Present:

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

(Councillors Gilbert, Diviani and Gribble attended up to Minute 101, 102 and 103 respectively)

Representing District Councils

Councillor Christophers

Members attending in accordance with Standing Order 25:-

Councillors Clatworthy, Edmunds, Julian, Moulding, Parsons and Way

Apologies

Councillors Chugg and Dezart

*97 Announcements

The Chairman welcomed Mr R Hodgins who was attending the meeting in his capacity as a co-opted, independent Member of the County Council's Standards Committee to observe and monitor compliance with the County Council s ethical governance framework.

*98 Minutes

RESOLVED that the minutes of the meeting held on 28 June 2015 be signed as a correct record.

*99 Success Regime: Appointment of Lead and Progress

The Chairman reported that NHS England was interviewing for the appointment of a Lead Officer that morning. The successful candidate would be invited to the next meeting and in the interim a briefing note on the appointment would be circulated to Members.

*100 Transforming Community Services: Eastern Locality Commissioning Intentions

(Councillors Moulding and Way attended in accordance with Standing Order 25(2) and spoke to this item challenging whether or not the NHS tests for change had been met, reporting local concerns about the impact of reduced inpatient bed provision in their respective communities)

The Committee considered the report of Northern, Eastern and West Devon Clinical Commissioning Group (PH/15/23 - text onlyPH/15/23) covering decisions made by the Group s Governing Body in public on 16 July 2015 in relation to future arrangements of inpatient care in the Eastern Locality, progress in introducing new models of care, the outcome of consultations and the next steps to achieve clinically and financially sustainable care.

The Committee received all papers considered by the CCG Governing Body which included the Wakley Stakeholder Reference Group report of May 2015 (an independent report by Sir John Evans), the minutes of the Eastern Locality Board Meeting of 27 May 2015 and the Wakley sub-locality Community Services Data review of 6 October 2014 and supplementary consultation reports.

The Chairman also reported the receipt of letters from residents from the Eastern locality objecting to the proposals (tabled at the meeting).

The NEW Devon CCG Chief Officer gave an overview of the decision to consolidate inpatient care in 7 community hospital sites with an overall reduction of 11 from 174-163 beds in the locality, the financial savings which would be reinvested for care in the community, and outlining the rationale for the decisions - to support quality care at home as well as resilient services in hospital - key messages and the benefits and the next steps including implementation and future reporting on progress and impact of the changes.

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

clarification of costs regarding the Wakley Stakeholder Reference Group proposals and to costs in relation to community care

the outcome of acuity audits in relation to inpatient bed care and the comparative costs and occupancy rates

outcome of investigations following complaints into NEW CCG s procurement processes which had been dismissed by Monitor

the current consultation by Northern Health Care Trust in Northern Locality in relation to inpatient provision and that NEW CCG was not part of that process

NEW CCGs intentions to evaluate, report on progress and assess the impact of the changes in the Eastern Locality

possible impacts of closure of residential care bed provision in Exmouth, implications of increased sheltered housing provision and residential development generally in the Eastern locality and throughout the CCG area and the consequent need for the CCG to work with local authorities and other providers

benefits of the Hospital at Home initiative in Exmouth and clarification of the current number of inpatient care bed provision in Exmouth

the CCG confirmed its intent to progress implementation of the decision made in July and explained this would not be affected by the procurement process in the Eastern locality.

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

RESOLVED that a Task Group be set up to review in detail the decision of NEW CCG Board in relation to inpatient and community care in the Eastern Locality (to include the impact on community urgent care provision (Minute 102 refers))

*101 Consultation on Community Health Services in the Coastal Locality and Plans for Future Discussions

(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)

(Councillor Clatworthy attended in accordance with Standing Order 25(2) and spoke to this item in support of Option 1 the CCG s agreed option)

The Committee considered the report of the South Devon and Torbay CCG (PH/15/22 - text only | pdf PH/15/22) on the decision of the Board to adopt Option 1, as outlined in the Report, for community care in the Coastal Locality and an update on the next steps. The paper also outlined progress with discussions in other localities.

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

the engagement process and open evaluation of 14 options, rationale for the decisions in relation to the clinical evidence and cost effectiveness

progress towards the implementation of the approved Option

creation of a new Integrated Care Organisation in South Devon from 1 October through the merger of South Devon Healthcare Trust (Torbay Hospital) and Torbay and Southern Devon Health and Care NHS Trust into a single Foundation Trust

on further consultation to take place on new models of care in relation to Torquay, Newton Abbot, Moor to Sea and Paignton Brixham localities progress of which would be reported to this Committee.

The Committee also acknowledged representations made by the local member (Teign Estuary] and others over the impact of the decision on care provision in Teignmouth.

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

RESOLVED that the plans for implementation in the Coastal locality and for broader discussions on future consultation in other parts of the Clinical Commissioning Group area be noted and that progress be reported to this Committee.

[N.B. The Chairman reported that Sallie Ecroyd had left the CCG for a new post and placed on record the Committee s appreciation of her liaison work with Scrutiny).

*102 Emergency Provision of Services

The Committee received the report of NEW Devon CCG (PH/15/24 - text only | pdf PH/15/24) summarising statistical information and other data in relation to emergency provision of services in respect of patient numbers presenting at Accident Emergency units across the Acute Trusts in New Devon CCG, Walk in Centres, and Minor Injury Unit activity as well as the possible impact of the 111 service on AE admissions.

