Agenda and minutes

Minutes of the meetings held on 13 June 2023 and 27 July 2023 (special meeting) (previously circulated)

RESOLVED that the minutes of the meetings held on 13 June 2023 and 27 July 2023 be signed as a correct record.

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.

There were no oral representations from members of the public.

Report from NHS Devon, attached.

The Committee considered the Report of NHS Devon on Dental access for adults and children in Devon. The Report outlined that dental services in Devon were provided in three settings: Primary care (high street), Secondary care (hospitals) and Community services (‘special care’).

The relationship between NHS dental services and private dental services was discussed. It was highlighted in the Report and wider discussion with the Committee that funding for dental patients on the NHS is only made available for approximately half of the population of Devon, which was national policy. There were therefore challenges to consider around how to prioritise those most in need of such services.

Members also raised concern around dentists prioritising private services above NHS services, and what solutions there may be. Officers advised that dentists providing NHS services would be doing so at a loss, and so providing private services (running a ‘mixed practice’) was often a necessity to remaining open, especially in light of the Cost-of-Living crisis; and that much of the problem was a national one relating to Government contracts which provide insufficient reimbursement to justify that as the sole source of income for a dental surgery.

Other member discussion with officers included:

• Government targets to increase the number of dentists by 2030;

• concerns around procurement processes for the introduction of new dental services, in particular around North Devon, which had seen a degradation in its dental services following a contract change;

• mobile dental units; and

• the mechanisms of Units of Dental Activity (UDA) contracts including how dentists claimed, and what measures were in place to prevent them spending NHS money on private patients.

• the role of the Housing Commission and key workers.

Report from NHS Devon, attached.

The Committee considered the Report of NHS Devon which provided an update against the five recommendations of the Committee, via the Community Pharmacy Spotlight Review. The recommendations were provided to NHS England; since then, NHS Devon had taken over commissioning of NHS pharmacy.

Member discussion with the ICS Development Director (Devon ICB) included:

• problems around training and retention of pharmacy staff, with the opening of a pharmacy school in Plymouth representing a positive step in training more staff and doing so locally, increasing the chance of retaining them;

• the recruitment of a system lead on a two-year contract to focus specifically on the workforce in Devon, including engagement with schools and supporting new graduates;

• exploring options for GP referrals to community pharmacies to result in income for the pharmacies; and

• ongoing challenges to change public habits and promote community pharmacy use.

The chair thanked the officer for the update and echoed the comments of members that, as local community representatives, they could assist in encouraging wider use of community pharmacy.

Report from NHS Devon, attached.

The Committee considered the Report of NHS Devon on the progress of delivering the ICS Devon (‘One Devon’) Digital Strategy. The current iteration of the strategy was approved in March 2023 and focused on five key priorities. These were: Digital Citizen; Electronic Patient Record and Operational Systems; Devon and Cornwall Care Record; Business Intelligence and Population Health Management; and Unified and Standardised Infrastructure. Updates were provided against each of these.

In the update, an officer from NHS Devon spoke in particular to the progress made in digitising social care records including the £1.1 millions of funding secured for this purpose; and challenges around virtual ward targets being brought forward from March 2024 to September 2023; and a pilot for over-65s aimed at providing them the technology and knowledge required to access the virtual ward.

Member discussion with officers included:

• the current state of technology pertaining to patient experience with the NHS, in particular the number of different mobile applications that a patient may have to download for varied information, the poor performance of these applications and inconsistency of information available. Councillors expressed that technological progress was needed in healthcare, but that there must be significant focus on improving end-user experience, including simple but effective communications with patients via digital means. The Officer advised that the NHS applications are managed at a national level – but that there were roadmaps for development of these applications to improve them;

• the importance of balancing digital expertise in the technological development of the NHS with user experience, ensuring that changes and improvements made work for the benefit on-the-ground NHS staff and patients;

• the comments arising from the CQC inspection of the Royal Devon University Healthcare NHS Foundation Trust around the Trust’s implementation of its electronic patient record system, with an officer confirming that the ICB was working alongside the Trust to make improvements; and

• the role of Integrated Adult Social Care working alongside domiciliary care providers in progressing with digitisation, who had expressed enthusiasm for the digital agenda.

