Agenda and minutes

To receive any apologies for absence.

Apologies were received from Councillors Martin Boiles and Steve Forster. Councillor Neville Penman, as the Conservative standing deputy, was in attendance in their place. 

Apologies were also received from Councillor Alan Dowden and Co-opted Members Councillors Trevor Cartwright and Alison Finlay.

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.

No declarations were made.

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 November 2017 were confirmed as a correct record, subject to the addition of Cllr Frankum’s apologies, 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:

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

Cllrs Keast and Harrison attended a meeting of the JHOSC on 12 December, where updates were heard from Dorset Clinical Commissioning Group (CCG), the affected Hospitals, Ambulance Trust and Local Authority on the progress of work undertaken on the CCG’s now agreed option to centralise urgent care at Bournemouth Hospital, and planned care at Poole Hospital.

The Dorset HOSC had made an outline decision to refer the review to the Secretary of State, and had put a recommendation before the JHOSC to support this referral (as all local authorities making up the JHOSC had not delegated their powers to refer to the Secretary of State for Health).  At the end of discussion on the issues, the JHOSC voted not to support the referral.  Since this time, the Dorset HOSC had decided not to progress a referral to the Secretary of State.

Further work was ongoing, specifically with the ambulance service serving the Dorset population, and a further meeting of the JHOSC would be held in due course.

Cllrs Harrison and Keast noted that this was a positive development for Hampshire residents.

Day Opportunities Consultation and Workshop

The HASC held a successful workshop on 7 December with officers from Adults’ Health and Care to understand proposals relating to day opportunities, and to work in groups to provide feedback and ask questions.  The outcomes of this session were compiled into a response from the HASC to the consultation, which had been circulated in its final form to Members.

The HASC were due to consider the final outcomes of the consultation at a pre-decision scrutiny item on 27 February, in advance of the Executive Member meeting on 13 March.

Working Groups update

The two working groups of the HASC, on social inclusion and sustainability and transformation partnerships, had both met and would report to the Committee in due course.

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

·      North Hampshire CCG and West Hampshire CCG: Transforming Care Services in North and Mid Hampshire - proposals

NHS NORTH HAMPSHIRE CLINICAL COMMISSIONING GROUP AND NHS WEST HAMPSHIRE CLINICAL COMMISSIONING GROUP: TRANSFORMING CARE SERVICES IN NORTH AND MID HAMPSHIRE

The Chief Executive Officers from Hampshire CCG Partnership (representing North Hampshire CCG) and West Hampshire CCG presented a report on Transforming Care in North and Mid Hampshire (see report, Item 6 in the Minute Book).  Also in attendance was the Chief Executive of Hampshire Hospitals NHS Foundation Trust, the Programme Director for Transforming Care Services, and the Clinical Chair of North Hampshire CCG, in order to answer questions from the Committee.

Members heard that the CCGs and Trust had been working closely together, as well as with other acute hospital trusts and social care, in order to arrive at the proposals considered on 30 November.  The papers considered at the joint meeting in public of the two CCGs highlighted the significant work that had been ongoing, including progress made by the clinical reference groups and stakeholder groups.  The proposals had benefited from input from both University Hospital Southampton NHS Foundation Trust and Frimley Health NHS Foundation Trust as the two acute services potentially impacted by any change to how Hampshire Hospitals are organised, as well as that from clinicians and GPs, and representatives from both Winchester and Basingstoke Councils.

Through joint working, a shared vision for health and social care had been developed, which focused on both in and out of hospital care.  This vision would meet best practice and enable access to specialist care for the sickest and most dependent patients.  It also aimed to tackle the challenge of a changing population demographic in Hampshire, with data showing that there was an increase of people in Hampshire who are ageing and suffering from long-term chronic conditions.

The CCGs and their partners recognised that there had been a lot of changes since 2012, not least the current financial situation which was much more challenging for the NHS.  Since this time, there had also been the publication of the national NHS strategies on the ‘Five Year Forward View’ and ‘General Practice Forward View’, which had impacted significantly on how service changes are delivered.  These developments in NHS policy had also introduced the need for hospitals to provide specialist care 24 hours a day, seven days a week.  Greater working between the NHS and social care through the Better Care Fund was also an important development, with much more impetus on working in partnership to provide joined up care. 

For the reasons above, the CCGs had felt it appropriate to revisit the approach taken to reviewing services in North and Mid Hampshire, although it was appreciated that it had been a long journey to reach this point.  In reaching the most recent set of proposals, the CCGs had felt it important to engage with external partners to develop what the future of all services, including primary care and community services might look like, rather than a sole focus on acute services, and through this, a new hospital building.  A piece of  ...  view the full minutes text for item 45.

To consider the report of the Director of Corporate Resources and Director of Public Health prior to the decision of the Executive Member for Public Health.

The Director of Adults’ Health and Care, the Director of Public Health and a representative of the Director of Corporate Resources attended before the Committee in order to present the revenue budget for Public Health for 2018/19 (see report and presentation, Item 7 in the Minute Book).

The presentation considered by the Committee covered Items 7 to 9 on the agenda.

