Agenda and minutes

To receive any apologies for absence.

Apologies were received from Councillors Adam Carew, Tonia Craig, and Rhydian Vaughan. 

Also present at the invitation of the Chairman: Councillor Liz Fairhurst, Executive Member for Adult Social Care and Health, and Councillor Judith Grajewski, Executive Member for Public Health.  

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.

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. 

Councillor Dominic Hiscock noted that his wife is a consultant radiologist at University Hospital Southampton.

To confirm the minutes of the previous meeting.

The minutes were agreed with the revision of a typo “do not” on page 11 of the minutes in the Agenda Pack.

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:

·         The Chairman noted that Cllr Rosemary Reynolds had stepped down from her position as a co-opted Member on the HASC and wished her the best. 

·         The Chairman welcomed Cllr Rod Cooper replacing Cllr Marge Harvey on the HASC who was elected as Vice-chairman of Hampshire County Council for 2020/21.

·         The Chairman congratulated the NHS on its 72nd anniversary.

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.

a.    Modernising our Hospitals and Health Infrastructure Programme - Hampshire Hospitals Foundation Trust

b.    Building Better Emergency Care Programme – Portsmouth Hospitals Trust

a. Modernising our Hospitals and Health Infrastructure Programme - Hampshire Hospitals Foundation Trust 

Representatives from the Hampshire Hospitals Foundation Trust outlined accelerated plans for modernizing services with £5 million received from the Health Infrastructure Programme (HIP).  This funding is a catalyst for much needed and multifaceted changes in primary care, mental health, a new midwife unit, ambulance services, to the meet the changes and challenges of the growing population. 

Building improvements come at significant cost and have been identified to be on the plan.  These changes, implemented in close collaboration with partners, will allow for the provision of services closer to home and benefit patients and staff in terms of wellbeing, flexible for future needs, and even in addressing pandemics.  

Engagement has continued through June and July alongside considering various sites which will be reviewed in September with stakeholders and a pre-consultation business case for approvals with formal consultation to follow.

The clinical vision and focus are for the right care in the right place at n the right time and the capacity to care for people using digital technology and innovation with support to access services quickly to maintain their health.  Centralized emergency services for offering the best care and outcomes with an outstanding, brilliant staff who can be retained and providing high quality innovative care with a focus on research and training. 

Covid has accelerated working in new ways and connecting services for the better.  The joining up of services and users needs to be an equal partnership in this journey.  Slick, efficient, and first-class services will help patients feel they are in control of their lives again with the support of health care partners and adults’ services.  There is a need to ensure that the new ways and technologies adopted will develop and nurture the right relationships in providing care and services.

Currently consultations are at a midway point with staff and public using video meetings and new ways of engagement.  It has been possible to reach more residents and to run daily meetings with different parts of the geography and various groups and partner organisations in north and mid-Hampshire.  

In response to questions, Members heard:

While some services will be digital, a location hub is necessary for clinical services.  Similar endeavours around the country are being looked at for examples as this is a long-term opportunity to make significant improvements.

With regards to the development of diagnostic services post-Covid, they may be helpful in general practices and community care locations.  However, the picture is evolving, with each aspect of diagnostics being considered, alongside innovations to meet a national need for diagnostic hubs.  

In terms of timelines, this project is different from previous ones undertaken in that it is a government led initiative and plan, where current infrastructure is no longer fit for purpose.  A lot has been learned from previous endeavours and with the integration of health and social care the collaboration and partnership has deepened.  Rethinking delivery of all services within the accelerated  ...  view the full minutes text for item 205.

To receive an overview on the HIOW system approach to COVID and work completed as part of the Local Resilience Forum response.

To receive Trust specific written updates from:

a.    Hampshire Hospitals Foundation Trust

b.    Southern Health Foundation Trust

c.    Portsmouth Hospitals Trust

Representatives from Hampshire and Isle of Wight (HIOW) organizations provided an overview of service changes and highlighted developments during the pandemic.  

Members heard that healthcare organizations and staff appreciated the “thanks” they had received and have been working hard with colleagues in Social Care, Police, and Fire.  All have been grateful for the public’s help in adjusting how they accessed services.  Residents adapting quickly and following the guidance has been key.  

The pandemic has been a major incident and one that has been ongoing for a long period of time.  The aim has been to prepare and plan for the reasonable worst case scenario whilst hoping for the best.  Capacity has been provided where needed and managed in new ways.  Changes that have been on the list for years, took place in 2-3 weeks.  It was imperative to maintain critical services and restore them, e.g. carefully rescheduling operations, considering PPE and social distancing needs.  Patients were quite anxious initially to come into the hospital, but the hope is that there has been a shift in thinking and they now feel safer returning.  