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

In accordance with Standing Order 23(2) Councillor J Bailey had requested that the Committee consider this matter, in light of recent national concerns around the use of reinforced autoclaved aerated concrete (RAAC) in public sector buildings.

The Locality Director - North and East Devon, NHS Devon explained that they were hoping to share a national announcement from Government that was due before the Committee, but that this had been delayed. They explained however that NHS England wrote to all trusts in 2019 regarding the use of RAAC, with 27 sites across England identified as containing this material. In Devon, since 2019, the identified sites had undergone surveillance work to assess the clinical and structural impact of RAAC. For instance, North Devon District Hospital was identified as having a small amount of RAAC – but a site visit confirmed that the RAAC was in good condition and was not load bearing, which was positive. No further sites had been identified as a concern; and regular monitoring and surveys were being undertaken to monitor risk.

Joint report from the Director of Integrated Adult Social Care at DCC, the Director of Public Health, Communities & Prosperityat DCC, and the Chief Medical Officer of NHS Devon (CX/23/181), attached.

(Councillor J McInnes attended in accordance with Standing Order 25 (1) and spoke to this item with the consent of the Committee regarding the consultation on the proposals to close the North Devon Link Service and the three remaining link centres, assuring the Committee that the Devon Partnership Trust would continue to be involved in the consultation).

(At 1 pm the chair left the meeting and the vice-chair assumed chairing responsibilities for the remainder of the meeting).

Members considered the joint report of the Director of Integrated Adult Social Care, the Director of Public Health, the Director of Communities & Prosperity, and the Chief Medical Officer of NHS Devon (CX/23/181), which provided updates on key and standing items and general information, including responses on issues raised at the previous meeting of this Committee.

Officers highlighted the commissioning by NHS England of dental prevention work, aimed at educating people to improve their dental health and aim to reduce loads on dental services via prevention. Also called attention to the imminent launch of a new Devon Specialist Stop Smoking Service, which would continue the work of the previous provider but would also allow targeted work to supporting young people who vape but have never smoked, in stopping to do so. A rise in sexually transmitted diseases in young people across Devon was also highlighted, with Devon and Torbay awarding a new contract for the C-Card Scheme to Preventx Limited. This would provide free online advice, and contraception, to young people. Members agreed on the importance of education on all three of these issues.

Other member discussion with officers included:

• the cessation of Council contributions to the Wellbeing Exeter Partnership Fund, as agreed by the Council’s Cabinet on 13^th September 2023, with there being some member concern about this decision and the implications on the Fund. Officers clarified that the Council’s funding to the Fund (which was for social prescribing) was being duplicated by national funding, and that the decision was made in light of a risk assessment and assurance that social prescribing would not cease without the Council’s funding;

• on homelessness, that conversations with Team Devon were ongoing alongside work with districts on proposals regarding the future of funding homelessness prevention;

• the future of North Devon Link Service. A member commented that making a decision on the future of the Link Centres based on patient numbers did not take full account of the picture; and that since the Coronavirus pandemic, changes to the referral system had impacted usage numbers, which did not reflect true need;

• that the forecast for the Public Health ringfenced budget was to break even;

• wider engagement for winter preparation was ongoing with community providers using local care partnerships following on from lessons of previous years’ winters;

• COVID and flu jab uptake;

• the impact of strike action on hospitals in Devon;

• ongoing, widespread problems with staff retention;

• the role of the Scrutiny Committee in the health providers’ quality accounts process and the intention of the Committee hearing from health  ...  view the full minutes text for item 127.

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 agreed the current Work Programme subject to inclusion of topics which arose from the meeting. This included Dentistry, the Committee’s Quality Account commentary process and the CQC inspection of the Royal Devon University Healthcare NHS Foundation Trust.

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:

·         Scrutiny Risk Registers (Risk Registers - Democracy in Devon)

·         Healthwatch Annual Report 2022/23

·         Future Hospitals: Update on University Hospitals Plymouth

The Committee noted 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.

• Scrutiny Risk Registers (Risk Registers - Democracy in Devon)
• Healthwatch Annual Report 2022/23
• Future Hospitals: Update on University Hospitals Plymouth