Agenda, decisions and minutes

To receive any apologies for absence.

Apologies were received from Councillor Sue Osborne – Councillor Steve Ashton as substitute, and Councillors Andrew Govier, Tony Robbins, and Emily Pearlstone.

To approve the minutes from the previous meeting.

Resolved that the minutes of the Scrutiny Committee - Adults and Health held on 7 December 2023 be confirmed as a correct record.

Resolved that the minutes of the Scrutiny Committee - Adults and Health held on 7th December 2023 be confirmed as a correct record.

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 of Interest.

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’.

A late request for a public question from Ray Tostevin, Quicksilver Community Group was received, and the chair allowed him to speak.

Ray Tostevin’s Question:

NHS Somerset ICB have voted unanimously to CLOSE the Yeovil HASU, despite widespread and continuing opposition from the public, patient groups, and NHS staff.  At their decision making meeting on 25 January, ICB members also agreed for £1.8million of capital funding from Somerset, to be spent creating a new HASU at Dorset County Hospital in Dorchester. Surely the ICB should be investing to KEEP the Yeovil HASU, NOT close it? This committee expressed serious concerns at the ICB proposals when you met in December. The ICB appear to have ignored those concerns. Will this committee now approach the Secretary of State, using new powers that took effect last week,  to officially call in the NHS Somerset stroke reconfiguration plans?

The committee resolved to write to the Secretary of State to ask them to use their powers under the Health And Care Act 2022 to intervene in the NHS Somerset stroke reconfiguration plan.

Ray Tostevin, chair of Quicksilver Community Group, sent in a late question that was approved by the chair.

Ray Tostevin:

NHS Somerset ICB have voted unanimously to CLOSE the Yeovil HASU, despite widespread and continuing opposition from the public, patient groups, and NHS staff. At their decision making meeting on 25 January, ICB members also agreed for £1.8million of capital funding from Somerset, to be spent creating a new HASU at Dorset County Hospital in Dorchester. Surely the ICB should be investing to KEEP the Yeovil HASU, NOT close it? This committee expressed serious concerns at the ICB proposals when you met in December. The ICB appear to have ignored those concerns. Will this committee now approach the Secretary of State, using new powers that took effect last week, to officially call in the NHS Somerset stroke reconfiguration plans?

The committee resolved to write to the Secretary of State to ask them to use their powers under the Health And Care Act 2022 to intervene in the NHS Somerset stroke reconfiguration plan.

In the discussion, the following points were raised:

·       A request for clarity on the position of Somerset Council, as Duncan Sharkey, Chief Executive Officer, was a voting member at the ICB committee that took the decision

·       A request for a piece of communications work around this and a statement to the public with the ongoing work on this decision

To discuss the work programme.

The committee discussed the Work Programme and made the following additions:

·       Workforce

·       Public Health Covid Update

·       Ambulance Service Update

·       Dentistry, following indication that model will change

·       Mental Health

·       Focus area on cancer community support

·       Social Care Training (Bridgwater Academy)

The committee also requested a list of the annual reports that they would receive so that they could identify gaps.

The committee discussed the Work Programme and made the following additions:

·       Workforce

·       Public Health Covid Update

·       Ambulance Service Update

·       Dentistry, following indication that model will change

·       Mental Health

·       Focus area on cancer community support

·       Social Care Training (Bridgwater Academy)

The committee also requested a list of the annual reports that they would receive so that they could identify gaps.

During the discussion, it was raised that there could be more frequent meetings of Scrutiny Committee – Adults and Health, but concerns were raised about the demand on Officer resources. It was also requested that there be more engagement with grassroots and work in communities, but as this is so local it would be difficult to scrutinise.

To consider the report.

The committee received the presentation and noted it. A discussion followed around staffing improvements, ongoing progress, communications, and the next phase. They requested a further update on Phase 3.

Helen Edelstyn, Head of Project Development at the Bristol, North Somerset and South Gloucestershire ICB, and Judith Hernandez del Pino, Hospital Director at Western General Hospital, gave a presentation detailing the overall vision for Weston, the successes they had already had, and the next phase of Healthy Weston.

During the discussion, the following points were raised and responded to:

·       Staff vacancy improvement figures are very encouraging, what is that attributed to, and how does it compare to numbers across Somerset and nationally? We are in line with the national average in terms of recruitment targets. Retention is also critical. Medical recruitment has historically been a big challenge in Weston, so it has been a very positive change. Some recruitment challenges are national problems, and we now fall in line with those, rather than having both national recruitment challenges and Weston-specific challenges.

