To approve as a correct record the Minutes of the meeting of the Social Care Health and Housing Overview and Scrutiny Committee held on 29 July 2013 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 29 July, 2013, 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.

Cllrs Mrs Goodchild and Duckett declared interests as members of their family were service users.

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

The Chairman announced the Healthwatch update would be deferred to a later date.  The Chairman sent her best wishes for a speedy recovery to the Chairman of Healthwatch.

The Chairman confirmation the visit to Biggleswade Hospital and Houghton Regis on Friday 1 November 2013.  Further details would be sent to Members nearer the time.

Congratulations were extended to Nick Murley on his appointment to the position of Assistant Director Business and Performance and Stuart Mitchelmore on his appointment to the position of Assistant Director Adult Social Care.

To receive petitions from members of the public in accordance with the Public Participation Procedure as set out in Annex 2 of Part A4 of the Constitution.

No petitions were received.

To receive any questions, statements or deputations from members of the public in accordance with the Public Participation Procedure as set out in Annex 1 of part A4 of the Constitution.

No questions, statements or deputations were received.

To consider any decision of the Executive referred to this Committee for review  in accordance with Procedure Rule 10.10 of Part D2.  

The Committee was advised that no decisions of the Executive had been referred to the Panel under the Call-in Procedures.

To consider any items referred to the Committee at the request of a Member under Procedure Rule 3.1 of Part D2 of the Constitution.

No items were referred to the Committee for consideration at the request of a Member.

To receive for information a verbal update from the Executive Member for Social Care Health and Housing.

The Executive Member for Social Care, Health and Housing updated the Committee on issues that were not included on the agenda, these included:

·        Attendance at a performance monitoring meeting with Assistant Directors where good progress being made on most indicators;

·        Brandon Lewis MP had visited the Houghton Regis Step up, step down facility;

·        Attendance at a meeting with Healthwatch colleagues to receive an update on progress and current challenges;

·        Visits to the Henlow Lakes facility and Gale Court in Barton;

·        Attendance at a meeting of the Welfare Reform Group.  It was hoped to report to the Committee on the emerging picture shortly;

·        Attendance at a meeting of the Older People’s Reference Group at which the success of the Just Ask vehicle was announced.

In response to a question the Executive Member confirmed there was an emerging policy relating to the building of residential care homes and extra care homes.  The Director of Social Care Health and Housing could be contacted on this matter.

To receive a 6 month progress presentation from the Bedfordshire Clinical Commissioning Group in relation to the delivery of their commissioning intentions for 2013/14.

The Chairman informed the Committee that Stephen Conroy, Acting Chief Executive of the Bedford Hospital Trust, had been invited to attend the meeting to provide Members with a verbal update on the critical Care Quality Commission’s (CQC) report on Bedford Hospital.

Members were informed that the CQC had issued their inspection report at the end of August 2013 following visits to Bedford Hospital made by inspectors to observe how people were being cared for.  The visit following on from concerns raised by the post graduate Dean about clinical supervision and was more in depth than previous inspections with 11 inspectors visiting at various times over 4 days.  The report highlighted actions that were required to be taken by Bedford Hospital.  The issue of safeguarding vulnerable adults on a dementia ward had caused alarm and the hospital had acted quickly to put things right.  The Hospital had implemented a cultural change on all wards which had included:

·        Daily matron meetings to check staff were available to cover shifts;

·        The monitoring of nutrition and hydration on patient notes;

·        The introduction of a dashboard on wards as an early warning system of problems.  A rapid response team would be brought onto wards if a matron was unable to resolve difficulties;

·        Monthly Board meetings to be open to the public.

Diane Gray, Director of Strategy and System Redesign, Bedfordshire Clinical Commissioning Group (BCCG) endorsed the action taken by Bedford Hospital Trust and confirmed the BCCG was working with Councils and Bedford Hospital on safeguarding and other issues.  The BCCG would take a further look at performance data sets and the comments made by Members and GPs on patient experiences.

In light of the update Members discussed the following:-

·        Whether the Bedford Hospital Trust Board failed over a number of months to put right the issues on Riverbank Ward.  The Chief Executive, Bedford Hospital Trust commented that the independent reviews would establish who was at fault for the issues.  The Hospital recorded all incidents which range from ward level, serious incidents and ‘never events’,  Bedford Hospital’s performance was one of the lowest in the country for ‘never events’.

·        The problems being encountered by patients with other providers following discharge from hospital.  In response, the Chief Executive, Bedford Hospital Trust commented that the Hospital’s record was good in this area, with a low figure for readmissions after 7 days from discharge, however, performance for readmissions after 30 days from discharge was higher, which gave cause for concern. 

