Agenda and minutes

The Chair welcomed Mrs R Saltmarsh who was attending the meeting in her  capacity as a Co-opted Member of the Council's Standards Committee to observe and monitor compliance with the Council’s ethical governance framework.

The Chair announced that Devon Carers had received, the previous evening,  a prestigious award from the Health Service Journal in recognition of a pioneering new project that supported unpaid carers. The project involved dedicated staff from Devon Carers, a service commissioned by Devon County Council and NHS Devon Clinical Commissioning Group (CCG), working closely with hospital teams and supported by Exminster-based Westbank, to identify situations where carers were involved, and where support for those carers was needed for patients to return home safely, or prevent hospital admissions.

Councillor A Leadbetter (Cabinet Member for Adult Social Care and Health Services and Chair of Devon Carers Forum) spoke at the invitation of the Committee and commended the leadership and all staff involved in gaining this prestigious national award.

The Committee also passed its congratulations to all the staff and partners involved.  

Minutes of the Budget and ordinary meetings held on 26 January 2021   (previously circulated)

RESOLVED that the Minutes of the Budget and Ordinary Meetings held on 26 January 2021 be signed as correct records.

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

No item was 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 representations from Viv Wilson MBE, Clive Wetton, Graham Bond (League of Friends), John Smith, Geralyn Arthurs and Councillor David Cox, on a matter to be considered by the Committee

namely ‘Modernising Health and Care Services in the Teignmouth and Dawlish Area’ (Minute 238*  refers). They highlighted their concerns relating to the consultation proposals and process (for a range of reasons) and need to retain services at the Hospital and the lack of inpatient/nursing beds in the area and requested that a formal referral be made to the Secretary of State for Health and Social Care).

(a) Letter from the Chair to the Independent Reconfiguration Panel, and IRP response to an invitation for a representative to attend this meeting and CCG Representation to the IRP (Page 7), attached. 

(b) Report of the Clinical Commissioning Group and letter to the Independent Reconfiguration Panel, (Page 15), attached.

(Councillor A Dewhirst attended in accordance with Standing Order 25 (2) and spoke to this item and referred to the continued local community objections to the proposals (based on a range of issues) and support for the retention of the Teignmouth Community Hospital. Councillor Clatworthy attended (under Standing Order 25) and spoke on the possible impacts of the proposals on the Dawlish Community Hospital and assurances from the Clinical Commission Group about capacity and reported views and concerns of the local Member of Parliament and also referred to the Minor Injuries Unit in Dawlish which currently was still closed).

The Committee received:

(a) correspondence to the Independent Reconfiguration Panel (IRP) from the Chair (Letter dated 5 February 2021)  following the decision at the last meeting to make an informal approach and which sought their support and advice;

(b) correspondence from the IRP (dated 15 February 2021) enclosing representations from the Clinical Commissioning Group (Letter dated 25 February) in response to the Committee’s informal approach to the IRP;

(c) correspondence from the IRP (dated 9 March) commending the continued dialogue between the Committee and the CCG and supporting any proposals to work in partnership to address points of difference and if necessary to seek third party mediation; and

(c) a Report from the Devon Clinical Commissioning Group to this Committee on an update which included the continuation of plans to develop a Health and Wellbeing Centre in Teignmouth, information on intermediate care operations, evaluation of the efficacy of intermediate care and qualitative patient experience care studies.

The Chair of the Devon Clinical Commissioning Group and its Director of out of hospital Commissioning (CCG) reported and referred to:

·         the common objectives of the Group and the Committee in helping to ensure efficient health and care services and best outcomes for the local population and generally across the County and including involvement of the wider academic community in developing evidence based strategies and assessments of qualitative (the patient experience) and quantative data; 

·         the CCG’s extensive and independent consultation process and learning points for the future including early engagement with Scrutiny; and

·         the designation of the Teignmouth Community Hospital as a community asset if so determined by the Torbay and South Devon NHS Foundation Trust (owners of the Hospital) and possible future options and opportunities; and involvement of the Local Coastal Engagement Group.

Members’ questions and discussion points with the Clinical Commissioning Group representatives included:

·         the need for early engagement with Scrutiny and close working relations in regard to these proposals and generally through the emerging Integrated Care System;

·         the time critical aspects of the proposals which related primarily to the planning application for the new Wellbeing Centre which had been recently submitted and ongoing planning for Intermediate Care arrangements;

·         assurance from the CCG that services would not be moved from the  Hospital until the alternatives were fully in place and with regular reporting to the Coastal Engagement Group;

·         Members’ concerns about the impact of the pandemic in regard to the CCG’s proposals now  ...  view the full minutes text for item 238.

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 Plan (STP) on the current position in Devon, the White Paper - Integration and innovation: working together to improve health and social care for all, the long term plan and NHS finance 2020/21.

The Committee  also received  an addendum to the Report which provided additional information concerning ICS governance and the most recent information concerning the Devon STP financial position.

The NHS Long-Term Plan set the ambition that every part of the country should be an integrated care system (ICS) by 2022. It 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 offer well-coordinated efficient services to those who need them.

The publication of the Government’s ‘Integration and Innovation: working together to improve health and social care for all’ White Paper on 11 February set the outline framework. Current proposals would enable the delivery of better  higher-quality care in a way that was less legally  bureaucratic, more accountable and joined-up.

Devon was preparing to become an ICS, and the system had made changes to how the organisations worked to strengthen their partnerships, which meant Devon was in a good position to implement the proposals in the White Paper.

