Agenda and draft minutes

The Chair welcomed all those present.

Apologies for absence were received from:

Councillors Paul Goggin, Ruth Jacobs, John O’Neal, Roz Wills, Chris Windows.

It was also noted that Julia Ross, Chief Executive Officer for Bristol, North Somerset and South

Gloucestershire Clinical Commissioning Group was unable to attend.

The following non pecuniary interests were declared;

Agenda item 10 – Councillor Harriet Clough declared as she was a current user of mental health services.   

Agenda item 7 - Councillor Shirley Holloway declared she was Chair of the League of Friends for Thornbury Hospital.

There was no Chair’s Business.

The minutes of the previous meeting were approved, subject to:

That paragraph 6.4, Communications and Engagement, be amended to reflect the following comments from Councillor Geoffrey Richardson;

1.      He had not raised any concerns about transport.

2.      In addition Councillor Richardson advised that he did not believe queries in relation to lack of transport to healthcare facilities; the CCG contacting the Local Authority Communications team; and the engagement work with Patient Participation Groups had taken place.

RESOLVED;

·         That minutes of the meeting on 26^th September 2018 be approved as a correct record, subject to the amendment detailed above.

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 Thursday, 24th October 2019.

Seven items of Public Forum Business were received and a copy placed in the minute book.

The Chair confirmed that written answers would be provided for publication on the Bristol City Council website within 28 days and circulated to Members of the Committee. 

RESOLVED; 

·         That public forum business be noted and the answers to questions circulated to the Committee when available.

The Programme Director of Healthier Together spoke to the report (details and accompanying slides are in the published pack).

The Committee raised concerns about mental health inequalities not being listed as one of the agreed design principles and were advised that mental and physical health and well-being were  integral and this should be made more explicit.

There was a discussion about delivery of the 5 year plan, the list of priority care programmes, how success was measured and how risk was managed, and the Committee was advised that there are key deliverables and milestones which were reviewed via robust performance and risk management procedures.

The Committee noted the profile and diverse representation of people living in the Bristol North Somerset South Gloucestershire area and were advised that more insight could be produced by engaging more with people, and enhanced linking of data between agencies, which was an area where the BHSSG was improving.

Bristol City Council Deputy Mayor, Cabinet Member for Communities stated that the ‘wheel’ (shown on slide 9/36) is not representative of Bristol’s diversity and, although representative of the wider area, should not be used as an evidence base for local decisions without further drilling down of data.

The Committee was advised of the need to define value, which included focusing on health outcomes that mattered to people.

The Committee asked what was being done to increase the representation of BME respondents on the Citizens Panel from the current 7%   to the actual BME representation of the population across the area, which was 10%.   and were advised that plans were in place to make improvements in this area.

There was a discussion about population figures within the 6 localities in the BNSSG (shown on slide 25/36).  The Committee asked for clarification of the figures and sources, and it was agreed this information would be sent to the Committee. 

Delivering digitally enabled health and care, including issues with accessing services via digital technology was discussed, and the Committee was advised that digital was not a replacement to traditional ways of accessing services such as phone and face to face, and there was a need to maintain both.

The Committee asked if the IT systems were being built ‘in house’ or whether packages were being utilised, and was advised that both were being done; for example, in outpatient care, there was a plan to procure a system.  Regarding extracting insights from data, this would be done in house. Financial challenges were referred to, with the Committee being advised that growth of 3.4% in real terms was expected over the next 5 years, so it was important this was used well, including investing in primary and preventative care; together with a plan of reducing the historical deficit by £50M over the 5 years.

The Committee was advised that the draft plan would  go to the Partnership Board on the 15^th November for sign off, before being submitted to NHS Improvement for agreement; and then be published. 

The  ...  view the full minutes text for item 8.

The Associate Medical Director of Bristol North Somerset South Gloucestershire CCG and The Director of Business Development at Sirona care & health spoke to the report (details and accompanying slides are in the published pack).

The Committee was advised of the objective to achieve equity across the BNSSG by upscaling every service for parity, rather than cutting from one area to give to another.   There was a discussion about the importance of being able to get people home from hospital, and that achieving a care plan could provide barriers to this.  The Committee was advised that a core part of overcoming barriers was to have an integrated care plan for one person, which followed them.

The Committee noted that South Gloucestershire Council was happy Sirona got the contract; that Sirona had already provided a good service in South Gloucestershire.

There was a discussion about the need for social care and health colleagues working together, and so the Committee would have liked to hear from Council social care officers.

The Committee was advised that the procurement process had social care representation from all Local Authorities, as well as Public Health representation.

The management arrangements regarding the transfer of services to Sirona was raised, and the Committee was told a Mobilisation Group for 1^st April 2020 was in place; that there was also a Service Transfer Group to help manage services not in scope, which would carry on and users of those services would not notice a difference on the 1^st April 2020. 

It was noted that Sirona already had a contract for children’s services and sub-contracted with Avon & Wiltshire Mental Health Partnership (AWP) for Child and Adolescent Mental Health Services; the arrangement with AWP should not change and Sirona would take back responsibility for children’s services across South Gloucestershire and Bristol. 

It was noted that Sirona had a close relationship with the South Gloucestershire Health Scrutiny Committee, Councillors and Officers, and had a challenging relationship which ensured accountability.

There was a discussion about working in partnership with the voluntary sector and the Committee wanted to know what Sirona intended to do with the extra money earmarked for the voluntary organisations to help build capacity. The Committee was advised that Sirona was working with organisations across the three areas; Sirona has met with 80 organisations so far, VOSCUR has been utilised; the issues in the local areas needed to be understood so the money could add value and investment decisions were to be made jointly.

