Agenda and minutes

Venue: Committee Suite - County Hall

Contact: Gerry Rufolo 01392 382299  Email: gerry.rufolo@devon.gov.uk

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Items
Note No. Item

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103.

Minutes

Minutes of the meeting held on 22 November 2018, (previously circulated)

Additional documents:

Minutes:

RESOLVED that the Minutes of the meeting held on 22 November 2018 be signed as a correct record.

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104.

Items Requiring Urgent Attention

Items which in the opinion of the Chairman should be considered at the meeting as matters of urgency.

Additional documents:

Minutes:

There was no item raised as a matter of urgency.

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105.

Public Participation

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.

Additional documents:

Minutes:

There were no oral representations from members of the public.

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106.

Whole System Performance pdf icon PDF 853 KB

Report of the Head of Adult Commissioning and Health; and the Director of Strategy, NEW Devon and South Devon and Torbay CCGs (ACH/19/98), attached

Additional documents:

Minutes:

(Councillor Leadbetter attended in accordance with Standing Order 25 (1) and spoke to this item at the invitation of the Committee)

 

The Committee received and noted the Joint 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/19/98) on activity and performance across the wider health and care system based on performance data as at November 2018 (Month 8), including later data where available. The analysis and performance commentary focussed on a range of measures covering acute and community hospital settings, primary care and social care selected by system leaders to provide Members with a whole system view.

 

Members discussion points/comments with the Cabinet Member for Adult Social Care and Health Services, the Chief Officer for Adult Care and Health Services, the Head of Adult Care Commissioning and Health, Director of Strategy (South Devon and Torbay CCG and NEW Devon CCG) and Associate Director of Commissioning (Devon CCGs) included:

 

·         future performance reports would be less process driven and more needs/outcome focussed; 

·         the Devon winter plan had been reviewed by NHS England (NHSE) and initial feedback had been received by the Clinical Commissioning Group (CCG); and the key areas within the plan included improved patient flow, maximising capacity across the health and care system and preventing avoidable delays that may reduce the quality of care;

·         work by the multi-disciplinary A and E Delivery Board which had included a focus on ambulance handover processes with significant improvements;

·         data relating to urgent and emergency care NHS 111 and 999 calls and the proportions and numbers leading to emergency admissions; and more information was requested on response times, use of NHS ‘apps’, and new method of recording by SWAST;  

·         delayed Transfers of Care (DToC) and pressures within Exeter RD&E and Torbay and South Devon, mitigated by short term intervention and re-ablement; and on ongoing analysis to identify the reasons for the increasing numbers;

·         analysis in terms of the increasing delays in treatments at the RD&E where other key indicators appeared to be positive;

·         the increase in the number of unfilled packages of care and contingency arrangements in place;

·         ongoing work force challenges across the health and adult social care, and initiatives to recruit and retain staff which was essential in ensuring consistency, experience and overall capacity;

·         the contribution of the Improved Better Care Fund in terms of Delayed Transfer of Care rates; and

·         cooperative working between the four acute hospitals.

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

 

RESOLVED

 

(a) that the care staff across health and social care be congratulated in meeting the challenges in difficult circumstances in relation to the reported increases in the (i) Delayed Transfer of Care rates, (ii) the unallocated care packages and (iii) waits for treatment; and the uncertainties created by Brexit and shortages of nursing staff especially in residential care homes; and

 

(b) that this Committee notes that future performance reports will  ...  view the full minutes text for item 106.

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107.

STP Update and the Development of an Integrated Care System in Devon pdf icon PDF 77 KB

Report of the Head of Adult Care and Commissioning and Director of Strategy NEW Devon and South Devon and Torbay CCGs (ACH/19/99), attached 

Additional documents:

Minutes:

(Councillor 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 and the Director of Strategy, NEW Devon and South Devon and Torbay CCGs (ACH/19/99) on updates on the latest national developments and progress in Devon and how the Integrated Care System should operate and improve outcomes for the Devon population.

 

Members discussion points/comments with the Cabinet Member for Adult Social Care and Health Services, the Head of Adult Commissioning and Health and the Director of Strategy (NEW Devona and Torbay and South Devon CCGs) included:

 

·         emphasis on prevention and the wider determinants of health and wellbeing as detailed in the NHS long-term plan relating to for example housing, leisure and parks (incorporating social prescription) leading to a more integrated system with alignment of services and the evolution of the Health and Wellbeing Board in this wider system; and the imperative of Devon district authorities being part of conversations moving forward; 

·         use of new technology to assist with dependence and including digital appointments with GPs for example; and

·         the amalgamation of the NEW Devon and Torbay and South Devon CCGs and the projected financial balance in 2019/20 and wider system balance for 2020/21 and a planned deficit for the providers of £40 millions.

