Agenda and minutes

The Chair welcomed members of the public to the meeting.

The Chair also welcomed Ian Hipkins to the meeting who was attending remotely in his capacity as co-opted member of the Standards Committee to monitor compliance with the Council’s ethical governance framework.

The Chair also advised that she had agreed to move the Primary Care item to later in the agenda to accommodate attendance from NHS representatives; and that Peter Hay, the Committee’s specialist advisor, was attending remotely.

Minutes of the meetings held on 24 January 2024, attached.

RESOLVED that the minutes of the meetings held on 24 January 2024 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 Council will declare any interests they may have in any item to be considered at this meeting, prior to any discussion taking place on that item.

The other registrable interests of Councillors of Devon County Council, arising from membership of City, Town or Parish Councils and other Local Authorities will automatically be recorded in the minutes.

For details of District and or Town and Parish Twin Hatters – please see here:

 County councillors who are also district, borough, city, parish or town councillors

The list of Membership of other Authorities can be found here: County councillors who are also district, borough, city, parish or town councillors

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 oral representations from: (i) Councillor Terry Elliot, (ii) Miss Anna Fors and (iii) Ms Sonia Gould regarding the North Devon Link Services and the Committee’s call-in of the Cabinet’s decision thereof. All three speakers were opposed to the decision made by the Cabinet.

The Chair thanked the speakers for attending and making representations.

In accordance with the Scrutiny Procedure Rules, the Chair of the Health and Adult Care Scrutiny Committee (Councillor Randall Johnson) has invoked the call-in procedure in relation to the decision of the Cabinet Member for Integrated Adult Social Care (Minute *491 refers) that:

(a) the NorthDevonLinkServiceDrop-inservicesthatrunfromtheLinkCentres inBarnstaple,BidefordandIlfracombe, be closed;

(b) that the closureincludes ceasingtheshort-termenablingsupportto thoseservice users inreceiptofCare Act2014 eligibleservices, and to note that the Council and DevonPartnershipTrustwillassistthosepeopleto accessalternative equivalent support; and

(c) that the Council work withDevonPartnershipNHSTrustandtheDevonMental HealthAllianceto support all serviceusers in their transition to alternativecommunitysupportovera periodof3 months minimum.

The grounds for this call-in are below and this has been discussed with the Monitoring Officer, as required by the Scrutiny Procedure Rules.

“There was insufficient information provided to ensure service users’ future support. Scrutiny has not been given the opportunity to receive evidence and additional information to ensure service users will be provided with a person based support.”

If the Scrutiny Committee decide to not make any recommendations to Cabinet, then the Cabinet Members decision can be implemented immediately. If the Committee ask Cabinet to reconsider the decision or recommend another course of action, then this will be considered at the Cabinet meeting on 10 April 2024.

The Cabinet Member decision is held in  ...  view the full agenda text for item 165.

(In accordance with Standing Order 25, Councillors C Leaver and J McInnes attended and spoke to this item with the consent of the Committee).

In accordance with the Scrutiny Procedure Rules, the Chair of the Health and Adult Care Scrutiny Committee (Councillor Randall Johnson) had invoked the call in procedure in relation to the decision of the Cabinet Member for Integrated Adult Social Care (Minute *491 refers) that:

(a) the North Devon Link Service Drop-in services that run from the Link Centres in Barnstaple, Bideford and Ilfracombe, be closed;

(b) that the closure includes ceasing the short-term enabling support to those service users in receipt of Care Act 2014 eligible services, and to note that the Council and Devon Partnership Trust will assist those people to access alternative equivalent support; and

(c) that the Council work with Devon Partnership NHS Trust and the Devon Mental Health Alliance to support all service users in their transition to alternative community support over a period of 3 months minimum.

The grounds for this call-in are below and this had been discussed with the Monitoring Officer, as required by the Scrutiny Procedure Rules.

“There was insufficient information provided to ensure service users’ future support. Scrutiny has not been given the opportunity to receive evidence and additional information to ensure service users will be provided with a person based support.”

The three accompanying documents (i.e. Record of Decision, Report and Impact Assessment) were attached for members and the decision available at this link.

The Chair invited all members of the committee who represented divisions in North Devon to comment on this item (including Councillor Leaver, attending under Standing Order 25). There was positive comment on the most recent consultation regarding the closure of the North Devon Link Services, and that it was an improvement on previous consultations; and local members also expressed that they understood the rationale for wanting to provide a better, more cost-effective service. However, local members raised concerns, including those brought to them by residents of their divisions, about the practicality of stopping the services given the perceived lack of availability and poor suitability of alternative mental health support in North Devon, particularly in context of the proposed ‘soft handover’ of services for existing users. One member referred to the report that had been considered by the Devon County Council Cabinet and the equality considerations therein – namely that rurality and social isolation (as pertinent to North Devon) are areas that warrant consideration, with questions as to how far this had been done.

In response to concerns raised by councillors about a “one size fits all” approach to mental health (with worries expressed that the changes represented a move towards such a model), officers explained that that was not the way in which they saw mental health services in North Devon moving forward. They outlined that the proposed new model for mental health services in North Devon would involve working with local communities to better understand individual need andthe support  ...  view the full minutes text for item 165.

Report of the Director of Integrated Adult Social Care, Devon County Council (IASC/24/06), attached

The Committee considered the Report of the Director of Integrated Adult Social Care, Devon County Council (IASC/24/06) which outlined the CQC assurance process regarding Integrated Adult Social Care, and the role of the Council in that process; and the Council’s ongoing self-assessment in anticipation of CQC inspection of its social care services.