The Committee asked about the proposed timescales before investment, and was advised that there was money already invested in services; there was a need to monitor the demand before investment decisions and changes were made.  Sirona expected to start this process in year one, to make investments in year 3.

The Committee asked how outcomes would be measured and stated that hospital admissions should not be used as a measure; Sirona was in agreement, advising that this was reflected in the Community Outcomes Framework – what  ...  view the full minutes text for item 9.

The Head of Stakeholder Engagement and Consultant Neonatologist, NHS England spoke to the report (in the published pack).

Also introduced were the NICU Lead Commissioner and Neonatal Services Project Manager.

Head of Stakeholder Engagement provided a statement for clarity, that there was no planned closure for Southmead hospital or the neonatal unit at Southmead.  The Committee was advised that the proposal as presented was to strengthen relationships that exist between the two neonatal units and reduce the amount of babies that needed to be transferred from Southmead to St Michaels for services not available at Southmead.  The proposal would result in all Level 3 Neonatal Intensive Care services being at St. Michael’s (UHB) with a supporting Local Neonatal and Special Care unit at Southmead (NBT).

There was a discussion about plans to create 10 extra cots at St Michaels, including timescale and costs, and the Committee was advised that Southmead specialised in pre term very small babies, at risk of having complications that may need surgical expertise; so on occasions unwell babies needed to be transported to St Michaels in specialised ambulance and have surgery. It was known that 30-40% of those babies (10-14 babies per year) ended up having to be transported so there was a need to design a system where they got all things in one go.

The Committee was advised that the suggestion was to bring expertise of 2 groups of clinicians together, involving good collaboration, which enabled safer care, so more babies survived. There were proposals to transfer the 8 intensive care cots from Southmead to St Michaels, and then funding had been agreed to open an extra 2 intensive care cots also at St. Michael’s.  This would create 41 intensive care cots in Bristol, for babies delivered in the Bristol, North Somerset and South Gloucestershire area and wider neonatal network region.

The Committee asked how the additional 30 women giving birth at St Michaels rather than Southmead would be identified; would the need for transport to St Michaels be identified early in the pregnancy.   The Committee was told that there were different choices where to give birth, but women don’t have a choice about going into labour pre-term, which would remove the choice for homebirth.  That group of women would still need to seek help at their local hospital, as some would go on to deliver early – although most would not.  The proposal would minimise the number of babies that need to be transferred after delivery.  If a woman was considered too high risk to transfer she would deliver and then move.  Staff would rotate around service - this was about creating a unified tertiary care system.

The Committee was advised that there was no reduction in cot numbers; and they were expanding; this was not about cost saving, but doing what it was felt as clinically correct.

The Chair referred to difficulties in recruiting staff, and asked if there was confidence about recruitment, and the Committee was advised that there  ...  view the full minutes text for item 10.

The Director of Transformation and Clinical Lead for Mental Health, Bristol North Somerset South Gloucestershire CCG spoke to the report (details and accompanying slides are in the published pack).

The Committee was advised that this is not just a mental health strategy, but is a mental health and well-being strategy. It was a piece of work that had engaged nearly 2000 people.  There was a need to investigate why we have experienced so many issues with mental health; mental health being part of health strategies was a really important part of societal change.

There was a discussion about public engagement, and the Committee was advised that the feedback showed early intervention and engagement may have prevented people going into crisis; the mental health and well-being strategy was person-centred; a key objective was to prevent crisis, and the data helped to understand what was needed regarding investment.

The Committee asked for reasons Vita Health won the contract and noted concerns about the choice, and was advised that there was a period of 3 months due diligence, including legal and clinical checks, to be assured about the and viability of company.  References had been obtained from other areas the company had provided mental health services.  Concerns had previously been raised and details were in the public domain.  Vita Health had 2 partners – Blue Bell and Windmill Hill City Farm and it was planned they would work through a hub-and-spoke model; there would be satellite clinics based in communities.  They started on 1^st September. 

The Committee was advised that services already being delivered would continue. There were three newly commissioned services: (i) Improving access to psychological therapies; (ii) sexual violence therapies services; (iii) Crisis café in Weston.  

There was a discussion about issues with provision of therapy and the Committee was advised of a gap between moderate to severe which was nationally recognised and there was work underway to address this gap, including providing different mental health services. 

Recruitment was noted as a challenging issue and the Committee was advised that staffing delays would now be   resolved with recruitment.   There was a 5000 person caseload inherited, and there was ongoing work to ensure the inherited waiting lists were minimised.  

The Committee was advised that the Crisis Café model had been around for 7 years, but not running to the same hours. . There were also Crisis Houses, where people could stay for up to a month.

The Committee was advised that more appropriate environments than A&E or a Police station was required for people in crisis; this is what the Crisis Café provides.  The Crisis café was planned to be running from May 2020, provided by Second Step. The process of developing the Crisis café was co-produced.

RESOLVED;

·         That the Committee be provided with relevant papers related to the procurement of services.

·         That progress and development of the mental health and well-being strategy be brought to the Joint Health Scrutiny Committee.

The Programme Director and Medical Director spoke to the report (details and accompanying slides are in the published pack).

The Committee was advised that there were significant staffing issues at Weston leading to issues and financial challenges.

There was a discussion about the consultation and the Committee was advised that there was a good response, which was representative of the local population; it had informed change - the final proposal changed as result of public consultation.

The Committee noted that there seemed to have been a robust and positive engagement from North Somerset scrutiny colleagues.

Recruitment and retention was discussed and the Committee asked how this was being approached with regard to planned increases in paediatric services.  The Committee was advised that there was good interest in paediatric positions at Weston Hospital, with opportunities to develop joint working with Bristol Royal Hospital for Children; there was confidence  that  posts would be recruited to so as to ensure cover of services.