Agenda and minutes

Apologies were received from Councillors S Adoh, S Morgan, G Sandy, A Turner, J Wassell and Z McIntosh (Healthwatch).  Cllr Angela Macpherson, Cabinet Member for Health & Wellbeing, sent apologies.

There were no declarations of interest.

To confirm the minutes of the meeting held on Thursday 9th February 2023 as a correct record. 

The minutes of the meeting held on Thursday 9th February 2023 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 annual scrutiny report, highlighting the work undertaken by all Select Committees, was presented at the council meeting in April. It included the primary care network inquiry and the rapid review of dementia support services.

·       Dr Nick Broughton, the Chief Executive at the Oxford Health NHS Foundation Trust, would be joining the Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board as its Interim Chief Executive.

·       NHS England had given formal notification that the work for the development of new health provision for the Lace Hill partnership had restarted. The integrated Care Board had expressed ongoing support for the project. The completion deadline had been extended to March 2025, with a view of services commencing in the spring of 2025. The business case, which included an impact assessment, was currently awaiting formal approval.

·       The Committee was expecting BHT’s draft annual quality account in May. The Chairman along with Cllrs Thomas, Mordue and Wassell would review the document and prepare a statement to be included in the quality account.

·       The next meeting of the Buckinghamshire, Oxfordshire and Berkshire West’s Joint Health Overview and Scrutiny Committee would be held on Thursday 15^th June 2023.

The Committee reviewed the System Winter Plan at its September meeting so this is an opportunity to hear from system leads about what worked well and what lessons have been learnt to help inform the Winter Plan for this year.

Contributors:

Ms Caroline Capell, Director of Urgent and Emergency Care, Buckinghamshire Healthcare NHS Trust

Dr George Gavriel, Chair, Bucks GP Leadership Group

Mr Raghuv Bhasin, Chief Operating Officer, Buckinghamshire Healthcare NHS Trust

Cllr Angela Macpherson, Cabinet Member for Health & Wellbeing

Mr Craig Mcardle, Corporate Director, Adults & Health

Ms Sara Turnbull, Service Director, Adult Social Care (Operations)

Mr Mayank Patel, Chief Officer, Bucks Local Pharmaceutical Committee

The Chairman welcomed Dr George Gavriel, Chair, Bucks GP Leadership Group; Raghuv Bhasin, Chief Operating Officer, Buckinghamshire Healthcare NHS Trust; Craig McArdle, Corporate Director, Adults & Health; Sara Turnbull, Service Director, Adult Social Care (Operations); Mayank Patel, Chief Officer, Bucks Local Pharmaceutical Committee, and Philippa Baker, Place Director, to the meeting.

During their presentation, the following key points were made:

·       As anticipated, the winter had been challenging, particularly due to additional pressures from industrial action. During the winter period, several initiatives were implemented to manage the high demand. Some schemes received national funding, such as the same-day emergency care approach. This allowed direct referrals from GP practices for certain conditions, bypassing the need for lengthy waits in the emergency department. HomeLink Healthcare services were piloted to facilitate the transition from hospital to home.

·       Bed capacity had been increased by 30 beds in the Olympic Lodge to help meet the increase in demand.  

·       A clinical assessment service had also been established, handling over 500 calls per week to alleviate pressures on primary care.

·       Efforts were made to keep patients at home to minimise hospital admissions whenever possible. Additional community beds were also set up in Amersham and Buckingham Community Hospital for step-down care.

·       50 virtual ward beds were established to help patients remain in their homes while receiving the necessary care. Numbers of patients who were medically optimised for discharge (patients that could be discharged but required ongoing medical optimisation) remained high both locally and nationally.

·       A 111 initiative had been established to direct patients to hubs instead of GPs. Patients were referred to appropriate pathways, such as urgent treatment centres or pharmacy out-of-hours services.  This initiative significantly reduced the pressure on GPs, with 70% of all 111 referrals being handled outside of GP practices.

The following points were noted during the Committee’s discussion:

·       Concerns were raised about the difficulty of getting timely GP appointments and how staffing was managed for ‘GPs at the front door’, while also supporting A&E and other units. It was acknowledged that using GPs in these positions could take away from primary care practices. To address this, shared roles between practices and services, as well as time-restricted positions for newly qualified GPs, were suggested to attract and retain more GPs in Buckinghamshire.

