Agenda and minutes

Minutes of the meeting held on 15 September 2021 (previously circulated)

RESOLVED that the Minutes of the meeting held on 15 September 2021 be signed as a correct record.

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

(An item taken under Section 100B (4) of the Local Government Act 1972)

The Chair had decided that the Committee should be appraised of a letter recently received from the Rt Hon Sajid Javid MP, Secretary of State for Health and Social Care. This  confirmed that he had written to the Independent Reconfiguration Panel (IRP) asking them to undertake an initial assessment of this case. He had asked the Panel to report to him by the middle of December 2021 subject to them being in receipt of all relevant information.

The Committee noted this development.

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 Devon Clinical Commissioning Group, attached

The Committee considered the Report of the Devon Clinical Commissioning Group which covered an overview of existing urgent and emergency care provision in Devon, integrated urgent care provision, the position in the short-term, plans for the longer term and local minor injury units and the system winter plan.

Member discussion points with the Devon Clinical Commissioning Group’s Associate Director, Urgent Care; Locality Director South Devon; and Clinical lead for Urgent and Emergency Care included:

·         the current and ongoing review by the Devon CCG of Urgent Care in regard to the Urgent Care Centres (Minor Injury Unity or Urgent Treatment Centres) and Members’ disappointment about the lack clarity in regard to these centres in view of the time taken to resolve these longstanding issues and need for them across Devon as an appropriate alternative to over-stretched Accident and Emergency settings;

·         the work-force challenges across health and care and the priority to ensure robust staffing and safe provision within the Units which was part of the Review with clearly evidenced continued increased demands and pressures, exacerbated by the pandemic; 

·         the role of the 111 services in diverting referrals from A and E to appropriate settings with the use of experienced clinicians, the increased demands on the service and the positive feedback from the work-force and assurance that these clinicians did not represent a diversion from front-line clinical care; and the need to promote the 111 service both locally and nationally; and

·         a Healthwatch survey on the patient experience of urgent and emergency care which had been commissioned by the CCG which would be made available to Members of this Committee.

It was MOVED by Councillor J Bailey, SECONDED by Councillor S Randall Johnson and

RESOLVED  that the Devon Clinical Commissioning Group be asked

(a) to involve Members in early and detailed engagement in regard to the review of urgent care provision in Devon prior to formal public consultation, and to include a Report on progress at the next meeting of this Committee on 20 January 2022; and

(b) the report to include information on the impact of the 111 service and local and national promotional campaigns to encourage its use by the public.   

Report of the South Western Ambulance Trust, attached

(Councillors Randall Johnson, R Chesterton, S Parker-Khan and R Peart declared a non-pecuniary interest by virtue of their membership of the Devon and Somerset Fire and Rescue Authority).

The Committee considered a report of the South Western Ambulance Service Trust on recent performance using National Ambulance Quality Indicator data, factors impacting on performance and demand in Devon, abstraction rates, handover delays at acute hospitals, the Trust’s response to the pandemic,  work with fire and rescue services, and a community first responder update.

Member discussion points with the Executive Director and Devon County Commander (both SWAST) included:

·         an update by the Executive Director on recent activity in October and  the increasing demand pressures (with data evidence) and since the Critical Incident announcement on 14 June 2021 the continuation of the highest alert level ‘Black’ in common with Ambulance Trusts nationally;

·         the high levels of hours lost to delays in transfers at the acute hospitals in wider Devon and the impact on the service and personnel and their health and wellbeing;

·         the additional recruitment of staff across call handling, graduate trainees and continued working with Devon and Somerset Fire and Rescue Service (to September 2022) to help mitigate demand pressures (on which further information would be provided in regard to assistance provided by the Fire and Rescue Service);

·         differential demand impacts and pressures resulting from demography (elderly frail population), the pandemic and impact on mental health, and 111 referrals;

·         the development of a pilot project with Mental Health input in call-centres which, if successful, could be rolled-out across the Trust area; 