 

The Committee noted that a stakeholder event with the Health and Wellbeing Board and Scrutiny with the NHS and other bodies would be arranged within the next few months.

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108.

Promoting Independence in Devon - Annual Report pdf icon PDF 74 KB

Report of the Head of Adult Care and Commissioning ((ACH/19/99), attached 

 

Additional documents:

Minutes:

The Committee considered the Report of the Head of Adult Commissioning and Health (ACH/19/99) on a summary of the Annual Report (or ‘local account’) of the adult social care functions of Devon County Council which included, a self-assessment, a range of evidence supporting the self-assessment; and links to further sources of external information. 

 

Members discussed adult social care and dementia friendly communities especially in the rural communities with isolation issues and lack of accessible services.

 

The Annual Report would include a passage on the work undertaken by this Committee over the last year. 

 

[N.B. a full version of the annual report  could be found with the vision and plan:

https://new.devon.gov.uk/care-and-health/adults/policies-and-procedures/adult-care-and-health-vision-planning-and-report/]

 

 

 

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109.

Improving Access to General Practice pdf icon PDF 289 KB

Presentation by the Clinical Commissioning Groups, attached 

 

Additional documents:

Minutes:

The Committee received a presentation on Improving Access to General Practice by M Procter, Director for Primary Care – Devon CCGs; and P Baker, Deputy Director for Primary Care – Devon CCGs.

 

The presentation covered what the CCGs were doing, the core offer (from October 2018) key challenges that were being addressed, uptake rates, future for procurement and public involvement; and survey content.

 

Members’ discussion points with the representatives included

 

·         the need for further data and information relating to access, numbers of GPs required any local shortages and recruitment and retention for example;

·         issues surrounding closure of practices for example in Shebbear;

·         patient lists ranging from 900/GP to 2400/GP depending on the skill mix available at a practice; and      

·         the importance of new technologies in making appointments and remote consultations/diagnosis and ensuring confidentiality within practices, one example being through good design of reception areas.

 

The Chair requested that a further report be presented to the June meeting of this Committee on the areas outlined above.

 

 

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110.

Winter Pressures Update

NEW Devon Clinical Commissioning Group to report

Additional documents:

Minutes:

This item was withdrawn by the Chair (covered in Minute 106 above).

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111.

Supporting Adults with Disabilities to be Independent, Safe and Part of the Community pdf icon PDF 146 KB

Report of the Head of Adult Care and Commissioning (ACH/19/102), attached 

 

Additional documents:

Minutes:

The Committee considered the Report of the Head of Adult Care and Commissioning (ACH/19/102) on people with disabilities in regard to learning disabilities, physical disabilities, autism and/or sensory needs.

 

Across Devon, Plymouth and Torbay authorities were committed to promoting the independence of people with disabilities. The joint strategy, Living Well with a Learning Disability in Devon 2018-2022, had been approved by the County Council’s Cabinet in October 2018 following discussion of the strategic principles at previous Scrutiny sessions. https://www.newdevonccg.nhs.uk/permanent-link/?rid=119946

 

The refreshed strategy informed work across the health and care system in Devon to support people with all disabilities to be confident, resilient and connected.

 

The Council’s Senior Commissioning Manager, Disabilities and Mental Health; and Assistant Director, Health & Social Care - Eastern discussion points with Members included:

 

·         projects to assist and encourage employers and adults with disabilities into paid employment where appropriate; and the important role of Job Centre Plus;

·         work by the County Council and its partners to recruit adults with disabilities into paid employment;

·         Provision within the draft budget for Extra Care Housing/Shared Lives for adults with disabilities; and

·         the role of the Devon Learning Disability Partnership Board to work together in partnership with stakeholders to help adults who have a learning disability and their families.

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112.

Local Suicide Prevention Planning Approach pdf icon PDF 160 KB

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

 

Additional documents:

Minutes:

The Committee considered the Report of the Chief Officer for Communities, Public Health, Environment and Prosperity on the approach to suicide prevention in Devon.

 

Upper tier local authorities, via their Public Health teams, were responsible for producing a local strategy and action plan.  Whilst this was not a statutory requirement, the Local Government Association, Public Health England and Association of Directors of Public Health all advocated for local plans.  Following an investigation into suicide in 2016/17, the Health Select Committee further recommended that local plans be subject to Scrutiny to ensure that they were transparent, accountable and deliverable.  In her role as Chair of the Health Select Committee, Dr Sarah Wollaston MP had written to all Local Authority Scrutiny members asking them to prioritise suicide prevention and keep a ‘watching brief’.

