Agenda and minutes

Minutes of the meeting held on 7 June 2018 (previously circulated)

RESOLVED that the Minutes of the Meeting held on 7 June 2018 be signed as a correct record.

Items which in the opinion of the Chairman should be considered at the meeting as matters 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, 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 Mary Hyland and Maureen Philips on matters to be considered by the Committee, namely Promoting Independence in Devon (Carers) and the Carers Event at Westbank Community Care Services (Minutes *79 and *83 refer).  They both expressed concerns regarding the level of support they received (in particular with ‘self-funding’) from the County Council, the statutory assessment process, the lack of respite available and the isolation they felt. 

The Chair responded, thanking the speakers for their attendance and presentations which

would be taken into account by the Committee during its subsequent deliberations.

Report of the Chef Officer for Communities, Public Health, Environment and Prosperity, attached  

(Councillor A Leadbetter attended in accordance with Standing Order 25 (1) and spoke to this

item at the invitation of the Committee)

The Committee received the Report of the Chief Officer for Communities, Public Health, Environment and Prosperity on activity of the statutory Devon Health and Wellbeing Board over the last year and its forthcoming work. Board meetings had included standing reports in relation to health and wellbeing outcomes, the Better Care Fund and updates from the Clinical Commissioning Groups (CCGs). The meetings typically had contained a theme-based discussion on an issue of local importance, with recent topics covering young people, domestic violence, and homelessness. Other reports between September 2017 and June 2018 had included updates on the Sustainability and Transformation Plan (STP), health protection, CAMHS, health and care integration, and suicide prevention.

In response to Members’ questions and comments the Chief Officer for Communities, Public Health, Environment and Prosperity and Councillor Leadbetter outlined the changes in Membership (as had been recommended by this Scrutiny Committee), the partnership working within the Board involving the Clinical Commissioning Groups, providers and other partners and reported the recent appointment of Dame Suzi Leather as the Chair of the Devon STP, who would be attending the next Board meeting.

Report of the Independent Chair of the Board, attached 

Ms S Walker (Independent Chair of the Devon Safeguarding Adults Board attended at the invitation of the Committee).

The Committee received and noted the Report of the Devon Safeguarding Adults Board (DSAB) on their Annual Report for 2017/18. The annual Report summarised safeguarding activity undertaken throughout 2017/18 by the Board and its key partners and set out the progress made against priorities.  There was a statutory requirement to present the Annual Report to the local Health and Wellbeing Board and in Devon it would also be presented to Cabinet.  

The Report helped ensure that key messages were portrayed and understood widely.

In response to Members’ questions and comments the Board’s Chair commented on:

·         a shortened version of the Report was available on the website with further information on performance data;

·         further investigation by the Board (a deep dive audit) into the comparatively low level of referrals in Devon, noting that the Care Quality Commission (CQC) had positively rated care providers;

·         their partnership work with the Safer Devon Partnership, the Council’s Adult Care services and other agencies; and their work with acute hospitals in promoting good practice; and

·         the reviews of cases in Devon were published and there was good information sharing with other safeguarding Boards to promote learning and develop prevention strategies and regional activity in developing a library of case reviews.

The Chair thanked Sian Walker for her informative presentation and accepted her suggestion that the work of the Board could again be the subject of a future Masterclass available for all Members.

[N.B More detailed information about the work of the Board is available on the DSAB website:  https://new.devon.gov.uk/devonsafeguardingadultsboard/]

Following on from the NDHT Action Plan (previously considered by this Committee) the Care Quality Commission (CQC) will publish their update report on Tuesday, 18 September 2018 which will be made available to Members for review.   
 

Deputy Medical Director, NDHT to report.

D Allcorn (Northern Devon Healthcare NHS Trust (NDHT)) attended and spoke to this item at the invitation of the Committee.

The Committee had received the Care Quality Commission’s (CQC) inspection report arising from their unannounced inspection of the North Devon Hospital on 17 and 18 July 2018. That inspection had focused solely on the improvements required as detailed in the warning notice following the inspection in October 2017. The Committee had also received the  NDHT Action Plan update dated 20 September 2018. 

The Committee received a presentation from the Northern Devon Healthcare NHS Trust which covered the CQC’s recent findings, where the Trust was now; key areas where further action was required; and the way forward. 

In response to Members’ questions and comments the Trust representative referred to:

·         the progress that was being made to improve services, the training in place and their robust audit plans, the need to embed, sustain and monitor the improvements that were being made whilst acknowledging that more work was required to address all the weaknesses identified;

·         the significant investment made by the Trust in their Accident and Emergency provision and new streamlined operating and triage practices;

·         clear ownership of the Risk Register in respect of Maternity Services, as recommended;

·         the positive patient feedback following CQC surveys which the Trust would share with Members when available; and

·         the new joint accountability arrangements with the Royal Devon and Exeter Hospital Trust (in the last 3 months) and effective working with a wider system approach.