·         operation by SWAST of the Tiverton Urgent Care Centre (commissioned by the Clinical Commissioning Group) a GP led model which was operating effectively with good staffing, and reducing the conveyance rate to acute settings and where Ambulances would also discharge patients when appropriate, with a positive patient experience (with 1815 patients in October, 59/day) and thereby mitigating pressures in acute settings and which had remained open during the pandemic;

·         the valued work of co-responders, St John’s Ambulance and other partners to support the Service and commissioning by the CCG of vehicles for lower acuity patients;  

·         the clear rules relating to waiting times both for SWAST and the Acute hospitals and the work of Acute hospital liaison personnel in managing the delays of transfers and the impact on patient wellbeing and the associated sharing of Clinical Quality information with commissioners; and

·         the role of the Service as a key partner within the Devon Integrated Care System (ICS) and the complex management relations and planning with all the seven ICS organisations across the SWAST footprint covering the wider south west region. 

The Chair thanked the SWAST Officers for their very informative presentation and response to member questions.  

It was MOVED by Councillor J Bailey, and SECONDED by Councillor M Wrigley and

RESOLVED that a Spotlight Review be undertaken to include reference to delays in transfers, response times, impact on patients and personnel, role of 111; and work with key partners within the Devon  ...  view the full minutes text for item 17.

Report of the Torbay and Devon Safeguarding Adults Partnership, attached

The Committee considered the Report of the Torbay and Devon Safeguarding Adults Partnership on its Annual Report 2020/21.  The Report had been presented to the Devon Health and Wellbeing Board on 28 October 2021 and would  be presented at Cabinet on 8 December 2021.

More detailed information about the work of the TDSAP was available on the TDSAP website: Home - Torbay and Devon Safeguarding Adults Partnership

The full annual report summarised TDSAP safeguarding activity undertaken throughout 2020-21.

The Annual Report would be published on the TDSAP website, alongside full details of Safeguarding Adult Reviews (SARs), which had been published during this and previous years.

The TDSAP was the strategic lead body for safeguarding, with an overriding objective to prevent and reduce the risk of significant harm to adults with care and support needs, from abuse or other types of harm or exploitation.

The TDSAP acted as the key mechanism for agreeing how these agencies work together to safeguard and promote the safety and wellbeing of adults at risk and/or in vulnerable situations. It did this by co-ordinating what each of the TDSAP partners did and made sure that they did it effectively.

The Care Act 2014 sets out that there are 3 key statutory requirements for the Partnership:

·         To deliver and publish an Annual Report

·         To ensure that the Partnership appropriately conducts Safeguarding Adult Reviews (SARs)

·         To develop and publish a Strategic Business Plan

The Strategic Plan for 2021–2024 had been developed and published on Strategic Business Plan 2021-2024 - Torbay and Devon Safeguarding Adults Partnership

Member discussion points with the Independent Chair of the Board included relatively high number and emerging themes from the Safeguarding Adults Reviews (SARS) which required further research and strong partnership working.

The Chair referred to the potential for further a further detailed examination of the issues (potentially at a future Masterclass for all Members). 

Report of the Chief Officer for Adult Care and Health, Devon County Council (ACH/21/140), attached 

(Councillor J McInnes attended in accordance with Standing Order 25 (i) and spoke to this item with the consent of the Committee and referred to the need to recognise the professional role and promote the esteem of social care personnel. He also reported that the County Council would  host a special live webcast event on 3 December 2021 to celebrate the county’s adult social care workers and hear their experiences to which all members were invited).

The Committee considered the Report of the Chief Officer for Adult Care and Health, Devon County Council (ACH/21/140) on a mid-year update on the finance and performance of the Adult Care and Health service. The report referred to the reform of Adult Social Care and funding concerns, the continued challenges from the pandemic, refreshed priorities, work with key partners and key messages from the Association of Adult Social Services.

