Agenda and minutes

Minutes of the meeting held on 8 November 2016 (previously circulated).

RESOLVED that the minutes of the meeting held on 8 November be signed as a correct record.

Items which in the opinion of the Chairman should be considered at the meeting as a matter 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 for this meeting, as set out hereunder, relating to a specific matter or an examination of services or facilities provided or to be provided.

In accordance with the Council's Public Participation Rules, the Committee received and acknowledged oral representations made by Ms Hancox, Mr Wearne, Ms Pearson, Ms Baker, and Dr McElderry (Minute *45 refers) and Mrs Pritchett (Minute *46 refers) on matters to be considered by the Committee, namely the ‘Your Future Care’ and Torbay and South Devon: Community Services Reconfiguration on implications for local community health and social care services.

The Chairman responded, thanking the speakers for their attendance and presentations which would be taken into account by the Committee during its subsequent deliberations.

2.05 pm

Report of NEW Devon Clinical Commissioning Group, attached

Ms E Fitzsimmons representing the NEW Devon Clinical Commissioning Group (CCG) attended and spoke to this item at the invitation of the Committee.

The Committee considered the Report of the NEW Devon CCG on the operation of the new service model for NHS 111 and Out of Hours Care for Devon now known as the Integrated Urgent Care Services (IUCS) since going live in October 2016. The Report also covered patient and public involvement during the development and procurement process, implications of the changes, ongoing review, evaluation and the next steps.  

Ms Fitzsimmons responded to Members’ questions relating to:

·         performance in terms of response rates, involvement of clinicians in the calls (taking more than 40% of calls) and the positive feedback received to date;

·         the low use of locum doctors and comparative figures before and after the introduction of the service.

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

RESOLVED that the progress with the introduction of the new Integrated Urgent Care Services be noted and a further review and evaluation report be presented to the Committee in 12 Months’ time. 

2.15 pm

Overall Approach

In line with previous practice, the 2017/18 budget proposals will again be scrutinised collectively, with a joint session of Scrutiny Committees to be held on 30 January 2017, following preliminary consideration by individual Scrutiny Committees.

The joint session will, as before, enable all Scrutiny Members to critique, question and challenge the budget proposals across services, to better understand the implications of the budget proposals across the Council and to make more effective recommendations to Cabinet and the Council.  Additionally there will be an opportunity for members of the public to address that meeting and make oral representations/presentations on any matter relating to the proposed budget.

The Council must have full regard to and consider the impact of any proposals in relation to equalities prior to making any decisions, as set out in equality impact assessments, and any identified significant risks and mitigation action required. 

This Meeting

At this and other Scrutiny Committees in the current cycle, Members are asked, in advance of the Joint Scrutiny meeting, to identify salient issues within each Committee’s  areas of responsibility, to examine the general thrust of the budget and take an overview of priorities and prospects as a means of informing discussion at the Joint Scrutiny meeting.           

At these meetings Chief Officers will report, inter alia, on:

·         the Cabinet’s Target Budget for services/suite of services;

·         how that compares to the target figure for 2016/17;

·         the likely implications of the 2017/18 target for individual areas of service (e.g. in percentage terms compared to current levels) and how those areas have been prioritised;

·         any comparisons between the current year and next year’s proposals for the major service areas, to illustrate the scale of change within those activities and how the budget has been allocated across services in those years (to illustrate changes of emphasis or priority);

·         any “alternative delivery models” or other initiatives contemplated for given services and how it is thought that these may reduce costs;

·         impact assessments undertaken in relation to the draft budget.

Questions

As in previous years, a dedicated electronic mailbox facility is available to Members to ask questions of fact or on the interpretation of budget papers, in advance of the Joint Scrutiny meeting, until 24 January 2017, details of which have been circulated previously. 

Report and Budget 2017/18 Impact Assessment

The Joint Report of the County Treasurer and Chief Officer for Communities, Public Health, Environment and Prosperity (CT/17/02) on the proposed budget for Public Health services for 2017/18 is, attached.