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

although there was limited information available from the CCG (due to NHSE commissioning primary care - GP and pharmacies plus optometry and dental services) about numbers attending GP practices or pharmacies national surveys indicated good access to GP services in Devon and as such the CCG felt that there was no need for further review

contrary to some reports there had been no decision by the CCG to close the Sidwell Street, Exeter Walk-In Centre and the Chairman suggested that the CCG should consider issuing a further press release to clarify the position

the impact on AE units of reduction of hours in the MIU s (to be also considered by Task Group established under minute 100 above).

*103 Integrated Care for Exeter (ICE): Progress

The Committee considered the report of the Head of Social Care Commissioning (SCC/15/41 - text only | pdf SCC/15/41) on the progress of the Integrated Care for Exeter (ICE) programme. The programme was a strategic alliance of public, voluntary and community sector organisations, working together to provide the infrastructure for designing better ways of working in the delivery of a sustainable system of care. Its aims were to: enable people to improve and promote their own health and well-being; be flexible, local and personalised; deliver a better experience of care; achieve better health and social care outcomes; and provide care more cost effectively.

The Head of Social Care Commissioning responded to matters raised or specific questions posed by Members namely:

the valuable work in relation to addressing the needs of homeless people in Exeter

the ICE Board s composition (as an operational body)

implementation of the programme would commence in November and be subject to review and evaluation

the compatibility between health and social care IT systems.

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

RESOLVED that the report be noted and that further progress and evaluation be reported to this Committee in July 2016 including IT issues.

*104 Safe and Effective Care within our Budget Consultation

(Councillors Edmunds, Parsons and Julian attended in accordance with Standing Order 25(2) and spoke to this item on concerns expressed locally about the proposals within the consultation relating to inpatient care bed provision).

The Committee considered the report of the Northern Devon Healthcare NHS Trust (PH/15/25 - text only | pdf PH/15/25) on the process and feedback to the Northern Devon Healthcare Trust's "safe and effective care within our budget" six week consultation ending on 29 September currently taking place in northern Devon in response to the 2015/16 budget settlement between NEW Devon Clinical Commissioning Group and the Trust.

The consultation consisted of 3 options: Option A: community inpatient beds located at two community hospitals; Option B: community inpatient beds located at NDDH; and Option C: community inpatient beds located at North Devon District Hospital and a community hospital.

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

local concerns about the proposals including a petition of some 8000 signatories and pace of the consultation (as reported by local members)

the proposed large reduction of inpatient beds from 74 to 40 in the locality (with some flexibility about precise numbers at any given point after the proposed change)

the resulting relatively small increase in community patient care numbers

the reduction of risks for patients moving from hospital based care to home care with additional support

recruitment initiatives to mitigate the use of agency staff being undertaken by the Trust including recruitment of nurses from overseas and pooling resources with other providers

good evidence of effective community care emanating from Torridge and Ilfracombe for example leading to improved patient outcomes

acknowledging there would be increased travel for a small minority of patients for the vast majority there would be no additional travel commitments

community services would be enhanced where inpatient beds were reduced

the proposed new contract for services in the Eastern locality area (with the RDE being the preferred provider)

the CCG decision not to undertake a joint consultation process with the Trust for the Northern Locality.

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

RESOLVED that the Northern Devon Healthcare Trust be asked to halt its consultation over community hospital beds to enable the opportunity for NEW CCG and NDHT to provide the Northern Devon community with a jointly agreed consultation platform.

*105 Health Wellbeing Scrutiny Committee Work Programme

The Scrutiny Officer reported that the Test of Change Torrington Task Group would report back to the January meeting of this Committee and the work programme would be updated following today s meeting to include:

(a) a report to the November meeting on the Devon Partnership Trust s proposals relating to changes to mental health care provision in Exmouth;

(b) formation of a Task Group to review the decisions of the NEW Devon CCG in relation to Transforming Community Services in the Eastern locality and emergency provision.

(c) a progress report to the July 2016 Committee on the Integrated Care programme for Exeter (ICE).

*106 Information Previously Circulated

The Committee noted a summary of documents/publications previously circulated for members, since the last meeting, relating to Health and Wellbeing developments and including matters which were currently being considered by this Scrutiny Committee:

(a) Urgent building works to be completed at Ashburton and Buckfastleigh Community Hospital.

(b) Final findings of the investigation from Monitor into NEW Devon CCG into the organisation s procurement process for the services which found the CCG had not breached the Procurement, Patient Choice and Competition Regulations in the areas investigated.

(c) Northern Devon Healthcare NHS Trust Consultation Launch: Safe and Effective Care within its Budget.

(d) Update on the NEW Devon Success Regime from NEW Devon CCG: Stake holder briefing 31 July 2015.

(e) Press release from South Devon Healthcare NHS Foundation Trust encouraging people to choose the most appropriate healthcare this summer, published Wednesday 29 July 2015;

(f) Briefing note from NHS NEW Devon CCG about the Governing Body s decision on the future of community services in the Eastern Locality.

(g) Letter to the Chairman confirming that there were no plans to sell Torrington Community Hospital and explanation of the process by which the NHS allocates buildings as surplus estate , as referenced in the 2013 Estates Strategy.

(h) Devon Partnership NHS Trust s summary of its aims, plans and priorities for 2015/16 dated 6 July 2015.

(i) Piecing it together: Effective scrutiny of health and social care integration published by LGA and CfPS circulated on 30 June 2015.

*DENOTES DELEGATED MATTER WITH POWER TO ACT

The meeting started at 2.00 pm and finished at 5. 55 pm

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