Agenda and minutes

To receive any apologies for absence.

Apologies for absence were received from Councillor Tonia Craig, Councillor Tim Groves deputised.

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.

No declarations of interest were received during this meeting.

To confirm the minutes of the meeting held on 3 September. (to follow)

Minutes of the meetings held on:

3 September 2024 and 17 September (SP25) to be presented at the next meeting.

Councillor Phil North, asked about the Primary Care Reference Group as mentioned in the meeting of 3 September and if as promised had the Chairman received the Terms of Reference and had a meeting taken place. The Chairman confirmed that the Terms of Reference had not be received and the Group had not met.  

To receive any announcements the Chairman may with to make.

The Adults’ Health and Care Directorate 5 Year Strategy Refresh – Year One Progress Update report is due to be presented at the 15 November Cabinet.  Cabinet is asked to note and endorse the continued good progress made by Adults’ Health and Care during 2023/24 to deliver its Vision and Strategic Plan, and the operating context in which performance was achieved.

Frimley Park JHOSC

The Joint Committee last met in September where they continue with a business-as-usual approach until the Government makes a decision on the New Hospitals Programme. The Trust gave no assurances in terms of site selection for the new facility and presented identical information from the previous meeting, Members of the joint committee we  all frustrated about lack of progress, the Chairman would keep the Select Committee updated.  

Public Health Strategy

The Public Health Strategy one year on is being presented to Cabinet in November settings out the progress that has been made since the Public Health Strategy 2023- 2026. The focus of the strategy meets The County Council’s public health duties of improving health and reducing inequalities and the County Council’s ambition for improving the health of the population and narrowing the gaps in health between groups. This includes aligning work with those areas considered the ‘building blocks of health ^[1]. The links between health and prosperity are well documented; healthy places and people are vital to delivery not only for this strategy but also to realise Hampshire’s vision for 2050.

World Mental Health Day

World Mental Health Day had taken place on 10 October 2024 a video  (appended to these minutes) shows new sensory walks and how they aligns with the 5 Ways to wellbeing.

To receive any deputations notified under Standing Order 12.

No Deputations were received.

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

     6a. Hampshire and Isle of Wight Healthcare NHS Foundation Trust

6b. NHS Hampshire and Isle of Wight and NHS Frimley Winter Operating Plan Update 2024/25

6c. Ambulance Performance

The Select Committee welcomed Ron Sheilds, Chief Executive Officer of the Hampshire and Isle of Wight Healthcare NHS Foundation Trust and Members  congratulated Mr Sheilds on gaining Trust status.

The CEO provided the Select Committee an overview of the journey from inception to delivery of the Trust, stating that they had an opportunity to bring together the fragmented structure of 4 providers delivering various aspects care, under one umbrella of combined services.  The new organisation, taking a holistic approach would look at physical and mental health in one setting, resulting in greater flexibility when commissioning, seeking to maximise value for money, and it had been anticipated that the budget should realise a small surplus at the financial year end.

Frimley ICB would continue to support, community mental health however some elements of neurodiversity would transfer to the new Trust. 

The success of the Trust would in the future be measured by the delivering of their short term strategy and combined with the strategies of the local authority with a focus on the health of the population. Examples of the areas of immediate concern were smoking cessation and obesity etc, with one of the main priorities of securing better health and mental wellbeing for young people.  Recognition of national excessive waiting times for neurodiversity assessment and diagnosis, the increase in cases had many strands and in part were attributed to young people’s access to information around mental health and some self-diagnosis, older people recognising  traits in their own behaviours. The Trust hoped to streamline waiting times by taking advance of  multiple routes to assessment, treatment and appropriate referrals. Education colleagues would also be called upon to support young people in that environment.

When asked how the Trust would respond to the national move in the reduction of police presence at instances of people in mental health crisis, the Trust reported no significant change in levels of support and that they had a good working relationship with the Police who had continued to work with other partner agencies to support vulnerable residents, the use of Section 136 powers ensured that police officers and ambulance colleagues continued to transport those in crisis to a place of safety. 

The Trust reported that dementia services in the context of aging, that clinicians would support this client group to remain mentally well for longer and where appropriate to help people to remain independent for longer and stay in their own home, to also support families to cope for longer.

