Present

Councillors Westlake (Chairman), Boyd, Brook, Chugg, Clarance, Colthorpe, Dezart, Diviani, Gilbert, Greenslade, Morse, Sellis, Wragg, Wright and Yabsley

(Councillor Brook and Wragg attended from Minute 77, Councillors Chugg and Gilbert attended up to and including Minute 76, Greenslade up to and including Minute 77 and Councillor Wright up to and including Minute 78)

Representing District Councils

Councillor Christophers

(Councillor Christophers attended up to and including minute 76.)

Members attending in accordance with Standing Order 25:-

Councillors Brazil, Davis, Hart, Moulding and Randall-Johnson and Ms D Fontana (Primary Parent Governor, People s Scrutiny Committee)

*72 Minutes

RESOLVED that the minutes of the meeting held on 17 November 2014 be signed as a correct record.

*73 Former Principal Public Health Adviser - Mr I Tearle

The Chairman, on behalf of the Committee, thanked Mr Ian Tearle, who had recently retired from the Council s employ, for his advice and guidance to the Council over many years initially with the former PCT and more recently within the Council s Public Health Team. The Committee wished him a long and happy retirement.

*74 2015/16 Budget

(Councillor Davis attended in accordance with Standing Order 25(2) and spoke to this item at the invitation of the Committee).

(Councillors Davis and Yabsley each declared a personal interest in this matter by virtue of both being County Councillor representatives on the Exmoor National Park Authority).

The Committee noted that, in line with previous practice, the proposed budget for the next financial year, 2015/16, would be scrutinised collectively, with a joint meeting of Scrutiny Committees to be held on 29 January 2015, providing an opportunity for Members to comment on proposals for the Council s Budget in its entirety.

This would follow the opportunity at this meeting for individual Scrutiny Committees to have an initial overview of the budget proposals and examine them to identify any specific issues or areas of interest that might be considered at the joint meeting for incorporation into any recommendations to Cabinet and Council.

The Committee considered the joint report of the County Treasurer and Director of Public Health (CT/15/11 - supplementary information CT/15/11) on the provisional financial settlement made by Government within the current and anticipated public sector financial regime and the spending targets set by the Cabinet for Public Health services which incorporated inflation, commitment and service prioritisation reductions. The Report also contained detailed budget proposals in respect of all Public Health services, in line with those targets, reflecting the different pressures and influences faced by services. The announcement by Government on the final settlement and Council Tax Regulations was expected shortly.

The draft ring fenced Public Health Services budget of 20,060, 000 had been enhanced by 4,567,000 for 0 - 5 children s services (part year effect of transfer in October 2015 and virement of 148,000 in-year for Youth Services). It provided for inflation and commitments and members noted the likely pressures on the budget in view of the ever increasing demands and costs.

Members noted that in terms of the level of funding year on year the Secretary of State had suggested that the Council had a 'spending power' increase of 0.5% against an average of a 2.1% reduction nationally. However, the County Treasurer had advised that the way in which 'spending power' had been calculated did not, in her view, give a true indication of the way Government Grant had actually diminished because it included redirected NHS money and Council Tax revenues which understated the real level of grant reduction. A fairer underlying measure would be to compare the baseline funding level which, on a like for like basis, had reduced by 14% over the previous year.

Members noted that for the Council overall, service inflation and commitments for the year were estimated at 19.9m and that to manage those combined pressures and set a budget within Government provisional targets, total savings of 45.9 m would need to be found together with the removal of one-off spending of 0.5 m included in the 2014/15 budget. The Committee were advised that their consideration of the draft budget was just part of the process of setting the County Council s budget which, following this meeting and the joint scrutiny session on 29 January, would culminate in the Cabinet on 13 February 2015 formulating a budget for consideration by the County Council on 19 February 2015.

The Director of Public Health commented on the likely implications of the 2015/16 target for individual areas of service confirming that within those services the overall approach had been to strike a balance between the reality of financial austerity while ensuring the delivery of essential services.

The Committee had also received an overview of the impact assessments for all service areas entitled Budget 2015/6 Impact Assessment (available at http://new.devon.gov.uk/impact/published/) in order that Members may be aware of the equality impact assessments undertaken as part of the budget s preparation and that any risk assessments and projections were adequate and that the evidence supported the assumptions made in the formulation of the budget. Members also acknowledged that the preparation of Impact Assessments was necessarily a dynamic process and that individual assessments for specific proposals may necessarily have to be developed and updated with time. Members of the Council must have full regard to and consider the impact of any proposals in relation to equalities prior to making any decisions and any identified significant risks and mitigating action required.

The Committee noted that from October 2015 commissioning responsibility for 0-5 children s services for health visitors would transfer to the Council from NHS England (with a additional and ring-fenced grant) which would create a comprehensive children service from 0 -19 years and that, from 2016/17. It was likely that the Public Health Grant would also be revised subject to a fair shares formula which it was hoped would incorporate an element for rurality .

