Agenda and minutes

Councillor George Sandy and Julia Wassell sent apologies.

Councillor Caroline Jones had replaced Councillor Patricia Birchley on the Committee.

The Chairman confirmed the appointment of Councillor Matt Walsh as the Vice-Chairman for the ensuing year.

Cllr Alan Turner and Cllr Matthew Walsh declared that they were both Trustees of the Princes Centre, an independent day care provider.

To confirm the minutes of the meetings held on 11 May 2023 and 17 May 2023.

The minutes of the meetings held on 11 May 2023 and 17 May 2023 were confirmed as a correct record.

Cllr Stuchbury commented that he would have liked to see more detail around the transfer of patients to and from Milton Keynes Hospital.

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.

The Chairman will update Members on recent scrutiny related activities since the last meeting.

Maternity services

Representatives from Buckinghamshire Healthcare NHS Trust (BHT) attended the meeting on 11^th May to present their proposal for improving maternity services in Buckinghamshire, including the permanent closure of the Wycombe Birthing Unit (births had been suspended since June 2020 due to the Covid pandemic and a shortage of midwives).  Following the meeting, a letter was sent to BHT requesting further information and a response has been received.

Members were asked to consider the response and the Chairman circulated the following summary.

The HASC discussion centred around the issue of whether the proposed changes represent ‘substantive change’ to the service and whether BHT have consulted adequately with users in order to identify how this service should be changed and operated in the future. 

Key points:-

-          Recruitment and retention of staff remains one of, if not the key challenge faced by health providers across all disciplines and this naturally affects how services can be provided safely and efficiently in the future.

-          It is clear that BHT have a well-staffed and experienced surgical team at Stoke Mandeville, but they are struggling to staff even a midwife led birthing team at Wycombe.

-          The proposed changes are designed to ensure that hospital births are managed at Stoke Mandeville where an experienced surgical team is on site to assist in the event they are required, thereby removing birth options from the Wycombe site and eradicating the current need to transfer any patients in difficulty from Wycombe to Stoke in the event they experience complications.

-          Any transfers currently needed are undertaken by SCAS, another service currently reassessing how it meets demand more efficiently in a difficult landscape.

-          Health services have undergone dramatic change due to the events and pressures of the last few years and there is clear need to ‘work smarter’ in the future at local as well as national level.  Undertakings that were outlined a number of years ago may no longer be deliverable.

-          The Select Committee’s overarching responsibility is to assess whether any proposed changes will bring harm or bring about better outcomes for patients and users.  By managing all births at Stoke Mandeville, potential delays and additional trauma in the event of complications arising will be reduced.

-          Events of the last few years have made it incredibly difficult to consult with users on ‘business as usual’ because business has been delivered in a far from usual manner.

Papers:

HASC Select Committee letter following May meeting

BHT response with two appendices

Dementia Rapid Review

The report was presented to Cabinet on 11^th July who responded to the recommendations made in the report.

Papers:

Final Dementia review report

Cabinet response table

The Chairman updated the Committee on the following.

Maternity services

·       At its last meeting, Committee Members considered Buckinghamshire Healthcare NHS Trust’s (BHT) proposal for improving maternity services.  The proposal was to support the permanent closure of the Wycombe birthing unit which had been suspended since June 2020, due to the pandemic and staff shortages, and to strengthen the midwifery ante and postnatal care at Wycombe Hospital.

·       Following the meeting, the Chairman wrote to the Chief Executive requesting further information and clarification on a number of points.  BHT responded with a detailed letter and two appendices which were part of the agenda pack for this meeting.

·       The Chairman read out a statement which Committee Members agreed.  This would be included in a letter to the Chief Executive of BHT after the meeting.  A copy of this letter would be attached to the minutes.

·       To conclude, Members agreed to support BHT in implementing their proposal to improve maternity services and would invite representatives back in due course to report on key performance data and provide robust evidence of strong, meaningful engagement with users of maternity services.

Rapid Review into Dementia Services

·       The Chairman reported that she and Councillor Heap had presented the rapid review report to Cabinet on 11^th July.  It had been well received by Cabinet and whilst not all 18 recommendations were aimed at the council, they were all agreed, with 9 agreed in part.

·       Monitoring the progress in implementing the recommendations would be coming to the February 2024 meeting.

Buckinghamshire, Oxfordshire and Berkshire West Joint Health Scrutiny

·       A joint health scrutiny meeting took place on 15^th June.  Following elections in May, there were some changes in membership to the joint committee.  There was a discussion around the Integrated Care Board’s joint 5 year forward plan, an update on the Integrated Care Partnership’s strategy to which the joint committee had submitted a written response which helped inform the final strategy.

Healthwatch Bucks annual report launch

·       The annual report launch took place on 13^th July and was attended by a number of Committee Members.

Buckinghamshire Healthcare NHS Trust’s Quality Account

·       A working group of Members drafted a HASC statement for inclusion in BHT’s Quality Account which was submitted on 13^th June.  The Chairman thanked Cllrs Thomas, Mordue and Wassell for reviewing the account this year.

There is an ambition to move to a more integrated and efficient model for hospital discharge and intermediate care in Buckinghamshire to improve patient outcomes and experience.

This item provides Committee Members with an opportunity to review the new model and examine the improvements being delivered.

