To approve as a correct record the Minutes of the meeting of the Social Care Health and Housing Overview and Scrutiny Committee held on 24 July 2017 and to note actions taken since that meeting.

RESOLVED that the meeting of the Social Care Health and Housing Overview and Scrutiny Committee held on 24 July 2017 be confirmed and signed by the Chairman as a correct record.

To receive from Members any declarations of interest and of any political whip in relation to any agenda item.

Cllr Duckett declared an interest at item 13 in his role as a part time domiciliary care worker.

To receive any announcements from the Chairman and any matters of communication.

The Chairman advised the Committee of recent news and events that included:-

·         A welcome to the new Accountable Officer at Bedfordshire Clinical Commissioning Group, Sarah Thompson.

·         The proposed merger of the Luton and Dunstable and Bedford Hospital.

·         A visit to the ELFT mental health facility at Townsend Court, Houghton Regis where residents from Weller Wing in Bedford are nursed.

·         The Enquiry into the Integration of Health and Social Care in Central Bedfordshire had entered its second phase and would focus on areas of good practice.

To receive petitions from members of the public in accordance with the Public Participation Procedure as set out in Part 4G of the Constitution.

None.

To receive any questions, statements or deputations from members of the public in accordance with the Public Participation Procedure as set out in Part 4G of the Constitution.

None.

To consider any decision of the Executive referred to this Committee for review  in accordance with Part 4D of the Constitution. 

None.

To consider any items referred to the Committee at the request of a Member in accordance with Part 4D of the Constitution.

None.

To receive a brief verbal update from the Executive Members for

·         Social Care and Housing and

·         Health.

The Deputy Executive Member for Adult Social Care updated the Committee on the latest developments that included:-

·         The submission of the Better Care Fund Plan.

·         The Gold Anglia in Bloom awarded to Priory View residents.

·         A single capital construction team was being developed in the Council and would include colleagues from Housing Services development team as well as colleagues from other Directorates.

·         The notable progress made by all partners in the Bedfordshire, Luton and Milton Keynes Sustainable and Transformation Partnership lead by the Chief Executive, Richard Carr.

The Executive Member for Health welcomed the news of the proposed Luton and Dunstable and Bedford Hospital merger and alluded to the growing pressures faced by the Acute Trusts.  In response a Member suggested a Park and Ride scheme be considered at the Luton and Dunstable Hospital to try and alleviated the parking pressures.

An introduction to Sarah Thompson, Accountable Officer, Bedfordshire Clinical Commissioning Group.

Sarah Thompson, Accountable Officer, had joined the BCCG in July 2017 and would hold the post for a year.  The role included a commitment to collaborative working with partners and stakeholders and to provide a quality of care to the public. 

The BCCG had been placed into financial recovery again by NHS England due to its failure to reach the financial targets previously set.  The BCCG continued to meet monthly with NHS England and predicted savings would be made within its current contracts, the Quality Innovation Productivity and Prevention scheme (QIPP) and working differently through the STP work streams. 

A Member raised a question regarding the main area of over expenditure.  The Accountable Officer referred Members to BCCG Board meeting held on 7 September 2017 and the financial paper that explained in detail the pressures that included the high volumes of patients attending the Acute Trusts for treatment.  Members were reassured that services to patients would be closely monitored during the period of financial challenge and an update would be presented to the Committee in January 2018.

To receive a presentation on the BCCG’s updated Commissioning Intentions.

The Account Officer, BCCG, introduced the updated CCG Commissioning Intentions that set out the main objectives and negotiated changes with providers.

Key changes included:-

·         the Out of Hours 111 Service to be administered regionally by the Hertfordshire Out of Hours Service with call handlers working in the Cambridgeshire, Peterborough, Bedfordshire and Hertfordshire areas in future. 

·         The provision of an Urgent Treatment Centre at Bedford Hospital in April 2018 that would compliment the new GP surgery available on the site and keep the numbers of the residents visiting Accident and Emergency to a minimum.

