To approve as a correct record the Minutes of the meeting of the Social Care Health and Housing Overview and Scrutiny Committee held on 26 November and 14 May 2018 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 26 November 2018 be confirmed and signed by the Chairman as a correct record.

The Minutes of the meeting held on 14 May 2018 be confirmed and signed by the Chairman as a correct record, subject to the amendment of Members’ Interests and the removal of Cllr S Goodchild and replacement of Cllr M Versallion.

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

Cllr Duckett declared an interest in his role as a part time care worker.

Cllr Versallion declared an interest as a Non-Executive Member of the Luton and Dunstable  Hospital Board.

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

The Chairman welcomed Patricia Davies, Accountable Officer, Joint CCGs to her first SCHH OSC meeting. The publication of NHS England’s long term plan that sets out its key ambitions for the service over the next ten years was announced.

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 Adult Social Care and Housing Operations

·         the Executive Member for Health and

·         The Executive Member for Assets and Housing Development.

The Executive Member for Adult Social Care and Housing Operations gave a presentation that highlighted the diverse, challenging and inspirational work undertaken by staff within the Directorate.

The Executive Member for Health advised an investigation into the reasons for the exclusion of young children from school was being undertaken.  The report would be circulated to Committee Members when completed.

School bids had been received to claim a portion of the £170m of Government funding named ‘sugar tax’, match funded by Central Bedfordshire, to enable all schools to take part in individual projects to reduce obesity in children.

The Executive Member for Assets and Housing Delivery announced up to £10m a year in housing would be supplied through the Housing Revenue Account and delivered by the Assets Team.  A new multi directorate and agency Housing Commissioning Panel had been created to deliver a coordinated housing commissioning plan.

In response to a question regarding the Houghton Regis Central project, the Director advised the Council was not in a position to award the contract and a letter to update residents would be circulated.

To consider and comment on an update on the change to phlebotomy services to residents in Central Bedfordshire.

The Assistant Director, Out of Hospital Care at Bedfordshire Clinical Commissioning Group (BCCG) introduced a report that updated the Committee on the delivery of the Phlebotomy Service in the south of Central Bedfordshire.  The BCCG acknowledged there was a gap in service for Dunstable residents and a new clinic had been provided at the Dunstable Health Centre.

It had not been possible to find suitable premises and provide staffing for a Houghton Regis clinic. However, feedback indicated residents from Dunstable and Houghton Regis were satisfied with the new arrangements in Dunstable.  Feedback from some residents on the Luton Arndale Phlebotomy service indicated there had been an issue in booking appointments, however, this problem had been addressed.  The CCG would continue to monitor feedback from residents.

Recommended that the Committee, while noting the extended hours in Dunstable, asks that the CCG continues to seek suitable premises for the Houghton Regis clinic and consider any further options in Leighton Linslade and wider Central Bedfordshire.

The new Community Health Services (CHS) contract, commissioned by Bedfordshire CCG, Bedford Borough, Central Bedfordshire and Public Health started on 1st April 2018.   East London Foundation Trust (ELFT) in partnership with Cambridgeshire Community Services (CCS) are delivering an outcomes based contract, which includes children’s and adult community services.

The report updates the Committee on the delivery of services to residents through the new contract.

The Assistant Director, Out of Hospital Services, BCCG, introduced a report that set out details of the Community Health Services contract awarded to ELFT in April 2018.  Feedback from GPs and service users had been positive and new initiatives, including the introduction of single point of access, and the work with Bedford Hospital on discharge of elderly patients had improved the service.

In response to a question regarding delayed transfer of care, the Assistant Director advised that Central Bedfordshire scored well nationally and that winter planning with partners had helped to reduce delays.  Work towards a single record by the Integrated Care System would help improve communications across the system as well an improved dialogue with schools and health and care services.

The Director of Social Care Health and Housing advised that residents in Central Bedfordshire used seven different hospitals and officers use the intelligence collected in a tracker to understand why residents are admitted to hospital and their subsequent care requirements. 

Concern was raised regarding the palliative care service and communications between GP Services, Community Health Services and patients.  Members learnt of a case where a resident’s care had not been carefully coordinated.  In response the Assistant Director advised measures to improve palliative care had been instigated.

RECOMMENDED the Committee

1.    The social care tracker used to deliver multi-disciplinary services to residents be included on the work programme and considered at the next meeting of the Committee.

2.    Request a report back in September 2019 outlining any further changes and improvements to services and patient pathways.

The purpose of this paper is to provide an update to the Overview and Scrutiny Committee on the progress made with the inpatient beds review in Bedfordshire, and provide an update on the work being undertaken to improve crisis care services.

