Agenda and minutes

To receive any apologies for absence.

Apologies were received from Cllrs Jan Warwick, Pal Hayre, Mike Thornton and Alan Dowden.  Deputies Graham Burgess, Lance Quantrill, Martin Tod, Dominick Hiscock were present.

The Chairman welcomed new co-opted member, Cllr Diane Andrews. 

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 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 Personal Interest in a matter being considered at the meeting should consider, having regard to Part 5, Paragraph 4 of the Code, whether such interest should be declared, and having regard to Part 5, Paragraph 5 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.

Cllr Tod declared a personal, non-prejudicial interest for all NHS-related items and all Public Health related items, as the Chief Executive of the Men's Health Forum - which receives funding from the Department of Health & Social Care, NHS England & NHS Improvement and Public Health England and is a health research and campaign charity.

Cllr Burgess declared a personal, non-prejudicial interest as Deputy Leader at Gosport Borough Council for Item 8.

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 9^th July 2019 were confirmed as a correct record and signed by the Chairman.  It was noted that due to matters arising from minutes, subsequent changes had taken place in dates of items returning to HASC.

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 the following announcements and briefing:

A. Young Persons’ Mental Health

Cllr Tonia Craig recently shared her concern about young people unable to access mental health services and not meeting the criteria for care if they have not had a crisis event.  Long wait times further exacerbate the mental health of at-risk young people and loved-ones struggle to help. The Children and Young People Select Committee is expecting a CAHMS update in November, the HASC will receive one in January, and these concerns have been shared with Executive Lead Member for Children and Young People, Cllr Stallard.

B. CQC Local System Review

Please note that the CQC Local System Review for Hampshire has been moved from the September HASC to the October meeting.

Briefings updates on the following items were circulated via email prior to the meeting:

A. Southern Health Update on Organisational Restructure

B. Southern Health’s New 17-bedded CAMHS Unit at Tatchbury Mount in Calmore

Dr Nick Broughton, Chief Executive from Southern Health was present to answer any questions about the two written updates.  There were no questions from members.

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

Items for Monitoring

a)  Out of Area Beds and Divisional Bed Management System (Southern Health)  

b)  Spinal Surgery Service Implementation Update (University Hospital Southampton) 

c)  Beggarwood and Rooksdown Surgeries Update (NHS North Hampshire CCG)

d)  Orthopaedic Trauma Modernization Pilot (NHS Hampshire Hospitals Foundation Trust)

e)  Andover Hospital Minor Injuries Unit Update (NHS Hampshire Hospitals Foundation Trust)

Items for Monitoring

a) Out-of-Area Beds and Divisional Bed Management System (Southern Health)

Representatives from Southern Health provided an overview of one of their most significant organizational challenges - managing out of area beds.  Managing demand of inpatient services within capacity has led to moving patients out of county and into private care. 

Having a variety of inpatient facilities and in keeping with the reorganization, there are 4 divisions that are managed together.  More local ownership and a new approach has led to fewer patients in out-of-area beds, and more capacity is being created to address demand.

A crisis lounge will assist with demand and relocation of facilities to allow more accessibility to patients, including a new OPMH ward.  This will be a complicated series of moves but will allow for refurbishment and accommodating needs in a dementia-friendly environment.  While currently in the early stages of proposals and commissioning beds, eventually purchasing additional beds will no longer be necessary.