The Chairman also reported the receipt of a response from Earle Howe, Parliamentary Under Secretary of State for Quality (Lords) at the Department of Health, to representations by the Council on funding for the Northern, Eastern and Western Clinical Commissioning Group from NHS England and by Government for public health in line with the historic funding formula. Earl Howe had stated that the Government still believed that to be the best way of protecting existing investment and services which it also argued meant that the people of Devon will have the best health services available to them .

Specific issues and observations arising from the current budget proposals raised at the meeting included the following:

acknowledging the flexibility within the budget to respond to identified needs and proposed variations from the current year to ensure value for money and reflect the Joint Strategic Needs Assessment;

use of social media to get the Public Health message across and the part Pharmacies could play in promoting public health;

the use of Public Health funding and strategies to raise awareness of the Prevention of Child Sexual Exploitation as proposed and complement the Health and Wellbeing Board s strategy and JSNA in this important area of activity;

encouraging collaborative working with and between District Councils to support public health activity such as through the Devon Youth Games by use of Public Health grants and innovative initiatives with the Dartmoor and Exmoor National Park Authorities to encourage access by all sections of the community to those areas to promote better health and wellbeing;

Devon remained, largely as a result of historical factors, the 7th lowest (of 152 upper tier authorities) funded Local Authority for Public Health;

the implementation and uptake of NHS Health Checks which compared favourably against other authorities despite the late start up in Devon from a standstill position and lack of NHS funding previously.

It was MOVED by Councillor Westlake, SECONDED by Councillor Sellis and

RESOLVED

(a) that the Cabinet be advised:

(i) that the provisional Government settlement and its impact on spending targets be noted;

(ii) that the proposed Public Health budget for 2015/16 be noted but that the Council continue to make representations over the relatively low level of funding for that service, particularly in regard to rural local authorities, notwithstanding the views of the Department of Health;

(b) that the Committee:

(i) receive a fuller report summarising the range of activity/work supported by the Public Health budget and on the impact of the lower level of funding allocated to Devon through the funding formula along with any comparative data from other Local Authorities, to identify whether or not more detailed work by a Task Group may be required;

(ii) welcome further information at the appropriate time on the use of additional funding for Public Mental Health;

(iii) ask officers to report further on any issues on funding arising from the introduction or failure to apply the Armed Forces covenant.

*75 Potential Interim Disinvestments

The Committee considered a further report of the NEW Devon Clinical Commissioning Group (PH/15/5 - text only | pdf PH/15/5) on those services which had been suggested would be limited. Following feedback the services under review would now be subject to guidance to clinicians, rather than enforced policy.

Representatives of the Eastern Locality Board commented or responded to matters raised or specific questions posed by Members, as follows, that:

the financial impact of the changes in the current and next financial year would be limited and were not intended to fully address the current and projected budgets deficits;

individual decisions would ultimately be taken by patients in consultation with their clinicians;

the CCG budget deficit was subject to continued discussion with NHS England

nationally an additional 250m had been earmarked by NHS England for financially challenged CCGs but the criteria for its allocation were not clear at this stage.

It was MOVED by Councillor Westlake, SECONDED by Councillor Sellis and

RESOLVED

(a) that a Spotlight Review be undertaken of the planned measures to reduce the budget deficit of the NEW CCG and that Devon MPs be invited to participate;

(b) that following clarification of the additional resources required a letter urging support for the NEW CCG from the national allocation of 250m be sent to NHS England.

*76 Transforming Community Services

(Councillor Moulding attended in accordance with Standing Order 25(2) and spoke to this item)

The Committee considered the Report of the NEW Devon Clinical Commissioning Group (PH/15/4 - text only | pdf PH/15/4) on the commissioning intentions for each locality with a focus on the development of preventive services, care at home and the role of community services including community hospitals. The Report also gave an overview of the associated involvement, consultation and suggested follow on action proposed in each of three localities.

Representatives of the Eastern Locality Board (NEW Devon CCG) attended at the Committee s invitation and commented or responded to matters raised or specific questions posed by Members, as follows; that:

consultations in regard to the Eastern Locality would take place between now and 24 February 2015;

the Northern Locality consultation report would be considered by the CCG on 25 February and proposals for community hospitals would then be subject to further consultation before decisions were made;

information on the consultation responses would be assimilated and made available;

the CCGs objective was not to significantly reduce the number of inpatient beds but to consolidate provision.

The Chairman also reported representations received from Councillor Way and others objecting to proposed inpatient bed closures at Crediton Community Hospital which would be forwarded to the CCG.

. It was MOVED by Councillor Westlake, SECONDED by Councillor Sellis and

RESOLVED that the update on the consultation processes be noted and that the outcome be reported to the next meeting detailing the responses and that evidence of projected increased populations arising from planned housing development have been taken into account in determining future proposals.

*77 Health Wellbeing Scrutiny Committee Work Programme

The Committee reviewed the work programme and determined those items to be included therein.

Mr John Rom of Devon HealthWatch spoke at the invitation of the Committee on the role of HealthWatch in ensuring the views of the community on health and wellbeing matters were made known.

