Agenda and minutes

Minutes of the meeting held on 16 June 2020 (previously circulated)

RESOLVED that the Minutes of the Meeting held on 16 June 2020  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.

There were no oral representations from members of the public.

Report of the Lead Chief Executive for the Devon Sustainability and Transformation Partnership (STP), attached

The Committee considered the Report of the Lead Chief Executive for the Devon Sustainability and Transformation Partnership (STP) on the NHS Long-Term Plan which set the ambition that every part of the country should be part of an Integrated Care System (ICS) by 2021. The Partnership encouraged all organisations in each health and care system to join forces, so they were better able to improve the health of their populations and offered well-co-ordinated efficient services to those who needed them.

NHS England and NHS Improvement (NHSE/I) set out a consistent approach to how systems were designed highlighting three levels at which decisions were made and the Report described the broad functions to be undertaken at each level. The Report also set out the position in Devon, the developing governance and accountability arrangements.

The Lead Chief Executive (STP) responded to Members’ comments and questions relating to:

·         the Financial Recovery Plan to address the current and projected revenue shortfall and that additional costs arising from COVID-19 were being covered as part of the emergency financial regime;

·         the focus to reduce the back-log of essential non COVID-19 activities and the financial implications and uncertainties for the future;

·         the developing STP’s place-based arrangements through the Local Care Partnerships (LCPs); and

·         the role of Local Government Scrutiny and that of Devon County Council’s Health and Adult Care Scrutiny Committee’s role to form part of the process in Devon in the developing the neighbourhood perspective and assisting in ensuring effective accountability and democratic input; and

·         this Report was due to be considered by the Plymouth and Torbay Councils.    

It was MOVED by Councillor H Ackland, SECONDED by Councillor S Randall-Johnson and

RESOLVED

(a) that the Report be welcomed as a necessary step forward in clarifying how collaborative arrangements will work across the Devon Health and Care system; and

(b) that this Committee remains committed to pursuing further with the Devon Sustainability and Transformation Partnership more precise understanding of how the requirements of good governance, transparent decision making and clear lines of responsibility will operate in the Integrated Care System within each of the three levels described - System, Place and Neighbourhood.

Report of the Associate Director of Commissioning (Care and Health) (ACH/20/127), attached

(Councillor A Leadbetter attended in accordance with Standing Order 25 (1) and spoke to this item at the invitation of the Committee and informed that the Report had been considered and approved by the Cabinet the previous day and that regular annual reporting and updates would be presented)

The Committee considered the Report of the Associate Director of Commissioning (Care and Health) (ACH/20/127).

Market Sufficiency and development was an ongoing iterative process and the Scrutiny Committee was invited to further comment on this Report.

The Report detailed the initial impacts of COVID19 on adult social care markets and set out actions to respond to them. It set out the strategic context, and assessment of market sufficiency, the Independent Sector Workforce, the Provider Engagement Network and financial considerations.

The Associate Director responded to Members’ comments and questions relating to:

·         work to transform, promote and recognise the professionalism and opportunities within the independent social care workforce;

·         possible and varied reasons for the relatively high turnover within adult social care;

·         the number (net) of the current shortfall of care staff within the County and the Proud to Care campaign and challenges in terms of staffing; 

·         the legal impediment in setting a minimum level of pay for the Independent sector (over and above the statutory minimum);

·         unallocated cases had now returned to the pre-COVID-19 levels and were being addressed; and

·         the development of non-building based care working on a more individual level.

The Vice-Chair referred to examples in other Local Authorities which facilitated and encouraged alternative business models for domiciliary agencies that were ‘not for profit’ where the users, their families and communities owned and controlled the organisation. These could take the form of micro-provider co-operatives. 

The Vice-Chair also suggested this would fit into the Devon Integrated Care System proposals within the neighbourhood and place-based structures.

