Present:

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

(Councillors Brook and Chugg attended up to and including Minute 109 and 111 respectively)

Member attending in accordance with Standing Order 25:-

Councillor Edmunds

Apologies

Councillors Christophers (representing District Councils), Dezart, Diviani, and Sellis

*107 Minutes

RESOLVED that the minutes of the meeting held on 14 September 2015 be signed as a correct record.

*108 Success Regime: Appointment of Lead and Progress

The Chief Executive (Devon County Council) attended and spoke to this item, as a member of the Success Regime Programme Board, on the scope of the Regime overseen by NHS England, Trust Development Authority and Monitor.

He outlined the whole system approach to address deep-rooted and systemic issues that previous interventions had not tackled and the difficult issues faced by NEW Devon Clinical Commissioning Group as part of the local health and care economy.

This process would be overseen by the Programme Board - Chaired by Dame Ruth Carnal and an Executive Board reporting thereto (and sub groups).

The process would be undertaken over 3 phases:

Phase One - the Diagnostic Phase, running from October to December 2015, to establish the underlying issues - size of the financial challenge and underlying causes for over-spend;

Phase Two to develop solutions to improve short-term performance, as well as developing longer term strategic solutions;

Phase Three (final phase): implementing those longer-term strategic solutions and turning plans into action.

The Chief Executive also responded to specific questions raised by Members including:

the size and composition of the Programme Board, the role of the Executive Board and a smaller Clinical Group (Chaired by the County Council s Director of Public Health) and Executive Group all supported by the recently appointed Programme Director

the importance of effective public engagement and liaison with the Scrutiny Committee

the uncertain timetable for change in the short and longer terms

the need to improve use of limited resources across the health and social care community whilst improving outcomes

how the Success Regime may effect current policies and strategies proposed or adopted by the NEW Devon Clinical Commissioning Group which would be a question best addressed by NEW Devon Clinical Commissioning Group management at this stage.

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

RESOLVED that Success Regime representatives be invited to the next meeting for an update on the process and progress.

*109 Safe and Effective Care within our Budget Consultation

(Councillor Edmunds attended in accordance with Standing Order 25(2) and spoke to this item on concerns expressed locally about the decision to close inpatient care bed provision In Ilfracombe).

The Committee considered the report of the Northern Devon Healthcare NHS Trust (PH/15/27 - text only | pdf PH/15/27) on the Trust's consultation "safe and effective care within our budget" which had ended on 29 September and the rationale for the Trust s subsequent decisions.

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Members noted that the Northern Devon Healthcare Trust Board had at its meeting on 6 October decided to adopt Option A locating community hospital inpatient beds at Holsworthy and South Molton. This would reduce overall inpatient provision in the NDHT area from 70 40 beds.

Trust representatives responded to matters raised or specific questions posed by Members relating, inter alia to:

the positive outcomes for patients with care in the community in their own homes and risks associated with prolonged stays in community hospitals

the reduction of inpatient bed provision and overall small impact on resources with over 7000 patients in home-based community care within the Trust area

the implementation phase of the decision which was underway

concerns from local members that the risks outlined by NEW Devon Clinical Commissioning Group had not been addressed by the NDHT

the current evidence of positive outcomes (including Family and Friends test) arising from the Torrington Test of Change and current work with NEW Devon Clinical Commissioning Group to develop improved Key Performance Indicators

the relative cost savings of closing community hospitals and improved Community Care provision

concerns expressed by some local clinicians during the consultation phase which in the view of Trust were not wholly representative of the general view of clinicians

the difficulty in creating community bed capacity at the Barnstaple Hospital site

the risk assessments undertaken on each patient (including winter weather conditions) as part of the community care package

difficulty of access to South Molton in-patient bed provision arising from the closure of provision in Ilfracombe (as expressed by the local member)

the option for Ilfracombe patients for inpatient bed care at the Barnstaple acute hospital if clinically necessary

undertaking by NDHT that it would carry out regular review of the effects of the changes and evidence delivery outcomes and be responsive to feedback in a timely manner.

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

RESOLVED

(a) that the Scrutiny Committee recognises the decision taken by NDHT but wishes to convey its concerns (including those from local clinicians and others articulated in the consultation) about the pressures arising from the reduced level of inpatient community bed provision across Northern Devon particularly against winter pressures;

(b) that a further progress report be made to the next meeting on Key Performance Indicators and reporting upon any actions taken to ameliorate the concerns expressed by NEW Devon CCG about changes in provision;

(c) that this decision be drawn to the attention of the Success Regime.

