Agenda and draft minutes

In December 2016, The Bristol City Council People Scrutiny Commission, North Somerset Health Scrutiny Committee and South Gloucestershire Health Scrutiny Committee held a meeting in common to consider the Bristol, North Somerset and South Gloucestershire Sustainability and Transformation Plan (BNSSG STP). (The minutes of the meeting are attached for information purposes.)

Subsequently, a statutory Joint Health Overview and Scrutiny Committee (JHOSC) has been established for the purpose of jointly scrutinising the BNSSG STP.

This is the first meeting of JHOSC. 

To open the meeting the Joint Committee was asked to confirm the appointment of a Chair (from the host authority).

In response to Councillor Kent’s question, it was confirmed that joint Chairing arrangements existed, as set out in the Joint Committees Working Arrangements, meetings would usually be led by each authority on a rotating basis.

The Joint Committee RESOLVED to appoint Councillor Brenda Massey as Chair.

The Chair welcomed the attendees to the meeting and led introductions of the Councillors from Bristol, North Somerset and South Gloucestershire and asked health colleagues and local authority officers to introduce themselves.

The Chair confirmed that this was the first formal meeting of the Joint Health Overview and Scrutiny Committee which had been constituted for the purpose of scrutinising the Bristol, North Somerset and South Gloucestershire Sustainability Transformation Plan.

The Joint Committee NOTED the Minutes of the Meeting in Common, 1 December 2016, which had convened to discuss the Sustainability Transformation Plan.

The report sets out the proposed chairing arrangements for future meetings, notes the terms of reference and proposes consideration of stakeholder involvement.

The Joint Committee is asked to consider the recommendations in the report.

The Chair introduced the business report.

A.        Proposed Chairing Arrangements for future meetings

The Joint Committee considered the proposed chairing arrangements for future meetings.

·         February 2018 – North Somerset Council

·         June 2018 – South Gloucestershire Council

Meeting dates to be confirmed outside of the meeting. Action: Officers

The Joint Committee AGREED the proposed chairing arrangements for future meetings

B.        Terms of reference and working arrangements

The Joint Committee considered the terms of reference and working arrangements as set out in the appendices.

In response to the Cllr Kent’s proposal to amend the Terms of Reference, to include scrutiny of the proposed merger of the regional clinical commissioning groups the following points were noted in discussion:

a.      The terms of reference had been agreed at the Full Council of each of the three authorities.  The Legal Officer confirmed that any proposed amendments would need to go back to the individual Full Councils of the three authorities.

b.      There was concern by councillors that it was not clear that they had the ability to scrutinise the proposed joint CCG and sub regional health body arrangements

c.       It was acknowledged that if the proposed merger of CCGs was agreed that the new body would not be formally constituted until April 2018. It was thought that although likely, the outcome shouldn’t be taken for granted within the context of this meeting.  It was advised that a decision would be taken on 25^th October.

d.      It was recognised that due to differences in the authorities’ committee calendars, there could be timing issues in managing the process to change the terms of reference

e.      It was not clear to all members that an amendment was required at this stage prior to the confirmation of the decision to merge.

f.        It was not clear to members whether a newly merged CCG would operate outside of the existing Sustainable Transformation Plan.  It was confirmed by the Chief Executive, BNSSG CCGs that the organisation(s) welcomed scrutiny holding them to account both in individual and joint form and confirmed that CCGs were core members of the STP and coterminous with the STP.  It was noted that any exercise of restriction of treatments for cost savings constituted a change to service but was not part of the STP.

g.      The Joint Committee was asked to note that individual authorities were engaged in ongoing dialogue with the CCGs to discuss individual local authority concerns.

The Chair asked the Joint Committee to vote on the proposed amendment to the Joint Committee’s Terms of Reference to be passed to individual authorities to progress.

That the terms of reference add the power to scrutinise the new CCG and other NHS bodies acting together across North Somerset, Bristol and South Gloucestershire.

Councillor Kent moved the amendment.

