Agenda and minutes

Minutes of the meeting held on 21 March 2023 (attached)

RESOLVED that the Minutes of the meeting held on 21 March 2023 be signed as a correct record.

Items which in the opinion of the Chairman should be considered at the meeting as matters of urgency.

No item was raised as a matter of urgency.

Members of the public may make representations/presentations on any substantive matter listed in the published agenda, as set out hereunder, relating to a specific matter or an examination of services or facilities provided or to be provided.

In accordance with the Council's Public Participation Rules, the Committee

received and acknowledged representations from Geralyn Arthurs

in regard to the Teignmouth Community Hospital (Minute *110 refers) on the case for its retention and referral to the Secretary of State for Health and Social Care; and  

(i) Richard Jones, (ii) Peter Stephenson, (iii) Si Johns, (iv) Councillor M Pearce; and (v) Alison Fewins, in regard to the Homelessness 18+ Contract (Integrated Adult Social Care Consultations) (Minute *111 refers) on the consultation process, the level of engagement with service users, impact of the proposed grant reduction and the need for its retention; and

(vi) Sonia Gould; (vii) Anna Fors; and (viii) Councillor Terry Elliott in regard to the  North Devon Link Centres (Integrated Adult Social Care Consultations) (Minute *111 refers) on the consultation process, the level of engagement with service users, the impact of the proposals and the need for retention of current services. 

The Chair thanked the Speakers and indicated that their views would be taken

into account when the items were considered.

Report of the Task Group, attached

(Councillors D Cox and M Wrigley declared a personal interest by virtue of their membership of Teignbridge District Council, the local planning authority).

The Committee considered the Report of the Task Group which covered its membership and scope, the formal process and steps for making a referral to the Secretary of State for Health and Social Care, the history of consideration of this issue from August 2020, the previous Spotlight Review, the perspective from the League of Friends of Teignmouth Community Hospital; and concerns of the Task Group today and its conclusions and proposed next steps which included a list of questions (in Appendix 1 of the Report) for NHS Devon.  

Members’ discussion points with the Director of Commissioning Primary, Community and Mental Health Care (NHS Devon), and the Head of Scrutiny (DCC) included:

·         confirmation that NHS Devon would respond in writing to the questions raised by the Task Group within 28 days following formal written notification and to any other questions Scrutiny may wish to raise in this matter;

·         confirmation from NHS Devon that funding for the new Health and Wellbeing Hub in Teignmouth was secured and not dependent on the sale of the hospital site and the NHS was committed to its delivery; and that a planning application for the Hub was being considered by the District Council this same day (subsequently, notification of approval was reported to this Committee); 

·         the need for detailed ‘social value’ impact assessments including the impact on GP services for example, which could be included in the questions raised by the Task Group; and

·         the referral process and the requirement for an evidence based alternative proposal in discussion with NHS Devon prior to any proposed referral.      

It was MOVED by Councillor M Wrigley, SECONDED by Councillor S Randall Johnson and

RESOLVED that NHS Devon be asked to respond to the questions detailed in Appendix 1 of the Report following which the Task Group would then conduct further information gathering activities, including speaking to local people with a view that the Task Group would conclude its investigation in time for the September 2023 meeting of this Committee. 

Report of the Director of Integrated Health and Social Care (ACH/23/174), attached. 

(Councillor M Wrigley declared a personal interest by virtue of his membership of the Teignbridge District Council’s Executive in so far as this item related to the Homeless 18+ Prevention Fund). 

(Councillor J McInnes attended in accordance with 25 (1) and spoke to this item with the consent of the Committee and referred to the consultation exercise and acknowledged the Speakers’ concerns and confirmed that decisions would be made by Cabinet). 

(Councillor S Aves attended in accordance with Standing Order 25 (2) and spoke in regard to the potential impact for vulnerable young people (0 -25 years), including care leavers and people in supported accommodation and impact on other agencies for example and posed 6 questions (which would be passed to the Director and Cabinet Member). 

The Committee considered the Report from the Chief Officer of Integrated Adult Social Care (Devon County Council) (ACH/23/174) on the   processes across initially  6 service areas, 3 of which had been halted for re-evaluation.

The Report including impact assessments (which had been provided for Members for each consultation based on proposals as they currently stood)  how the consultation had been delivered; and a summary of the consultation feedback in regard to (i) North Devon Link Services, (ii) 18+ Homeless Prevention Contribution and Contract Fund; and (iii) Wellbeing Exeter.

As a result of the feedback recommendations were currently being developed for presentation to the Cabinet on 12 July 2023.  

The Director of Legal Services and Democratic Operations reported on the  paused consultations to allow additional time for further consideration and matters arising from the consultations would be considered by Officers and Members. 

Members’ discussion points with the Director of Integrated Adult Social Care Officers, the cabinet Member and the Director of Legal and Democratic Services included:

·         the provision of suitable alternatives should be in place if reductions in grants or services were approved;  

·         concern about the consultation arrangements in regard to the Link Centres and discharged service users and the impact of the pandemic on numbers and resulting effect on data analysis;

·         concerns about the lack of information on consultation feedback, the adequacy of the Impact Assessments, the wider costs to partner agencies; the impact on health inequalities across vulnerable communities; the need to focus on prevention, and the adequacy of the consultation arrangements;

·         no service options for consideration by this Committee for recommendation to Cabinet; and the need for consideration of proposals by Scrutiny in open Committee; and

·         reference to wider governance considerations.

It was MOVED by Councillor R Scott and SECONDED by Councillor M Wrigley  and

RESOLVED that a special meeting of this Committee be arranged (date to be confirmed) to consider policy issues, and options and service proposals (with reference to any governance issues, the consultation feedback, impact assessment) prior to determination by Cabinet.

