Agenda and minutes

Scrutiny Advisor welcomed all those present.

Members of the Committee elected the Chair and Vice-Chair.

Councillor Brenda Massey was elected Chair; nominated by Councillor Celia Phipps, seconded by Councillor Gill Kirk.

Councillor Celia Phipps was elected Vice-Chair; nominated by Councillor Brenda Massey, seconded by Councillor Gill Kirk.

RESOLVED;

That;

·       Councillor Brenda Massey be elected as Chair

·       Councillor Celia Phipps be elected as Vice-Chair

The content of the Annual Business Report was noted.

RESOLVED;

That;

·       The Sub-Committee note and agree the Terms of Reference;

·       The Sub-Committee note and agree the Membership;

·       The meeting on the 11 March 2020 be the only meeting of the 2019/20 municipal year.

There were no apologies for absence.

The following non pecuniary interests were declared;

Councillor Celia Phipps declared she was a Social Prescriber, working with Bridgeview Medical Primary care Network; employed in the Voluntary sector in partnership with Knowle West Healthy Living Centre and BS3 Community.

The Chair explained that this was the first meeting of Health Scrutiny Sub-Committee of the People Scrutiny Commission; and this provided an opportunity to have more focus on topics for health scrutiny which was not previously able to fit on the People Scrutiny Commission work programme.

The Chair asked the Director of Public Health to provide an update on Covid-19. An update was given to the Sub-Committee.

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 democratic.services@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 March 2020.

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 12.00 noon on Tuesday 10 March 2020.

The following public forum was received and a copy placed in the minute book;

Questions

Q1 -11: Questions from Councillor Massey.

Q12-13: Questions from Councillor Kirk.

RESOLVED;

That the Public Forum be noted.

The Director of Strategy, AWP, spoke to the report (in the published pack).

The following points were made during the ensuing discussion:

·       Area placements were a significant focus; there were a number of work programmes with the aim of provision of a more sustainable service.

·       Deputy Mayor (Communities, Public Health, Public Transport, Libraries, Park, Events and Equalities) raised concern about issues with communication; that people were not able to navigate the system due to lack of communication.

·       The Committee was advised that the issues surrounding communication were taken on board; it was acknowledged that more needed to be done to find a way to deal with this.   It was agreed that a coherent pathway that showed people what services were available, what they looked like, and what to expect, was needed.

·       Whilst performance had been good there were situations where people were unable to access services due to communication problems.

·       Members stated that the performance in the report did not reflect some constituents’ experiences.  Members were advised that whilst the Key Performance Indicators were good and showed some improvement it was acknowledged that there were experiences of waiting times which needed addressing; some could be addressed with existing resources, but this was limited.

·       The Committee was advised that due to system pressures there was not the capacity to deal with those that did not engage or had disengaged – this was an indicator of pressure on the system.

·       The issues were not due to workforce churn, but due to capacity - more referrals than workforce. 

·       There was a very low bed base compared to the rest of the UK; there was a need to improve recovery capacity.  Rising caseloads had impacted the Intervention and Recovery teams.  It had been identified that not all referrals had needed to be made.

·       It was very important to work in partnership to utilise other sector preventative work which would free up capacity for people in need of care.  Working in Multi-disciplinary teams was a positive way of providing people with more opportunities; a way of working that has not been implemented thus far.  

·       Delayed Transfer of Care was an issue for people with acute mental health conditions.  Reasons for DToC included waiting for housing, including supported and specialist housing; key groups being stepped up into secure pathway – there was need nationally for those placements  (MoJ involvement). 

·       If someone had a specific need the supported housing staff may require specialist training and so this would take more time.  There was little provision outside acute mental health.

·       The Committee was advised that there were good close relationships and links to social care; housing was coming on board with a better relationship with AWP now. 

·       It was very positive that the staff retention rate had improved.

·       There had been workshops with GPs to instil confidence regarding prescribing; GPs were under pressure and so there was a need to ensure they were aware that specialist support was available if needed and that it was  ...  view the full minutes text for item 8.

Head of Service Hospitals and Front Door spoke to the report (in the published pack).

During the ensuing discussion the following points were made:

·       Community services were being developed; an in-house trading company was being investigated for homecare provision. There was a review on current in-house services – how they were used and how they could be improved.

·       The Committee was advised that in-house homecare company could provide greater value for money and this in principle was a sustainable proposition.

·       It was damaging to older people’s health to remain in hospital longer than required; there was concern about step down not being back to home.  The Committee was advised that a mixed model approach was important, that the aspiration was to have as many people at home as soon as possible, but appropriate pathways were required for those who presented with complex needs.

