Agenda, decisions and minutes

To receive any apologies for absence.

Apologies were received from Councillors Tony Robbins, Christine Lawrence, Hilary Bruce, Ben Fergusson and John Bailey.

To approve the minutes from the previous meeting.

Resolved that the minutes of the Scrutiny Committee - Adults and Health held on 12 September 2023 be confirmed as a correct record subject to the addition of the recording of a comment made by the NHS representative to indicate that they rarely used Section 106 monies to support activities in new building of houses.

Resolved that the minutes of the Scrutiny Committee - Adults and Health held on 12 October 2023 be confirmed as a correct record subject to the addition of a note to the effect that the NHS rarely make use of Section 106 monies.

To receive and note any declarations of interests in respect of any matters included on the agenda for consideration at this meeting.

(The other registrable interests of Councillors of Somerset Council, arising from membership of City, Town or Parish Councils and other Local Authorities will automatically be recorded in the minutes: City, Town & Parish Twin Hatters - Somerset Councillors 2023 )

There were no new declarations.

The Chair to advise the Committee of any items on which members of the public have requested to speak and advise those members of the public present of the details of the Council’s public participation scheme.

For those members of the public who have submitted any questions or statements, please note, a three minute time limit applies to each speaker and you will be asked to speak before Councillors debate the issue.

We are now live webcasting most of our committee meetings and you are welcome to view and listen to the discussion. The link to each webcast will be available on the meeting webpage, please see details under ‘click here to join online meeting’.

There was one Public Question from Eva Bryczkowski:

Question 1

For people who are not registered as an NHS patient, how long will it be before they can register as a new NHS patient in Somerset?

Thank you for your question concerning access to NHS dental services in Somerset.

The way patients engage with dentistry has evolved. Patients no longer stay with one dentist for life; instead, they typically visit a dentist for the duration of their treatment.

To find a dental surgery that suits your convenience, whether near your home or workplace, you can use www.nhs.uk. You can reach out to dental practices through phone calls or by visiting their individual websites to inquire about available NHS appointments.

In case of a dental emergency, we have established procedures to ensure that individuals without a regular dentist, requiring urgent dental care, can receive prompt assistance. Patients should contact NHS 111 for guidance on accessing urgent dental appointments in their area.

Additionally, we have introduced an initiative where patients can receive stabilisation care to ensure their dental health remains stable.

We understand that finding a dentist can be challenging, and dental surgeries may not always have the capacity to accept new NHS patients. In such cases, you might need to join a waiting list, seek out a different dentist currently accepting new NHS patients, or consider private dental care.

As of April 1, 2023, our dental commissioning team has taken responsibility for overseeing NHS dental services in Somerset. We are actively collaborating with local providers to address the shortage of NHS dental services in the region. Our efforts include implementing initiatives to increase the availability of dental appointments and launching preventive care programs to support patients in maintaining their oral health.

A key part of our initiatives is close collaboration with the local dental committee, including Somerset dental practices, local public health experts, and the local dental network and managed clinical networks. Together, we are developing new care pathways and identifying opportunities to expand dental capacity within our community. Furthermore, we are working alongside Local Authority Public Health teams to promote and enhance oral health, focusing on both children and adults.

We are also exploring opportunities to commission additional NHS services from dental practices that have the capacity to provide them. It's important to note that dental practices providing NHS treatment are listed on www.nhs.uk, and they are contractually responsible for maintaining accurate information on this platform. Regular updates are emphasized to ensure patients can access up-to-date information about available services.

We hope this information provides clarity on the current state of NHS dental services in Somerset and reassures you that we are actively addressing these challenges to improve access to dental care for our community. Please do not hesitate to reach out if you have any further questions or concerns. Your oral health is our priority, and we are committed to delivering the highest quality care possible.

Question 2

What happened at the national consultation and what result the  ...  view the full decision text for item 31.

There was one Public Question from Eva Bryczkowski:

Question 1

For people who are not registered as an NHS patient, how long will it be before they can register as a new NHS patient in Somerset?

Thank you for your question concerning access to NHS dental services in Somerset.

The way patients engage with dentistry has evolved. Patients no longer stay with one dentist for life; instead, they typically visit a dentist for the duration of their treatment.

To find a dental surgery that suits your convenience, whether near your home or workplace, you can use www.nhs.uk. You can reach out to dental practices through phone calls or by visiting their individual websites to inquire about available NHS appointments.

In case of a dental emergency, we have established procedures to ensure that individuals without a regular dentist, requiring urgent dental care, can receive prompt assistance. Patients should contact NHS 111 for guidance on accessing urgent dental appointments in their area.

Additionally, we have introduced an initiative where patients can receive stabilisation care to ensure their dental health remains stable.