Presenters:

Jo Baschnonga, Programme Director Health & Care Integration

Jenny Ricketts, Director of Community Transformation, Buckinghamshire Healthcare NHS Trust

Papers:

Presentation attached

The Chairman welcomed Cllr Angela Macpherson, Cabinet Member for Health & Wellbeing, Craig McArdle, Corporate Director for Adults & Health, Jo Baschnonga, Programme Director for Health & Care Integration and Jenny Ricketts, Director of Community Transformation, Buckinghamshire Healthcare NHS Trust.

During the presentation, the following key points were made.

·       During the Covid pandemic, helping patients to return home as quickly and safely as possible was critical in order to reduce infection.  Nationally a model called “discharge to assess” (D2A) was mandated with an allocated funding stream.

·       In Buckinghamshire, at the peak of the pandemic, there were 180 D2A beds and 11,000 hours of temporary home care.  This was acknowledged as an unsustainable model in the long-term.

·       The ambition was to move to a more integrated and efficient model for hospital discharge and intermediate care to improve patient outcomes and experience.  The new model would be underpinned by the “Home First” approach, integrated services around patients and partnership working across the system.

·       D2A bedded pathway closed at the end of March 2023 which had freed-up 140 care home beds.

·       Three new care home hubs had been opened with a fourth due to open in July.  These were for people with complex health needs that prevents assessment within 4 weeks and not appropriate to wait in the acute hospital setting.

·       A new integrated discharge team was launched in June to help patients on the wards to plan their discharge and review referrals for discharge pathways.

·       Olympic Lodge was being used to manage surges in demand with 547 patients admitted between October 2022 and May 2023 of which 457 were able to return home and the average length of stay was 10.4 days.

·       Chartridge ward, a 22 bedded ward at Amersham Community Hospital, would be re-purposed into a new intermediate care hub with an onsite multi-disciplinary team.

·       Intensive inpatient rehab would be available at Buckingham Community Hospital (14 beds) and Waterside Ward at Amersham Community Hospital (21 beds).

·       Development of Community diagnostic hubs was being discussed which would offer essential diagnostics from a local site.  Residents had stated that they prefer to visit a local site for diagnostics rather than visit Stoke Mandeville or Wycombe Hospitals.

·       “Hospital@Home” would allow patients to receive acute care monitoring and treatment at home.  For example, patients with respiratory conditions were having their oxygen levels monitored virtually.

·       Urgent Community Response (UCR) had supported around 10,200 patients.  The national response target was 70% within 2 hours.  In Buckinghamshire, the UCR response was 86% within 2 hours.

·       Onward Care was a data driven, tech enabled service that aimed to help stabilise frail people at high risk of readmission.

·       An ambulatory frailty same day emergency care services had been introduced in the Emergency Department.

·       Marlow and Thame Community Hubs were providing ambulatory services for vulnerable and frail adults.

·       Three big conversations had taken place in Aylesbury, Thame and Marlow to show residents the services available.

·       An Admiral Nurse had been recruited to support people living with dementia to stay independent longer and  ...  view the full minutes text for item 7.

Ms Z McIntosh, Chief Executive, will update Members on recent projects undertaken by Healthwatch Bucks.

Papers:

Update attached

Zoe McIntosh, Chief Executive, Healthwatch Bucks took Members through her update of recent projects and activities since the last meeting, including the following,

·       GP surgery care when you’re deaf, Deaf or hard of hearing – the aim of the research was to identify health inequalities that might affect deaf, Deaf or hard of hearing people and Healthwatch Bucks spoke to 90 people about their experiences of accessing GP surgery care in Buckinghamshire.  Healthwatch Bucks recommended that BOB Integrated Care Board should encourage Buckinghamshire GP surgeries to sign up to the Healthwatch Bucks Deaf and Hearing Loss GP Practice Charter and display the Charter in their practices and on their websites.

·       Healthwatch Bucks published its annual report for 2022-23 which highlighted information about the work carried out on behalf of Buckinghamshire residents last year.  The report was included in the agenda papers.  Zoe thanked all the volunteers who work on behalf of Healthwatch Bucks.

The Committee will discuss and agree the scoping document for the proposed rapid review into Future Healthcare Provision in Buckinghamshire. This is a joint review with the Growth, Infrastructure and Housing Select Committee.

The review group will include members from both Committees.

Papers:

Draft scoping document attached

The Committee discussed and agreed the draft scoping document for an in-depth review of future primary healthcare planning.  The Chairman reported that Cllr Poll and Cllr Darby (a Member of the Growth, Infrastructure and Housing Select Committee) would be co-chairing the review.

Evidence gathering would start late September/October time with two or three full days of meetings.

The Chairman asked the Committee for expressions of interest in being part of this review to be sent to her after the meeting.

For Committee Members to discuss and agree the items for future meetings.

Papers:

Draft work programme

The Committee discussed the draft work programme and agreed the items for the next meeting.

·       System Winter Plan;

·       South Central Ambulance Service – review progress in implementing the actions from the improvement plan;

·       Patient Transport Services – particular focus on key challenges.

A Member mentioned the draft autism strategy which was out for consultation.  The deadline for submitting comments was Sunday 24^th September and the final strategy was due to be launched by the end of 2023.  Link below to the consultation.

Buckinghamshire Autism Strategy 2023 to 2027 consultation - Your Voice Bucks - Citizen Space

The next meeting is due to take place on Thursday 12 October 2023 at 10am.

Thursday 12^th October 2023 at 10am.