To approve as a correct record the Minutes of the meeting of the Social Care Health and Housing Overview and Scrutiny Committee held on 18 September 2017 and to note actions taken since that meeting.

RESOLVED that the Minutes of the meeting of the Social Care Health and Housing Overview and Scrutiny Committee held on 18 September 2017 be confirmed and signed by the Chairman as a correct record.

In light of the Minutes the Committee were advised that the Council was awaiting feedback on its Better Care Fund submission. A date for a Member Briefing on Performance Metrics would also be arranged.

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 10 in his role as a part time domiciliary care worker.

·         Cllr Versallion declared an interest at item 10 as a Non-Executive Director of the Luton and Dunstable Hospital.

·         Cllr Spurr declared an interest at item 10 as a Member of the Luton and Dunstable Board in his role as Executive Member and Chairman of the Health and Wellbeing Board.

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

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

·         HealthWatch had launched a survey on the Musculoskeletal Service (MSK)

·         Priory View had been presented with a Social and Affordable Housing award by the Local Authority Building Control (LABC).  The scheme at Creasey Park, Dunstable had also won an LABC award in the inclusive building category.

·         ELFT had been awarded the contract to run Community Health Services by the Clinical Commissioning Group and Councils.

·         A meeting of the Joint Health Overview and Scrutiny Committee took place on 14 November and received an update on the STP that included an STP update, digitisation, care homes and the Accountable Care System.

·         A visit to Biggleswade Hospital had been arranged for Members on Thursday 14 December at 1pm.

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 Member for Social Care, Health and Housing.

The Executive Member for Health updated the Committee on the latest developments that included:

·         A Community Health initiative that had been established to help those recovering from drug and alcohol problems. 

·         Recent attendance at the Health and Wellbeing Board Member Conference.

The Executive Member for Social Care and Housing updated the Committee on developments that included:

·         Attendance at the National Conference for Children and Adults, which focused on the theme of prevention.

·         The pressure of homelessness and the current demand on Housing Services.

·         A new step up, step down facility that had been opened in Beech Close, Dunstable that was delivered by Aragon Housing Association and the Council’s Reablement Service. 

·         Congratulations were extended to the Director of Social Care Health and Housing who had been appointed Vice President of the National Association of Directors of Adult Social Services commencing in April 2018.

Executive Members also confirmed that at the request of the Committee, a drop-in session on budgets would be arranged. The Committee were also advised that a process and procedural guide, to be used when a resident was at risk of being made homeless, would be circulated to the Committee.  The Executive Member would advise on donations that could be made to support the prevention of homelessness.

To consider and comment on the proposal to merge Bedford Hospital and Luton & Dunstable University Hospital and the potential implications of these plans on local residents.

Stephen Conroy, Chief Executive at Bedford Hospital and David Carter, Acting Chief Executive of the Luton and Dunstable University Hospital presented a report on the proposed merger of the two hospitals.  The Committee were reassured that all core services would remain on both sites and the proposed merger had the support of both Hospital Boards.  Both hospitals had good and exceptional performance and quality records and looked forward to the opportunity to learn from each other in order to further improve their services to patients and to reduce the costs in management and administration.

The timetable of April 2018 to establish one hospital trust was a challenge, but the Chief Executive’s were confident this deadline was achievable.  It was noted that the benefits outlined in the report would not be delivered on day one, however, changes would start to transition during 2018/19.

In response to several questions from Members the Committee were advised of the following: -

• the merger plans took into account Central Bedfordshire’s ambition to establish community health hubs and spokes.  It was acknowledged that, despite the merger plans, the plans of the Sustainable and Transformation Partnership (STP) for care out of hospital, were fundamental to the success of the new hospital trust.
• the hospital would continue to be accountable to Members at Scrutiny meetings and the Board of Governors. The importance of appointing representative Members as non-executive directors to scrutinise the performance of the board and represent the interests of NHS foundation trust members and the public was key.
• a reduction in acute care spending was not planned given the growing and ageing population, but the STP plan was for an increase in primary care spending resulting in a slowing of increase of acute funding.
• Milton Keynes hospital had not wished to enter into merger discussions, however, it would be possible for them to engage in a merger at a later date.

RECOMMENDED that the Committee: -

1.    Supports the ongoing work to establish a business case for merger between the Bedford and Luton & Dunstable Hospitals while stressing the need to cater for the residents of Central Bedfordshire and Central Bedfordshire’s ambition to establish hubs and spokes within the primary care system.

2.    Looks forward to further detail on the clinical benefits as well as the financial benefits of such a merger.

3.    Seeks reassurance that there will be broad representation on a new Joint Trust Board.

4.    Requests further information when the full business case has been developed.

The paper provides an update on Primary Care services provided in Central Bedfordshire and the plans in place to ensure patients continue to receive quality care.