The Report also detailed finance information as at month 6. This showed an overspend of £5.193m subject to achievement of £3.204m of management actions. A total of £1.352 m savings had been achieved at month 6; and Government funding during the pandemic in 2021-22; and Devon County Council comparative performance.

Member discussion points with the Chief Officer and Locality Director North and East Devon (Adult Care and Health) included:

·         the ever increasing demands and pressures with people with complex needs across the system, the impact of the pandemic and the risks and challenges from the upcoming winter and financial pressures (with £1/hr social care spend equating to £1.3m);

·         possible impacts of the requirement of front-line care staff to be vaccinated, with exemption certificates required by 24 December 2021;

·         the overall contribution of adult social care of £728m to the Devon economy;

·         the need to recognise the value of social care, professional development and career progression, and to improve pay accordingly to help address the work-force issues within adult social care and affordable local housing was also an important factor in Devon; and work with the NHS in developing recruitment and new career pathways for social care under the Health Service Trusts;

·         the need to develop new ways of personal care and delivery with technology and equipment to promote independence with family support; 

·         recruitment using social media in local neighbourhoods and villages;

·         in the event of unallocated care hours, alternative local solutions would be planned and no individual would be left without support; and

·         the impact of the national living wage and national insurance increases which should be reflected in the forthcoming financial settlement expected in December and the need to ensure a balanced budget and address  current projected overspends as detailed in the report.

The Chair thanked the Officers for their update.

Report of the Director of Public Health, attached

The Committee the Report of the Director of Public Health on the position on the delivery of Public Health service during 2021-22, the delivery of the Council’s strategic objectives across public health and health protection, and delivery of the budget.

Discussion points with the Director of Public Health included:

·         additional pandemic grants from central government would cease at the end of the current fincial year and to date no additional resources had been announced; and

·         additional spending pressures were difficult to predict and dependent on the development of the pandemic notwithstanding the excellent impact of the vaccination programme; and all the current precautions should remain in place for the foreseeable future. 

The Chair thanks the Director and his staff for all their valued and continued work during the pandemic.

Joint report from Devon County Council and NHS Devon Clinical Commissioning Group(ACH/21/142), attached

The Committee considered the Joint report from the County Council and Devon Clinical Commissioning Group (ACH/21/142) on the latest news from the Devon Health and Care system covering celebration of local success and achievements, a COVID-19 update, Skills for Carer annual report, and workforce challenges in Devon, additional workforce funding, the North Devon Link Services, a Proud to Care update and a LoveCare update; and on a new purpose-built GP practice in Crediton. 

Member discussion points with the Locality Director North and East Devon included the merger of the Northern Devon Hospital Trust with the Royal Devon and Exeter Hospital Trust which would help ensure the sharing of  expertise and maintenance of good clinical standards.

In accordance with Standing Order 23(2) Councillor J Bailey has asked that the Committee consider this matter.

In accordance with Standing Order 23(2) Councillor J Bailey had raised these items and referred to the need for further reports arising from recent masterclasses and briefings.

The Chair reported that these would be covered during a Winters Pressures update in March and current reviews which should also outline the impacts of longer waiting lists/cancellation of elective surgery within the context of the  ICS NHS Long Term Plan.

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  topics arising from this meeting. 

[NB: The Scrutiny Work Programme was available on the Council's website at: Scrutiny Work Programme - Democracy in Devon]

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) Risk Register for Health and Adult Care.

(b) Devon CCG: Coronavirus Vaccination in Devon Briefing: Updates.

(c) Masterclass Information covering: Deprivation of Liberty Safeguards, the Joint Strategic Needs Assessment; Devon Health and Care System Under Pressure; and Improving Support for People with Disabilities.      

The Committee noted 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) Risk Register for Health and Adult Care.

(b) Devon CCG: Coronavirus Vaccination in Devon Briefing: Updates.

(c) Masterclass Information covering: Deprivation of Liberty Safeguards, the Joint Strategic Needs Assessment; Devon Health and Care System Under Pressure; and Improving Support for People with Disabilities.