Agenda and minutes

The Chair welcomed all attendees to the meeting and explained the emergency evacuation procedure. Those present were asked to introduce themselves as follows;

·       Vicky Marriot, Healthwatch BNSSG

·       Jenny Bowker, Deputy Director of Primary Care at BNSSG ICB

·       Wavell Vere, Senior Commissioning Manager, Southwest Collaborative Commissioning Hub

·       Rosanna James, D2A Programme Director, Sirona care & health

·       Greg Penlington, Head of Urgent and Emergency Care, BNSSG ICB

·       David Jarrett, Director of Integrated and Primary Care - Bristol, North Somerset and South Gloucestershire ICB

·       Dominic Moody, NHS Bristol, North Somerset and South Gloucestershire ICB

·       Andy Newton, NHS Bristol, North Somerset and South Gloucestershire ICB

·       Christina Gray; Director: Communities & Public Health (DPH)

·       Hugh Evans, Executive Director: Adult and Communities

·       Johanna Holmes, Scrutiny Coordinator

Also in attendance were;

·       Councillor Helen Holland - Cabinet Member with responsibility for Adult Social Care and Integrated Care System

·       Councillor Asher Craig – Deputy Mayor and Cabinet Member for Children’s Services, Education and Equalities

There were none.

Councillor Lorraine Francis asked for it to be noted that she is a social worker for Avon and Wiltshire Mental Health Partnership.

The minutes of the previous meeting were agreed as a correct record.

There was no Chairs business on this occasion.

Up to 30 minutes is allowed for this item.

Any member of the public or Councillor 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:-

Questions - Written questions must be received 3 clear working days prior to the meeting.  For this meeting, this means that your question(s) must be received in this office at the latest by 5pm on Thursday 5^th October.

Petitions and Statements - Petitions and statements must be received on the working day prior to the meeting.  For this meeting this means that your submission must be received in this office at the latest by 12 noon on Tuesday 10^th October.

The published Public Forum document can be found here.

Tara Miran (on behalf of St Pauls Dentist Action Group) submitted three public forum questions related to 9. on the agenda.  Written responses to the questions were provided ahead of the meeting.  Ms Miran then asked three supplementary questions as follows:

1. Regarding the new provider in St Pauls; people had been waiting for such a long time. What was causing the delay?

The Deputy Director of Primary Care at BNSSG ICB said they were working with a potential provider on due diligence but this was taking longer than had been expected.  It could be a few more months before they could share further information or say who that provider would be.

2. When would the facility be re-opened? Many people were waiting, and many of those were said to be in considerable pain and needed a timeframe.  People had been told there would be some interim care provided but this had not happened.  Why was there no emergency interim care?

The timescales would need to be fed-back when more information was available.  In the interim a mobile unit had been considered but there is no capacity to do this at the moment. Patients could call 111 for emergency dental care. 

Tara Miran replied that the lack of communication on this had been very disappointing.

3.     When the practice is open, how long will it take for it to be working at full capacity? 

The reply was, there are capacity issues within and across NHS dentistry and this applied to all practices across Bristol.  Some flexibility had been announced nationally recently which could help speed things up though. 

The Members resolved to;

·       To note the Scrutiny Committee’s Terms of Reference.

·       To note the membership of the Committee for the 2023-24 municipal year.

·       To note the Chair and Vice-Chair for the 2023-24 municipal year.

·       And agreed the dates of two further meetings of the Committee during the 2023-24 municipal year as follows:

•    Thursday 7th December 2023, 4.00 p.m.

•    Wednesday 7th February 2024, 4.00 p.m.

 To include:

·       Menopause Services in Bristol

·       Local Voices - Update

Vicky Marriot introduced herself and briefly explained the role of Healthwatch.

It was noted that Healthwatch have had their funding reduced by 49%.

The Healthwatch item and published presentation slides were split into two sections as follows:

• Your NHS menopause experience
• ‘Local Voices’ Report for Quarter 1

Your NHS menopause experience;

It is estimated that there are around 13 million women who are currently peri- menopausal or menopausal in the UK.

Vicky described the ‘Your NHS menopause experience’ research that Healthwatch had undertaken in Bristol, North Somerset and South Gloucestershire earlier this year.  The report summarises the feedback from women about their experiences and makes seven evidence-based recommendations from the key themes that emerged.  It was said that a steering group had now also been set up.

The key findings of the survey were summarised, many of which were negative experiences, which included:

-        A general lack of available information and more help was needed to help women access the appropriate advice.