In order to exit the lockdown safely and prevent a second outbreak, the guidance and safety measures need to be followed.  While numbers have dropped, Covid is still active.

Different agencies have been working well together in unifying understanding and action.  Covid outbreaks have been less clear and building urgency in communities has been critical.  Maintaining critical services in the priority areas of support have been key, including protecting the vulnerable and keeping them safe and maintain public order. 

Work must continue in that perspective and with effective precautions.  Careful plans are now being put into place for a new normal while watching out for the next wave.  The reasonable worst case is still on everyone’s minds and they are ready for quick and critical fact-based decisions even with scant information but in the right context.  

The real thing is often never quite like the exercise and Covid has had a life changing impact.  However, it has been a privilege to come together with colleagues and organizations focused on issues as one team while maintaining the sovereignty of each team.  

Upon clinical reflection, there have been about 2 million people affected including those who have been tested and those whom providers suspect may have been infected.  There are high numbers of patients in some areas, fewer in others. There has been a fairly uniform experience overall with anxieties about outbreaks and hotspots.  Approximately 5-10k residents have died naturally and 1400 of those of Covid in Hampshire and Isle of Wight.  Many were elderly and frail so there has been some crossover in those areas.  

Hospital resiliency was maintained, and capacity was always available against anticipated numbers.  This is a tribute to the integrated work that goes on with partners and the community response.  

While there has been some alarm about care homes, work with social care and care home colleagues continues alongside the restoration of critical and then  ...  view the full minutes text for item 206.

To receive an overview on the three different aspects in relation to COVID-19: the pandemic context, the impact on health and wellbeing, and the development of Outbreak Control Plans.

The Director of Public Health provided an overview of the Outbreak Control Plan.  Members heard that data is being evaluated from the very beginning in terms of who is receiving it, how it is being measured it, and with 3358 people having been diagnosed as of 8th June.  

Testing developments are being scaled up via NHS and with additional providers from the private sector and military.  Initially, it was unclear who would be tested, but there is more clarity now.  The mortality rate is actually closer to 1%.

Understanding the impact on health and wellbeing from a national perspective as well as the effects of delays, death, and disease will be critical.  Mental health issues and the bereavement process will be looked at in LRF work across Hampshire including managing worries, issues, and accessing the support needed.  

The Health Protection Board and a Member led Board are being set up to defend against future outbreaks.  There have not been pandemics at this scale in recent history and work is progressing with partners to provide assurance for issues across borders and manage those for Hampshire.  Further clarity is pending on the remit of the new funding to ensure the right structures are in place to manage risks.  

There will be more local ownership of testing, underpinned by local data rather than nationally led sites.  More results at the local geography level will help audit potential outbreaks while providing support for vulnerable residents and continued collaboration with partners and local leadership.

In response to questions, Members heard:

With regard to PPE the early days were in common with rest of country in terms of being unprepared and having a “just in time” approach but is now ready for a potential second wave or a new pandemic.  There is sufficient capacity and stock for the future.  LRF support is in place as well as mechanisms to support care and NHS sectors with help from Public Health.

The current evidence is that young and school age children are less affected by the virus.  Children being low spreaders and using consistent bubbles will help protect the staff.  Good ventilation and height difference will help in some cases, but teachers will need protection.  Testing for the bubble along with the staff will only be undertaken if there are symptomatic cases.  

Rebuilding public confidence in returning to hospitals will be critical.  Close collaboration is continuing with NHS and work taken forward to support and mitigate any new outbreaks.  Hospitals are conducting pre-admission tests and ensuring Covid wards are kept separate, has had a remarkable effect in preventing cross contamination and providing protection.  

Upper tier local authorities now have a plan in place and while there will be updates, a link to the plans on the website will be circulated via email following the meeting. 

Mental health and wellbeing issues and the ongoing low-level anxieties.  There are some not shielding who are still not wanting to go out.  It has been identified as issue to better understand prevalence  ...  view the full minutes text for item 207.

To receive an overview of the response and support provided across the county of Hampshire to vulnerable residents and people supported by adult social care services and the moves toward recovery of our services and usual support services.

The Director of Adults’ Health and Care provided an overview on welfare response and arrangements overseen by the Local Resilience Forum.  

Members heard that the response has been supported by partners with close collaboration between HCC, 4000 volunteers, the Voluntary Care Sector (VCS), NHS, districts, and boroughs sharing best practices, collaboration, learning, coordinating the response.  Being a large County Council with 11 districts and boroughs, this required swift and concerted efforts.  

