Agenda and minutes

To receive any apologies for absence received.

Apologies were received from Councillors Adam Carew and Marge Harvey, and district and borough co-opted member Councillor Alison Finlay.

The Chairman welcomed Cllr Trevor Cartwright to the meeting, as a newly appointed co-opted member representing district and borough councils.

All Members who believe they have a Disclosable Pecuniary Interest in any matter to be considered at the meeting must declare that interest and, having regard to the circumstances described in Part 3 Paragraph 1.5 of the County Council's Members' Code of Conduct, leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with Paragraph 1.6 of the Code. Furthermore all Members with a Non-Pecuniary interest in a matter being considered at the meeting should consider whether such interest should be declared, and having regard to Part 5, Paragraph 2 of the Code, consider whether it is appropriate to leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with the Code.

Members were mindful that where they believed they had a Disclosable Pecuniary Interest in any matter considered at the meeting they must declare that interest at the time of the relevant debate and, having regard to the circumstances described in Part 3, Paragraph 1.5 of the County Council's Members' Code of Conduct, leave the meeting while the matter was discussed, save for exercising any right to speak in accordance with Paragraph 1.6 of the Code. Furthermore Members were mindful that where they believed they had a Non-Pecuniary interest in a matter being considered at the meeting they considered whether such interest should be declared, and having regard to Part 5, Paragraph 2 of the Code, considered whether it was appropriate to leave the meeting whilst the matter was discussed, save for exercising any right to speak in accordance with the Code.

Councillor Jan Warwick declared a non-pecuniary interest in Item 7, as she is a part-time specialist pharmaceutical advisor to the Care Quality Commission.

To confirm the minutes of the previous meeting

The Minutes of the meeting of the Health and Adult Social Care Select Committee (HASC) held on 21 July 2017 were confirmed as a correct record and signed by the Chairman.

To receive any deputations notified under Standing Order 12.

The Committee did not receive any deputations.

To receive any announcements the Chairman may wish to make.

The Chairman made three announcements:

Dorset Clinical Services Joint Health Overview and Scrutiny Committee (JHOSC) update

The JHOSC last met on 3 August, where the Clinical Commissioning Group (CCG) presented the outcomes of the consultation on the proposals for the future of Dorset’s clinical services.  The consultation outcome was fairly balanced in terms of support for either of the main options (Option A being to centralise urgent care in Poole, and planned care in Bournemouth, and Option B to centralise urgent care in Bournemouth, and planned care in Poole), with Option B being Dorset CCG and the Hampshire HASC’s preferred option.  The JHOSC remained split on their support for the proposed model, with those representing Poole and West Dorset tending to speak more unfavourably of Option B.  There remained disagreement about travel times. Hampshire’s representatives would continue to monitor this issue, but remained supportive of Option B.  The CCG had on 20 September taken the decision to implement Option B, and the JHOSC would need to meet to consider this decision.  Should the JHOSC vote to refer this matter to the Secretary of State, Hampshire would play no part in this, as the Council did not delegate its referral power to the JHOSC.

Councillors Harrison and Keast agreed with the Chairman’s comments, and noted their support for the chosen option.

Requests for Item consideration at Full Council

At the most recent Council meeting in July, a number of topics were referred to the HASC for consideration.  The following action had been taken:

·      Mental health in schools: Councillor Harrison had been contacted about this topic, which the Children and Young People Select Committee will review should there be any progress on this area from central government.

·      Motor Neurone Disease Charter – Councillor Fairhurst was due to consider this at a future decision day, following Councillor Dowden’s request.

Briefings and Updates

The Chairman noted that updates would be shared after the meeting with the Committee on:

·      Antelope House Psychiatric Intensive Care Unit – update on staffing following urgent temporary closure (Southern Health NHS Foundation Trust)

·      Low Secure Mental Health Beds for Children and Adolescents (Southern Health NHS Foundation Trust)

·      Primary Care Prescribing (via West Hampshire CCG)

To consider and make recommendation to the Executive Member for Adult Social Care and Health and the Executive Member for Public Health on the departmental transformation to 2019 savings proposals and public consultation feedback.

The Director of Adults’ Health and Care spoke to the report and presentation, which set out the departmental transformation to 2019 savings proposals and public consultation feedback (see Item 6 in the Minute Book).

Members heard an overview of the key findings of the balancing the budget consultation held by the County Council the previous summer, and noted that all of departments in the Council had been asked to proportionately contribute a further 19% saving of their budget by April 2019, as part of the next ‘Transformation to 2019’ (T19) programme.  For Adults’ Health and Care, this resulted in an overall requirement of £55.9m.  An overview was provided of the Department’s ‘Transformation to 2017’ (T17) savings, which would see a total of £43.1m achieved by the end of the 2017/18 financial year.  With the proposed T19 savings, this would bring the cumulative total to £191m by the end of 2020.

There were four principles that underpinned the Departmental approach to T19:

·      Prevention: strengthening the prevention strategy to reduce and/or contain demand.

·      Independence: increasing the number of clients living independently and reducing the cost of care.

·      Productivity: improving the efficiency and productivity of the Department’s operations.

·      External spend: increasing outcomes and service efficiency from commissioned services.

Within these principles were four main blocks, which centred on the use of additional health and social care integration funding; living independently (older people’s and physical disabilities); learning disabilities, children’s to adults transition, mental health and social inclusion; and working differently.  All of these were underpinned by the theme of demand management and prevention.