-        Women have low expectations when they seek professional support.

-        Many women are unaware of some symptoms due to the lack of available information. 

-        The impact of cultural conditions & differences;  the menopause is still a ‘taboo’ subject in some cultures and is not discussed at all.

-        Many women said their symptoms were being mis-diagnosed to begin with and highlighted a lack of knowledge on this subject within the GP sector.

Vicky also referenced the ‘Local Voices – Quarter 1 Summary Update’ and said that ‘access the NHS dental services ‘ was highlighted as the biggest issue for three years now.

Questions and Comments from the Committee Members were as follows:

-        The recommendation of creating specialist hubs or clinics that could be accessed without a referral was a very good idea. However, it was concerning that perceptions in some cultures still meant that some women would not seek help.

-        A Member thanked Vicky for her report and the research but commented that the NHS had previously committed to putting feedback at the forefront but had then cut that service by half.  This did not show the commitment that had previously been pledged.  

-        It was very frustrating and sad to hear how women from minority groups were struggling and that this remained a problem. The situation did not appear to being taken as seriously as it needed to be. 

-        Had the survey revealed anything about support for women in the workplace?  Yes it had and this was all detailed in the full report.

-        The recommendations were clear about the need to provide hubs or extra services.  Members requested a future up-date on how this was progressing.

-        The Cabinet Member with responsibility for Adult Social Care and Integrated Care System said that both reports that had been referred to had also been discussed at the last Women’s Commission meeting where they also heard from women speak from experience at the meeting.   Were the hubs likely to be physical hubs or virtual?  This  ...  view the full minutes text for item 8.

This report was introduced by Jenny Bowker, Deputy Director of Primary Care at BNSSG ICB and Wavell Vere, Senior Commissioning Manager, Southwest Collaborative CommissioningHub.  Some of the key points in the report were summarised as follows;

-        It was very challenging for people trying to find an NHS dentist nationally as well as locally.

-        It was said that the ICB were now in charge of making decisions on this and were supported by the NHS Commissioning Team.

-        The ICB were developing a local dentistry plan.  The ‘Appendix – ICB Dental Summary’ slide to the published report was taken from a group work session.  The Committees views on that would be welcomed as it was taken forward. 

-        There is some general misunderstanding about how funding for NHS dental services works.  The contracting process changed in 2006 which meant a cap on 50% of the population receiving NHS dental care, which in turn meant the other 50% of the population needed to purchase private dental care.

-        There are huge variances in units of dental activity (UDA) values i.e., £24 - £35 for what can be paid for in contracts.  This it was said causes strains on the system and many people have subsequently switched to private care. This also results in differences in what provision dental practices can offer.  Some practices now have mixed private and NHS contracts in place.  Support was being provided to practices to help them adjust to the new UDA.

-        In 2020 a programme was established to improve recruitment and retention of dentists so as to improve access to NHS dentistry.  There are currently only 35% of the required NHS dentists in post.

-        Patients are not registered at dental practices but are ‘known to the practice’.

-        111 telephone helpline service: A discussion was had on what emergency dental care people should be able to access via this.

o   Two pilot programmes. One of these will run until March 2024 and help with the increased demand and stabilisation of care. These are called ‘urgent care slots’.  There are eight practices in Bristol that provide ‘urgent care slots’ for patients.

-        When the St Pauls practice closed invitations to submit expressions of interest (EoI) were sent to other providers.  Discussions with BUPA did also continue.  Final due diligence was currently said to be taking place with a practice that could not yet be named. 

There was some uncertainty about the dates of when contacts might be in place.  Putting a date on this was said to be very difficult because if no agreement could be made they would have to go out to full tender which could take another 18-24 months.

Members asked the following questions;

A Member commented that it appeared the situation for youth and children’s dental services were not quite as serious as they were for adults. Why was this?  It was said that the majority of pilot

projects and specific programmes were focused on children.  ...  view the full minutes text for item 9.

Rosanna James, D2A Programme Director, Sirona care & health introduced the item to Members.

Rosanna confirmed as per the report that the programme is fully operational with partners, right  across the board.

In the past, the solutions to what was referred to as ‘bed blocking’ were different.  Since June the programme team had implemented actions across a number of priority areas for improvement and transformation delivery work. 

The Director said they were sited on patient’s long term health needs and help to enable independence where it’s required. The focus was now on enabling people go home where possible unless this is not the right solution for them.