The Chair thanked the Trust for the update and the work of their staff in making progress and asked that a further report on the progress of the updated Action Plan be made to the next meeting in November 2018.

Report of the Head of Adult Commissioning and Health (ACH/18/92), attached 

(Councillor A Leadbetter attended in accordance with Standing Order 25 (1) and spoke to this

item at the invitation of the Committee)

The Committee considered the Report of the Head of Adult Commissioning and Health (ACH/18/92) on Devon County Council’s vision for Adult Social Care and 5-year plan (updated annually).  The Annual Report, Vision, and Plan (supported by more detailed strategies and plans) were developed to align with both the County Council’s strategic plan and the developing strategy of the wider Devon Sustainability and Transformation Partnership (STP) with the Council’s plan organised around the latter’s priorities to maximise the potential benefits of joint working.

In response to Members’ questions and comments the Head of Service and Councillor Leadbetter outlined

·         the Council’s arrangements with Westbank in supporting carers;

·         the potential benefits in utilising new technology at all levels to supplement care packages by meeting people’s needs in different ways;

·         the promotion of self-help initiatives, including social prescribing;

·         the need for targeted interventions where appropriate; and 

·         developing work to map current provision.                                                               

It was MOVED by Councillor Randall-Johnson, SECONDED by Councillor Way, and

RESOLVED

(a) that the alignment between this organisational plan and the planning framework for the wider health and care system in Devon be noted; and

(b) that the aspiration in future years to a more integrated planning process across the health and care system with organisational reporting being an output of that approach, be noted.

Report of the Head of Adult Commissioning and Health, Devon County Council; and Director of Strategy (South Devon and Torbay CCG and NEW

Devon CCG) (ACH/18/91), attached

(Councillor A Leadbetter attended in accordance with Standing Order 25 (1) and spoke to this

item at the invitation of the Committee)

Dr S Manton, Joint Director (Strategy) North, East and West (NEW) Devon CCG and South

Devon and Torbay CCG attended and spoke to this item at the invitation of the Committee)

The Committee considered the Report of the Head of Adult Commissioning and Health, Devon County Council and Director of Strategy (South Devon and Torbay CCG and NEW Devon CCG) on an update of the Sustainability and Transformation Partnership (STP) for wider Devon and the emerging Integrated Care System (ICS). The paper highlighted the two-year STP report recently published; an update on national developments in relation to ICS and local work.

The Director of Strategy, the Head of Adult Commissioning and Health and Councillor Leadbetter responded to Members’ questions and/or commented on:

·         the development of Integrated Care Providers (ICP) nationally regarding a new form of contracted services coming together based on outcomes (wider social care and health determinants) and which at this stage these new contracts were not mandatory;

·         historically different funding levels and resources across wider Devon and the need to address inequality of opportunity and outcomes and deployment of resources accordingly;    

·         the evidence base for decision making provided by the Joint Strategic Needs Assessment JSNA;

·         the complex reasons behind any delays in patient hospital discharge into the community; 

·         the prevention workstream within the STP headed by the County Council’s Chief Executive; and

·         challenges faced in work force planning in an environment of near full employment, joint staffing arrangements, recruitment and the international workforce and the design and development of a medium-term plan by the CCGs details of which could be reported to a future meeting.

A Member referred to the STP Savings Summary 2017/18 (previously circulated to Members) and implications of the possible impacts and called for a spotlight review. The Committee noted that at the time of the publication of these figures they had related to projections of significant overspend if no action was to be taken. The STP programme was addressing the issues which had been identified.  

Members also noted that the Committee’s Standing Overview Group’s next meeting would focus on the STP and ICS governance and integration. 

It was MOVED by Councillor Randall Johnson, SECONDED by Councillor Way and 

RESOLVED that the progress on the Sustainability and Transformation Plan and the Integrated Care Systems development be noted and progress be reported to this Committee.

In accordance with Standing Order 23 (2) Councillor Ball has asked that the

Committee consider this matter

Presentation attached

In accordance with Standing Order 23 (2) Councillor Ball had asked that the Committee consider this matter.

Councillor Ball gave a presentation on his engagement with the community of Okehampton in response to NEW Devon CCG decisions which had led to the loss of inpatient beds at Okehampton hospital and the development of the New Model of Care in the Town and its environs, including new and improved health and care services at the Community Hospital. The local engagement and leadership by Councillor Ball with officers included a successful community information day and a Proud to Care jobs fair which brought local people and healthcare professionals together to promote recruitment into local health and care services.