[NB:

An overview of the impact assessments for all service areas entitled ‘Budget 2017/18 Impact Assessment’ has also been made available to all Members of the Council in order that Scrutiny Committees may have access to all necessary equality impact assessments undertaken as part of the budget’s preparation.  The document will also be available at:

https://new.devon.gov.uk/impact/published/budget-setting-201718/

Members are requested to familiarise themselves with its contents, retaining it for future meetings accepting that this is a dynamic process and individual assessments may necessarily be updated with time.  ...  view the full agenda text for item 44.

(Councillor Davis, Cabinet Member for Improving Health and Wellbeing, attended in accordance with Standing Order 25(1) and spoke to this item at the invitation of the Committee).

The Committee noted that in line with previous practice the proposed budget for the 2017/18 financial year would be scrutinised collectively with a joint meeting of Scrutiny Committees to be held on 30 January 2017 providing an opportunity for Members to comment on proposals for the Council’s Budget in its entirety.  This would follow the opportunity for individual Scrutiny Committees – as at this meeting – 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 referred to above for incorporation into any recommendations to Cabinet and Council.

The Committee then considered the Joint Report of the County Treasurer and Chief Officer for Communities, Public Health, Environment and Prosperity (CT/17/2) on the provisional financial settlement made by Government within the current and anticipated public sector funding regime and on the spending targets set by the Cabinet for all service areas, including inflation, commitment and service prioritisation reductions.

The Report contained the detailed budget proposals for all health and wellbeing services and in particular the proposed budget for Public Health - which would also be presented to Place Scrutiny Committee as part of that Committee’s consideration of budgets for Communities, Public Health, Environment & Prosperity services generally - prepared in line with those targets, reflecting the different pressures and influences faced by services.

The proposed budget for Communities, Public Health, Environment & Prosperity of £35,203,000 incorporated inflation and commitments of £2,468,000 and required budget savings of £576,000.  The ring fenced Public Health Services grant for 2017/18 was £28,238,000 being a shortfall of £714,000 (2.5%) over 2016/17. Future grant allocations were expected similarly to reduce by a further 2.6% year on year until 2020/21. This shortfall – which was for one year only -  had been offset by an  injection of funding from corporate resources because, in future years, changes would  be made to contracted services to bring the budget back into balance. The shortfall had been a direct consequence of the removal of £1,600,000  from the ring-fenced reserve by the Department of Health.

Members noted that overall, service inflation and commitments for the Council for the year were estimated at £43,026,000 and that to manage those combined pressures and set a budget within Government provisional targets, total savings of £22,229,000 would need to be found in the 2017/18 budget.  The announcement by Government on the final settlement and Council Tax Regulations was expected shortly. 

The Chief Officer for Communities, Public Health, Environment and Prosperity commented on the likely implications of the 2017/18 target for individual areas of service noting that the overall approach remained one of striking a balance between financial realities and ensuring the delivery of essential services. In order to achieve a balanced budget against the future forecast of reduced funding, there were  ...  view the full minutes text for item 44.

2.45 pm

Report of NEW Devon CCG attached

(Councillor Ball attended in accordance with Standing Order 25(2) and spoke to this item relating to the positive dialogue with the CCG following the last meeting of this Committee and issues relating to requests under Freedom of Information rules).

Dr T Burke, Mr R Sainsbury, Ms J McNeill and Mr N Pearson (NEW Devon Clinical Commissioning Group) attended and spoke to this item at the invitation of the Committee.

The Committee considered the Report of NEW Devon CCG on the ‘Your Future Care’ proposals following a 13 week period of public consultation which had commenced on 7th October 2016 and which had now closed. The consultation had set out four options for the location of a reduced number of inpatient beds in community hospitals in Eastern Devon. These options were in the context of developing a model of care in the whole of Devon to consistently deliver three core service components to help people remain at home. The Report outlined the extensive consultation processes and responses and a detailed summary and the next steps.  

Members were assured that, following the Decision Making Business Case and impact assessments, the CCG’s Governing Body decision would be made no earlier than March 2017.

