Agenda and minutes

To received any apologies for absence.

An apology for absence was received from Councillor Cynthia Garton, Councillor Andrew Joy and Councillor Phil North.

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 5 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.

Declarations of interest were received from:

Councillor Andy Tree in respect of agenda item 6a “Whitehill and Bordon Health and Wellbeing Hub Update” in his capacity as Deputy Leader for the planning authority.

Councillor David Harrison in respect of agenda item 6b “Cowlin House Update”, in his capacity as a County representative.

To confirm the minutes of previous meetings held on

-       3 September 2024 (attached)

-       17 September 2024 (attached)

-       15 October 2024 (to follow)

Minutes of the meetings held on 3 September, 17 September and 15 October were agreed and signed as a correct record.

To receive any announcements the Chairman may wish to make.

Building Better Emergency Care

Dr Knighton, key clinicians and other medical staff welcomed the HASC Chairman and gave a guided tour of the new emergency facility at the Queen Alexandra Hospital in Portsmouth. The department was impressive in its building design and the benefits of the visit would assist in future questioning when the Trust report back to the HASC. For those Members that were unavailable on this occasion, a second visit is being planned for the New Year if any members wish to attend.

Primary Care Joint Reference Group

The Chairman and the Director of Public Health met with lead Hampshire and IOW ICB officers to review the group’s terms of reference, remit and objectives.  A meeting would be arranged and those Members of the HASC that expressed an interest would be approached to join.

JSNA Training Session

The Director of Public Health agreed to deliver an interactive training session to assist Members in the future scrutiny of the Joint Strategic Needs Assessment (JSNA). A date would be circulated to Members in due course.

Winter Pressures

The County Council had held discussions with local charities and community organisations to promote Pension Credit uptake, which included Citizens Advice, the Hampshire’s Council for Voluntary Services Networks and those organisations that worked to support older adults at increased risk. All were willing and already promoting the uptake and where necessary were supported individuals with their applications. The Community Wellbeing Worker service that supports social work teams in helping people maintain their independence had also ensured that pensioners who were entitled to Pension Credit were supported to claim the benefit.

The number of impacts of cold weather and winter on the health of older people and those with pre-existing and chronic medical conditions that are at a higher risk of increased incidences of heart attacks, stroke, respiratory disease and falls are well known and researched. The Public Health team produced a weekly update on the circulating infections and as a committee the HASC recognised the importance of the reduction of the risks associated with exposure to cold weather and included vaccinations.

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.

The Committee received a report (item 6 in the minute book) which provided

Members with information about the issues brought to the attention of the

Committee which impacted upon proposals to vary health services in Hampshire as follows:

a. Whitehill and Bordon Health and Wellbeing Hub Update

b. Crowlin House Update

The Chairman welcomed Lisa Medway and Martyn Rogers of Hampshire and Isle of Wight Integrated Care Board (HIOW ICB) and invited them to provide the Select Committee with their presentation.  Giving some context, it was reported that NHS Hampshire & Isle of Wight Integrated Care Board (ICB) is working with the Whitehill & Bordon Regeneration Company (WBRC), East Hampshire District Council (EHDC), NHS providers and other partners on the creation of a new Health Hub at Whitehill & Bordon (the Health Hub).

The purpose-built health hub would combine primary medical care (provided by

Badgerswood and Forest GP Surgery), community pharmacy service (provided by Chase Pharmacy Limited) and community health services currently delivered from the Chase Community Hospital (CCH) onto a single site, located in the new town centre would provide a vital part of the wider regeneration plans for the area. Discussions regarding lease agreements would be concluded in December.

As part of the reported key milestones in January to June the Trust would seek to enter into a procurement agreement to engage contractors and to discuss the construction design with completion of the build and anticipated opening of the facility in 2026/2027.

In response to Members questions the Select Committee heard that

-     By way of assurance to local councillors and residents, it was confirmed that

lengthy discussions with the prospective GP surgery continued but had yet to result in a lease agreement being formally signed; however, officers were confident that the agreement would be signed and were working with the practice to realise this. Once agreed the practice would relocate into the hub with services to enhance the patient experience and convenience to include pharmacy and a range of mental health support for older and young adults.

-     An increased patient list would enable the practice to create an attractive prospect for those clinicians’ seeking employment, and to keep pace with patient demand.

-     In appreciation of the future increase in housing and developments of the local plan, the clinicians and providers were looking at different ways to deliver innovated care.

