Present

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

(Councillors Brook, Colthorpe, Gilbert and Wragg attended from Minute 93)

Representing District Councils

Councillor Christophers

Member attending in accordance with Standing Order 25:-

Councillors Barker, Davis and Moulding

Apologies

Councillors Dezart and Diviani

*89 Minutes

RESOLVED that the Minutes of the meeting held on 24 March 2015 be signed as a correct record.

*90 Torrington Test of Change

The Committee considered the report of the NEW Devon CCG (PH/15/15 - text only | pdf PH/15/15) on the background to the Test of Change in Torrington and an update on the current model of care and impact on the community in Torrington. The Report also included the NEW Devon Clinical Commissioning Group s and Northern Devon Healthcare Trust s response to the Member Investigation under taken by Councillor Boyd and other local Members considered at the last meeting.

The Northern Devon Healthcare Trust and NEW Devon Clinical Commissioning Group representatives also gave a detailed presentation relating to:

key data to demonstrate safety and quality of provision operating in Torrington including feedback from patients

responses to the patient stories which had already been investigated

commentary of the Member Investigation report presented at the last meeting

success of the care model being provided in Torrington since November 2014

with increased levels of community services and early development into a Hub .

and the representatives responded to matters raised or specific questions posed by Members including inter alia:

evidence relating to the impact on acute hospital bed admissions and the respective costs of impatient care and care in the community;

level of staffing for rapid response teams and community care which was sufficient;

positive surveys relating to user experiences and quality;

historic information relating to a proposal for the disposal of the community hub building and need for further assurance that there was no current plan to do so by the Health Trust;

the impact of the recently announced Success Regime at this early stage in relation to NEW Devon CCG and its TCS programme;

evidence relating to support and objections during the consultation period for the Test of Change;

evidence relating to patient stories and complaints and concerns noting that many were before the new model was fully operational.

Councillor Boyd, the local Member, indicated that he had met with NEW Devon CCG and NDHT representatives and agreed a number of changes to the Member Investigation presented at the last meeting.

It was MOVED by Councillor Boyd, SECONDED by Councillor Greenslade and

RESOLVED

(a) that this Committee request the NEW Devon Clinical Commissioning Group to defer any further bed closures until the Success Regime has considered the request at (c) below;

(b) that this Committee defer further consideration of the model of care in Torrington

until the Success Regime has considered the situation;

(c) that the NEW Devon CCG be requested that the bed closures that have already occurred at Torrington and elsewhere be formally considered as part of the Success Regime ;

(d) that further consideration to a Task Group or Spotlight Review of the Test of Change model in Torrington in relation to a possible formal referral to the Secretary of State subject to all requirements for such a referral being met;

(e) that a letter be sent to the Secretary of State for Health requesting a response to the letter from the Committee relating to concerns about the level of funding for the NEW Devon Clinical Commissioning Group;

(f) that the Committee seek written assurance from the Northern Devon Healthcare Trust that it will not dispose of the Torrington Hospital Site;

(g) that the Committee accepts the Northern Devon Healthcare Trust invitation to undertake a visit to Torrington to view the services in place and model of care delivered in the community.

*91 Consultation on Community Health Services in the Coastal Locality

(Councillor Christophers declared a personal interest in this matter by virtue of being an owner of a residential care home in the area of the South Devon and Torbay Clinical Commissioning Group area)

The Committee considered the report of the South Devon and Torbay Clinical Commissioning Group (PH/15/16 - text only | pdf PH/15/16) on the outcome of the consultation on community health services in the Coastal locality and alternative options put forward during the consultation and the next steps in the decision-making process.

The South Devon and Torbay CCG representatives responded to matters raised or specific questions posed by Members namely:

the preferred option by the CCG at this stage prior to formal consideration by its Board;

preference by the local County Councillor (Teign Estuary) for option 3 detailed in the papers;

consideration by the CCG Board of the proposals and options at its Board meeting on 26 July when a decision would be made.

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

RESOLVED that the consultation response be noted and that a further report by the South Devon and Torbay Clinical Commissioning Group on the outcome of the Board s meeting and rationale for its decisions be submitted to the next meeting of this Committee.

*92 Axminster: Stakeholder Briefing

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

The Committee considered the report of the Northern Devon Healthcare Trust (PH/15/18 - text only | pdf PH/15/18) on the Stakeholder Briefing on progress to reopen the in-patient services at Axminster Community Hospital.

The Northern Devon Healthcare Trust representatives responded to matters raised or specific questions posed by Members namely:

the Trust was in a position to create a full roster of nurses at Axminster

Community hospital and the aim was for the 16 bed unit to re-open during July;

the Trust would continue to advertise vacancies using banners, social media

and NHS jobs and in the meantime it planned to fill the remaining 20% of hours with a 'nursing pool' and using NHS Professionals and some agency staff;

the Trust was continuing to investigate the long term sustainability of the Unit

working with the NEW Devon CCG and voluntary partners;

the lessons that can be learned from this positive outcome with the support the local community and League of Friends which could be replicated in other areas.

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

RESOLVED that a Task Group comprising Councillors Boyd, Greenslade, Westlake and Wright explore the positive lessons to be learned for other areas from the success of the Trust working with the local community in retaining in-patient services in Axminster Community Hospital.