The Clinical Commissioning Group’s representative responded to Members’ questions

relating to:

·         careful consideration of all responses and the independent role of Health Watch Devon in the consultation and community engagement events and role of the local Public Engagement Committees;

·         the relatively tight time scale for decision making with an assurance from the CCG that decisions would be made when the Decision Making Case was ready which was anticipated for March 2017 and that any delay would cause further uncertainty and anxiety;

·         errors relating to post code information which had been quickly corrected by the CCG and that all Freedom of Information requests were being dealt with by the CCG’s Consultation Response Unit  and clarification from questioners sought as necessary; 

·         continuous analysis of impact assessments (which was part of the Decision Making Business Case);

·         views of hospice care and the need to prioritise packages for ‘end of life’ care;

·         the robust implementation process and checks to ensure a safe transition and reconfiguration of services.

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

RESOLVED that the NEW Devon CCG be requested to provide a further update to this Committee’s March meeting.

3.15 pm

Report of the South Devon and Torbay CCG attached

Ms J Turner (Locality Manager) and Mr R Chalmers (Head of Communications and Strategic Engagement) South Devon and Torbay Clinical Commissioning Group (CCG), attended and spoke to this item at the invitation of the Committee.

The Committee considered the report of the South Devon and Torbay Clinical Commissioning Group on the 12 week formal consultation and a feedback report independently produced by HealthWatch.

It was noted that the clinical basis for the proposals put forward by the CCG for consultation was supported by the independent South West Clinical Senate. The report also outlined alternative proposals put forward by the public and their evaluation by the CCG, and the timetable for decision to be followed by effective planning for reconfigured services. Proposals would be published shortly and be considered by the CCG’s Governing Body at its meeting on 26 January 2017. 

Members’ comments and questions to the CCG representatives covered operating hours for the Minor Injuries Unit, disposal of surplus assets and capital receipts for community use and consultation meeting arrangements and other forms of feedback with on-line resources.

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

RESOLVED that this Report be noted and that the proposals and plans be reported to the March meeting of this Committee.

3.30 pm

Report of NHS Property Services attached 

The Committee received a report from NHS Property Services in response to questions previously posed by Members, namely (i) how much was each individual community hospital being charged for rent by NHSPS and (ii)  how much was the rental income for NHSPS nationally compared with the amount spent on maintenance?

The response received from NHS England was that:  

“(i) Further to the information provided in July, market rent values for the individual hospitals remain commercial in confidence while lease negotiations are being concluded.

(ii) In 2016/17 our budgeted rental income is £408 million. This includes freehold and leasehold income. For leasehold properties, we normally hold a head lease on behalf of the NHS. The level of rent we have to pay our superior landlord is set out in the terms of this lease. We recover this cost by invoicing our customers for the same amount (plus a 5% management charge to cover our costs). Our customers’ rents will be subject to the same review patterns as our head lease. In 2016/17, our budgeted spend on ‘Hard Facilities Management’ (normally referred to as ‘Hard FM’), which is mainly for routine, small-scale maintenance, is £98 million. These are direct costs and do not include overheads such as the salaries of our FM teams. It is also important to note that the £98 million does not include the money spent on larger maintenance projects that become part of our Construction Project Management (sometimes known as ‘Capital’) programme. The forecast CPM spend for 2016/17 is £60 million and typically funds a range of projects from new roofs and boilers to refurbishments and new-builds.”

While noting that the Committee had no powers to compel NHS Property Service attendance regarding the transfer of 12 community hospitals to NHS Property Services (as part of NHS Northern, Eastern and Western Devon Clinical Commissioning Group plans to award its contract for community services to the Royal Devon and Exeter NHS Foundation Trust) Members asked that NHS Property Services should be invited again to the next meeting to answer members’ questions.

The Chairman indicated that he would invite MPs to raise this matter in Parliament.  

3.45 pm

Report of the Task Group (CS/17/03) attached

The Committee considered the report of the Task Group (CS/17/03) (comprising members of this Committee in collaboration with Corporate Services Scrutiny) on a review of the mechanics of the funding settlement that was given to Clinical Commissioning Groups in Devon each year by central Government to:

·         clearly establish the principles upon which the local NHS is funded by central Government.

·         come to a view on whether the principles that underpin the funding formula disproportionally disadvantage Devon and if Devon is comparably underfunded as a result.

·         make representations to Central Government as appropriate to challenge the allocation of funds.

The Committee noted that Task Group members had recently met with Sarah Wollaston MP and the Report had been well received and could be used to support the case for fairer NHS and social care funding in Devon.   