Longer term success would be measured by a reduction in people dying from smoking or obesity. The CEO agreed to report back to the Select Committee with some post discharge data and figures related to the short and longer term successes.  

The Health and Adult Social Care Select Committee

RESOLVED to note the update.

The Select Committee received a joint presentation from NHS Hampshire and Isle of Wight ICB and NHS Frimley ICB outlining the winter operating plans for 2024/25.

Darren Cattell, Senior Responsible Officer for Urgent and Emergency Care, NHS Hampshire, and Isle of Wight advised that the ICB were in the process of planning for winter and to better inform Member, suggested reporting back to the committee later in the work programme to discuss the success of the plan.

The main focus of winter planning was to deliver a safe winter for the population and to ensure that residents stayed healthy and remained in their own homes for as long as possible. An element of the plan in action had been demonstrated by the vaccination programme which had been promoted by Public Health and colleagues. 

The Select Committee further heard that the ICBs had

-       Continued to support residents in timely way 

-       That there has been an increase in the range of  emergency care services.

-       Clinician had been working to produce an integrated plan to reduce the recognised levels of waste in the system.

-       Seeking to maximise urgent care services

-       Working with primary care Portsmouth

-       Seeking to deliver a single point of access, the system had been signposted to an alternative and more appropriate facility ie. in 20 calls, 9 people did not attend A&E.

-       The vaccination programme had been working well with over 1000 patients vaccinated in the previous 2 weeks, with continued monitoring and looking at ways to further promote the benefits of being vaccinated

Dr Zaid Hirmiz, Deputy Chief Medical Officer, NHS Hampshire, and Isle of Wight, informed the Select Committee that the plan was

-       Not just a winter, emergency care

-       That the plan has to work across all areas of the clinical pathway to assist the public to stay safe and stay well

-       A comprehensive programme of comms was in place to inform the public of  NHS 111, pharmacy etc. to assist in the delivering on the promise of the patient being in the right time at the right place, to assist in freeing capacity of GP within the system. How to access to the digitally deprived

-       Content review of the access to GPs and the reduction in wait times, supported by the initiatives to ensure that the patient is in the right place at the right time.

-       Virtual wards across both ICBs were in operation and due to be rolled to additional disciplines ie. children’s services and mental health, as an example of the management of the more acute illnesses being managed outside the hospital environment. The service had been received positively by patients and carers.

-       The step up and step down treatment in Hampshire would be enhanced with additional capacity for winter.

-       Planning for risk of those vulnerable residents at risks of falls etc. by using a multidisciplinary approach

On behalf for Frimley ICB, Nicola Airey, Director of Places and Communities reported that the Trust were in a similar position in terms of winter planning and had continued to  work with colleagues to deliver the national programme. In addition to improving signposting patients to urgency care facilities, the introduction of the Epic software system had been used to track and log patient activity. 

The Committee discussed concerns in the continued delayed patient handover from ambulance to emergency department, conscious the national target of 15 minutes had consistently been exceeded. Causes for these delayed admission were discussed in full by the ambulance performance team.   

The Select Committee discussed a revision in the reporting timetable of the plan to better align to the work programme with national timetable, this would allow for improved future reporting, greater detail of the plan and confirmation of wrap around care etc.

Health Protection

Simon Bryant, Director of Public Health informed the Select Committee that the

Health Protection Board’s plan was in action and that regular information had been shared weekly during winter months and monthly in summer months. Colleagues acknowledged receipt of the useful weekly/monthly updates.

The Select Committee RESOLVEDto note the update and request a further update.

The Select Committee received an update from the South Central Ambulance Services in response to a CQC inspection in 2022 and the subsequent improvement programme and action plan put in place to strengthen the service in areas of leadership and performance.  Details were given of the continued engagement between officers and the NHS recovery support team. The performance data included figures from the South East Coast Ambulance Service.

The Select Committee heard

-       The service had made enormous progress

-       Successful recruitment of a new CEO

-       Following an earlier procurement issues, a new fleet of up to 70 ambulance would be in place by the end of the financial year.

-       Next year the service would remain in the recovery programme.