·        The need for a team to work across the hospital and community was needed and was being considered by the BCCG and Hospital Trust, however, this would take time to implement. 

·        The importance of listening and learning from GPs and family members and to accept help from visitors willing to support hospital staff.

·        The inconsistency of care by nursing staff was highlighted and questions raised about the standards of training and supervision of nurses at Bedford Hospital.  In response the Chief Executive said there had been issues regarding consistency  ...  view the full minutes text for item 56.

To receive a presentation and comment on the revised service delivery model for MSK services and to review the lessons learnt from this service reorganisation.

Diane Gray, Director of Strategy and System Redesign, BCCG, gave a presentation on the procurement of an integrated Musculoskeletal (MSK) system in Central Bedfordshire.  The presentation included details of the current service and short comings that had been identified and the challenges for the BCCG to deliver an equitable service across Bedfordshire bearing in mind financial pressures.

With this in mind, the BCCG formed an MSK CCG panel headed up by a local GP from Biggleswade.  The specification for the service contract had been awarded to the preferred bidder who had formed partnerships was based on a single budget for a 5 year prime contract.  The with other healthcare bodies, including national organisations.  BCCG had gained national recognition for undertaking this model of contract and would share the learning with others.

The Committee discussed the contents of the presentation and a number of points were raised by Members as follows:-

·        Whether the contractor could ‘cherry pick’ the services they delivered.  The Director of Strategy and System Design confirmed the budget for the contract was for all MSK provision.

·        That clinical champions involved in the commissioning of services initiative were welcomed by Members.

·        Monitoring of the contract was paramount to the success of the MSK service.  The Director of Strategy and System Design explained that GPs and the CCG managers would form part of the monitoring team. 

·        Whether the service could cope with peaks in service during winter months.  The Director responded that peaks in trauma and planned care had been taken into account.

The Committee wished to thank the Director of Strategy and System Redesign (BCCG) for her presentation that provided a clear insight into the proposed MSK service for the future.

NOTED the presentation

To consider and comment on the Framework Agreement for Care Homes in Central Bedfordshire report prior to consideration by the Executive.

The Assistant Director Strategic Commissioning introduced a report on the Care Homes Framework Agreement.  The report provided an overview of the approach to implement a framework agreement for commissioning places in care homes that links the quality of care to be agreed and for fixed contract price.  The report also outlined a quality monitoring system which assesses the quality of each care home and allocated it to a quality performance band.  The Committee were informed that providers had been slow to enter into the new contract arrangements and officers had provided additional support to them.  For this reason the deadline for tender submissions had been extended with the new arrangements to come into effect in January 2014.  The new national Care Homes Framework would not come into effect until 2015, however, the processes proposed would be reviewed and merged with the new system.

In response to the report and the additional presentation, the Committee discussed the following points:-

·        The need to monitor the 6 month period given to care home providers to improve.  The Director of Social Care Health and Housing explained with limited power the Council could decide to stop using a provider, however, with a limited supply of care homes it would be difficult to offer an alternative solution to suit residents.

·        That social care providers be made aware of training available to them.

·        The importance of the Council monitoring performance with their partners including Bedfordshire Clinical Commissioning Group officer and GPs and the Care Quality Commission. 

Recommendation

That the Care Homes Framework Agreement be supported and the comments of the Committee be taken into account by the Director of Social Care Health and Housing.

To receive a progress report on the action plan resulting from the Winterbourne View report.

The Assistant Director Commissioning introduced a report, which set out the Council’s progress and key work streams that have been developed and introduced by health and social care partners in Central Bedfordshire in response to the abuse of residents at the Winterbourne View Hospital.

Officers had undertaken a review of everyone with a learning disability who was in a hospital setting and agreed a joint strategic plan for improving services within the BCCG area.  Work into the transitions process for children with disabilities move to adult services had began to ensure a joined up planned approach that meets the projected demand and needs for these children.

The Committee thanked the Assistant Director Commissioning for the update in relation to progress on the key work streams.

NOTED the report.

To receive a verbal update from the Chairman of Central Bedfordshire Healthwatch.

Due to unforeseen circumstances this item was deferred.

NOTED the item would be rescheduled at a date to be confirmed.

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

The Committee received their work programme and the Executive Forward Plan and agreed that an update on developments at Bedford Hospital  regarding Paediatric Services and the Care Quality Commission’s report be received at a future meeting.

RESOLVED that the Committee’s Work Programme be approved subject to the amendments as detailed in the Minute above.