·       The importance of providing same-day urgent care in central locations like Wycombe and Aylesbury was emphasised to relieve pressure on GP practices, allowing them to focus on managing complex patients.

·       Members heard that Olympic Lodge was funded through external monies the previous year and the decision was made to keep it open until the 22^nd May.  It would reopen on the 1^st  October. The model used at Olympic Lodge had been independently evaluated and shown better outcomes for patients. The plan was to work with a small number of care homes to create a similar model in the community, aiming to establish a broader intermediate care offer in the system.

·       In terms of community beds, there were currently 56 beds  ...  view the full minutes text for item 6.

The Select Committee undertook an inquiry into the development of primary care networks in Buckinghamshire last year and this item is an opportunity to review the progress being made in implementing the recommendations which were made in the report.

Contributors

Ms Philippa Baker, Place Director

Mr Simon Kearey, Head of Primary Care Development and Delivery

Cllr Angela Macpherson, Cabinet Member for Health & Wellbeing

Mr Craig Mcardle, Corporate Director, Adults & Health

Ms Sara Turnbull, Service Director, Adult Social Care (Operations)

Papers

6 month recommendation monitoring response table

The Chairman welcomed Philippa Baker, Place Director and Simon Kearey, Head of Primary Care Development and Delivery, to the meeting.

During their presentation, the following key points were made:

·       The inquiry provided important recommendations and progress had been made in various areas, albeit at different rates.

·       The past year had seen 39% increase in the additional roles for PCNs, and approximately 75% of the allocated funds had been utilised. Recruitment challenges in primary care were acknowledged, but progress was still being made.

·       It was crucial to have a diverse range of skills and practitioners to meet the increasing demand and reduce reliance on GPs. This diversity would contribute to the transformation of services and reduce dependence on GPs.

·       The Integrated Care Board (ICB) worked closely with the GP Leadership Group in Buckinghamshire, enabling productive collaboration with GP colleagues. Primary care representatives were included in the recently initiated Buckinghamshire Executive Partnership and the Health and Care Integration Board.

·       In response to several recommendations focusing on engagement with Patient Participation Groups (PPGs), the ICB was developing an engagement strategy which would be presented to the Board in May. Collaboration with the new head of communications would ensure effective engagement with patients through platforms like patient forums.

The following points were noted during the Committee’s discussion:

·       A Member mentioned the need to expand and engage with community boards and neighbourhood groups, as some community boards had not yet reached out to their PCNs. Mr Kearey acknowledged the importance of engaging with community boards and the need for better coordination. He highlighted the challenge that some community boards have sub-boards focused on health and well-being. Members emphasised the importance of facilitating a two-way dialogue between community board members, health partners and PPGs.

·       A Member highlighted the importance of population health management and obtaining up-to-date data on the various needs in different areas. They noted that some of the data published by the Council was outdated, and that data should be provided to PCNs and community teams to identify gaps and improve patient outcomes, particularly in rural areas.

·       The importance of engaging with PPG chairs was highlighted. It was suggested that meetings between PCNs and PPG chairs be held to allow patients to have a voice at both the practice and network levels.

·       A Member highlighted the importance of the clarity of information shared to patients, noting the high amount of acronyms and technical terms used in healthcare which needed to be conveyed clearly to the public.

·       The Chairman commented on recommendation three in the report, which asked for a annual report outlining PCN performance (including staffing, PPG development) to be developed for the Select Committee meeting, when it considers the 12 month update on the recommendations.

·       A Member raised concerns about the funding to Healthwatch Bucks in supporting the PCNs and PPGs in Buckinghamshire compared to the other authorities within Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS).   It was noted that funding for Healthwatch had been regularised for the ensuing  ...  view the full minutes text for item 7.

Committee Members will receive an update on the proposed model for improving maternity services in Buckinghamshire.