Councillor Hope seconded the amendment

Upon being put to the vote,

The Joint Committee RESOLVED that the proposed amendment be referred to individual authorities to progress through their governance processes. (17 members voted in favour with 1 abstention). Action:  ...  view the full minutes text for item 2.

The Joint Committee to note apologies for absence and substitutions.

The following apologies for absence were noted:

Bristol City Council

·         Councillor Chris Windows

North Somerset Council

·         Cllr Mike Bell - Cllr Deborah Yamanaka attended in substitute

·         Cllr David Hitchins - Cllr Charles Cave attended in substitute

South Gloucestershire Council

·         Councillor Keith Burchell

·         Councillor Sarah Pomfret

To note any declarations of interest from the Councillors.  They are asked to indicate the relevant agenda item, the nature of the interest and in particular whether it is a disclosable pecuniary interest.

Cllr Phipps expressed a declaration of interest, and confirmed being employed by the Southmead Development Trust Social Prescribing Project.

To note any announcements from the Chair.

There was no Chair’s Business.

The total time allowed for this item is 30 minutes.

Members of the public and members of council may participate in Public Forum. 

The detailed arrangements for so doing are set out in the Public Information Sheet at the back of this agenda. 

Public Forum items should be emailed to scrutiny@bristol.gov.uk and please note that the following deadlines will apply in relation to this meeting:-

Petitions, Statements and Questions – must be received, no later than, the working day prior to the meeting.  For this meeting, your submission must be received in this office, no later than 12.00 noon on Friday, 20 October 2017.

The following public forum items were received:

Statements

PS 01 Mike Campbell

PS 02 Viran Patel (Additional statement not included in the Public Forum pack)

Mr Campbell’s representative (Protect Our NHS) presented his statement. Mr Patel was not in attendance.

The Joint Committee RESOLVED that the statements be noted.

Questions

PQ 01 Ms Daphne Havercroft

PQ 02 Mr Shaun Murphy

PQ 03 Mr Viran Patel

Shaun Murphy presented his questions. Ms Havercroft and Mr Patel were not in attendance.

It was noted that a written response would be provided to the questioners as per the Joint Committee’s working arrangements. (attached at Appendix B)

The Joint Committee RESOLVED that the questions be noted.

In response to a member’s question in respect of statements that had been submitted in respect of the Condon family, the Chair confirmed that the statements would go to the meeting of Bristol’s Overview and Scrutiny Management Board Wednesday, 1 November 2017.

The purpose of this paper is to update the Joint Health Overview & Scrutiny Committee on progress with the BNSSG STP plans.

It covers:

1.         Recap of the BNSSG STP

2.         Case for change and strategic framework development

3.         Developing a single commissioning voice

4.         Work Programme

5.         STP communications and engagement approach

6.         Next steps/ timescales.

The Joint Committee considered the Sustainability Transformation Plan update report and presentations, (attached to these minutes at Appendix A) for information and discussion.

Julia Ross, Chief Executive, BNSSG CCG introduced the context for the presentations that followed and advised that the Sustainability and Transformation Partnership (previously the Sustainability and Transformation Plan) was the framework for how members organisations worked together in a more integrated way.

A.        Recap on the BNSSG STP

Laura Nicholas, BNSSG STP Programme Director presented a recap of the progress to date of the BNSSG STP and shared examples of work that was being done differently as well as the plans for future engagement with councillors as the approach was developed.

In response to the presentation the following points were raised:

1. Cllr Kirk sought clarification over whether there was a statutory or legal framework that underpinned the STPs and Accountable Care Systems and sought to understand where the democratic accountability lay with reference to this.  In addition, there was a question over whether these had been debated in Parliament and whether any legislation had been passed.  It was confirmed that the STP did not have statutory or legal status but was a vehicle for members in health and local authorities to plan together over a larger footprint, and in a strategic way for their populations.  Each individual organisation was still statutorily accountable for its own business and the local authority was a partner to the STP as it current stood.