Referring to ‘Figure 3 in the published report: D2A Transformation Programme Deliverables’ it was said that there was still a need to improve and increase the use of data across health and social care elements of the pathway (including outcomes data), for example, utilising dashboards and models to make long term decisions. 

There had been significant inroads into achieving the target of saving 200 acute beds.  Currently 172 acute beds have been saved by July 23 vs. the baseline reporting period. But programme monitoring indicates there remain opportunities to improve joint health and social care decision making, which is likely to impact on the choice of pathway at the point of discharge from hospital.

With regards to preparations for winter, some funding had now been re-profiled and some extra funding had also been released. 

A successful application had been made to the Better Care Fund Support Programme (BCFS).  This was a national funding pot for system improvement work related to intermediate care and discharge transformation programmes.  The BNSSG ICB had been selected to receive additional support in two areas. Culture, Leadership and Learning and Improved Out of Hospital Demand and Capacity Modelling.

The following points were discussed and questions asked;

Patient discharge process; at what point did that conversation begin? A Member suggested it should begin when a patient enters the hospital or there it’s at risk of being left too late and causing delays.  The Programme Director said they were making a good progress across sites in Weston General Hospital and the Bristol Royal Infirmary (BRI) but there was still some work to do on this at Southmead Hospital. Discharge planning should not start at the point patients become medically fit to leave, as that would cause delays to their overall time in hospital. The programme does seek to bring forward discharge planning, but is also designed to improve joint decision making and reduce the number of times bedded pathways are chosen.

A Member commented about readmission rates and if they were being analysed, for example patients should be surveyed to see if things were improving, which he suggested they probably were. 

Another Member commented about the number of different factors causing additional pressures throughout the whole discharging process.  But highlighted the need for quality and safety checks to be signed-off and the right decisions being made at right time for patients. They  ...  view the full minutes text for item 10.

Greg Penlington, Head of Urgent and Emergency Care, BNSSG ICB introduced the item to the Committee Members.

Mr Penlington summarised the information in the published papers including the following points:

• There has been record investment in some services which were near to capacity.
• The annual planning process focusses on winter, so it has been possible to additionally invest in schemes and services such as urgent and emergency care (UEC) and ‘Home First’ services.
• The investment in community services via Sirona means there is now a good spread of services.
• There is continual tracking and monitoring of delivery via the Operational Delivery Groups.
• Same day emergency care, where teams respond to people with urgent needs who may otherwise deteriorate has been expended and will help to reduce the lengths of many patients’ hospital stays.
• The development and expansion of home care services such as NHS@home and virtual wards which help to reduce overall admissions and increase earlier discharge times.
• The work resulting from additional investments at the Children’s Hospital was said to be progressing well including a positive increase in capacity and the emergency department.
• Pharmacies can now offer much than was previously the case and people can book into programmes and services via 111 as well now.
• Mr Penlington said he would take away the earlier point about communication of access to urgent care slots for NHS dentistry via 111.

The following points were discussed and questions asked:

A Member asked about covid and flu vaccinations and how a low up take-up might affect the numbers who contract them.  It was replied that any potential surges were being monitored very closely. 

A Member raised issues with telephone calls to GP surgeries not always being picked up now.  Was there any data on this? It was replied that some data on the new system had had recently come though and it did show there might be some initial problems. This was being looked into. The data did show the highest volume of calls were on Mondays. The Member responded that issues such as surgeries not answering phones and being put in a long que to speak to someone on 111 showed just how much pressure there currently was on health services.

A Member queried some of the figures on the ‘Forecasting pressures on the system’ presentation slides. On the Bristol Royal Hospital for Children slide, it appeared that no mitigations had been implemented. And for the Southmead (NBT) slide, the numbers did not add up. 

Mr Penlingtonconcurred with the points raised and said he would take this error back.

A Member asked about hospital staff absence rates and said it had been reported that many workers were at breaking point. Was the modelling data looking at staff sickness rates?

It was replied that there was support in place to help people and investments were being made to alleviate situations but the exact details would need to be obtained and reported back.

A Member asked about the dedicated clinical teams  ...  view the full minutes text for item 11.

The Members noted the published Stroke Programme paper which was ‘for information’ purposes.

The Members noted the work programme.

The final point of the meeting was a request from external officers for joint health scrutiny (JHOSC) meetings where possible as this would reduce the need to repeat what was often the same information to each HOSC in the BNSSG area.

The Chair thanked everyone for attending and closed the meeting.