Contributors

Nr Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust (BHT)

Ms Heidi Beddall, Director of Midwifery, BHT

Mr Ian Currie, Chair of the Women’s, Children’s and Sexual Health Division (BHT)

Ms Ashleigh Skinner, Co-Chair, Maternity Voices Partnership

Paper

Improving Maternity Services in Buckinghamshire

The Chairman welcomed Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust (BHT), Karen Bonner, Chief Nurse, Heidi Beddall, Director of Midwifery, Ian Currie, Chair of the Women’s, Children’s and Sexual Health Division and Ashleigh Skinner, Co-Chair, Maternity Voices Partnership.

During their presentation, the following key points were made:

·       Women currently had the choice to have their baby either at home, in a midwifery led birthing unit at the Aylesbury Birth Centre (within Stoke Mandeville Hospital) and obstetric led labour ward at Stoke Mandeville.  Ante-natal and postnatal outpatient care was offered at both Wycombe and Stoke Mandeville.

·       Births had been suspended at the Wycombe Birth Centre (WBC) since 2020 which had originally been due to the Covid-19 pandemic and the need to reorganise the service and more recently due to the shortage of midwives.

·       The WBC was originally established in 2009 and 350-400 births a year were expected.  In 2019/20, the last year it was operational, only 169 women, out of the 4,737 deliveries at BHT, chose to give birth at WBC.  Out of the 169 women, 39 were transferred to Stoke Mandeville Hospital at the start of, or during labour with a further 33 being transferred after birth.

·       BHT want to continue to strengthen the midwifery ante and post-natal care at Wycombe and build on the continuity of carer model, mental health care, smoking cessation support and infant feeding support.

The following points were noted during the Committee’s discussion:

·       A Member raised concerns about the changes to maternity services provided in Wycombe, particularly in light of the high rates of caesarean sections (40%) and high-risk residents in the area. Ms Beddall assured the Committee that the changes aimed to improve services, not reduce them. The proposed improvements would prevent women from needing to visit multiple venues for different support services related to pregnancy and birth, as well as smoking cessation and healthy living.

·       Women also had an opportunity for home births, which offered the same care model as the Wycombe Birth Centre (two midwives and an option for ambulance transfer to Stoke Mandeville in case of emergencies). Despite the structural challenges Wycombe Hospital had faced, the decision to change maternity services was unrelated. Mr Macdonald emphasised the organisation's efforts to find the right balance in providing safe, sustainable, and value-for-taxpayer services. It was noted that the primary focus on the project was to improve care rather than following a financial incentive.

·       Members asked what engagement and consultation activities had been undertaken to include residents’ views about the proposed changes. Ms Beddall explained that regular engagement events had been held, including campaigns to increase the number of people electing to give birth there. An extensive survey with over 800 responses revealed that women preferred a midwife-led birthing centre attached to a labour ward. The Bucks Maternity Voice partnership had also gathered feedback through listening clinics, surveys, and attending groups with mothers and their partners and families. A ‘Mamas and Babas’ group, which particularly focused on Wycombe’s Pakistani population, had also  ...  view the full minutes text for item 8.

At its February meeting, the Select Committee agreed the scoping document for a rapid review into the dementia journey and the support services available for people living with dementia and their carers in Buckinghamshire. 

The Review Group held a number of evidence gathering meetings during March and the report with the key findings and areas of recommendation is to be discussed and agreed by the Committee Members.

Contributors

Cllr Carol Heap, Chairman of the Review Group

Cllr Shade Adoh

Cllr Phil Gomm

Cllr Robin Stuchbury

Cllr Nathan Thomas

Cllr Alan Turner

Paper

Draft Dementia Review report

Cllr Heap, Chairman of the Rapid Review Group, thanked Members for their work on the review. The report contained 18 areas of recommendation which were aimed at the council, health, voluntary and community organisations.  The report was due to be presented to Cabinet on 11^th July.

The Chairman thanked Cllr Heap and the members of the review group for the comprehensive report.

The Committee agreed the rapid review report.

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

The Chairman advised the Committee that the development of the work programme for future meetings would be discussed in a separate meeting.  The draft work programme would then be on the agenda for the next meeting.

This is an information only item at this meeting.

In Ms McIntosh’s absence, the Chairman asked Members to note the update from Healthwatch Bucks.

The dates for future meetings will be confirmed at the full council meeting on 17^th May.

The provisional date of the next meeting would be Thursday 20 July 2023 at 10am. The Chairman thanked the Committee for their work over the year.