-     In a bid to resolve potential issues with patient access and extended transport concerns, a change in the service model would include services made available from varied locations, for example, physiotherapy would be delivered at the hub supported by gym access via health centers, this would allow for patients to be signposted to the correct place.

-     Members were concerned that planned increases in the local population, and the loss of a larger space at Chase Hospital for the provision of health services in future would result in a significant gap in access to services. Officers confirmed that in the immediate future, once vacated there were no plans to repurpose the Chase Hospital site, and the asset would be returned to the NHS Properties Ltd.

-       Commitment to climate change had been a consideration, the target for all NHS estates would be a rating of net zero and officers agreed to provide further information.

The Select Committee had several concerns and requested officers provided a written response to the following: 

-       An update regarding the outcome of discussions with the GP surgery and any progress in terms of the lease agreement.

-       Outcome of any public consultation regarding the impacts of access and transport journeys to the new hub.

-       The future of the decommissioned hospital site.

-       In terms of climate change, how would net zero be achieved with the consideration of energy implications as patients and staff would need to undertake additional travel using more energy and the production of increased omissions.

The Chairman concluded that all points had been noted and looked forward to hearing future updates.

RESOLVED:

The Select Committee noted the update and progress of the development of the Health and Wellbeing Hub.

The Chairman invited officers of Hampshire and Isle of Wight NHS Trust to present the report which gave Members some background to the provision of residential services currently provided at Crowlin House and the recommendation to cease care at the home in March 2025; when a new model and more appropriate level of care would be established. The purpose of the care home had been to provide accommodation for people that had their right restricted under the Mental Health Act who required personal care in a non-clinical setting. Over time the step-up and step-down care for individuals close to completing their rehabilitation and recovery goals had become outdated and the model of care did not reflect value for money. It was suggested to replace this model with an innovated way to support those preparing for independent living in the community.  

Adult Health officers in conversations with NHS colleagues regarding Crowlin House were conscious that the future plans for the facility were not endorsed by all Hampshire residents; but reported to Members that the Mental health investment had been ringfenced and would be repurposed and targeted to the areas and people of greatest need and support, the detail of future options would be reported back to the Select Committee. The report would feature the recovery and reablement approach to supporting patients in addition to a focus on the prevention of acute mental health crisis. 

RESOLVED:

The Select Committee noted the update, and outcome of the consultation exercise including the future provision for residents as they transition once the facility ceased to operate on 31 March 2025.

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

The Committee received a report (item 7 in the minute book) which provided

Members with information about the issues brought to the attention of the

Committee which impacted upon the planning, provision and/or operation of

health services within Hampshire, or the Hampshire population as follows:

a. Dentistry Update

b. Primary Provision

The Chairman welcomed James Roach of the Hampshire and Isle of Wight Integrated Care Board who gave a presentation. It was reported that there had been positive developments since the last appearance before the Committee.

The Select Committee heard the following detail:

-       There had been an increase in residents accessing the service and that officers were attempting to stabilise future provision. 

-       The mobile dental unit continued to be a real success with 14,000 additional treatments including the identification and referrals of urgent and complex cases.  

-       To support the continued recruitment and retention, potential clinicians were offered golden hellos and the option to receive relocation costs.   

-       Future plans in Portsmouth similar to an existing model in Liverpool, regarding the establishment of a dental school to enable further dental development.

-       The success of dental activity procurement on the Isle of Wight will be mirrored in Hampshire.

-       As part of outreach work and to promote dental and oral care a programme of visits are scheduled in local schools.

Following questions from the Select Committee, Members heard

-       The vision for success would include continued patient access to a NHS dentist to support this the ICB remained committed to fund dentistry in the coming year and in line with the Government’s ambition to increase numbers of NHS dentists against those choosing to go into private practice, to support dentists to attract new patients, while remaining realistic that some practices may not currently have capacity to accept new patients.

-       In consideration of the relationship between acute and community dental settings, officers confirmed that there is a need to increase the urgent and 111 provision to ensure that issues are dealt with more appropriately in the community and to streamline the transition from primary care into secondary.

-       An increase in a single point of access should relief pressures on dentists cancelling appointments at short notice.

-       Officers recognised parts of Hampshire were not served by the mobile dental unit and would speak to the provider to expand the service to other areas across the county and would investigate easier access and promotion of the service.

-       A range of procurement options were being explored to address access issues for those residents in most deprived areas.

