Agenda and minutes

The Chair welcomed Councillor Bullivant to his first meeting of the Health & Adult Care Scrutiny Committee since his appointment as the Cabinet Member for Integrated Adult Social Care & Health.

The Chair also welcomed Chief Medical Officer of NHS Devon, Dr Nigel Acheson, to the meeting.

Members of the Council will declare any interests they may have in any item to be considered at this meeting, prior to any discussion taking place on that item.

The other registrable interests of Councillors of Devon County Council, arising from membership of City, Town or Parish Councils and other Local Authorities will automatically be recorded in the minutes. 

For details of District and or Town and Parish Twin Hatters – please see here:

County councillors who are also district, borough, city, parish or town councillors

Members were reminded that they should declare any interests they may have in any item to be considered, prior to any discussion taking place on that item.

The list of Membership of other Authorities can be found here: County councillors who are also district, borough, city, parish or town councillors

Minutes of the meeting held on 21 March 2024, attached.

RESOLVED that the minutes of the meeting held on 21 March 2024 be signed as a correct record.

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

There was no item 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.

There were no oral representations from members of the public.

Report of NHS Devon, attached.

The Committee considered the report of NHS Devon on the development of a dementia strategy for Devon. At the time of the meeting there was no comprehensive strategy regarding dementia, resulting in fragmented efforts and insufficient support for individuals impacted by dementia and their carers. The report outlined the importance of developing such a strategy in the context of rates of growing dementia, with dementias (including those caused by Alzheimer’s disease) being the second-biggest driver of mortality in England, after Coronavirus. Early identification of dementia symptoms was highlighted in the report as key, as this would allow people to maintain improved wellbeing and remain active citizens for longer, particularly in the context of Devon’s aging population.

NHS Devon had held a system workshop on dementia in January 2024 in support of this work, with key system partners across Devon engaging well. Seven key points that were agreed for inclusion in a final strategy, which was aimed to be ready for implementation from April 2025, were outlined in the report. It was expressed that the development of a comprehensive strategy should support, and not impede, the work that was currently underway in Devon for dementia care.

Officers highlighted the importance of strengthening relationships and collaboration with statutory and voluntary service providers with respect to the diagnosis of dementia and care of dementia patients. Members also heard that the development of a joint dementia strategy between NHS Devon and Adult Services would be recommended to the Devon County Council Cabinet in July 2024.

A number of members, whilst broadly praising the scope and intent of the report, raised concerns around the lack of detail it contained. Members wished to see more data on dementia represented in total figures rather than percentages to better understand the scope of the problem; and further information on specific plans to provide better services to dementia patients including details on how levels of success would be measured.

Other key points of discussion between officers and members included:

·         The extent to which NHS Devon could obtain developer contributions to assist with the furthering of dementia services in the county. It was explained to members that this issue was on the radar of NHS Devon and that further information could be provided to members upon request;

·       That use of terminology such as “burden,” which was included in the report, could be seen as inappropriate;

·       That consideration should be given to supporting older people, namely the most likely group to be impacted by dementia, access the support needed, for example ensuring that efforts to access GP appointments were not hindered by technological barriers such as the use of the internet, which older people would be disproportionately impacted by;

·       The importance of at-home care for those with dementia to ensure they remain in a familiar environment surrounded by friends and family, with live-in specialist dementia services not always representing the best placement for many who suffer from dementia;

·         The need for benchmarking data across other local authorities and the close  ...  view the full minutes text for item 177.

Report to follow.

(In accordance with Standing Order 25, Councillor T Adams attended and spoke to this item with the consent of the Committee).

The Committee considered the report of the Director of Integrated Adult Social Care (IASC/24/09) which provided information on the developing position on transitions for SEND young people in Devon. This referred to the process of supporting young people to move from Children's to Adult Services. Members from the Children’s Scrutiny Committee were therefore invited to attend the meeting in consideration of this report, due to its relevance across both services.

The report outlined the joint inspection of the Authority’s SEND arrangements in December 2018 which identified a need to ensure that young people with SEND were better supported as they moved into adulthood. The Children’s Scrutiny SEND Task Group reported in June 2020 with the recommendations outlined in the report. The issue was revisited by that Scrutiny Committee in July 2023, with the report outlining the work that had gone on in the last 12 months, and those that were underway for 2024/25.

Officers explained that, although things were not progressing as fast as hoped within this area there was nonetheless sustained progress. It was further explained to members that there had been significant focus on a cultural shift within the authority and cross-service scrutiny of performance had been implemented to ensure continued improvement.

Key points of discussion between officers and members included:

·         That listening to young people with experience of the transition between Children’s Services and Adult Services was of paramount importance in informing what changes need to be made to the process;

·         The Authority’s need to look at transition earlier in a young person’s life, routinely from 14, to ensure a better process of transition;

·         Financial challenges, and to what degree members could expect to see better value for money in this area. Officers explained that the amount of money going into Adult Services was decreasing and there was a focus on achieving this value for money, but that there were many variables (such as inflation levels and the rurality of Devon) that impacted service costs which were not controllable by Devon County Council.

Members also raised concerns around the lack of detail in the report, with attention drawn to a report that had been published for consideration by the Audit Committee which included a significant level of detail on transitions to Adult Services, detail which was not included in the report received by the Scrutiny Committee. Members wished for more data on this topic including the indicators by which progress would be measured. It was proposed, with officer agreement, that a further report containing more detail would be beneficial for consideration at the November 2024 meeting of the Committee.

