Agenda and minutes

To receive any apologies for absence.

Apologies were received from Councillors Adam Carew and Jane Frankum. 

Apologies were also received from 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 27 February 2018 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:

Care Quality Commission Review

The final report from the Local System Review held in March would be available in June.  A summit was due be held, to which HASC Members would be invited. Details would follow in due course.

Working Groups update

The two working groups of the HASC, on social inclusion and sustainability and transformation partnerships, had both met.  Cllr Keast, who Chairs the Social Inclusion working group, provided a summary updating Members on the progress of this review, and Members would receive a fuller version of this briefing following the meeting. 

Briefings

An update on the move of the Kite Unit had been received and would be circulated following the meeting.

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 Action

• Hampshire Hospitals: Outpatient, X-ray and community midwifery services in Whitehill & Bordon: Reprovision of services from alternative locations or by an alternative provider
• Southern Health: Plans to develop Secure Forensic Mental Health and Learning Disabilities Services

Items for Monitoring

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

Hampshire Hospitals NHS Foundation Trust: Outpatient, X-Ray and Community Midwifery Services in Whitehill and Bordon:  Re-provision of Services from alternative locations or by an alternative provider

The Chief Executive of Hampshire Hospitals NHS Foundation Trust appeared alongside a representative from Hampshire CCG Partnership in order to speak to a report on service in Chase Hospital, Whitehill and Bordon (see report, Item 6 in the Minute Book).

Members heard that the Trust had chosen to appear before the Committee at this early stage, as the proposals had caused some concerns locally, and it was important to outline the reasons for proposing the withdrawal of some services from Chase Hospital.  The report considered these reasons in detail, but primarily they related to a reduction in the use of Hampshire Hospitals by those in the Whitehill and Bordon area as their preferred provider of acute secondary care services, which had reduced the number of outpatient and other specialty appointments being attended.  Most of the population in this area chose instead to receive services from the Royal Surrey, Frimley Park or Portsmouth.  The report covered travel times to these hospitals, showing that these services tended to be chosen because the acute services were closer to home than those offered by Hampshire Hospitals in Winchester and Basingstoke.

The reduction in the number of referrals was leading to reduced efficiency in clinical staff time, since they needed to travel from acute service sites in order to attend clinics in Chase.  The report showed that approximately 1.5 hours per session were lost through clinician travel, which could better be used at other sites to tackle rising waiting times and an increasing number of patients.  The Chase Hospital had a number of different providers operating from the same building, duplicating the same services, which was also inefficient; further thought needed to be given by the CCG, working in conjunction with providers, to see how the mix of providers could be adjusted to reduce these inefficiencies.  It was too early at this stage to report on whether any of the services that Hampshire Hospitals proposed to withdraw from the Chase could be replicated by another provider.

In relation to maternity appointments, expectant mothers were currently receiving antenatal appointments from Hampshire Hospitals midwives but choosing to have their babies at an alternative provider.  It was proposed that as most of these individuals were choosing to give birth in Royal Surrey County Hospital, it would make clinical sense for their maternity appointments to be supported by the Royal Surrey’s midwives.

The Chief Executive of the Trust noted the five tests of service change that the HASC needed to consider in coming to a view on the nature of a service change, and accepted that in relation to GP support, engagement and patient choice more work needed to be completed before the full picture was available.  It was also recognised that transport options from Bordon to Alton were limited and further work would need to take place around this.

The CCG and  ...  view the full minutes text for item 63.

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 NHS Trust: Care Quality Commission Re-Inspection – Monitoring of Quality Improvement Plan

Councillor Tonia Craig left at this point in the meeting.

Portsmouth Hospitals NHS Trust; Care Quality Commission Re-Inspection – Monitoring of Quality Improvement Plan

The Chief Executive of Portsmouth Hospitals NHS Trust and his representatives attended alongside a representative from Hampshire CCG Partnership in order to speak to the Quality Improvement Plan and related issues (see report, Item 7 in the Minute Book).

Members heard that a number of papers had been sent to the Committee including progress against the quality improvement plan, which was a detailed overview of all the actions being undertaken by the Trust.  This overview provided an indication of those actions that are on track and those where delivery required further action.  This spreadsheet was the same document made available to the internal Trust review group considering progress made against recommendations.  Also included within the papers were the outcomes and Trust statement on the Care Quality Commission (CQC) investigation into radiology services.

