agency workers.

·       A Member asked about strategies and support that had been put in place to limit burnout in staff members. Ms Quesada explained that staff had regular supervision with their managers, and there were opportunities for teams to get together to reflect on and discuss work situations. A social work task force group was also in placeand the service had also appointed wellbeing champions. Responses to the together survey had been positive, with staff showing high levels of motivation and engagement. In addition, staff members on ASYE had support from the ASYE coordinator, and access to  ...  view the full minutes text for item 7.

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

Presenter

Zoe McIntosh, Chief Executive

Papers

Update attached

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

activities and made the following main points:

•       A report on social prescribing had been completed to gather information about people’s experiences with the service. Feedback was generally positive, but some issues were highlighted around transport and waiting times. The feedback from the report was shared with the ICB, including with Philippa Baker,  Place Director for Buckinghamshire.

•       A second report had been published concerning young onset dementia, which detailed experiences from people living with the condition in Buckinghamshire. It was established that the support was difficult to access and people living with dementia and their carers felt it was not age appropriate. The feedback had been forwarded to both Buckinghamshire Council and the ICB.

The Chairman thanked Ms McIntosh for her update.

For Committee Members to discuss and agree the scoping document for the HASC Select Committee’s next piece of work which is a review of support for people living with dementia and their carers.

Presenters

All Committee Members

Papers

Scoping document

The Chairman thanked Cllr Heap and the Principal Scrutiny Officer for their work on the scoping document. It was noted that Cllrs Turner, Thomas and Gomm had volunteered to join the Review Group. Committee Members were asked to email the Principal Scrutiny Officer if they were interested in being part of this Review.  Evidence gathering would take place across 3 full days in March.

For Committee Members to discuss and agree the items for the next meeting.

Items on the work programme for the April meeting:

·         Primary Care Network Inquiry – 6 month recommendation monitoring;

·         Maternity Services;

·         Adult Social Care – Quality Assurance Framework.

Suggested additional/substitute item:

·         Evaluation of system winter pressures.

Presenters

All Committee Members

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

·       Maternity Services;

·       6-month recommendation monitoring of the Primary Care Networks  Inquiry;

·       Evaluation of the System Winter plan.

The Chairman proposed holding a work programming session in advance of the new council year in May.

The next meeting is due to take place on Thursday 20^th April 2023 at 10am.

Thursday 20^th April 2023 at 10am.