Agenda and minutes

Apologies were received from Tiffany Adonis-French, Service Director, Operations (Adult Social Care).

Cllrs Turner and Walsh declared a non-pecuniary interest as trustees of an independent day care centre.

To confirm the minutes of the meeting held on 30 November 2023 as a correct record.

The minutes of the meeting held on 30^th November 2023 were confirmed 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/get-involved-with-council-decisions/select-committees/

There were no public questions. 

The Chairman will update Members on recent scrutiny related activities since the last meeting, including the work of the Buckinghamshire, Oxfordshire and Berkshire West Joint Health Overview and Scrutiny Committee.

The Buckinghamshire, Oxfordshire and Berkshire West Joint Health Overview Scrutiny Committee (BOB JHOSC) had met on 24^th January 2024 to review the BOB Integrated Care Board’s (ICB) draft Primary Care Strategy, consider the Communication and Engagement plan and receive updates from the Healthwatch organisations within the BOB footprint. Formal responses on the Primary Care Strategy would be submitted by the JHOSC and the HASC Select Committee.

A small group of JHOSC Members had been reviewing the ICB’s Data and Digital Strategy and the formal response would be submitted to the ICB shortly.

The Chairman reported that she had attended a meeting with colleagues at the Swan Practice in Buckingham which included an update on the plans for a new development at Lace Hill.  At this stage, this was not a matter for the HASC Select Committee but a close eye would be kept on this issue.

The Committee will review the progress in implementing the improvements detailed in the Adult Social Care Transformation Programme.  The aim of the programme is to implement the Better Lives Strategy, to create a sustainable system that improves outcomes and delivers personalised, integrated and high-quality care for the residents of Buckinghamshire.

Presenters:

Cllr Angela Macpherson, Cabinet Member, Health & Wellbeing

Sara Turnbull, Service Director Strategy, Improvement & Governance

Tiffany Adonis-French, Service Director, Adult Social Care Operations

Papers:

Presentation attached

The Chairman welcomed Cllr Angela Macpherson, Cabinet Member for Health and Wellbeing and Sara Turnbull, Service Director Strategy, Improvement & Governance.

The Cabinet Member for Health and Wellbeing introduced the report, explaining that Adult Social Care (ASC) was on a journey to bring about long-term service improvements, involving transformational change across services. The report gave details on performance data relating to service users, financial planning and co-production and these aligned with the ASC’s Better Lives Strategy.

The Service Director explained that the programme scope had been refreshed in the autumn to reflect the largest areas of opportunity. The national challenges around social care were immense and it was necessary to work more efficiently.  The ASC Improvement Plan included short-term goals as well as longer term projects which would delivered over the next 3 to 5 years.

During the discussion, the following questions and points were made:

·       The Chairman noted that the pace of delivery seemed slow and asked what the key issues were. The Cabinet Member for Health and Wellbeing explained that programmes such as shared lives and supported living were being delivered at different paces. Joint working with the housing team would be critical in the longer term to ensure successful delivery of these projects.

·       A Member expressed concern that ASC had not included any capital investment in the Council’s Medium-Term Financial Plan. The Cabinet Member explained that there had been no capital investment for some time and this was under consideration. The service was on track to deliver all the MTFP savings in the year 2023 to 2024. Operational efficiencies were already producing results, such as an increase in care hours. In the longer term, work would progress on finding solutions around housing.

·       The Better Lives Strategy had been embedded in the Transformation Programme from the start but the emphasis had shifted towards living well, enablement and reablement.

·       Innovation often came from learning about programmes in other authorities. A good example was Shared Lives which could be explained as the fostering of adults, either for short-term respite or the longer term. This brought both personal benefits and financial savings. Also under consideration was the Homeshare scheme where a person rented a room in a private house and helped the homeowner in return for a reduction in rent.

·       A Member asked about the risk factors in delivering the MTFP and asked how the strategy could be delivered whilst savings were made. The Cabinet Member explained that demand for adult social care was increasing rapidly and inflation was affecting care costs but she stressed that this is a national issue. In spite of this, the service had been over-delivering on savings.

·       The prevention approach had been critical – Prevention Matters had supported 700 residents via a combination of telephone calls and one-to-one visits. It was acknowledged that there was a need for wider working and partnerships with the voluntary and community sector.

·       23% of the enquiries coming into the ASC team were requests for information and guidance so customer service was  ...  view the full minutes text for item 6.

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

Papers:

Update attached

Zoe McIntosh, Chief Executive of Healthwatch Bucks, introduced the update. She made the following points:

·       Healthwatch Bucks had publicised the ICB’s draft primary care consultation. Healthwatch had submitted its response to the ICB on 28^th February 2024. This had included reports on primary care, including the lack of awareness of social prescribing.

·       The Continuing Health Care (CHC) report was published on the Healthwatch website. This stemmed from a BOB ICB Task & Finish group on “Hearing People’s Voices” which was carried out in 2023. The Healthwatch team had spoken to 11 people who had not been deemed eligible for continuing healthcare. There had been a great deal of confusion about the process with some health professionals also having limited understanding of continuing healthcare. The report made a number of recommendations including the need for more clarity of the initial CHC process and patients should be made aware of the advocacy service, Beacon Continuing Healthcare.