-       The main improvement focus and areas included culture and wellbeing, governance and patient safety

-       Delayed handovers at emergency departments was in part addressed with ensuring that patients were placed in the correct environment which would not always been the emergency department. Ambulance crews were made better use of community services. However there had still be a recording of 5238hrs lost in September and 218 days of staff time.

-       A slight decrease in demand had been noted with an expectation that numbers would increase during winter months

-       Instances of category 1 patients had increased by 7.5% impacted the ability to respond in the targeted 7 minutes.

-       Category 2 patients had seen a variation in demand and performance, the same was reported for categories 3 and 4.

-       Category 3/4 may not need an ambulance response and work continued to inform partners and patients of the right place, right time,  the emergency department may not be the most appropriate facility which had been improved with the single point of access all supported with the introduction of adult social care line housed in the control room. The combination had resulted in a reduction in ambulance dispatch with 50% of callers being signposted to an appropriate service.

In response to questions from the Select Committee officers reported that:

-       The service is responsible for call from the boundaries of Hampshire and Thames Valley, of up to 37% of their 999 calls. However patients requiring emergency care would be taken to the closet hospital to their home and this was not boundary related.

-       Officers agreed to provide a slide on ambulance breakdowns at their next Committee appearance.

-       Handover delays were damaging to the reputation of the service.  Working in partnership with the Team at Queen Alexandra as 5238hrs lost in September, which equated to a loss of 218 days of staff time had been unacceptable, similar delays had been seen in Southampton which was attributed to an error in systems.

The Committee noted the work undertaken and would continue to monitor progress.  

RESOLVED: That the Health and Adult Social Care Select Committee noted the update and requested further updates.

7a Building Better Emergency Care Programme.

The Select Committee received a presentation from Portsmouth Hospitals who reported on the progress and build of the new emergency department facility at the Queen Alexandra Hospital. Peter Ridley, Chief Officer and John Knighton, Chief Medical.

Officers outlined the background and requirement to the development 21 century facility that would be efficient and fit for purpose and Members heard that:

-       The development had been driven by, persistent ambulance delays and the  impact on the patient experience, despite staff, working hard to keep patients safe.

-       The original business case would allow for a facility that would be fit for purpose,  an improved space, faster access to diagnostics with rapid access to triage and a learning space for staff. In addition there would be a dedicated paediatric single point of access separate from the adult area, improved benefits in, infection control and a holistic approach to care working with the whole hospital environment which had been in part achieved with the input and experience of clinicians.

-       Transition plans would seek to embed new ways of working, as staff move into the new unit.

In response to Members questions, officers reported that:

-       There had been a recognition in the need for significant change in an approach to reduce ambulance handover times to move from 45mins towards the national target of 15 minutes. Officer made an undertaking to provide performance and evidence of the improvement of the patient experience at their next visit and a tour of the department was offered to Select Committee Members

-       The clinicians recognise that delays in treat and transfer would not be addressed in isolation by the new opening of a department and the key component to success would include working across the local healthcare landscape, managing demand at the front door working with system providers to facilitate timely discharge to optimise the appropriate movement around the organisation.

-       No plans to use the old building as it would take lots of funding to bring it back fit for purpose.

-       Planning for the varied demographic in the catchment area included a focus on the premise of the patient in the right place at the right time, working with public health and ICB colleagues to plan access to primary care and appropriate access in the acute setting

-       The local Portsmouth HASC are also scrutinising the success of the facility, Members would be keen to hear from them.  

RESOLVED that the Health and Adult Social Care Select note the building better emergency care update.

To consider and approve the Health and Adult Social Care Select

Committee Work Programme.

The Select Committee agreed to monitor capacity at the Emergency Department located at Queen Alexandra Hospital to determine if the needs of the population would be met and welcomed an invitation to visit the unit.

Following changes in community transport, the Select Committee would request an update to seek assurances regarding the future impacts on children and vulnerable residents.

RESOLVED: That the Health and Adult Social Care Select Committee

Agreed potential items for the work programme that would be prioritised and allocated by the Chairman of the Health and Adult Social Care Select Committee in consultation with the Director of Adults’ Health and Care.