(NB: In accordance with Standing Order 32(4) Councillors Brook and Colthorpe asked that their votes against the motion be recorded)

*110 St John s Court

The Committee considered the report of the Devon Partnership Trust (DPT) (PH/15/27 - text only | pdf PH/15/27) on its change programme called SMART Recovery to include a plan to relocate from St John s Court to more affordable premises in Exmouth and on local public engagement meetings which had been undertaken.

DPT representatives responded to matters raised or specific questions posed by Members including:

the relative low use of St John s Court and the changes since refurbishment works which had been undertaken some 4 years prior

the DPT would develop an Options Appraisal which it would share with members

revenue expenditure on buildings which was not sustainable

the commitments of the Trust to inform patients, carers and the local member of progress of the plans

advantages in buildings and resources close to or provided with other health care practitioners and clinicians where practicable.

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

RESOLVED that Devon Partnership Trust be requested to submit a progress report to this Committee in March 2016.

*111 Analysis of Hospital Mortality Rates

The Committee considered the report of the New Devon Clinical Commissioning Group (PH/15/29 - text only | pdf PH/15/29) on mortality rates in hospitals across the Devon area focusing primarily on Summary Hospital-level Mortality Indicator. An additional indicator around Potential Years of Life Lost from causes considered amenable to healthcare had been included as a Clinical Commissioning Group wide measure.

The Francis Inquiry had recommended that Scrutiny Committees regularly review acute hospital mortality rates.

The Committee noted that all four acute Trusts in the Devon area were reporting mortality rates lower (better) than the national average and after deeper analysis there was no cause for concern across all providers.

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

RESOLVED that the NEW Clinical Commissioning Group be requested to submit an Annual Report on hospital mortality rates and by exception any specific concerns to the Committee.

*112 Cancer Treatment Waiting Times Position

The Committee considered the report of the RDE Hospital Foundation Trust (PH/15/31 - text only | pdf PH/15/31) on increased levels of patients diagnosed and treated with a cancer and efforts to address deteriorating cancer waiting times performance with constraints on capacity which had resulted in difficulties in meeting key cancer targets, a situation that was replicated across England.

The Trust was currently working with Monitor, NEW Devon Clinical Commissioning Group, South West Cancer Network and the Intensive Support Team to ensure it maximized all available opportunities for improving cancer waiting times performance.

The Trust representatives and NEW Clinical Commissioning Group representative responded to matters raised or specific questions posed by Members including:

other waiting time performance indicators involved a range of cancer treatments

despite the poor compliance with this particular indicator (patients not receiving treatment within a 62 day timeframe) the excellent standards of clinical care and good outcomes for patients which compared favourably with national indicators and also evidenced by positive views and feedback from patients

the differing referral pathways and work with patients through all stages to keep them informed with regular reviews

the additional resources being committed for cancer services, a priority area, during a period of projected budget deficit

the various reasons for increased demand for cancer services

the ongoing liaison and education work with GPs in the locality and further afield to improve early diagnosis and local and national public campaigns to increase awareness

other referral pathways and evidence of some patient non-attendance for consultation

work of the hospital and partner voluntary agencies in valued psychological support for patients and carers.

The Trust undertook to provide a progress report in 6 months to members on waiting times indicating whether or not these had been reduced to the anticipated level.

*113 Health Wellbeing Scrutiny Committee Work Programme

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

RESOLVED

(a) that work programme be amended to include the following items:

(i) Success Regime (Minute *108);

(ii) North Devon Health Trust: Community Care and Community Hospitals progress report on development of Key Performance Indicators and on concerns expressed by NEW CCG about the changes in provision (Minute 109);

(iii) SMART Recovery programme: Devon Partnership Trust - progress report (Minute 110);

(iv) Analysis of Hospitality Mortality Rates - annual report by NEW CCG (Minute 111);

(v) Spotlight Review relating to the East Devon TCS (Minute 100) exercise comprising the Chairman, Councillors Gilbert, Greenslade, Wragg and Wright be held in the New Year;

(vi) report on Public Health Acuity Audits; and consideration of the HealthWatch Discharge report.

(b) that Councillor Gilbert be appointed to the Corporate Services Joint Task Group review on Income Generation.

(c) that the next meeting on 20 January 2016 commence at 10.30 am.

*114 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.

*DENOTES DELEGATED MATTER WITH POWER TO ACT

The meeting started at 2.00 pm and finished at 4. 30 pm

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