·       A Member complimented Healthwatch on its work in communicating with the public and asked about feedback on child mental health services. The Chief Executive of Healthwatch explained that it encourages feedback on services by various means and always passed feedback on to providers and commissioners.  Healthwatch Bucks were in the process of setting their 2024-25 priorities with a view to children and young people, and their health (including mental health) being a priority for the year.  

The Chairman thanked Healthwatch Bucks for its invaluable work in ensuring the patient voice was included in all health and social care discussions.

For the Select Committee to consider the report of the review group on “Planning for Future Primary Healthcare in Buckinghamshire.”

Contributors:

Cllr Chris Poll (Joint Chairman)

Review Group Members

Papers:

Review report attached

The Chairman explained that four members of the HASC committee had participated in the joint review alongside four members from the Growth, Infrastructure and Housing Committee. The Chairman thanked all the Members and the officers involved. This was echoed by Committee Members. The Chairman stated that the report and recommendations would not solve the problems in planning for future primary healthcare but it was hoped it would be used to help accelerate important conversations.

·         Cllr Poll thanked healthcare partners, the Committee and Democratic Services officers for their work on the report.

·         A Member expressed concern about the lack of data collection from some GP surgeries. Some GP surgeries had opted not to provide patient data which lead the review group to conclude that this was leading to an unclear view of what the needs were across the county. 

·         Recommendation 4 of the report was discussed and it was noted that the council considers town and parish councils as strategic partners in their capacity as landowners.

·         It was noted that the report needed to be discussed by both Cabinet and the Integrated Care Board as the recommendations were aimed at both.

The committee agreed the report.

Following the Committee’s rapid review into Dementia Support Services for people living with dementia and their carers, this is an opportunity to review the progress in implementing the agreed recommendations at 6 months since the report went to Cabinet.

Presenters:

Cllr Angela Macpherson, Cabinet Member, Health & Wellbeing

Craig McArdle, Corporate Director, Adults & Health

Philippa Baker, Place Director, Integrated Care Board

Adrian Timon, Co-chair Dementia Strategy Group and Senior Commissioning Manager Mental Health

Dr Sian Roberts, Co-chair, Dementia Strategy Group and Dementia Lead, Integrated Care Board

Papers:

Updated recommendation response table

The Chairman welcomed the following people to the meeting:

o   Dr Sian Roberts and Adrian Timon, Co-Chairs, Dementia Strategy Group

o   Philippa Baker, Place Director, Integrated Care Board

o   Craig McArdle, Corporate Director, Adults & Health

The Cabinet Member for Health and Wellbeing introduced the 6-month progress report on the Dementia Review. More information would be given at the 12-month review but several action points had seen major progress.

During the discussion, the following questions and points were made:

·       A Member noted the progress made in a relatively short timeframe and said that there was information in the update which she was not aware of, including the workshops run with Buckinghamshire Culture on ageing well. The Member was not sure how these events were publicised. The Cabinet Member for Health and Wellbeing explained that there was now an Ageing Well Partnership Board. She agreed that it was important to share information and would take these points on board.

·       The Chairman asked if there were any changes to the Dementia Strategy Group. Adrian Timon explained that the group had been expanded and now included colleagues from Public Health. The expansion of the group had led to a loss of strategic focus so they were developing a process which meant key members could attend and give an overview of their area of work, when required.

·       Funding was a constant challenge and a Member asked where funding would come from in the future. The Place Director, Integrated Care Board and the Corporate Director, Adults & Health would be meeting on the afternoon of 29^th February 2024 to discuss future investment. The Corporate Director noted the pressure on all budgets and stressed that dementia care would be a priority for investment.

·       Much work had been done in the last 6 months to ensure that memory screening and post diagnostic support were consistent across all Primary Care Networks. There was some variance, but many PCNs were committed and had conducted good quality annual patient reviews. Two training courses had been provided for social prescribers and other staff.

·       In care homes, the Diagnosing Advanced Dementia Mandate (DiADeM)initiative had supported diagnoses. Around 70% of care home patients had dementia and it was important that they were correctly supported. The DiADeM project was a pilot carried out in Buckinghamshire and would end in May 2024. Anecdotal evidence showed that it had been effective and well received. It was hoped that the project would continue in the future. This would be dependent on a business case being made. The Chairman hoped that there would be clarity around funding for Dementia Support Services at the 12-month review, due in September 2024.

·       The work for patients with early onset dementia was praised but there were concerns raised that most of the estimated 240 people affected in Buckinghamshire were not being properly supported. The problem stemmed from the historical emphasis on the over-65 cohort. There was not a standardised infrastructure to support patients with early onset dementia across the country.  ...  view the full minutes text for item 9.

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

Papers:

Work Programme

Members agreed the following items for the next meeting, to be held on 11^th April.

·         Dentistry

·         Development of Primary Care Networks Annual Report

The next meeting is due to take place on Thursday 11^th April 2024 at 10am.

11^th April 2024 at 10.00am