The Head of Mental Health Services, BCCG, introduced a report that highlighted key areas of focus on the Mental Health Crisis Care service and the provision of inpatient beds for Bedfordshire.   The review encapsulated opinions obtained from public engagement events and users and looked to improve the service for children through to adult services.  An evaluation of the review would culminate in a renewed service provision from April 2020.

The success of the street triage service and alternative therapy services for females had reduced the need for inpatient beds.  A rise in service demand for male inpatient beds had resulted in ELFT redistributing bed provision.  An exploration into the reasons for the upturn in male need was underway.  An additional service development would include a business case for crisis resolution and home treatment. 

The Associate Director, ELFT, advised the success of the  crisis café pilot in Bedford had resulted in plans for additional cafes in Mid and South Bedfordshire, in partnership with the voluntary sector where possible.  Other key service improvements had included the provision of Primary Care Mental Health Workers based in GP surgeries.  The principle of the service is early intervention and prevention.

In light of the report Members discussed the following. In summary:-

·         That the Committee be advised in advance of any new premises for the planned new mental health in-patient unit.

·         That early support schemes were invaluable, but good communication was key and welcomed the use of the System One by the Primary Care Mental Health Linkworkers.

·         That ELFT continue to develop an overlap in age range for 18-25 year olds to ensure the continued support to vulnerable, adolescent residents.

RECOMMENDED that the Committee:

1.    Wishes to be kept up to date concerning progress as to identifying opportunities for alternative acute inpatient provision. 

2.    Welcomes the success of the Mental Health Street Triage Service.

3.    Is informed when the business case for the crisis resolution and home treatment is ready.

4.    Recognises the need for an early GP appointment to diagnose Mental Health issues and access to further assistance.

5.    Notes concerns around the transition from child to adult and the need to deliver improvements.

To consider and comment on the proposal to create a Dunstable Care Hub and the implications for primary care services in the area.

The Head of Infrastructure and Integration , BCCG, introduced a report that advised the Committee of its intention to consult the patients of the five GP Practices in Dunstable who are likely to move from their current premises to the Dunstable Hub when it is built.  The Consultation would also ask what other services people would like to be delivery from the hub.

In light of the report, Members discussed the following in summary:-

·         The need to manage patients’ expectations and advise when a move to the Hub was expected.

·         That Members would be briefed on the emerging GP premises strategy and to the plans to create an interim solution for Houghton Regis.

·         That a link from the Central Bedfordshire website to the Dunstable Hub consultation be published.

RECOMMENDED that the Committee be appraised of the results of the consultation and how the views are seen to inform the development of the Dunstable Hub.

The Committee will be introduced to the new Joint Account Officer for Bedfordshire, Luton and Milton Keynes Clinical Commissioning Groups.

The recently appointed Joint Accountable Officer (JAO), Clinical Commissioning Groups (CCGs) introduced a short presentation that outlined the key focus of her role to deliver the best Clinical Commissioning Group outcomes at scale and at place across Bedfordshire, Luton and Milton Keynes.  A programme of work to introduce new Governance arrangements with the Good Governance Institute would start in February 2019 and would support the smooth running of the Commissioning Collaborative and particularly creating stability within Bedfordshire.

In response to a question raised regarding the merger of Bedford and the Luton and Dunstable hospitals, the JAO advised the hospitals’ bids for capital funding from NHS England had not been successful.  There were no plans to take services away from Bedford Hospital and the CCG would support both Trusts in a future merger.

A Member requested an update on the rumours that Milton Keynes and Luton CCGs wished to leave the current Integrated Care System.  The Joint Accountable Officer advised that she and her colleagues on the Joint Executive Team were all employees of Luton, Bedfordshire and Milton Keynes CCGs and confirmed that Milton Keynes had instigated conversations about a move.

NOTED the introduction made by the JAO and wished to see greater stability from the CCGs’ and certainty for the future.

The report updates Members on the progress made by officers in addressing the recommendations of the SCHH OSC, following its enquiry into the Integration of Health and Social Care in Central Bedfordshire, Phase I and Phase II.

The Executive Member for Adult Social Care and Housing Operations introduced the Executive’s Response to the Enquiry lead by SCHH OSC Members into the Integration of Health and Social Care in Central Bedfordshire. 

The principles and key recommendations had helped to change attitudes and helped deliver a joint approach for the delivery of services with partners so that residents are at the centre of decisions about their care.

Progress was on-going in areas such as the development of health and care hubs. However, many other recommendations had been actioned.

NOTED and welcomed the positive comments and looked forward to the next steps in the realisation of Integrated Health and Social Care.

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

The Committee considered the current Work Programme and Executive Forward Plan .  The Work Programme was approved subject to the addition of the social care tracker to be considered at the March 2019.