It was MOVED by Councillor H Ackland; SECONDED by C Wright and

RESOLVED that the Cabinet be requested to consider and investigate the feasibility of an alternative business model(s) with a view to facilitating a pilot ‘not for profit’ organisation to help alleviate and address the recognised lack of domiciliary care workers in the County.

Report of Torbay and South Devon NHS Foundation Trust and NHS Devon Clinical Commissioning Group, attached

(Councillor J Clatworthy attended in accordance with Standing Order 25 (2) and spoke to this item broadly in support of the proposals noting some local concerns and the effective promulgation of the consultation documents)

The Committee considered the Report of the Torbay and South Devon NHS Foundation Trust and NHS Devon Commissioning Group on NHS Devon Clinical Commissioning Group (CCG) on its formal public consultation on future services in Teignmouth and Dawlish launched on the 1 September 2020 and to run to 26 October 2020.  

The original consultation timeline was designed to enable work to commence in October 2020. However, due to COVID-19, the timescale for the health and wellbeing development had been delayed and the start date had now moved to January 2021. However, the Clinical Commissioning Group remained committed to holding a transparent process and to keeping an open mind.  A full copy of the consultation document was appended to the Report.

The Head of Integrated Care at NHS Devon Clinical Commissioning Group, the Director of Transformation and Partnerships (CCG) and Dr Greenwell (local GP) responded to Members’ questions relating to:

·         the quality and clarity of the consultation material widely distributed in the South Torbay area which was commended by Members and the virtual arrangements as a result of the pandemic;

·         financial and other information which was included in the supporting documents listed on the CCG’s website and available at: https://devonccg.nhs.uk/get-involved/current-projects/health-and-wellbeing-services-in-teignmouth-and-dawlish;

·         the predicted impact on Dawlish and Newton Community Hospitals; and

·         the involvement of Devon Healthwatch in independently collating and analysis of the consultation responses for report to the Devon CCG.

Members noted that the full analysis of the consultation outcome for the Clinical Commissioning Group would not be available until after this Committee’s next meeting. 

It was MOVED by Councillor S Randall-Johnson, SECONDED by Councillor S Russell and

RESOLVED

(a) that an update Report from the Clinical Commissioning Group on consultation (with the fullest information available at the time from Devon Healthwatch) be presented to this Committee’s next meeting on 12 November 2020; and 

(b) that Members use their role as community leaders to encourage wide engagement in the consultation process in the coastal communities affected.

Report of the Associate Director of Commissioning (Devon CCG, Northern & Planned Care & Cancer), attached   

The Committee considered the Report of the Associate Director of Commissioning (Devon CCG, Northern and Planned Care and Cancer)

The Report built on a paper presented to the Standing Overview Group (Minute 205 refers) in July 2020 regarding Restoration and Transformation planning, focusing on further areas of good practice and innovative work undertaken during the COVID19 pandemic response. The Report also gave an overview of Winter planning 20/21 identifying the actions of the Clinical Commissioning Group and Sustainable Transformation Partnership system needed to fulfil national and NHSE/I winter planning requirements.

The Report covered, inter-alia, activity and performance, phase 2 recovery, what was happening now and current considerations, and winter planning 2020/2021.  

The Associate Director and the County Council’s Director for Public Health responded to Members’ comments and questions relating to:

·         the relatively good performance in Devon for elective inpatient, day case activity and key Cancer targets throughout the COVID-19 pandemic;

·         greater use of digital technology in terms of general practice appointments;

·         use of the ‘Nightingale’ hospitals in providing safe and fast diagnostic testing for the peninsula for a range of conditions;

·         work by the CCG in engaging and working with care homes and other out of hospital providers;

·         the detrimental wider impacts of the pandemic and implications for  future activities which would require continued and further analysis;

·         the past detrimental and disproportionate impact of the pandemic on social and community care;

·         further information on the flu programme (on which additional detail was requested);

·         progress of the NHS Testing and Trace programme and care home testing and the national issues and difficulties;

·         adequacy of Personal Protection Equipment supplies to nursing/residential care homes;

·         the consequential revenue cost of COVID-19 at approximately £74m to date (£20m of which related to the Nightingale hospitals) which had been covered centrally; 

·         following re-deployment of staff from Minor Injury Units (MIUs) for the pandemic two units in North Devon were now planned to be re-opened; and

·         the need for more information relating to access to digital GP appointments.     