Report of the Director of Legal and Democratic Services (LDS/24/18), attached.

(In accordance with Standing Order 25, Councillor P Bullivant attended and spoke to this item with the consent of the Committee).

The Committee considered the report of the Director of Legal and Democratic Services (LDS/24/18) on learning from the visit to the NHS Nightingale Hospital, Exeter, that was undertaken by the Vice Chair of the Scrutiny Committee and the Scrutiny Officer.

The report provided a brief history of the NHS Nightingale Hospital, being part of the national response to COVID-19, and the only hospital of its time to admit acutely unwell COVID patients after the initial April 2020 waves; its current role as a community diagnostic centre; outlined funding and running costs; and included key points of learning and observation from the visit which was led by a number of NHS Devon staff.

A number of members expressed, based off of their personal experience, support for the NHS Nightingale Hospital Exeter, and commended NHS Devon for the creative approach that the Hospital has had to significantly help to reduce waiting lists for certain elective procedures. The Committee further discussed how best to maximise capacity of these services to take pressure off of other NHS services.

Report of the Director of Legal and Democratic Services (LDS/24/25), attached.

Councillor Ian Hall declared a personal interest by virtue of sitting as the co-Chair of the One Eastern Devon Partnership Forum (OEDPF).

The Committee considered the report of the Director of Legal and Democratic Services (LDS/24/25) on key learning points from the Local Government Association (LGA) ‘Prevention Matters’ workshop held on 21 May 2024. A number of councillors attended the workshop which was facilitated by LGA representatives, with input from Devon County Council representatives such as the Cabinet Member for Integrated Adult Social Care and Health, and the Director of Public Health, Communities and Prosperity.

The workshop outlined: the importance of ‘prevention’ in healthcare, including the distinction between primary, secondary and tertiary prevention; twelve key challenges facing Devon (with some common across the country, and others reflecting the unique challenges faced by Devon); and Devon’s assets and opportunities. Issues were also identified by member input during the workshop, alongside ways they – as elected councillors – could use their role to make a positive difference.

Joint report of the Director of Integrated Adult Social Care at DCC, the Director of Public Health and Communities at DCC, and the Chief Medical Officer of NHS Devon (IASC/24/09), attached.

(In accordance with Standing Order 25, Councillor P Bullivant attended and spoke to this item with the consent of the Committee).

The Committee considered the Joint Report of the Director of Integrated Adult Social Care at Devon County Council, the Director of Public Health and Communities at Devon County Council, and the Chief Medical Officer of NHS Devon (IASC/24/09) which contained updates on key and standing items and provided general information on specific actions, requests or discussions during the previous meeting of the Committee.

The Committee also heard from Councillor L Hellyer, the Committee’s nominated Scrutiny Champion Against Domestic and Sexual Violence and Abuse who updated the Committee on a number of aspects of abuse and how it should be understood, including some misconceptions that people may have around how abuse symptoms manifest. Councillor Hellyer also outlined Devon-specific developments on supporting victims of abuse including a gradual increase in dispersal units, plans for dedicated safe accommodation for women with complex needs, and domestic abuse training that was available to staff such as GP receptionists to assist in their understanding of the ways in which abuse can manifest itself in patients, in order that these staff can better identify victims of abuse to ensure support is received.

Discussion between officers and members included:

·         A verbal update on the North Devon Link Services. It was explained that injunctive relief had been refused, and that no further detail of legal proceedings could be shared with the committee;

·         Minor Injury services including in Ilfracombe, and how these services were provided, with discussions being had to consider an enhanced service agreement with local General Practitioners to provide minor injury and illness services; and Bideford Minor Injury Unit (MIU) which remained closed, with officers outlining the challenges of staffing this MIU due in part to more attractive employment opportunities for those with the skills required to be employed in a Minor Injuries Unit such as more sociable working hours. Members also heard that there was work ongoing considering a Devon-wide MIU strategy to address what was currently a fragmented and inconsistent offer of MIUs across Devon;

·         Lynton Health Centre, which was (as at the last meeting of this Committee) due to cease running, under the previous healthcare provider, after 30 April 2024. Members heard that the provision of services from Lynton Health Centre had been taken over by another provider who also operate Queen’s Medical Centre in Barnstaple;

·         The timeframe for the opening of Women’s Health Hubs, for which funding had previously been announced. Officers were uncertain but advised that timeframes could be explored and this information provided to members after the meeting; and

·         The implications of predicted savings needed to be made by the Authority in the future, including on the Better Care Fund, alongside those savings sought to be made by NHS Devon moving forward.

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 Risk Register to see if there are any specific items therein it might wish to explore further.

The Committee agreed the current Work Programme subject to inclusion of topics which arose from the meeting. This included future work reviewing the emerging dementia strategy.

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:

·       Various Draft Quality Accounts (Member comment previously invited) including:

·       University Hospitals Plymouth NHS Trust

·       Devon Partnership Trust

·       South Western Ambulance Service NHS Foundation Trust

·       Royal Devon University Healthcare NHS Foundation Trust

·       Annual Work Programme Masterclass (held 15 May 2024) - Recording & Presentation

·       Scrutiny Annual Report – Full Council, 23 May 2024 - Accessible here

·       Scrutiny Risk Registers - June 2024

The Committee noted 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.