*93 Success Regime

The Committee considered the report of NEW Devon Clinical Commissioning Group (PH/15/19 - text only | pdf PH/15/19) on the introduction to the Success Regime where Devon was one of three areas in England where local health and care organisations would work together to make improvements for patients.

The purpose of the Success Regime was to protect and promote services for patients in local health and care systems that were struggling with financial or quality problems, or sometimes both. It would provide increased support and direction and aimed to secure improvement in three main areas:

- Short-term improvement against agreed quality, performance and financial metrics

- Medium and longer-term transformation, including the application of new care models where appropriate

- The development of leadership capacity and capability across the health system, ensuring collaborative working

The NEW Devon CCG Chief Officer responded to matters raised or specific questions posed by Members namely

the current and projected deficits faced by NEW Devon CCG and the reasons for

them relating to demography, rurality, differing needs, national standards and the continued difficulties for provider services in a climate of budget pressures and rising expectations;

a Success Regime Programme Director was expected to be appointed by the Regulators shortly when more information would be known

the view held by some members for the Success Regime to address issues relating to the Transforming Communities programme.

Further information on the Success Regime is available on the following link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/432130/5YFV_Success_Regime_A_whole_systems_intervention_PDF.pdf

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

RESOLVED that the Success Regime s Programme Director when appointed be invited to attend a future meeting of this Committee.

*94 Transforming Community Services (Minute *87): NEW Devon CCG

(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/15/17 - text only | pdf PH/15/17) on an update on the Transforming Community Services Programme in Northern, Eastern and Western Devon and the next steps

The NEW Devon CCG representatives responded to matters raised or specific questions posed by Members namely:

the underlying principle of services close to home behind the Transforming Community Services programme and the focus on effective integrated social care across all three localities;

the procurement strategy and identification of preferred bidders across the localities;

the Northern Locality Board support for a shift from 74 to 40 in-patient beds in Community Hospitals and the rationale which was evidence based and following extensive consultation; the consolidation of services would be safe and effective with experienced staff and the principle that beds would not be withdrawn until safe community provision was available;

the result of acuity audits in respect of Community Hospitals;

the cost/efficiency savings from consolidation into larger inpatient bed units;

decisions made by the Eastern Locality Board at its meeting in May 2015 and its consideration in public of the independent Report of Sir John Evans (which had included alternative options for the Wakley area) which would also be considered by the NEW Devon CCG s Board on 16 July (the CCG undertook to make available the Board s papers which were published on its website and its meetings were also open to the press and public).

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

RESOLVED that the report be noted and the outcome of NEW Devon CCG Board meeting on 16 July 2015 be reported to this Committee.

*95 Integration Spotlight Review

The Committee considered the report of the Spotlight Review (CS/15/12 - text only | pdf CS/15/12) on local Health and Social Care integration with the aim to understand the principles behind integration and proposed future actions for all relevant parties. The Review followed an invitation from the Centre for Public Scrutiny to further consider the integration agenda.

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

RESOLVED

(a) that the recommendations from the Spotlight Review as detailed in report (CS/15/12 - text only | pdf CS/15/12) be endorsed and that the Cabinet and both Clinical Commissioning Groups be requested to implement them as appropriate;

(b) that a copy of the report be sent to all relevant agencies requesting that they also undertake the actions as appropriate.

*96 Hospital Discharge: Factors affecting patients leaving hospital and blockages

The Committee received a presentation from representatives of the Royal Devon and Exeter NHS Foundation Trust on how the Trust was currently working and developing ways to improve discharges from hospital of their patients ensuring safe and timely quality care packages for the increasing number of patients with complex needs.

The Trust representatives responded to matters raised or specific questions posed by Members namely:

following challenge the recent provisional findings of Monitor in relation to the future contract of health and social integrated care for the CCG Eastern locality;

incidents of pre-black days in relation to emergency admissions (further details of the number of days would be circulated to members) and that the position had improved with amber or green status;

no correlation between the recent closure of County Council residential care homes and in-patient admissions could be identified but overall there was an increase in demand with more complex cases;

the recent improved outpatient pharmacy services was already making a positive difference and improving the efficiency of discharges;

the integrated Care Exeter (ICE) programme would be initiated shortly and progress would be monitored and evaluated with the overall aim to improve capacity and effectiveness.

Members requested that a further report on the progress of the ICE programme would be included in the Work Programme.

*97 Health Wellbeing Scrutiny Committee Work Programme

The Scrutiny Officer reported that the work programme would be updated following today s meeting to include:

(a) further consideration to a Task Group or Spotlight Review of the Test of Change model in Torrington in relation to a possible formal referral to the Secretary of State subject to all requirements for such a referral being met (Minute *90);

(b) a Task Group investigation of the positive lessons for other areas to be learned from the success of the Trust working with the local community in retaining inpatient services in Axminster Community Hospital (Minute 96).

(c) a progress report on the Integrated Care programme for Exeter (ICE).

.

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

*DENOTES DELEGATED MATTER WITH POWER TO ACT

The meeting started at 10.00 am and finished at 4.05 pm

(adjourning between 12.25 pm and 2.00pm).

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