Agenda and minutes

To receive any apologies for absence.

Apologies were received from Councillors Martin Boiles, Marge Harvey, Mike Thornton and Jan Warwick.  Apologies were also received from co-opted members, Councillors Trevor Cartwright and Alison Finlay and Tina Campbell who has stepped down. 

The Chairman welcomed Councillor Rhydian Vaughn in place of Councillor Steve Forster who retired.  The Chairman also welcomed Amanda Scally standing in for Jennifer Watts.

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.

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.

There were no declarations of interest.

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 4^th May 2019 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 the following announcements:

a. Welcoming Maggie MacIsaac as Chief Executive for Southampton City CCG  

The Chairman wished to congratulate Maggie MacIsaac in her new role but waited to do so as she was not in attendance.

b.  Welcoming Cllr Judith Grajewski as the Executive Member for Public Health  

The Chairman welcomed Cllr Judith Grajewski as the new Executive Member for Public Health who had taken over from Cllr Patricia Stallard.

c.  Orchard Close Task and Finish Working Group Update 

The Chairman provided an update on the Orchard Close Task and Finish Working Group that held its first Members’ meeting on Friday, May 31^st with Cllrs Briggs, Carpenter, Harvey, Thornton, Frankum, and himself. 

The Orchard Close Voluntary Sector, Carer, Service User & Officer Working Group met on June 15^th.  Cllr Jan Warwick will be joining the Members’ group from the next meeting as Cllr Marge Harvey had stepped down from the role.  

Both groups will continue to meet, collaborate, and explore options giving progress updates when appropriate and a report to the full HASC in November. 

d.  Beggarwood Surgery  

The Chairman provided an update on the Beggarwood Surgery in the North Hampshire CCG area which is seeking new providers as the current contract holder decided they no longer wanted to provide these services and have started the six-month notice period.  This has been a concern for local patients, and HASC has continued to closely monitor the developments.  The NHS has been working very hard with various agencies to maintain the services at Beggarwood Surgery.  The CCG has been invited to attend the September HASC with fuller and further particulars.  

Briefing: 

1. A health hub development update regarding Whitehill & Bordon Health Hub was shared via email with all HASC members.  This item went to HASC May 2018, with a September 2018 decision confirming substantial change, followed by a further update at the November 2018 meeting, and then February 2019.  The HASC will continue to track progress and request updates as necessary.   

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)    Integrated Primary Care Access Service

b)    Proposed Changes to the Mental Health Crisis Teams Across Solent NHS and Southern Health for PSEH

Items for Monitoring

a)      Integrated Primary Care Access Service

Representatives from the Fareham and Gosport and South Eastern Hampshire CCGs and Southern Hampshire Primary Care Alliance provided an overview of the partnership and service delivery.

Members heard regarding integrated care and the changes introduced and proposed next steps.  Previously, a complex range of services were offered that resulted in duplication and competition, as well as difficulties staffing that led to cancelled appointments.  Multiple sites were running with operational challenges and some services were also used more than others at various times.

In 2017, the government introduced new funding for GP extended access to run every day, including after hours and weekends.  New integrated primary care access service combines GP extended access service for out of hours, home visits, and urgent appointments.  A pilot reflected that users were prepared to travel and preferred a service that was flexible and not confusing to use with various locations and hours.

Upon the completion of contracts in June and in considering the services together alongside public engagement, the CCG decided to commission a single simplified service offering urgent or routine appointments during the day and home visits after-hours.  The GP Alliance was the only interested provider and awarded the contract.

Service hubs offer longer hours of care with a wider and enhanced range of health care professionals and easier access for users.  The improved IT system allows providers to access patient records after-hours including notes, results, ordering tests and referrals, increasing consistency and safety in patient care.  Continued home visits for those unable to travel and for mental crisis patients is through private provision of services.  The location and set-up of the hubs with GPs supporting nurses and NPs eliminates lone practitioner safety issues. 

There was not a great deal of time to mobilize these services but with stakeholder engagement, the changes were implemented in June.  Whitehill and Bordon was an area at issue and have asked the alliance to reintroduce the service for the hours that it was previously available.  Areas of difficulty and access will continue to be monitored and addressed.

In response to questions, Members heard:

·         Service in Whitehill and Bordon will be reinstated from 1^st August 2019 and had received positive responses in general.

·         Lots of work is being done around sharing information about the service and accessing it via 111 to help users know where to go when GP surgeries are closed to reduce the immense pressure on A&E.

·         More work will be done with local communities and especially the elderly, vulnerable, and those whose conditions may worsen with time.

·         The consolidated service will allow for consistency, strategic planning and fitting in with the NHS long term plan and alignment, with a secure place in the integrated care model going forwards.

·         Community engagement, lone provider risks, and practicalities of running services are all considered, but operating from privately owned sites has further resource implications and growth limitations.

·         This service is available to all patients offering routine appointments  ...  view the full minutes text for item 146.