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

RESOLVED that the Cabinet and the NHS in Devon be requested to endorse the report and recommendation below:

(a) make representations to Central Government to review the way in which the NHS is funded (with copies to Devon’s MPs); and

(b) that the Task Group request the opportunity to present this report in person, with the Cabinet Member, to the Secretary of State for Health in order to request that the criteria upon which the funding formula is based be amended to better reflect the needs of the population in Devon taking into account rurality, age of the population and a complete picture of the local health and social care cost.

4.10 pm

Report of the Spotlight Review (CS/17/02) attached

The Committee considered the report of the Spotlight Review (CS/17/02) to identify and establish the principles of evaluating service change using quality metrics and data about community healthcare as presented by NHS providers; to a review how information was provided to committee to monitor quality; and agree how and on what basis quality measurements should be reported and presented to committee.

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

RESOLVED

(a) that the Scrutiny Protocol Rules be amended and the NHS in Devon be requested to endorse the report and recommendations below, namely: 

(i) that all witnesses and presenters including Devon County Council and NHS to provide: clarity in communications from the NHS specifically: presentations to Scrutiny Committees to last no longer than 10 minutes; a limit on verbose reports and effective, short, data rich reports and Communications with everyone to be in plain English (no acronyms or assumptions made);

(ii) that Health and Wellbeing Scrutiny Committee to receive regular performance reports from providers co-ordinated by the relevant CCG - these reports to be based on a co-produced dashboard of indicators between Scrutiny Committees and the NHS Scrutiny Committee/CCGs/Providers;

(ii) that when substantial variation to services is planned the Health and Wellbeing Scrutiny Committee be notified using a pro-forma that has been agreed in advance by this Health and Wellbeing Scrutiny Committee and Clinical Commissioning Groups;

(b) that the Health and Wellbeing Scrutiny Committee receive a progress update in 3 - 6 months’ time.

In accordance with the previous practice, Scrutiny Committees are requested to review the list f forthcoming business (previously circulated) and to determine which items are to be included in the Work Programme. The Work Programme is also available on the Council's website at http://www.devon.gov.uk/scrutiny_programme.htm

The Committee may also wish to review the content of the Cabinet Forward Plan, available at http://new.devon.gov.uk/democracy/how-the-council-works/forward-plan/ to see if there are any specific items therein it might wish to explore further.

The Committee noted that the Work Programme had been or would be amended to include a

further report on a Review of Performance;  and Public Health Nursing procurement and other changes arising from this meeting.

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

available at http://www.devon.gov.uk/forward_plan]

Below is a list of information previously circulated for Members, since the last meeting, relating to topical Health and Wellbeing developments including matters which have been or are currently being considered by this Scrutiny Committee.

(a) The Community Hospitals Association response to the NEW Devon CCG consultation "Your Future Care".

(b) Care Quality Commission (CQC) consultation document, ‘Our next phase of regulation: A more targeted, responsive and collaborative approach’, follows the strategy for 2016 to 2021, published in May 2016, which sets out the vision for a more targeted, responsive and collaborative approach to regulation, so that more people get high-quality care.  

(c) NHS England update on the funding of a major extension to the national HIV prevention programme with the aim of supporting those most at risk and reducing the incidence of HIV infection.  

(d) Devon Partnership NHS Trust announcement of the plans for a major new facility in the county that will significantly improve the care and treatment available to people locally.

(e) The Devon Partnership Trust press release in respect of a new Psychiatric Intensive Care Unit (PICU) on the Wonford House site in Exeter and the business case for the new £5.5m unit. The PICU will support people from Devon, Torbay and Plymouth and drop-in event On 17 January between 4.00 and 6.00pm.  

(f) CQC News Letter: monthly update for Scrutiny Committees.

(g) DPT Stakeholder Briefing: November 2016: an update on some of the DPT’s latest developments, issues and news. 

(h) Health Watch Report report following a number of concerns received in relation to the Blue Badge assessment process.

(i) Letter from Chairman of NEW Devon CCG giving notification of the appointment of Janet Fitzgerald as the new Chief Officer, on an interim basis.

The Committee received a list of information previously circulated for Members since the last meeting relating to topical Health and Wellbeing developments including matters which have been or were currently being considered by this Committee.