·       There was value in keeping people well at home; there was a need to utilise the voluntary and charity sector to improve the offer and achieve this; the way the voluntary sector was enabling services now was not sustainable.

·       3% of annual income related to the Community Care contract must be spent on the voluntary sector. £3M /year would now go into the voluntary sector.  There was ongoing work to ensure value would be added within the sector, which included how and where money should be spent; there had been innovative projects come forward.  The voluntary sector would now help to design the system.

·       The challenges have included the move to what the goals were for individuals rather than what prescribed goals should be; which referred to the Wigan model, which would achieve buy-in via co-production of services.

·       The Cabinet Member for Adult Social Care said there had been workshops with national and local providers which highlighted that organisations were more engaged with this approach than originally thought, which was positive. This provided a positive opportunity to use direct payments in a way that people would like, which took note of their own goals, what the individual would like.

·       The Chair stated that it was important to ensure the home was ready for people to return to, which included appropriate adaptations. Some of that meant working with housing providers as well. All services need to work together. This needed to be considered if home care was to be taken in-house.

RESOLVED;

That the viability of using an in-house trading company for homecare provision should continue to be investigated and findings reported to the Committee.

There was a 10 minute break at 3:20.

To follow

The Director of Commissioning, BNSSG CCG, spoke to the report (in the published pack).  The Area Director (Bristol) and the Director of Business Development, Sirona, was also present.

During the subsequent discussion the following points were made;

·       The Committee noted that GPs were independent but integral to NHS.

·       There was a resilience dashboard to understand what were the key indicators to show any issues with practices. 

·       There had been a Primary Care strategy developed.  It was agreed that this should be brought to the Committee at a later date.

·       Members raised residents’ concern that the temporary arrangements including portacabins would last more than 1 year.

·       The Committee noted that due to a low amount of residents that had asked for information and/or support with moving practices as part of the dispersals it suggested a well-managed process.

·       The Committee was advised that, regarding Bishopston, planning permission process had taken longer than envisaged, and so would be longer than 10 months; it was the intention to maintain Bishopston.

·       Increased lists as a result of housing delivery activity were discussed, and Members were advised that there were assessments for the capacity of each practice and how this related to how they operate and utilise space.  For example, Horfield was identified as needing more space to meet need, although after further analysis better use of space was identified as a solution.

·       There were ongoing meetings and partnership working with Council planning,  public health and housing teams to work in an integrated way. There was a need to gain a better understanding of how planning for new housing related to and impacted upon need and capacity.

·       Members were advised that some practices worked with a reduced number of Partners as opposed to GPs; that some new GPs did not necessarily want to be Partners; and that different practices worked on differing ratios of GPs/Partners.

·       To ensure appropriate capacity there was a need for practices to work together.

·       There was a challenge around appropriate bus routes between practices.  The Committee was advised that transport was an important consideration when assessing dispersal arrangements and decisions.

·       Part of the new community health contract involved ensuring community services could work more closely with GP practices; workforces were already working closer together.  The Committee was advised that the aim was to take as much pressure/load as possible from GP practices, and there was a strong willingness for improved partnership working.

·       Members were advised that the participation patient groups (PPG) would exist within surgeries; it was also important for full consultation and so feedback from many patients as possible was key.  There was work to improve PPG engagement; this had not happened in some parts of Bristol.

·       The Chair stated that there was a strong group at Greenway Community Practice.

·       The Chair raised concern that some patients had issues seeing the same GP on occasions.

·       There was a discussion about ‘did not attend’ rates and the related costs to practices.

·       The Committee was advised that there was not local routine monitoring  ...  view the full minutes text for item 10.

To follow

The Director of Commissioning, BNSSG CCG, spoke to the report updating the Sub-Committee on the mobilisation and service transfer of the adult community contract.  The Director of Business Development, Sirona, was also present.

During the ensuing discussion the following points were made;

·       The Committee was advised that, from 1 April 2020, there would be a single adult community services provider and single children’s service provider over the Bristol, North Somerset, and South Gloucestershire area. 

·       Appropriate TUPE arrangements for all staff (3000 approx.) would be in place by the 1 April 2020.

·       Part of the contract specification was a requirement to level up services, which would result in a consistent offer based on need.

·       The integrated care approach had a focus on prevention and early intervention.

·       Members of the Committee agreed that there should be a focus on consistency of approach across the area, and it was positive that Continuing Healthcare (CHC) teams were brought in-house, which could provide more consistency and higher standards.

The work programme was noted.

RESOLVED;

That the mental health strategy would be brought to the Health Scrutiny Sub-Committee on the 2020-21 work programme.