Members’ discussion points with the Programme Director – Integrated Care System Development and the STP Finance Lead included:

·         there was a requirement for the system to have a plan to address health and social care needs;

·         the ICS NHS Body would be charged with the day to day running of the ICS and Committee Members questioned the governance arrangements for both the ICS NHS Body and the ICS Health and Care Partnership and the role of this Scrutiny Committee to help ensure better democratic input;

·         the need for Adult Social Care and Housing and other partners being further integrated with the NHS;

·         the role of the developing five Local Care Partnerships in Devon (aligned to local authority districts) in developing local priorities and democratic input;

·         the need to prioritise prevention measures across the health and care system and generally across all public services irrespective of governance arrangements; and

·         the current financial position (2020/21) where the current shortfall (exceptionally as a result of the pandemic) would be underwritten and that the settlement for the next finacial year (expected later this month)  was delayed as a result of the pandemic.   

The Chair thanked the Officers for their attendance and asked for regular update reports for future meetings of this Committee on this key area of work.

Report of NHS England and NHS Improvement, attached

The Committee received the Report of NHS England and NHS Improvement on their commissioning of dental services across England, having taken this function over from Primary Care Trusts when the NHS was reorganised in 2013. NHS England and NHS Improvement’s offices in the South West region manage these contracts locally.  Dental services in Devon were provided in three settings: (i) Primary care – incorporating orthodontics; (ii) Secondary care; and (iii) Community services – incorporating special care.

The Report gave detail relating to the above three settings, the impact of the pandemic in 2020/21, access to High Street Dentistry, the Devon and Cornwall Dental Helpline, Orthdontic and urgent dental care, workforce capacity, and measures to improve access, secondary care provision, current dental provision.

Members’ discussion points with the Director of Primary Care and Public Health for NHS England and NHS Improvement in the South West; the Programme Manager  - Dental Services (NHS England and NHS Improvement – South West); and the Head of Stakeholder Engagement at NHS England included:

·         there was evidence that good oral hygiene and effective dentistry was  essential for all ages, especially children and older people and also across the vulnerable groups who required support to access good dental care, and an invitation was extended for Members to attend Work Shops arranged by NHS England / Improvement;

·         contractual activity had been reduced during the pandemic and national guidance on targets for April onwards was imminent;

·         the reduction in units of dental activity combined with the problems of recruitment and retention meant there is no immediate resolution to the substantial waiting list of people wanting to register with an NHS dentist and the Service would welcome the help and support of the Local Authority to help as part of the ‘Proud to Care’ campaign for example to address the identified shortages in Devon;

·         the allocation of newly qualified Dentists ona national level on which more information was requested; and

·         the opportunity for increased capacity with use of Dentists from the National Performance List but this would have significant resource implications. 

The Chair thanked the Officers for their informative presentation and noted that this would be a worthwhile subject for a future Masterclass for the Scrutiny Committee and all members of the Council.

Report of the Acting Director in Hospital Commissioning (Clinical Commissioning Group), attached

Report of the Members (CSO/21/8), attached

The Committee considered a report on the work of this Committee with a forward from the Chair.

The Report covered the impact of the pandemic on the Committee’s work and operating practices, its work with the Health Providers in Devon and partnership with the Devon Clinical Commissioning Group, work through the Committee’s Standing Overview Group, various Task Groups and Spotlight Reviews, the value of Members’ visits to establishments throughout Devon to help gain, inter alia, a better understanding of the new Model of Care, and the benefits of the many Masterclasses held for all members. The Report also outlined the support provided by the Specialist Adviser.    

The Chair with reference to the above referred to the value of Scrutiny as a ‘critical friend’.

It was MOVED Councillor H Ackland, and SECONDED by Councillor P Crabb and

RESOLVED that new Council be asked to recognise the value of effective Scrutiny and continue the work this Scrutiny Committee has led on over the last 4 years.

Report of the Head of Scrutiny, attached  

The Committee considered the Report of the Commissioning Liaison Members on a Review of their roles and work over the last four years. The Report included the current Protocol for the Liaison Members.

It was MOVED by Councillor A Saywell and SECONDED by Councillor H Ackland and

RESOLVED that the new Council be asked to continue the role of electing one or two Commissioning Liaison Members for each Scrutiny Committee.

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: Scrutiny Work Programme - Democracy in Devon

Members suggested, in addition, further topics be added for consideration by the new Scrutiny Committee (post County Council elections) as follows:

(a) the Annual Adult Social Care Report;

(b) Devon Doctors: 111 service:  progress report on the Improvement Plan;

(c)  Adult Safeguarding Review with reference to adults in residential care; and

(d) Lessons from the pandemic across health and adult social care.

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) Devon Clinical Commissioning Group: Coronavirus Vaccination in Devon  February and March 2021 Briefings.

(b) Public Health Impacts of Food Insecurity: What do we know in Devon?: Paper by Public Health Devon

(c) Oral health needs assessment (OHNA): commissioned  by NHS England / NHS Improvement (SW) from an independent organisation to inform the SW Dental Reform Programme.

(d) Torbay and South Devon NHS Foundation Trust Update: 26 February 2021.

(e) Internal Audit Plan and Risk Management Information.

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

(a) Devon Clinical Commissioning Group: Coronavirus Vaccination in Devon February and March 2021 Briefings.

(b) Public Health Impacts of Food Insecurity: What do we know in Devon?: Paper by Public Health Devon.

(c) Oral health needs assessment (OHNA): commissioned by NHS England / NHS Improvement (SW) from an independent organisation to inform the SW Dental Reform Programme.

(d) Torbay and South Devon NHS Foundation Trust Update: 26 February 2021.

(e) Internal Audit Plan and Risk Management Information.