In response to Members’ questions Councillor Ball indicated that his experience was not a blueprint for other members and communities but an example of allowing his community to come together and learn and find about what was needed and the opportunities available.

The Members commended Councillor Ball on his local leadership and work with the community and agencies.

Report of the Health and Adult Care Scrutiny Committee Members (CSO/18/29), attached

The Committee received Report of the Health and Adult Care Scrutiny Committee Members on a series of visits to community health and care settings across the County to enable members to gain feedback from staff and a better understanding of the way in which the model of care in Devon was working operationally and the key issues affecting services from a frontline perspective.

Members had visited the Exeter Community Health & Care Team, Exeter Community Hospital; Holsworthy Community Health and Care Team, Holsworthy Community Hospital; and Teignmouth Community Health & Care Team, Teignmouth Community Hospital. In addition, the local member for Otter Valley had visited Honiton and Ottery Community Hospitals on 9 August 2018.

Members agreed that the system appeared to be working well and supported by the dedicated and motivated staff who fully endorsed the concept and the new way of working for the benefit of the community.  Members were encouraged to continue to visit their local teams.

Report of the Health and Adult Care Scrutiny Committee Members (CSO/18/28), attached 

The Committee considered the Report of the Health & Adult Care Scrutiny Committee Members (CSO/18/28) on a Members’ visit to a Carers Event at Westbank on 23 July 2018. The session with carers, care ambassadors, commissioners and the provider had covered:

•       the approach to Carers’ Support Services, key features of the new service “Caring Well in Devon” and the carer offer;

•       the County Council’s response to the views of carers expressed in the biennial Carer Survey, the outlook for the next survey which would be undertaken this year and factors which may affect that; and

•       the new National Action Plan for Carers and expectations relating to carers in the forthcoming Green Paper on Social Care for Older People.

The Committee noted the concerns expressed by the Carers under the Public Participation Scheme (Minute 75* refers).

It was MOVED by Councillor Wright, SECONDED by Councillor Randall Johnson and

RESOLVED

(a) that as part of the new Caring Well in Devon contract officers continue to develop a systematic approach to capturing feedback from carer ambassadors; and

(b) that a Spotlight Review on carers be added to the scrutiny work programme.

In accordance with previous practice, Scrutiny Committees are requested to review the forthcoming business (previously circulated) and determine which items are to be included in the Work Programme. The Work Programme is also available on the Council’s website at

http://democracy.devon.gov.uk/mgPlansHome.aspx?bcr=1 to see if there are any specific items therein it might wish to explore further.   

The Scrutiny Officer reported that member site visits to a range of residential care homes would be arranged and that a request had been received from the Devon Partnership Trust (DPT) to review its Mental Health and Wellbeing Strategy. 

RESOLVED that the current outline Work Programme be noted subject to inclusion of the

following topics (arising from this meeting) for future consideration:

(a) Northern Devon Healthcare NHS Trust Action Plan progress (Minute *80);

(b) STP and Health and Care Integration (Minutes *82);

(c) Spotlight Review Carers (Minute *85);

(d) Spotlight Review DPT Mental Health and Wellbeing Strategy; and

(c) Report of Residential Care Homes Visits.

[NB: The Scrutiny Work Programme was available on the Council's website at

https://new.devon.gov.uk/democracy/committee-meetings/scrutinycommittees/

scrutinyworkprogramme/]

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

(a) NHS 111 Online in Devon - Health & Adult Care Scrutiny Committee: briefing from the CCGs on NHS Online 111 launched in Devon at the end of the July;

(b) NHS England Briefing note on GP care in Hatherleigh and Shebbear;

(c)  Devon STP 2-Year Report highlighting what the STP set out to achieve, the progress that has been made and plans;

(d) Briefing note by NHS England on the Hatherleigh Medical Centre and Beech House Surgery, Shebbear move to temporary accommodation.

The Committee noted the list of information previously circulated for Members, since the last meeting, relating to topical developments including those which had been or were currently being considered by this Scrutiny Committee:

(a) NHS 111 Online in Devon - Health & Adult Care Scrutiny Committee: briefing from the

CCGs on NHS Online 111 launched in Devon at the end of the July;

(b) NHS England Briefing note on GP care in Hatherleigh and Shebbear;

(c) Devon STP 2-Year Report highlighting what the STP set out to achieve, the progress

that has been made and plans; and

(d) briefing note by NHS England on the Hatherleigh Medical Centre and Beech House

Surgery, Shebbear move to temporary accommodation.