There were approximately 3,000 staff employed within Adults’ Health and Care, and in due course it was expected that the Department would need in the region of 150 fewer full time equivalents, through natural attrition, redeployment and potentially voluntary redundancy.  Through the T17 programme, it was expected that there would be a staffing reduction, but the requirements of the changes implemented required additional growth in staffing in some areas, and this may be the case for T19.

An additional £18.9m was being made available in 2019/20 through the Integration and Better Care Pooled Fund, which would offset some of the savings required by the Department.  These funds would be used to invest in joint and integrated service delivery programmes, and to protect core social care services.

The living independently proposals were centred on creating options so that people can live independently for as long as possible.  Through intermediate care, such as reablement (both home and bed-based), individuals can be supported to re-learn the life skills that enable them to remain independent, and to need less ongoing support.  As a result of this work, the number of people being admitted into acute care should reduce, which should improve flow through hospital and enable the limited social care resource to be targeted at those with higher needs.  There were also greater opportunities for exploring how technology-enabled care can be used to reduce cost; innovative devices already in use in Hampshire had helped to  ...  view the full minutes text for item 25.

To consider a report of the Director of Transformation and Governance on issues brought to the attention of the Committee which impact upon the planning, provision and/or operation of health services within Hampshire, or the Hampshire population.

·       Portsmouth Hospitals Trust: Care Quality Commission Re-Inspection

Portsmouth Hospitals NHS Trust: Care Quality Commission Re-Inspection Enforcement Notice – Urgent Care Update

The Chief Executive and representatives of Portsmouth Hospitals NHS Trust, together with the Chief Executive and representatives of Hampshire Clinical Commissioner Group (CCG) Partnership, spoke to the recent Care Quality Commission (CQC) re-inspection report of the Trust (see Item 7 in the Minute Book).

The Chief Executive of the Trust outlined to the Committee the issues arising from the CQC report, which detailed the findings from two inspections that took place earlier in 2017.  The report had made difficult reading for the Chief Executive, who had been in post for only a couple of weeks at the time of its publication, and for the Medical Director who had been in his role for a similar period of time.  However, they both accepted its findings in full, and had worked closely with the Board to take a number of immediate actions, in addition to those taken when the CQC first provided an overview of its concerns post-inspection.

The Chief Executive outlined that a number of actions were being taken by the Trust, and the feedback from staff to date was that they were absolutely committed to addressing the issues at pace, and to providing the best care to patients.  The challenges being faced by the hospital were not new, and those raised in relation to urgent care and flow through the hospital had been communicated previously to the Committee over the past two years.  The Trust accepted that they were not getting their delivery of care 100% right, and were committed to changing this, and making sure that staff were able to meet this challenge.  This was particularly the case in urgent care, where staff had faced an ongoing period of high demand for services, but remained resilient and focused on improvement.

The Chief Executive explained that in his view there were a number of conditions that weren't right in the organisation whilst the inspections took place, and part of his role was to create the right environment in the hospital to ensure that the best care could be provided.  The Trust subsequently had a new quality improvement plan, which had been reviewed and refreshed to ensure it could meet the areas where action needed to be taken.  A first draft of this had been submitted to the CQC and partners on 1 September, and this would be finalised for publication by 31 October.  In the meantime, a Quality Summit would be held with partners and the CQC to review the document, and ongoing engagement work would continue with staff to ensure they understand and can take ownership of the plan. 

There had been a number of leadership changes in the Trust since the inspections were held, and since joining the organisation in July the Chief Executive had been impressed with how colleagues were working collaboratively at a senior level.

The Medical Director was also newly in post but had been a consultant at the Trust for  ...  view the full minutes text for item 26.

To receive a presentation setting out the work being undertaken by Public Health to transform and redesign substance misuse services in Hampshire, and to provide feedback on the proposals.

This item was deferred at the request of the Chairman and agreed by the Committee.

To agree the draft Terms of Reference for the ‘Social Inclusion Transformation to 2019’ working group of the Health and Adult Social Care Select Committee.

The Committee reviewed the draft Terms of Reference for the ‘Social Inclusion and Transformation to 2019’ working group of the Health and Adult Social Care Select Committee.

The Committee heard that the final membership would be:

·      Cllr David Keast (Chair)

·      Cllr Anne Briggs

·      Cllr Alan Dowden

·      Cllr Marge Harvey

·      Cllr Barbara Hurst (District and Borough co-opted member)

RESOLVED

That the Terms of Reference are approved.

To agree the draft Terms of Reference for the ‘Sustainability and Transformation Partnerships’ working group of the Health and Adult Social Care Select Committee.

The Committee reviewed the Terms of Reference for the ‘Sustainability and Transformation Partnerships’ working group of the Health and Adult Social Care Select Committee.

The Committee heard that the final membership would be:

·      Cllr Roger Huxstep (Chairman)

·      Cllr Fran Carpenter

·      Cllr Pal Hayre

·      Cllr Mike Thornton

·      Cllr Alison Finlay (District and Borough co-opted member)

RESOLVED

That the Terms of Reference are approved.

To consider and approve the Health and Adult Social Care Select Committee Work Programme.

The Director of Transformation and Governance presented the Committee’s work programme (see Item 11 in the Minute Book).

RESOLVED:

That the Committee’s work programme be approved, subject to any amendments agreed at this meeting.