The presentation outlined the overall County Council financial position. The local government grant settlement announced in 2016 provided provisional figures for authorities for 2016/17 and the following three financial years, including 2018/19, to aid financial planning, and the settlement for 2018/19 was mostly unchanged compared to the forecast position.  Since this time, however, a two year pay offer had been made for local government workers of 2% per annum, and changes to the National Living Wage will affect the lower pay grades.  This pay award  was not previously factored into the County Councils Medium Term Financial Strategy, (MTFS), and therefore consideration would need to be given as to how to meet this ongoing cost pressure.

There will be a significant draw from the Grant Equalisation Reserve in 2018/19 in order to support the budget whilst savings are required as part of Transformation to 2019.  In a change from previous years, the Government has changed the Council Tax referendum cap, enabling a potential increase of 2.99% without consultation, plus up to 3% for social care (6% over a three year period allowed).  This development would be discussed by Cabinet in February.

A fair funding review had been announced by Government, which would see a consultation on how local government would be financed in future.  This review promised to implement any changes by 2020/21.  Also announced was a green paper on funding adult social care, although this would not result in any new funding in this area for 2018/19.

An overview of the Council’s reserves strategy and financial position was provided, which set out that of the £524.2m held, approximately £79.4m, or 15.1% of the reserves, were truly ‘available’ to support one-off spending, although most of this was already allocated.

For Public Health, the key challenges would be managing the ongoing planned reductions to the ring-fenced public health grant, whilst maintaining the mandated services required by statute.  It would be important to continue the prevention and intervention work around healthy lifestyles, including tackling childhood and adult obesity, smoking, and physical activity, in addition to the other priority areas listed.

In considering the wider County Council budget, Members heard:

·         That the assumption of a 1% pay increase for local government workers was appropriate as this has been the agreement for the previous few years.  The announcement of a 2% offer would result in a £5m pay-gap which would need to be met by the County Council’s budget.

In considering the more detailed Public Health revenue budget, and in response to questions, Members heard:

·         Any underspend on public health activities are held by the team locally to offset the cost of services in  ...  view the full minutes text for item 46.

To consider the report of the Director of Corporate Resources and Director of Adults' Health and Care prior to the decision of the Executive Member for Adult Social Care and Health.

The Director of Adults’ Health and Care and a representative of the Director of Corporate Resources attended before the Committee in order to present the revenue budget for Adult Services for 2018/19 (see report and presentation, Item 8 in the Minute Book).

Members received an update on progress against the ‘Transformation to 2019’ proposals.  As previously reviewed in September 2017, the savings for the County Council were £140m, and agreed in November 2017.  Departments would be using cost of change funds to help achieve the full savings, and where this wasn’t fully possible, funding from the grant equalisation reserve.

Members heard details on the proposed 2018/19 revenue budget for Adult Social Care, as well as the key departmental challenges and issues.  For 2018/19, it was expected that the increasing cost of care associated with growth in demand could be met within the £10m allocated per annum for this purpose.  The revenue budget included an allocation of £19.9m in a centrally held pot, which contained savings that had been achieved early, and the integrated better care fund budget which had not yet been allocated.

As there were no questions on this item, the Chairman moved to debate, where it was heard that although one member had a high level of confidence in the officers, they would not be voting for the budget as they did not agree with the approach to apportioning savings across all Departments.

RESOLVED

That the Health and Adult Social Care Select Committee support the recommendation being proposed to the Executive Member for Adult Social Care and Health in section 1 of the report.

To consider the report of the Director of Corporate Resources and Director of Adults' Health and Care prior to the decision of the Executive Member for Adult Social Care and Health.

The Director of Adults’ Health and Care and a representative of the Director of Corporate Resources attended before the Committee in order to present the capital programme for Adult Social Care for 2018/19 – 2020/21 (see report and presentation, Item 9 in the Minute Book).

Members heard details on the proposed 2018/19 capital programme budget for Adult Social Care, which included £481k for maintaining current operational buildings, and approximately £10.7m for the Disabled Facilities Grant.  Any underspend on the Extra Care programme would also be rolled forward into 2018/19.

In considering the more detailed Adult Social Care capital programme, and in response to questions, Members heard:

·         That the Disabled Facilities Grant was an annual payment received by the County Council, but passported on to the District and Borough Councils for supporting adaptations to homes, such as handrails and accessible washrooms.  The County Council’s role was to make sure the planned spend by the Districts and Boroughs is appropriate before the funding is released.

·         The Grant is allocated to each District and Borough Council centrally based on a funding formula; the County Council did not play any part in determining which authority received which settlement.

RESOLVED

That the Health and Adult Social Care Select Committee support the recommendation being proposed to the Executive Member for Adult Social Care and Health in section 1 of the report.

To consider and agree a revised framework for assessing substantial change in NHS provision.

The Director of Transformation and Governance’s representatives presented the updated Framework for Assessing Substantial Change (see report, Item 10 in the Minute Book).

RESOLVED

That the framework is agreed.

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).

It was agreed that a briefing on the strength-based approach in Adults’ Health and Care should be heard at a future health member development session.

RESOLVED:

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