2. It was important not to conflate Accountable care systems with STPs which were something different and about delivering a service in a different way which could only be done with a set of underpinning legal arrangements and the BNSSG CCG were not currently seeking to establish this type of arrangement although it could be an option for the future.  The Chief Executive, BNSSG CCG suggested that a written reply would be appropriate to respond to these questions in more detail.  Action: BNSSG CCG

3. Further, it was suggested that an informal seminar could be arranged for councillors, to provide some background knowledge on these subjects. The Chair agreed that this would be a useful approach.  Action: BNSSG CCG

4. Cllr Yamanaka commented that whilst it was known that NHS funding would not be cut locally over the next five years, asked whether the funding was in real terms taking into account inflation or irrespective of inflation.  The Programme Director BNSSG STP advised that a written answer would be provided, to detail how the inflation calculations were worked through as different inflation rates could be applied. Action: BNSSG CCG

5. It was noted that future allocations would be determined by spending reviews that would be decided at a national level.  It was noted however, that the rate of spending was currently increasing faster than the rates of inflation. The Chief Executive, BNSSG CCG confirmed that as a tax funded organisation, the focus was now to change delivery to a more appropriate model to service populations and to operate within the resources  ...  view the full minutes text for item 7.

The Joint Committee to note the Healthy Weston update.

The Joint Committee considered the report and verbal update on the Healthy Weston programme.

The Chief Executive, BNSSG CCG provided the context and an outline of the programme known as ‘Healthy Weston’ before handing over to Dr Peter Collins, Medical Directory, Weston Area Health NHS Trust.

The following key points were noted:

a.      Weston area health trust had been a challenged hospital for some time, second smallest hospital in the country trying to provide a wide range of general hospital services which was difficult to make sustainable both from a financial perspective and from a health care workforce perspective.  A lot of work had been carried out to look at Weston as a place, with all of the health and social care providers working together to deliver services in a way that better use could be made of the resources available. 

b.      Significant work had taken place to align the work of providers, commissioners and primary community services into a cohesive vision to meet the needs of their populations and could start to demonstrate real change.

c.       The decision to implement temporary overnight closures at Weston Hospital, due to safety concerns, had gone well due to the ability to call on health partners to take care of patients.  It had also acted as a catalyst for work being done to look for different models of care and start a healthy debate with the public regarding the provision of the best care possible within the resources available.

In response to the summary report, the following points were raised:

a.      Cllr Willis confirmed that the North Somerset Council’s Health Overview and Scrutiny Committee would be discussing the Healthy Weston Programme at its next meeting. A huge amount of work had been done by North Somerset and North Somerset Councillors were very much engaged in the process.

b.      Cllr Biggin commented that there may not have been sufficient communication with local residents to explain the safety issues related to staffing that resulted in the decision to implement temporary overnight closure. Work had been carried out to spread the message that this is a collection of different services that could be provided in a different way. There was a responsibility to ensure that patients that attended Weston could be treated safely and if that was not possible to find alternative ways of treating them. The education piece had been all about the staffing difficulties and it would take time to communicate that effectively.

c.       Cllr Holloway recognised that the situation was complicated and queried how close they were to receiving a list of targets and timescales.It was advised that in respect of the wider work programme a detailed plan was expected at the end of the financial year.

Cllr Knight left the meeting

d.      Cllr Scott commented that Police and Education Services were publicly lobbying central government for an increased allocation in the forthcoming budget and queried whether there was a risk of the NHS falling behind if they just accepted the settlement. It  ...  view the full minutes text for item 8.

Presentation delivered at the meeting to update on progress with the Sustainability and Transformation Plans.

Attached are the responses to Public Forum Questions submitted to the meeting of the Joint Health Overview and Scrutiny Committee held on 23 October 2017.

a.      Response to PS 01 Mr Mike Campbell

b.      Response to PQ 01 Ms Daphne Havercroft

c.       Response to PQ 02 Mr Shaun Murphy

d.      Response to PQ 03 Mr Viran Patel