-       National data had been available when capturing patient numbers, a focus on local figures would provide information on how Hampshire is coping in those areas that are seeing increased housing development. However, in the absence of a demand profile it would be difficult to make assumptions on how many clinical areas are required to support future provision.

-       A breakdown of Dent Aid would be shared with Members once this information becomes available.

The Select Committee were encouraged by the work and progress made.

The Health and Social Care Select Committee

RESOLVED: To note the report and update of dentistry and dental services available in Hampshire.

The Select Committee received an update from the Hampshire and Isle of Wight Integrated Care Board in relation to pharmacy provision.

Officers reported that in general terms Hampshire and the Isle of Wight had greater access to pharmaceutical support than in many other parts of the country, however it was noted that not every town or village had a dedicated community pharmacist located in their area. It was reported that the primary care recovery action plan would seek to address some of the access issues which have resulted from recent pharmacy outlet closures, this was due in part to the business element of the service experiencing medication shortages which resulted in huge financial risk. As the outlets were runs as individual businesses separate to the NHS, the ICB had no powers if a pharmacy decided to close. Planned community health care would be looking at the opportunities for GP and Pharmacy outlets to build stronger co-dependance in a bid to create an environment that would improve access and enhance the patient experience. 

To provide a more accurate picture the ICB would look at mapping the number of pharmacies and attempt to understand the reasons driving the closure outlets. Members called for a varied and increased communication presence to support those digitally deprived residents to alert them to local closures.

Members were concerned that some pharmacy outlets did not provide full or appropriate areas for residents to have a private and confidential consultation with a pharmacist.  Officers reported that a minimum standard and level of expectation was in place and would feedback Members concerns locally.

The Select Committee had noted the enormous progress and the ongoing work happening in the community to address the challenges of access, supply and demand and were conscious that ICB milestones are yet to achieved. 

The Health and Social Care Select Committee

RESOLVED: To receive the report and noted the update of pharmacy services provided in Hampshire and the Isle of Wight.

To consider a report of the Director of Adults’ Health and Care.

The Director of Adult’s Health and Care was invited to present her report which provided an update and reassurances regarding the programme of proposed service changes to adult residential care.  As previously reported care home closures (Copper Beeches, Cranleigh Paddock, Bishops Waltham House, Green Meadows, and Solent Mead (both the home itself and the Day Service)) and the transitional planning arrangements were shared. Future arrangements would see a combination of Hampshire run and private care home facilities.

Staffing considerations included confirmation of voluntary redundancies and redeployment. Residents and families may not have initially been convinced by the relocation but understood the reasons for the change.

Contractors had been engaged and working with Hampshire 2050 lead continued to consider the strategic options such as decommissioning, site restrictions and titles etc.

In response to Members questions, officers confirmed that AI had been a consideration and was being explored to support delivery of services and that over time would present an affordable option in supporting a reduction in clinical intervention.   

RESOLVED:

That the Health and Adult Social Care Select Committee:

1.    Noted the detail regarding the robust and sensitive management of the closures of five residential care homes: Copper Beeches, Cranleigh Paddock, Bishops Waltham House, Green Meadows, and Solent Mead (both the home itself and the Day Service).

2.   Noted the Care Home Investment Programme continued to make progress in the delivery three new care homes and modifications/expansions to three existing homes, all of which will cater for Hampshire residents with a range of complex dementia and nursing care needs.

To receive a report of the Director of Adults’ Health and Care.

The Director of Adults’ Health and Care presented a report that provided the Health and Adult Social Care Select Committee with an overview of the national arrangements whereby the Care Quality Commission (CQC) would assess and rate the quality and performance of Local Authority Adult Social Care teams. The background of arrangements were provided and an explanation of how Hampshire Adults’ Health and Care were preparing for the assurance assessment for the first time.  At present no date for an inspection had been indicated by the CQC.

The Assistant Director outlined the framework and structure the CQC would focus on to measure performance of local authority teams.  The categories had been grouped into 4 main themes, these were, work with people, provision of support, ensuring safety within the system and a demonstration of strong leadership. Hampshire awaits notification of the inspection but continued to prepare behind the scenes. A Practice Improvement Network included discussions with the senior management team and the CQC Steering Group review how the service is responding against the 4 themes and focus areas and the importance of feedback and intelligence from Members incorporated and formed part of future content. Action plans and areas of governance were reported to the Select Committee and this information is updated regularly to remain on target in response to the pending CQC inspection.