In response to questions, Members heard:

·      That the Trust received an unannounced inspection of its urgent care services in February which focused on the Trust’s response to winter pressures.  The Trust had been one of a number of Trusts inspected due to its status as a ‘high risk’ system. 

·      The CQC’s urgent care inspection report highlighted some areas of positive progress but was also clear on areas for definite improvement.  All the recommendations from this report had been picked up through both the quality improvement plan and the wider system improvement plan.  The Chief Executive was confident that those recommendations requiring urgent action had been implemented, and that the comprehensive inspection that had been undertaken in April and May would see improvements.

·      It had been three years since the Trust had last been subject to a comprehensive CQC inspection; the reports published since had focused on areas of the Trust’s activity but had not provided overall ratings.  The inspections were considering all elements of the Trust’s business, with the exception of gynaecology.  The inspection elements had finished in the last week, with the most recent visit focusing on whether the Trust was a well-led organisation.  It was expected that an initial draft report would be available towards the end of June.

·      The CCG had been involved in the oversight process, with a significant role in ongoing quality committees, and the Director of Quality and her team actively involved in assisting the Trust.  Meetings and the sharing of information took place both weekly and monthly, in order to ensure that actions are being completed.   The CCG continued their view that improvement was being evidenced in the Trust, and the new Board were committed to leading the Trust through its improvement journey.

·      At the last meeting where Portsmouth Hospital Trust appeared before the Committee, the issue of the urgent care department and acute medical unit’s estate was raised and discussion was held on whether works could be undertaken to improve the flow and layout of this area of the hospital.  This estate issue remained difficult to  ...  view the full minutes text for item 64.

To receive a presentation regarding the future model of care for Substance Misuse services in Hampshire.

Councillors Steve Forster and Jan Warwick left at this point in the meeting.

The Chairman agreed to take Item 8 out of order on the agenda.

Representatives of the Director of Public Health attended before the Committee in order to present an overview of the future Substance Misuse model in Hampshire (see presentation, Item 8 in the Minute Book).

The scope of the substance misuse service and the prevalence of alcohol and drug use in Hampshire were outlined to the Committee, as well as the impact such misuse has on families and communities.  The aim of the new Hampshire Substance Misuse Strategy was to prevent and reduce the harm associated with substance misuse (to individuals, their families and communities) and to increase the opportunities for recovery for those dependant on drugs / alcohol.

The priorities of the new service were outlined, including the key work stream of prevention and early intervention.  The key elements of the new model were highlighted, which included an adult substance misuse service, a specialist young people’s substance misuse service, and a pharmacy drug-treatment service.  Within these services would be a range of programmes and elements designed to provide an holistic service.  To this end, the successful partner providing the service, Inclusion, who were a Staffordshire-based service who held a number of substance misuse contracts across the country, had entered into a partnership arrangement with a number of other key providers who could provide support to those accessing substance misuse services.

The procurement of the new service had taken place throughout the summer and autumn of 2017 and would be operational from 1 July 2018.  As part of the re-commissioning of this service, work had been undertaken with service users and stakeholders to find out what had been working well, what the barriers were to accessing services, and what could be done differently.  These thoughts had been incorporated where possible in the new service model.  The new model also included a number of best practice tools, such as the ‘Don’t Bottle It Up’ alcohol test which helped individuals to identify personal substance abuse, and the provision of Naloxone in pharmacies and substance misuse services, which had anecdotally helped to reduce the number of opioid-related deaths in Hampshire by approximately 70 to date.

In response to questions, Members heard:

·      That Public Health work with licencing authorities and make recommendations on restrictions on licencing, in order to tackle issues such as binge drinking and premises that sell alcohol inappropriately.

·      Substance misuse during pregnancy is a key issue picked up through the substance misuse service, and Public Health work closely with health commissioners to secure these service, and to tackle how women with drug and alcohol issues can be supported throughout their pregnancy and postnatally.

RESOLVED

That the update is noted.

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 9 in the Minute Book).

RESOLVED:

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