Report of the Director of Public Health, Communities and Prosperity, attached  

The Committee considered the Report of the Director of Public Health, Communities and Prosperity on an overview of health inequalities, the importance of the wider determinants of health, inequalities in England and in Devon, and local actions to reduce these. The Report recognised there were multiple causes and addressing health inequalities required actions through the life-course and across agencies and communities.

Members’ discussion points with the Director, and Public Health Consultant, and Specialist; and the Chief Medical Officer (NHS Devon) included:

·         detailed data analysis on life expectancy trends according to gender and across socio-economic groups, vulnerable groups and geography;

·         the impact of any proposed wealth tax;

·         a proposal for restrictions on smoking within social housing and private rentals;

·         vaping as an alternative for tobacco smokers and concerns about its wider use, particularly by younger people;

·         the input of Public Health in the planning process; and work with local planning and housing authorities and other agencies;

·         the impact of increasing obesity rates in primary school children, younger people and the general population and the role of Public Health; and

·         close and developing working relations with NHS Devon and other partners through the Integrated Care System and development of joint  Health and Wellbeing Strategies.

The Committee noted the Report to inform and support the County Council and the wider systems approach to health inequalities and that the themes outlined would be considered as part of the Committee’s future work programme, recognising that the causes of health inequalities were multi-faceted and required a range of actions both in the short term and over time.

Joint report from the Council and NHS Devon (ACH/23/174), attached

(Councillor J McInnes attended in accordance with Standing Order 25 (1) and

spoke to this item with the consent of the Committee and referred to the new

Care Quality Assurance framework and LGA Peer Challenge from 19 to 21 July 2023 and Masterclass on 15 June for all Members).

The Committee considered the Joint report from the Council and NHS Devon

(ACH/23/174) on the latest news from the Devon Health and Care system.

This included updates on the NHS Devon performance covering Urgent and Emergency Care and Elective for February 2023; CQC assurance of Adult Social Care duties; Integrated Adult Social Care 2022-23 budget update as of March 2023; Devon Integrated Care Board financial position as of February 2023; delays to implementation of the Liberty Protection Safeguards, the Hewitt Review, CQC report published on services at the Royal Devon University Healthcare NHS FoundationTrust, update on digital strategy; and on a lead research nurse global nursing award. 

Members’ discussion points with the Chief Medical Officer (NHS Devon) and the Director of Integrated Health and Care included:

•      the performance of the new provider for the NHS 111 service and current demand and workforce capacity issues;

·         the improving performance in Elective Care although the waiting list remained substantial, and the positive impact of the Exeter Nightingale services;

·         relating to percentage of beds occupied by patients who were medically ready for discharge, whilst current performance was improving this remained a high priority for NHS Devon with the County Council and the Integrated Care System;

·         the role of work force leads across the ICS to promote training/flexibility and retention, particularly across the specialities;

·         request for further information in future reports on Mental Health (workloads and treatments), Dentistry across the County (with reference to the lack of services in the localities), and the position of the Dawlish MIU (on which information would be provided for the Vice Chair); 

·         the work of community pharmacies across the public and private sectors to reduce GP workloads for example, and the ability of newly pharmacists to prescribe and work to promote top-up training for current pharmacists to enable further prescribing; and

·         the number of ‘never events’ at the Royal Devon University Healthcare NHS Foundation Trust and the CQC report on its short notice inspection.   

The Chair requested further information in future reports as outlined above and thanked the Officers for their report and commended the successes evident at the Nightingale. 

In line with the recommendations of the Scrutiny in a Commissioning Council.pdf (devon.gov.uk) Task Group Report, the Committee is requested to select a Commissioning Liaison Member, whose role will be to work closely with the relevant Cabinet Members and Director/Heads of Service, developing a fuller understanding of commissioning processes, and provide a link between Cabinet and Scrutiny on commissioning and commissioned services.

In line with the recommendations of the Scrutiny in a Commissioning Council.pdf (devon.gov.uk) Task Group Report, the Committee was  requested to select a Commissioning Liaison Member, whose role would be to work closely with the relevant Cabinet Members and Director/Heads of Service, developing a fuller understanding of commissioning processes, and provide a link between Cabinet and Scrutiny on commissioning and commissioned services.

The Scrutiny Officer would canvass Members in regard to the vacancy.

In accordance with previous practice, Scrutiny Committees are requested to review the list of forthcoming business and determine which items are to be included in the Work Programme.

The Committee may also wish to review the content of the Cabinet Forward Plan and the Children’s Services Risk Register to see if there are any specific items therein it might wish to explore further.

The Committee noted the current Work Programme subject to inclusion of topics which arose from the meeting. This included the Teignmouth Community Hospital Task Group and agreement to a special meeting of the Committee to consider Integrated Adult Social Care service proposals.

[NB: The Scrutiny Work Programme was available on the Council's website at: Scrutiny Work Programme]

Below is a list of information previously circulated for Members, since the last meeting, relating to topical developments which have been or are currently being considered by this Scrutiny Committee.

(a) A summary of planned communications for Easter 2023 from NHS Devon to provide some assurance on the proactive steps they are taking ahead of the long Easter weekend and junior doctor strikes.

Information previously circulated for Members, since the last meeting, relating to topical developments which have been or are currently being considered by this Scrutiny Committee:

a summary of planned communications for Easter 2023 from NHS Devon to provide some assurance on the proactive steps they are taking ahead of the long Easter weekend and junior doctor strikes.