Members heard that it was not known exactly when notification would be given to the Council by the CQC regarding their inspection, but that other local authorities across the region had received notification, so it was anticipated that Devon would receive theirs sooner rather than later. In anticipation of this, documents regarding how adult social care in Devon is managed and undertaken were made publicly available for interested parties (including the CQC), as well as self-assessment documents such as annual reports.

Report of NHS Devon, attached.

The Committee considered the Report of NHS Devon which provided an update on Primary Care in Devon. It outlined:

·         the ambitions of and progress on the Primary Care Access Recovery Plan, which had two key priorities: to make it easier for patients to contact their GP, and for patient requests to be addressed on the same day (for instance with urgent treatment, an appointment booked or the patient being signposted to another service);

·         an update on the Pharmacy First service which was launched in January 2024 to allow a number of common conditions to be treated at local high street pharmacies without patients needing to see a GP. The report outlined that 97 percent of community pharmacies in Devon would be offering the service, and that it represented an easier and more convenient way for patients to access care; and

·         an update on Lynton Health Centre, which was due to cease running after 30 April 2024 (by the current healthcare provider) and NHS Devon’s subsequent focus on ensuring suitable GP provision remained available locally. The report outlined that there were no plans to close the practice in April or to change funding available for the provision of GP services to the local population, with NHS Devon hoping that a new provider will take over the running of the service from May.

Officers outlined some of the positive aspects of Primary Care in Devon, in particular that access to GPs was in a good position in Devon, compared to other counties; and that patient satisfaction was also high.

The Committee also heard from a General Practitioner based in Ivybridge, who reflected on the increasing demand for GP services, as well as the increasing complexity of healthcare systems. He expressed that the South West had good medical training prospects and a decent capacity to fill GP placements and recruit into the region, but that the challenges faced by GPs were nonetheless very real and needed addressing. Such challenges were corroborated by other NHS representatives at the meeting, with NHS Devon working with individual practices to try and help with resilience.

Member discussion points included:

·         Concern around the limitations of relative measures of success; namely that viewing Devon’s performance in relation to other authorities could lead to concluding good performance, which may not be true in isolation, only compared to other authorities;

·         Support for Pharmacy First, however with members noting that it would require a significant degree of work to change public behaviour and get members of the public used to going to a pharmacy for treatment of certain illnesses;

·         Reference in the report to reaching “peak GP” workforce, and concern around this;

·         The availability of data regarding the level of people using primary care services who do not need to; and

·         Significant issues remaining in some areas in terms of accessing a GP appointment.

It was expressed that members would benefit from further reports to the Committee regarding access to Primary Care.

Report of the Health and Adult Care Scrutiny Standing Overview Group (LDS/24/15), attached.

The Committee considered the Report of the Health and Adult Care Scrutiny Standing Overview Group (LDS/24/15). The report outlined the statutory responsibility of healthcare trusts to publish annual quality accounts. It was decided in September 2023 “to reinstate sessions with the providers to discuss their Quality Accounts and overall performance, and report back to Committee,” after such sessions had ceased in response to the Coronavirus pandemic and continued service pressures. Members were invited to a Standing Overview Group session on 8 February 2024, with representatives from five healthcare providers, to provide feedback on their quality accounts.

Members expressed interest in consulting non-Executive Directors of acute service providers in the future, to ascertain their view on the quality accounts published by their trusts.

No additional comments were made on the learnings that were to be shared with health providers, as detailed in the report.

Joint report of the Director of Integrated Adult Social Care at Devon County Council, the Director of Public Health, Communities & Prosperityat Devon County Council, and the Chief Medical Officer of NHS Devon (IASC/24/07), attached

The Committee considered the Joint Report of the Director of Integrated Adult Social Care at Devon County Council, the Director of Public Health, Communities & Prosperity at Devon County Council, and the Chief Medical Officer of NHS Devon (IASC/24/07) which contained updates on key and standing items and provided general information on specific actions, requests or discussions during the previous meeting of the Committee.

Member discussion points with officers included:

·         The transition of young people to adulthood who were previously in receipt of support from Children’s Services, particularly those in care. Officers explained that there did need to be an eligibility to receive adult care services to transition between the two, and that care leavers were prioritised as part of the transition process;

·         Dental health, with members supporting action to encourage good oral hygiene habits, acknowledging the role of prevention in dental health, but raising concern about the lack of NHS dentists in Devon;

·         Lung cancer screening and access to this programme for Devon residents;

·         Specific concern around dental services in North Devon. It was explained to members that the NHS was continuing to look at what the final provision of dental services in North Devon would look like, but that a detailed verbal update could not be given due to regulations around procurement processes. In response to queries around dental access, officers highlighted that a dental van had been allocated under a national recovery plan for dentistry, which would be suited to accessing geographically isolated communities. Further details would be provided to the Scrutiny Committee when available; and

·         Minor Injury Units (MIUs), including: Bideford GPs supporting the provision of MIU services in Bideford (it was clarified that they were not staffing MIU itself, but providing equivalent care in the area); Ilfracombe MIU services ceasing from 31 March 2024 with efforts being made to meet these needs in the area; and the imminent reopening of Dawlish MIU, which was welcomed by members.

n 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 Scrutiny Risk Registers to see if there are any specific items therein it might wish to explore further.

The Chair advised members that an online session to discuss the work programme for the coming year would be organised in due course.

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.

·         NHS Dental Services in Devon: Stakeholder Briefing – February 2024

·         Integrated Adult Social Care Self-Assessment / Annual Report Masterclass – 27 February 2024 (Recording and Presentation)

·         Scrutiny Risk Registers - March 2024

Members noted the following 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:

·         NHS Dental Services in Devon: Stakeholder Briefing – February 2024

·         Integrated Adult Social Care Self-Assessment / Annual Report Masterclass – 27 February 2024 (Recording and Presentation)

·         Scrutiny Risk Registers - March 2024