A significant number of vulnerable people were helped alongside older adults and existing service users.  HCC care services and independent providers used a two-pronged approach to provide support with a comprehensive communication strategy and social media advertising leading to 13 thousand vulnerable residents reaching out.  

Services were provided through local response centres served by district and borough councils, offering additional food boxes due to restrictions or in the early days including residents who were not entitled but still experiencing hardship.  The links between districts and food banks have been key, easing and oiling the collaborative relationships around operations.  

With partial easing of arrangements for the shielded including food boxes is expected to end soon, people will need support to rebuild their independence, access provisions and also manage anxieties.  There is a need to reinstate services for service users that were ceased due to necessary social distancing.  Increase in the emergency provision of mental health concerns and care for the vulnerable will be important to recovery.  

A special focus will remain on those groups hard to reach in Hampshire including supporting domestic abuse victims, rough sleepers, and those with substance abuse issues.   There is a need to flex quickly and ensure business continuity as much as possible, such as moving to virtual work to ensure statutory services continue but also taking steps to restore services for those that are paused.  In line with Outbreak Control Planning, this is an opportunity to develop a recovery plan based on lessons learned and considering significant workforce aspects.  Unparalleled developments of the pandemic led to a continuous improvement plan.  Reflective sessions have been planned to look back over what has happened before looking forwards.

In response to questions, Members heard:

While there were some initial local challenges or lack of coordination, volunteers have made an incredible impact and food banks were generously helped by grocery stores.  

The government shared information about those vulnerable but this came through in parts across several weeks leading to challenges in coordination for response across a challenging geography.  Grassroots parish and district work and Facebook groups were encouraged but there was a need to introduce consistency, safety, and contend with significant data sharing restrictions.  Not all shielded residents were registered or had not consented to sharing information.  It remains a massive testament to the volunteers of whom there were more than there was demand.  

Relationship managers were introduced for all districts and boroughs.  In terms of local response, there was spontaneous volunteering and working with partners but over a few weeks, there was a need to ensure that the  ...  view the full minutes text for item 208.

To receive an overview of the progress of Covid-19 and its significant impacts upon the care home sector in Hampshire during the period March 2020 to 12 June 2020.

The Director of Adults’ Health and Care provided an update on the Care Home Support Offer and echoed the Chairman’s sentiments in celebrating the NHS and highlighted that it is an anniversary of the foundations of social care as well.  

Members heard there has been an impact across all communities and staff in social care.  While there has been immense humanity, dedication, and skill evident in the sector, it is important to highlight that it is still in response mode and the pandemic is still very much active in communities.  

Across the 500 care homes in Hampshire, 449 deaths have been noted positive for Covid-19.  There are annual, seasonal, and monthly variations in the data and there has been a review of excess deaths in care homes.  While Covid-19 positive many be noted on the death certificate, it may not be the primary cause of death.  National testing reports from acute hospitals did not start taking place until mid-April and there may have been a larger Covid factor that was not captured at the national level until mid-July.  There is uncertainty for providers and an impact on financial sustainability, that has led to supporting the wider care sector. 

Cllr Hiscock left at this time.  

Care homes received emergency PPE until regularized supply was put into place and it was difficult to know with initial guidance, which PPE was for where and when.  There is a need for ongoing testing, with updates and reports from sector providers.  Staffing suffered from absences which was a key factor as the needs remained the same, with an increase in the overall costs to care homes.  There are a significant number of empty beds at the moment and with an impact in their income and bottom line, despite the hard work.

Announcements have been made by government regarding the national fund to support infection prevention and control in the care home sector.  Area CCGs, the CQC, and Healthwatch sit on the Board, among others, meeting weekly to provide support.  The goal has been to get this funding out to providers as soon as possible and slightly in advance of work that had to be done.  Positively, all audits that have been undertaken, reflected that they had complied with the grant conditions and within permissible spends e.g. it was not for void beds or PPE.  Every care home provider has received this support based on the number of beds.  Work is being undertaken to learn lessons at pace but in a way that is sensitive to the needs of individuals and families, to better understand the transmission and learn those lessons rapidly.  

In response to questions, Members heard:

Additional resources have been allotted for surcharges being applied for services. 

Testing prior to discharge has been ongoing but data can only be reported from 15th  April onwards.  In terms of preparing for the anticipated surge at acute hospitals, some 25,000 patients were discharged rapidly from acute hospital settings from March to create capacity into many settings.  Agency  ...  view the full minutes text for item 209.

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.  

RESOLVED -  

That the Health and Adult Social Care Select Committee:  

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

b.    That a Covid-19 Working Group be set up to consider the issues and help prioritise those that come to the full HASC.

The meeting closed at 2:10pm.