The Chair also referred to wider Mental Health impacts of the pandemic and the need for more data and information in this area both for children and adult mental health and suggested that this could be the subject of a future Masterclass.

It was MOVED by Councillor M Shaw, SECONDED by Councillor  and J Yabsley and

RESOLVED

(a) that the Clinical Commissioning Group (CCG) be asked to bring a more detailed report for the restoration of elective activity, its financial impact and measures to increase capacity (including outsourcing) to the November meeting of this Committee; and 

(b) that the Clinical Commissioning Group be asked also to produce a report on more detailed plans for systematically engaging the digitally excluded sections of the population.

Report of the Standing Overview Group meeting held on 31 July 2020,  (CSO/20/16), attached

The Committee received the Notes of the Standing Overview Group meeting held on 31 July 2020 on key areas relating to Care Homes Testing and Recovery and Restoration in the NHS in respect of non-COVID-19 urgent services and issues identified by Members in regard to these two areas.  

In accordance with previous practice, Scrutiny Committees are requested to review the list of forthcoming business and determine which items are to be included in the Work Programme.

The Committee may also wish to review the content of the Cabinet Forward Plan and the Children’s Services Risk Register to see if there are any specific items therein it might wish to explore further.

The Committee noted the current Work Programme subject to inclusion of the topics arising from this meeting.

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

https://www.devon.gov.uk/democracy/committee-meetings/scrutiny-committees/scrutiny-work-programme/]

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

(a) Torbay and South Devon NHS Foundation Trust Update: 21 August 2020 - Health & Adult Care Scrutiny Committee.

(b) Devon Partnership NHS Trust: Care Quality Commission Inspection - Health & Adult Care Scrutiny Committee.

(c) Torbay and South Devon NHS Foundation Trust Update: 7 August 2020 - Health & Adult Care Scrutiny Committee.

(d) Modernising Health and Care Services in Teignmouth and Dawlish: briefing by NHS Devon CCG on the future of health and care services in Teignmouth and Dawlish.

(e) Torbay and South Devon NHS Foundation Trust Update: 24 July 2020 - Health & Adult Care Scrutiny Committee.

(f) DCC Adult Social Care Briefing – 6 July 2020.

(g) Devon STP CQC Review – Press Release.

(h) CQC Report on Torbay and South Devon NHS Foundation Trust - Health & Adult Care Scrutiny Committee.

(i) Response to Members Questions - 16 June 2020 Health & Adult Care Scrutiny Committee.

Information previously circulated for Members relating to topical developments included: 

(a) Torbay and South Devon NHS Foundation Trust Update: 21 August 2020 - Health & Adult Care Scrutiny Committee.

(b) Devon Partnership NHS Trust: Care Quality Commission Inspection - Health & Adult Care Scrutiny Committee.

(c) Torbay and South Devon NHS Foundation Trust Update: 7 August 2020 - Health & Adult Care Scrutiny Committee.

(d) Modernising Health and Care Services in Teignmouth and Dawlish: briefing by NHS Devon CCG on the future of health and care services in Teignmouth and Dawlish.

(e) Torbay and South Devon NHS Foundation Trust Update: 24 July 2020 - Health & Adult Care Scrutiny Committee. (f) DCC Adult Social Care Briefing – 6 July 2020.

(f) Devon STP CQC Review – Press Release. (h) CQC Report on Torbay and South Devon NHS Foundation Trust - Health & Adult Care Scrutiny Committee. (i) Response to Members Questions - 16 June 2020 Health & Adult Care Scrutiny Committee.