The Chairman for Bedfordshire Clinical Commissioning Group gave an update on primary care and plans to ensure residents in Central Bedfordshire received quality care.  The proposals would provide daily access to services and greater resilience in the health care system. Hubs would offer a variety of services from GPs and multi-disciplinary teams, dependent on the needs of the population in the vicinity.

The Committee raised concerns regarding the recruitment of new GPs to which they were assured that the new ways of working would see the GP’s life become easier, however, it was a gradual progress with some GPs resistant to change. In particular the pressures in the West Mid Beds locality were discussed in light of which a briefing on current GP provision to accommodate the growing need in this area was proposed. 

In light of the discussion it was confirmed that an update on the Out of Hospital Strategy would be presented to the OSC at the 18 March 2018 meeting.  Cllr Goodchild would also receive an update on proposals for Houghton Regis.

RECOMMENDED that the Committee: -

1.    Welcomes the collaborative progress being made to deliver integrated primary care services to the residents of Central Bedfordshire.

2.    While recognising the pressures on GPs and their surgeries and GPs’ desires to develop their skills, it stresses the need for a continuing well staffed GP service.

3.    Stresses the need to ensure further collaboration with social services, housing and mental health as part of an improved primary care system.

4.    Emphasises the need to educate the general public about the appropriate use of pharmacists and GP surgeries.

5.    Welcomes further updates particularly on the Out of Hospital Strategy at the 18 March 2018 meeting.

6.    Needs to better understand the position today and for the future of GP surgeries taking into account demographic growth and emerging health issues and the areas each serves.

7.    Requires feedback on the continuing discussions about the establishment of hubs and spokes in the Dunstable and Biggleswade areas.

Consider and comment on the annual report of the Safeguarding Adults Board, with a particular focus on how awareness raising and knowledge of adult safeguarding could be improved for the public and within the wider community.

The Independent Chairman of the Bedford Borough and Central Bedfordshire Adults Safeguard Board (SAB) introduced the 2016-17 annual report, which in summary outlined the following: -

·         Pressure on the Deprivation of Liberty Safeguards (Dols) nationally, although there was no backlog in cases to report for Central Bedfordshire. 

·         A focus on ensuring there was no duplication in efforts in safeguarding and that each service complemented the work of the others.

·         The correct governance structure was in place that included the establishment of a Safeguard Adults Review sub group to review untimely deaths. 

In answer to a question on transition arrangements from child to adult safeguarding, the Independent Chairman reported there were some young people who received support as Children who were not eligible for care and support when they become adults, but may still be vulnerable.  This was a concern for the SAB and was something the Board would be seeking to address together with the Safeguarding Children’s Boards. 

A Board Manager would be appointed to support the independent running of the Board going forward.

RECOMMENDED that the Committee: -

1.    Welcomed insight into the work of the Bedford Borough and Central Bedfordshire Safeguarding Adults Board.

2.    While understanding the need for the Board to be as independent as possible, the Committee recognised the interaction between the various parties who bring their own legitimate agendas to the table, appreciating that the appointment of a Board Manager could help to develop the Board’s independence.

To consider the process to re-procure care home places for older people and pass comments on to the Executive . The outcome of this process and the award of contracts is due to be considered by the Executive on 5^th December 2017. 

The Head of Managing the Needs of Older People (MANOP) introduced a report that set out the background and procedure for the re-procurement of care homes places for older people.  The new contract set out the specification for care services, monitoring arrangements, fee rates and detailed terms and conditions in order to meet the Council’s objectives.  Key changes include: -

·         a contract period of 15 years with the provision for contract variation and a ‘break clause’ were included.

·         The contract would align arrangements with Bedfordshire Clinical Commissioning Group and allow joint development of new services.

·         The payment of third party top ups would be regularised with arrangements for collection and distribution.

RECOMMENDED that the Committee: -

1.    Agreed that the framework model with spot contracting as a fall-back option was the appropriate approach.

2.    Welcomed and endorsed the approach being taken to contracting with the care home market.

3.    Was supportive of the proposals to deliver greater transparency and clarity on the costs of residential care through publication of information and the development of more robust arrangements for the management of 3rd Party Top Ups and customer contributions.

4.    Looked forward to hearing the positive outcomes that could be achieved through co-working with Bedfordshire Clinical Commissioning Group.

The report provides Members with details of the currently drafted Committee work programme and the latest Executive Forward Plan. Members will be provided the opportunity to discuss in the list of items proposed for the Committee work programme, helping shape the future direction of travel.

RECOMMENDED that the work programme be agreed subject to the addition of the following items: -

·         Primary Care verbal update - February 2018

·         Integration Enquiry Report Part 2- March 2018

·         Update hospital merger

·         Verbal Update on Primary Care Service in West Mid Beds

·         Update on the Contract for Residential and Nursing Home placements to the September 2018 meeting (6 months+ into the contracts)