The discussion moved to care package assessment and reassessments, to ensure that the appropriate levels of need and support are met. In a bid to ensure productivity and mindful of costs, online assessments were offered in the first instance before moving to face to face for those with digital challenges.

In terms of value for money and the best use of resources, this would not be a feature of the inspection and review.  However the Cabinet and officers had commissioned auditors to ensure that the County Council had made the best use of available resources and steps had already been taken to ensure future value for money. 

RESOLVED:

That the Health and Social Care Select Committee

1. Noted the report and acknowledged the work undertaken by the Adults Health and Care Directorate to prepare for the CQC assurance process.

2. Would promote awareness of the guidance from CQC on the role of local democratic leadership? in respect to the assessment framework across Adult Social Care bringing insights into local people's experiences and outcomes of adult social care in Hampshire alongside the Director of Adults, Health and Care.

3. Noted the positive strengths identified within the recently published Local Account whilst also bringing scrutiny to the areas which have been identified as needing improvement.

To receive a report of the Director of Adults’ Health and Care.

The Chairman invited the Director of Adults’ Health and Care to introduce the report which provided the Select Committee with an update in respect of the local authority responsibilities to monitor the social care market and its safeguarding vulnerable adults.

Members heard that the annual report included the following headlines

-       An increase in Section 42 inquires rates

-       Successful use of safeguarding adults’ tools for senior social workers

-       Working closely with UK immigration to ensure that good arrangements are in place

-       An increase in safeguarding hubs

-       A demonstration of strong performance and commitment to the service

In response to Members questions, officers reported that the increased in over reporting had been preferable to under reporting and by streamlining categories appropriate enquiries would be taken forward ensuring that no referrals would be missed.

In terms of training a 3 day course had been offered to ensure that all staff were up to date.  

A amendment in the Mental Health Act would see a reduction in the potential to detain or section those in crisis, however there are community alternatives available which are appropriate to support and signpost those clients which would require additional mental health social workers to enable the increased community activities.

. 

RESOLVED:

That the Health and Adult Social Care Select Committee noted:

1.    The positive progress and strong performance of the Directorate to keep adults at risk safe from abuse and/or neglect, whilst acknowledging ongoing risks to fulfilling statutory safeguarding duties in the context of increased numbers of safeguarding concerns being reported.

2.    The commitment of a wide range of Adults’ Health and Care staff, and wider partner agencies, to delivering robust safeguarding arrangements in Hampshire.

3.    The contribution of the Hampshire Safeguarding Adults Board (HSAB) to safeguarding strategy, assurance, and the development of policy across the four local authority areas of Hampshire, Portsmouth, Southampton, and the Isle of Wight.

4.    The work of the Provider Quality Team and the associated Quality Outcomes and Contract Monitoring Framework (QOCM) to provide market oversight data and intelligence, support qualityimprovement in the independent market and to undertake due diligence activities for newly commissioned Adults’ Health and Care contract frameworks.

To receive a report of the Director of Public Health.

The Director of Public Health introduced the purpose and responsibilities of the Health and Wellbeing Board and outlined the content of the annual report.  The Health and Wellbeing Board remained a statutory body, and a range of initiatives had been undertaken since the last presentation. 

The Select Committee heard that:

-       The new local Health and Wellbeing strategy once complete would be presented to the Select Committee  

-       There had been evidence of the residents of Hampshire and the Isle of Wight enjoying healthier and longer lives which could be demonstrated by the improvement in health outcomes for all, smoking cessation has been one of the 5 main health missions.

-       In the absence of a measurements of happiness, mental wellbeing had been monitored as an alternative.  

-       Funding had been made available to groups to encourage and increase levels of activity these included Energise Me and the support to women to feel safer in the streets to take part in activities in open spaces.

RESOLVED:

That the Health and Adult Social Care Select Committeenote:

·         The update, progress, and upcoming priorities of the Board’s work.

·         That the annual report that has been signed off by the Chairman and agreed by partners of the Health and Wellbeing Board.

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

The Select Committee discussed dentistry and pharmacy access in the North of the County and would welcome a further update.

The Chairman advised that the Hampshire Together JHOSC awaits the Spring announcement by the Government when it is hoped that the Hampshire Together development would be included in the list of 40 hospital development programme and be authorised to proceed.  

Primary care in Hampshire had been the subject of a strategic review, the Reference Group established by the ICB would include Select Committee membership. The ICB in collaboration with HCC officers continued to work on recommendations and prioritise areas of concern.

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.