·         That the STP would help drive the changes in the way the Acute Hospitals and GP surgeries operated, including the creation of integrated care hubs as set out in the GP five year forward view.

A concern was raised regarding provision for residents in the south of the district.  In response the Accountable Officer advised of emerging plans in the Leighton Buzzard area lead by Dr Chris Marshall that would see a holistic approach to GP services in hospitals and in the community.

The Executive Member for Health supported the transformation proposals that, given time, would make a difference to patients’ experience.

The finalised Commissioning Intensions would be published on 1 October 2017

RECOMMENDED the Committee welcomes the ambitions of the Commissioning Intentions and looks forward to up-dates as these ambitions are realised.

To consider and comment on the proposals for the Mental Health Crisis Care service and the outcome of the service user engagement.

Rachel Volpe, Head of Mental Health Services at the BCCG presented a report on the work undertaken on Mental Health Crisis Care to reshape some services contracted to the East London Foundation Trust (ELFT).  Some key changes supported in the engagement work had been implemented and it was proposed that Mental Health support workers in primary care and acute care services be expanded.

Concern was raised about the provision of mental health services for homeless people.  In response the Head of Service advised that a ‘Core 24’ health crisis care service for homeless and other vulnerable groups was in  the process of being expanded and due to be Core 24 by April 2018.  A joint working partnership that included Housing colleagues was in place.  The STP work stream P2 supported this work with the voluntary sector partners.

RECOMMENDED the Committee:-

1.    Recognises the need to expand the mental health crisis service not only across the primary and secondary health sectors but also in the community.

2.    Emphasises the need to understand the many surrounding issues such as homelessness, drug and alcohol dependency which affect those with mental health issues.

3.    Recognises the role of the voluntary sector and its contribution and encourages that cross working.

4.    Request a report back on progress in January 2018.

To receive a verbal update on the Better Care Fund Plan 2017-19.

The Director Social Care Health and Housing delivered a presentation that outlined details of the Better Care Fund (BCF) 2017-19 that had been submitted for approval to NHS England.  The submission detailed a plan of action on how the Council would achieve integration by 2020 aligned with the STP and partners including housing.  Approval was expected at the beginning October.

Plans for 2017/19 focussed on five schemes that included:-

·         Prevention and early intervention

·         Integrated and improved outcomes trough Out of Hospital Services

·         Integrated Health and Care Hubs

·         Enhanced Care in Care Homes

·         High Impact Change Model

In light of the presentation Members of the Committee raised the following concerns:-

·         How the data protection regulations would be overcome to allow partners to share medical data.  The Director advised the role of an accelerated STP and Accountable Care Organisation was to unpick this issue and find a solution.  The Council would focus on this important area of work with its STP partners.

·         Whether the overwhelming number of national and local boards set up to deliver integration exceeded the benefit to patients.  The Director advised the STP had appointed and funded analysts to fully understand the extent of change that could be made.  A tracker had been created and the Health and Welling Board would oversee the data gathered.

·         A Member briefing would be organised to consider the performance metrics and point to new ways of working to ensure the timely transfer of patients into the right care settings.

RECOMMENDED the Committee:

1.    Welcomes the achievements of the Better Care Fund plan 2016/17 and noted the many challenges.

2.    Notes the funding secured to make the business case for establishing hubs and looks forward to hearing about progress as to how integration of health and social care will be brought about.

3.    Looks forward to arrangements being made for a Member briefing about improving transfers of care and issues around prevention.

The report provides Members with details of the currently drafted Committee work programme and the latest Executive Forward Plan.

The Committee considered the work programme and Executive Forward Plan and agreed to include the following items:-

November 2018 -

·         Hospitals Merger

·         Primary Care areas of good practice

January 2018

·         BCCG financial position update

·         Mental Health Crisis Care update

·         Private Ambulance Service update

AGREED the work programme as set out in Appendix A subject to the addition of those items outlined above.