We understand that finding a dentist can be challenging, and dental surgeries may not always have the capacity to accept new NHS patients. In such cases, you might need to join a waiting list, seek out a different dentist currently accepting new NHS patients, or consider private dental care.

As of April 1, 2023, our dental commissioning team has taken responsibility for overseeing NHS dental services in Somerset. We are actively collaborating with local providers to address the shortage of NHS dental services in the region. Our efforts include implementing initiatives to increase the availability of dental appointments and launching preventive care programs to support patients in maintaining their oral health.

A key part of our initiatives is close collaboration with the local dental committee, including Somerset dental practices, local public health experts, and the local dental network and managed clinical networks. Together, we are developing new care pathways and identifying opportunities to expand dental capacity within our community. Furthermore, we are working alongside Local Authority Public Health teams to promote and enhance oral health, focusing on both children and adults.

We are also exploring opportunities to commission additional NHS services from dental practices that have the capacity to provide them. It's important to note that dental practices providing NHS treatment are listed on www.nhs.uk, and they are contractually responsible for maintaining accurate information on this platform. Regular updates are emphasized to ensure patients can access up-to-date information about available services.

We hope this information provides clarity on the current state of NHS dental services in Somerset and reassures you that we are actively addressing these challenges to improve access to dental care for our community. Please do not hesitate to reach out if you have any further questions or concerns. Your oral health is our priority, and we are committed to delivering the highest quality care possible.

Question 2

What happened at the national consultation and what result the  ...  view the full minutes text for item 31.

To receive the report.

The Committee discussed the latest Adult Social Care budget report and noted the details. 

The Committee agreed that the Winter Planning information could be raised later or circulated to the Committee.

The Lead Member for Adult Social Care introduced the report covering the latest Budget Report. The current position is £523.7 m against a net budget of £493.4m. This results in a £30.3m adverse variance of 6.1%.

• Adult Services are showing a £14.9m adverse variance against their budget (8% of service budget). This variance is mainly in the adult social care and

Learning Disabilities budget areas.

• Children’s Services are showing a £11.8m adverse variance against their budget (9.6% of service budget). This variance relates to External

Placements.

• Climate and Place are showing a £2.3m adverse variance against their budget (2.6% of service budget). This adverse variance is seen across Waste Services, Infrastructure and Transport and Economy, Employment and Planning.

• Strategy, Workforce and Localities are showing a £1.3m adverse variance against their budget (6.4% of service budget). This variance is reported in Legal Services.

• Resources and Corporate Services are showing a £0.3m adverse variance against their budget (1.39% of service budget), This variance is reported in Legal Services.

Adult Social Care: Key Performance Summary

The Committee had a presentation on the Key Performance areas of Adult Social Care.

The Committee heard that the monthly average volume of calls handled by Somerset Direct was 5,893 in 2021/22 and 5,830 in 2022/23. So far in 2023/24 the average is 5,682. Whilst there is a high demand the support and advice given by Somerset Direst has been able to resolve a high level of queries at this very early stage thus taking the pressure off statutory services .

Overdue Care Act Assessments and Reviews.

The Committee heard that The number of overdue assessments and reviews continue to remain high, impacted by rising demand, complexity of need and ongoing internal workforce pressures.

Unmet need (homecare provision)

Somerset has continued to see the impact of additional investment and focused commissioning activity, as well as some pick up in care provider recruitment of new starters over recent months, with levels of unmet homecare need falling to their lowest ever levels since March 2021. The average package size for Homecare has increased year on year. This can be attributed to greater complexity of need in a ageing population.

My Life My Future

The Committee had a brief summary of the My Life My Future Programme and the five workstreams it contains. These are the drivers for the ambitious service which is future focussed, providing the right care, in the right place, at the right time.

The Committee discussed the report and asked the following: -

·         Why had the volume of ‘handbacks’ increased? This was sometimes an issue of capacity of small providers, Sometimes the poor behaviour of service users and due to workforce capacity.

·         Do people get the care they need? This is followed up and the fact that 80% of people are able to remain in their own home is testament of a successful service. Those who do return to hospital are often due to a new and unrelated matter.

·         Are  ...  view the full minutes text for item 32.

To receive the report.

The Committee had a presentation and report to update them on the Quality, Safety and Performance  of the Integrated Care Board (ICB).

Primary Care Access

The Committee was informed that Primary Care services have continued to experience considerable operational challenges in July 2023 with approximately half of the GP practices in Somerset reporting their OPEL status as OPEL 3 or above (Operational Pressures Escalation Levels). The practices reported pressure still showing in General practice due to staff shortages, sickness and patient demand and annual leave. In July 2023 there were approximately 286,000 primary care consultations with either a GP or other healthcare professional, which is an increase of 4.8% when compared to July 2022. Of these consultations 59.3% were delivered face to face (compared to the South-West Regional average of 66.9% and 6 68.3% in England) and 80.9% were made within 14 days and 43.9% made on the same day.