It was MOVED by Councillor Westlake SECONDED by Councillor Sellis and

RESOLVED that the programme be updated by the addition of:

Report on the Public Mental Health and the Making Every Adult Matters and rough sleepers in Exeter;

Update on the implementation of the Military Covenant;

Spotlight Review on the planned measures to reduce the NEW CCG budget deficit with Devon MPs invited (prior to 16 March);

Report on Public Health Funding and spotlight review if necessary;

Possible Spotlight Review (with People s Scrutiny Committee) on the integration between Health and Adult Social Care;

Report on emergency provision including AE, GP opening times, use of pharmacies and community provision.

[NB: The Work Programme was available on the Council's website at http://www.devon.gov.uk/scrutiny_programme.htm]

*78 Axminster Consultation: Community Services

(Councillor Moulding attended in accordance with Standing Order 25(2) and spoke to this item).

The Committee considered the report of the Northern Devon Health Care Trust (PH/15/7 - text only | pdf PH/15/7) on the outcome of public consultations held between 2 to 30 December 2014 on proposed temporary changes required to deliver safe staffing in Axminster and Seaton inpatient services which had been considered by the Trust s Board on 7 January 2015. The Board had decided to temporarily move 10 inpatient beds from Axminster to Seaton Community Hospital to ensure that the service was resilient and consistent and mitigate the risks of lone working registered nurses.

The Trust s Representatives responded to matters raised or specific questions posed by Members, namely:

the outcome of legal challenges;

the operational and patient safety grounds upon which the decision was based and which was reversible;

the changes by the Trust were not part of the ongoing TCS consultations by the NEW CCG which had been acknowledged had resulted in public confusion and concern;

the changes had been made following consultation with the CCG and that ultimately final decisions rested with the CCG;

5 community hospitals in the Trust area had no beds and the remaining 12 hospitals had at least 16 inpatient beds;

the acceptability of the practice of lone registered nursing was not appropriate;

the difficulties for the NHS in recruitment of registered nurses in all settings;

the offer of the League of Friends at Axminster of 300,000 for staffing.

It was MOVED by Councillor Westlake, SECONDED by Councillor Sellis and

RESOLVED that a further report be presented to the next meeting and that, in the meantime, the Trust be asked to advise the Committee how it proposed to use the additional 300,000 from the local League of Friends for recruitment and retention of staff and the timescales involved.

*79 Torrington Community Hospital: Test of Change

The Committee considered a progress Report of the NEW Devon CCG (PH/15/6 - text onlyPH/15/6) on the engagement and decision making process by CCG Boards on 25 and 26 November 2014, culminating in a decision to permanently close the inpatient beds with immediate effect.

In addition it had been agreed that the additional funding would remain in place to continue providing services to the people of Torrington using the enhanced model of care, and that the health services would work with the local community to maximize the cost effective potential of delivering additional services from the hospital site (the development of a health, social care and voluntary sector 'hub').

The CCG had acknowledged that a small group of people would be disadvantaged by not having the beds available in their own community but this was outnumbered by the people who could then receive care in their own home.

Councillor Pennington (the Chairman Torridge District Council s Scrutiny Committee) spoke to this item at the invitation of the Chairman, having first declared an interest by virtue of his employment with the CAB and MacMillan Cancer Project)..

Representatives of the Northern CCG also spoke at the invitation of the Committee and commented or responded to matters raised or specific questions posed by Members, namely that:

the new community hub had started and was being developed with more nurses and therapists serving more people in the community and that improvements had been made with a single point of access, discharge co-ordinator and oversight group and developing work with the local community voluntary sector;

there was evidence and signs of effectiveness and positive feedback

Devon HealthWatch were involved in the ongoing evaluation process

resources were being committed more effectively; and that this was not a budget saving exercise but a strategy to create a sustainable and safe service.

The Committee also received an update from the Members authorised at the last meeting to investigate and consider the proposals (Minute *66 refers) and the Chairman of the investigation questioned the rationale of the evidence for improved services, effectiveness and cost benefits and patient safety and cited the independent reports; and were of the view that the changes were not supported by the local community.

The Scrutiny Officer outlined the process and detailed evidence required for making a referral to the Secretary of State.

It was MOVED by Councillor Westlake, SECONDED by Councillor Wright and

RESOLVED that the Clinical Commissioning Group provide further information of evidence used to make the changes and criteria by which this Committee can evaluate whether any of the anticipated outcomes were being delivered.

*80 Community Services Proposals: Progress of the Coastal Locality Consultation

The Committee considered a progress report from the South Devon and Torbay CCG (PH/15/3 - text only | pdf | supplementary information PH/15/3) on consultations on proposals for community health services in the Coastal locality, which had started on 1 December and would end on 8 March 2015.

The Coastal Locality Manager and Coastal GP Local Lead responded to questions posed relating to the consultation exercise, the outcome of which would be reported to this Committee.

*DENOTES DELEGATED MATTER WITH POWER TO ACT

The meeting started at 10.00 am and finished at 4. 35 pm.

The Minutes of this Committee are published on the County Council s website at:-