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.

a)    CQC Update for Portsmouth Hospitals Trust

b)    CQC Update from Southern Health Foundation Trust

c)    CQC Inspection Report from Frimley Health NHS Foundation Trust

d)    CQC Inspection Report from University Hospital Southampton Foundation Trust

a)    CQC Update for Portsmouth Hospitals Trust

Representatives from Portsmouth Hospitals Trust presented a report providing an update on the action taken by the Trust in response to the areas the Care Quality Commission had identified as “Requiring Improvement”.  Members heard:

·         The Trust was taking a different approach to move to a culture of continuous improvement and engagement not simply due to CQC ratings, but from their own aspirations to provide excellent care.

·         A shared assurance and improvement programme with commissioners alongside heat map activity with CCGs and Healthwatch to agree collaboratively on concerns and address issues raised with an agreed plan for working together to investigate, respond, and measure improvements.

·         A quarterly programme of quality reviews and conducting mock investigations similar to the CQC with other partners in health and social care system to track and evaluate improvements on the ground with an agile and responsive programme of quality reviews.

·         Ward accreditation programmes and early visits to provide encouragement towards bronze, silver, and gold awards based on CQC metrics and locally raised issues.

·         An integrated joined-up improvement plan with activities will be key, rather than having various plans in response to feedback from CQC, local teams, and aspirations

Regarding ambulance delays, Members heard:

• Despite a capacity plan for winter pressures with added investment and resources, winter was challenging with a steady increase in daily attendance including older and more vulnerable patients.
• Significant improvements have been made to aim for a 93% occupation rate to weather the winter effectively.
• There was a deterioration in ambulance handover delays and requires a significant amount of work to improve.
• The older building layout not designed for nearly 400 attendants daily creates added challenges to deliver consistent flow with higher than 92% occupancy.
• 95% is the average occupancy and measure of hospital capacity with robust middle grade staffing overnight and support.
• The objective is to move towards upper quartile of national performance for ambulance delays which is ambitious but necessary to maintain.
• The necessary actions include continued commitment with consolidations and evidence-based improvements for the occupancy project, as well as proactive bed moving to decompress the emergency department at times of maximum crowding.
• The Trust have received 58 million for an emergency/urgent care rebuild and transformation programme over the coming years to fit current and new challenges
• Whole system response and data from past reviews revealed the 4 key drivers (population health and demand, emergency department processes, bed occupancy, and out of hospital service).
• A 92% occupancy goal to provide consistent flow, avoid ambulance holdups.
• Users need to know how to access emergency care and facilities with necessary support for people who are ready to go home.
• The immediate next steps include: discharge targets, reduce number of medically fit patients, increase paramedic access to alternative care, and implement agreed out of hospital schemes.
• Local health and social care partners (including the county), as well as NHS England and NHS improvement collaborations are underway.

In response to questions, Members heard:

• Every patient is triaged by  ...  view the full minutes text for item 147.

To receive an update on the Hampshire Suicide Audit and Prevention Strategy.

Members received a report and presentation from the Interim Director of Public Health regarding the Hampshire Suicide Audit and Prevention Strategy.  Members heard regarding the role of scrutiny in reviewing the strategy and the aim to reduce the rate of suicides and the effect of someone taking their life.  Every day in England around 13 people die by suicide and impacting on a further six people. 

Members heard that Hampshire have had a strategy plan before it was required, and it closely mirrors the national plan.  Most suicides happen at home, but extensive research has been undertaken to understand the people and circumstances.  The information from the audit sheds light on the correlation to key factors including poor mental health, and key social and life factors.  Sensitive reporting and language around suicide, such as using the word “dying” rather than “committed” is critical.  While Hampshire suicide rates are less than the England average the key aim is to lower the rate of suicides.  Prevention is a critical aim through understanding the challenges such as men being 3 times more likely than women, helping GPs understand and identify risks with patients, etc.

Members noted that the analysis was extensive and commended the team on their work and the significant task at hand.  In response to their questions, Members heard:

• The NHS is responsible for the health of those in the prison and the prison service have a robust plan for those at risk but once released they can benefit from mentors and Samaritans.
• Initiatives are in place for men’s groups to encourage them to improve the mental health of the population through an EU funded programme.
• Collaboration with Children’s Services, relationship and sex education will be mandatory from September 2020, teaching resilience and coping strategies.

Members noted the department and county’s care and commitment, and very much appreciated the Director’s engagement and support for the local community.  Members highlighted that in comparison to road safety numbers and accompanying budget, the budget for suicide prevention was lacking and needed to reflect its true magnitude.

RESOLVED:

That the Committee:

• Reviewed  the Hampshire Suicide Prevention Strategy for Hampshire.

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

·         A topical item was suggested regarding consultant surgeons and high earners whose pensions are negatively affected due to working with the resulting consequences of Hampshire residents not receiving timely surgeries. 

·         A 111 informational presentation was suggested and noted as being a useful topic for all members and recommended for a future Member Briefing.

RESOLVED:

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

Meeting closed at 1:11pm