 

Devon, in partnership with Plymouth and Torbay, had issued a strategic statement aligning the seven priorities in the national strategy:

https://devoncc.sharepoint.com/:b:/s/PublicDocs/PublicHealth/EZWx1r5XUWVBk0svqohfT4YBkUqmF2YeLKQa4T4VtMAqbQ?e=UrTm9y

 

As each area had its unique geography and demography each Local Authority developed their own implementation plan:

https://devoncc.sharepoint.com/:b:/s/PublicDocs/PublicHealth/EW4a_QNNT51HrvTS6henmGIB2dF1UtjnO-g2Cb26tvXjkA?e=dbIsih

 

The Senior Public Health Officer (Health Inequalities) discussion points with Members included:

 

·         the key targets for Devon with reductions of 10% by 2021 and the DPT working towards no suicides in inpatient settings;

·         the work of ‘Pete’s Dragons’ in Exmouth and suggestion from members that the advice and views of the Royal British Legion and SSAFFA (the Armed Forces Charity supporting veterans and their families) should be sought;

·         approaches to include the private as well as public sector organisations within the strategy;

·         identification of gaps in the provisions of counselling services in Devon;

·         the work of the Prison Partnership Board addressing suicide, and

·         that the Officer was willing to talk to parish councils, the DPT and the CCGs about the strategy and would welcome any input about the implementation plan. 

 

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

 

RESOLVED that following a review of the efficacy of the current strategy by the Standing Overview Group consideration be given to a Spotlight Review in due course.

 

 

 

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113.

Understanding the Model of Care - Residential Care Homes/Personal Care Visits pdf icon PDF 90 KB

Report of Members’ Site Visits (CSO/19/4), attached

Additional documents:

Minutes:

The Committee considered the Report of the Health & Adult Care Scrutiny Members

(CSO/19/4) on a series of visits to health and care settings across the County to enable Members to get a first-hand account from staff of how the system was working, on how supported staff felt and whether there were issues of concern. The visits were about members getting 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 reported that they had found the visits to be of real value and interest and indicated that other Members should endeavour to attend future ones. They noted from the case studies the relative high turnover of staff due in part to low wages in the care sector.  

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114.

Quality Accounts - 6 Month Update pdf icon PDF 83 KB

Report of the Health and Adult Care Scrutiny Members (CSO/19/06) attached

 

 

 

 

                       

Additional documents:

Minutes:

The Committee received the Report of the Health & Adult Care Scrutiny Members (CSO/19/06) on progress against health providers’ Quality Accounts which detailed quality and safety improvements from the previous year as well as planned improvements for the year to come. On 15 May 2018 NHS providers delivered presentations to the Members of the Standing Overview Group on their Accounts for 2017-18 and priorities in terms of improvement for 2018-19. On 19 December 2018 the following providers had presented to members a summary of their Trust’s Quality Account and progress for the first 6 months of 2018/19 in meeting priorities:

 

·         Royal Devon and Exeter NHS Foundation Trust;

·         Devon Partnership NHS Trust;

·         Northern Devon Healthcare NHS Trust;

·         South West Ambulance Service NHS Foundation Trust, and

·         South Devon NHS Foundation Trust.

 

 

 

 

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115.

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.   

Additional documents:

Minutes:

The Committee noted the current Work Programme and

 

RESOLVED that the current outline Work Programme be noted subject to inclusion of the following topics (arising from this meeting) for future consideration:

 

(a) Suicide Strategy (for consideration by the Standing Overview Group, prior to any agreement to undertake a Spotlight Review);

 

(b) Rapid Response Service – update in June;

 

(c) Carers – Spotlight Review, subject to the availability of performance data; and

 

(d) Visits to Health and Adult Social Care settings.

 

[NB: The Scrutiny Work Programme was available on the Council's website at https://new.devon.gov.uk/democracy/committee-meetings/scrutinycommittees/ scrutinyworkprogramme/]

 

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116.

Information Previously Circulated

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

 

(a) Update by the NEW Devon CCG on the proposed merger of NEW Devon CCG and South Devon and Torbay CCG.

 

(b)  Health & Care Insights from Torbay and South Devon NHS Foundation Trust.

 

(c) Information on the completion of essential building work at Tavistock Hospital.

 

 

Additional documents:

Minutes:

The Committee noted the list of information previously circulated for Members, since the last meeting, which related to topical developments which have been or are currently being considered by this Scrutiny Committee:

 

(a) Update by the NEW Devon CCG on the proposed merger of NEW Devon CCG and South Devon and Torbay CCG.

 

(b)  Health & Care Insights from Torbay and South Devon NHS Foundation Trust.

 

(c) Information on the completion of essential building work at Tavistock Hospital.