NHS 111 Service

There are ongoing pressures across the wider UEC (Urgent and Emergency Care) system both in Somerset and nationally. During the cumulative period April and July 2023 there were 62,000 people across Somerset who contacted (and had their call answered) by the NHS111 Service and this represents a 20.1% cumulative increase in demand over this period and comparable increase of 19.9% was also seen in the latest reported month (July 2023). The average speed to answer calls in Somerset improved by 20 seconds in July 2023 to 213 seconds compared to the England average of 159 seconds. There has been a significant reduction in the number of abandoned calls since HUC took over the running of the NHS 111 Service in Somerset from April 2023. Of the total calls received in July 2023 12.4% were abandoned compared to the previous England average of 9.1% and is an improvement upon the previous month. 63.5% of calls were assessed by a clinician or clinical advisor compared to the England average of 43.8%.

Ambulance Performance

The number of people calling the ambulance service in July 2023 was 2.5% lower than the same month in 2022, but on a cumulative basis during the period April to July 2023 there was an overall 0.6% increase in demand.

A&E Performance

Demand for A&E services has increased in 2023 and during the cumulative period April to July 2023 attendances to A&E has increased by 2.3% across Musgrove Park Hospital (MPH )and Yeovil District Hospital (YDH) sites, and in July 2023 reduced by 1.9%. In July 2023, A&E 4-hour performance at MPH was at 65.1% and at YDH 67.2%, which is an improvement upon the previous month at both sites. Both MPH and YDH 4-hour performance is above (better) than the National and South-West average and MIU performance of 96.9% is comparable to the previous month.

Elective Recovery and Waiting Times

The waiting times expectation in 2023/24 is that there will be no patients waiting in excess of 104 and 78 weeks throughout the year, and the new ambition is for there  ...  view the full minutes text for item 33.

To receive the report.

The Committee discussed the report and presentation commissioning was devolved to the ICB on 1^st April 2023. The Committee welcomed the offer of a Dentistry Masterclass for all Councillors in due course.

The Committee discussed a report on Pharmacy and Dental Services.

Pharmaceutical Services are commissioned from independent contractors, Community Pharmacy, Dispensing Doctors and Dispensing Appliance Contractors. Community pharmacy contractors comprise ‘bricks and mortar’ pharmacies and distance selling pharmacies. There are not generally individual contracts for pharmaceutical services commissioning, there is a contractual framework laid out in the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. In order to provide NHS pharmaceutical services, the contractor must be on their local pharmaceutical list. Access to pharmaceutical lists is controlled by regulations, the process for this is the responsibility of the ICB. Once on the list, contractors must meet their terms of service including providing essential services in line with the contractual framework and can choose to provide advanced services if they meet the requirements of those services. Distance selling pharmacies are not permitted to provide essential services to patients face-to-face at their listed premises, although they can provide advanced and enhanced services face to face.

There are two types of NHS dental contracts: General Dental Services (GDS) contract and Personal Dental Services (PDS) Agreement. GDS and PDS are nationally agreed regulatory and contractual frameworks. GDS contractors must provide mandatory services and can provide additional services. They are not time limited and do not have a fixed expiry date. PDS Agreements allow contractors to provide mandatory services or additional services. They are time limited and have a fixed expiry date (usually five years) however, contractors providing mandatory dental services with a PDS agreement can convert this activity to a GDS Contract. ICBs contract directly with independent contractors (dental practice owners), who then employ and / or subcontract with staff to deliver NHS dental services. Dental Public Health Consultants are responsible for assessing the oral health needs of their local populations and publishing and updating the Oral Health Needs Assessment. ICBs will need to commission dental services to meet the needs of their population. Current contracts are based on existing arrangements. The commissioner will need to determine whether any new contracts or temporary arrangements must be competitively tendered and procured in accordance with procurement law and any procurement protocol issued by NHS England.

The Committee discussed the report and aired a general frustration of all residents on not being able to access NHS funded dental care. The Committee were surprised to learn the Government funding for Dental Services is based on an assumption that funding will only be available to cover 50% of the population and the rest will voluntarily opt for Private Dental Services was not generally known.

The Committee share a general frustration that the current contract was not delivering a service to residents in Somerset and the solution was very slow in being delivered. The Committee were assured that Flexible Commissioning would yield results but needed to be tempered with an understanding that there is a national shortage of Dentists and encouraging then to take on NHS services was proving to be a challenge.

The Somerset Policies for Adults and Health Committee  ...  view the full minutes text for item 34.