In response to questions, Members heard:

• Longer stays in Hampshire versus the national average are due to several reasons, including the limited range of community services available here.  There is a need to expand the variety of alternatives to inpatient admissions and the long-term plan highlights need to invest more in community mental health services and crisis management.  Longer stays have higher financial costs and are detrimental to patients but in the short-term people must be accommodated should they need impatient care.  Progress continues to be made in this area.
• Challenges with foreseeing volume of beds and past closures have led to purchasing beds to accommodate needs in the meantime.  With new leadership, there are now alternatives to admission, stepdown admissions, and a comprehensive plan for additional inpatient capacity.  Renting facilities as an alternative has significant challenges in staffing nurses and specialists.
• While prior planning is preferable to crisis management, new leadership must face current organizational challenges and work with commissioners to increase investment in mental health services with comprehensive crisis and inpatient care.  Colleagues in primary care can ensure that there are mental health workers to better support patients moving towards and model of care that focuses on prevention and wellbeing.
• Planned work in Tatchbury is continuing and will provide mental health support for children.  Other much needed units for disadvantaged residents will be completed in the next financial year.
• Long serving members of HASC have seen new models of care put into effect with removal of beds which are now being added back in for adequate capacity.  Scrutiny must challenge these assertions and are only worthwhile if lessons are learned.  The impact on distressed carers and families, as well as challenges for community teams with inadequate resources and insufficient accommodation are closely monitored and not being underestimated.  Funding is provided to allow for family contact and bonds to remain.  In-house care is always the preferred option and length of stay in external beds are limited as much as possible.
• While the cost of internal beds is approximately 50% that  ...  view the full minutes text for item 155.

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.

No issues to consider. 

None to consider.

The Director of Adults’ Health and Care, alongside the Interim Director of Public Health, spoke to the report and presentation, which set out the departmental transformation to 2021 savings proposals and public consultation feedback (see Item 8 in the Minute Book).

Members heard an overview of the key findings of the balancing the budget consultation held by the County Council in summer 2019, and noted that all of departments in the Council had been asked to proportionately contribute a further 13% saving of their budget as part of the next ‘Transformation to 2021’ (Tt2021) programme. For Adults’ Health and Care, this resulted in an overall requirement of £43.1m (Adult Social Care £36.3m and Public Health £6.8m). With the proposed savings, this would bring the cumulative total to £242.4m by the end of 2022.  It was also identified that not only were savings being achieved, but also that Hampshire County Council continues to invest in adult social care service provision.  It was noted that Tt2019 was significantly more challenging than previous programmes and Tt2021 will be even more difficult with extended delivery and overlapping programmes with increasing risk and complexity.

There has been greater than anticipated demographic and service level challenges for an aging population and support needs increasing in terms of their complexity and impact on people’s lives.  £41m has been delivered of the challenge and 15m yet to deliver into this year and next.  The delivery of Tt2019 will be happening in parallel to Tt2021 savings.  There is continued uncertainty beyond 2020-21and pressure of quality and safety, workforce fit to deliver, and dual challenges due to increase in demand, complexity, and inflated costs of providing services. 

The key issues for the County Council have largely neutral implications and any additional funding for Adults Health and Care will offset the recently emerging pressure.

These five principles are the foundation for the departmental approach to Tt2021:

• Prevention: Strengthen the prevention strategy to reduce and/or contain demand. Includes: improved working with Carer’s and Voluntary and Community Sector (VCS), improved information and advice Connect to Support Hampshire (CtSH) and greater and wider use of Technology
• Independence: Increase the number of clients living independently and reduce the cost of care
• Productivity: Improve efficiency and productivity of the department’s operations
• External spend: Increase outcomes and service efficiency from commissioned services Income generation: Increase departmental income through traded services including technology enabled care

Within these principles were five main blocks, which centred on:

• Younger Adults services including learning disabilities, physical disabilities, mental health and children’s to adults' transition
• Older Adults services for people aged 65 and over
• In-house care provision
• Working differently
• National grant funding – resource to support provision

 All of these were underpinned by the theme of demand management and prevention.

Cllr Burgess left for another meeting at 12:38pm. 

For Public Health, a range of significant savings proposals across commissioned spend, will include mandated and non-mandated service areas such as:

• Substance Misuse
• Smoking Cessation
• Health Checks
• 0-19 Services

Increased focus will be  ...  view the full minutes text for item 157.

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

A suggestion was made regarding a joint scrutiny committee and would be followed up by email.

RESOLVED:

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