·       How many patients return to Weston after receiving specialist care elsewhere? What is the impact of that? Patients are repatriated where they need to be. If they can go home after specialist care, they do, whereas if they need ongoing care they return to WGH. The hospital has the capacity to support these patients.

·       On Phase 3 of Healthy Weston – what is the work on the way for the Surgical Hub? This is a plan for a system hub for high volume, low complexity surgery. Currently doing mapping with system partners including Musgrove, Bristol, in order to look at how to develop that approach to manage care needs.

·       An update was requested on the Surgical Centre of Excellence work

·       What is the current public engagement to highlight Healthy Weston and the changes in the hospital? We deliver a series of stakeholder updates and work closely with colleagues in primary care, demonstrating the changes and new pathways through primary care networks. More work is needed around this – we are not always very good at success stories.

·       Who does acute stroke get referred to? Predominantly to North Bristol Trust, as part of the BNSSG transformation. A very small amount goes to Musgrove. Weston has stroke rehabilitation, so patients come back once they are out of the acute phase.

·       With recruitment improvements, there must be reduced vacancy costs. What are the figures for that? There are improvements, but we do not have numbers available.

Cllr Slocombe (Chair) thanked the officers for the presentation, and requested that they return once they have done more work on the surgical hub and public engagement.

To consider the report.

The committee received the presentation from Public Health on Housing as a determinant of Health and noted it. They discussed the complexity of housing provision and the need for an integrated approach.

Alice Munro, Consultant in Public Health, gave a presentation on the upcoming Annual Report of the Director of Public Health, due to come to Executive Committee in March. The report is an independent and personal view from the Director of Public Health, covering matters outside ‘business as usual’, often about issues whose profile should be raised and where the whole system needs to respond.

The themes for this report are ‘Homes and Health’, highlighting that homes provide a strong essential foundation for good health, and ‘Neighbourhood’, highlighting how resilient communities can support people to live healthy independent lives.

During the discussion, the following points were raised and responded to:

• The report findings have a lot of interconnected thinking in terms of housing and type of housing. What can councillors do to address it? There are recommendations in the report for different audiences, to look at the powers regarding the local plan and the transport plan. The final report will have more detail.
• There are different levels of care in care homes on hospital discharge than there used to be, possibly lower levels. Is that something commonly found with hospital discharge? There is variety in the supported housing model, when someone leaves hospital they have an assessment to see what their needs are and what is available. Work with the individual and looking at what they need, including from the private sector.
• Example of a case where someone was discharged to an unpaid carer, but carer had to work and so they were left without care. What efforts are being made on hospital discharge to support that? There are several different pathways, which can be augmented with Village Agents, Red Cross, and other VCSEs. Pathway 0 has the ward look at whether they are able to go home, Discharge to Assess involves a hub and a multi-agency decision.
• It’s about neighbourhoods and making sure they care for each other.
• Complex Care Team is a great example of the NHS working for older people with a holistic approach, difficult referrals and needs being met in a short amount of time
• How can we get the message out about homes being adapted for older people? Do we as adults need to take more responsibility for preparing for getting older? That would be a question for colleagues in Communications – many people don’t perceive themselves to be vulnerable or anticipate that they might need support in their home or housing adaptations. Need to raise awareness and be pro-active instead of responding to a need.
• How can Adults and Health Scrutiny contribute to this and connect to the broad developments like housing and the local plan? Earlier this week there was a meeting with Housing, Social Care, and Public Health to look at the housing plan in Somerset. May be possible to do this item as a workshop for the scrutiny committee.
• This could be an area that chairs of Scrutiny such as Adults and Health, Communities, and Childrens etc. come together on.
• There is  ...  view the full minutes text for item 50.

To consider the report.

The committee received the report and presentation and thanked Mel Lock, Penny Gower, and Emily Fulbrook for their hard work around the budget. They discussed care provider fee increases and expectations for future increases, and what the primary cost drivers were in this area.

Penny Gower, Service Manager, Adults & Public Health Finance, gave a presentation and a report that provided the overview on the current position in the whole council and Adult Services specifically, highlighting the pressures and mitigations in the service.

Mel Lock, Executive Director Adult Services and Lead Commissioner Adults & Health, detailed the challenges in the market of care providers and the work that had been ongoing to stabilise that, including international recruitment.

During the discussion, the following points were raised:

• There has been so much pressure on the team, with ten years of accounts done in one year, and we want to acknowledge how hard they’ve all been working.
• Concerns about innovation getting lost and working creatively with VCSEs. Would be great to hear more good news. Keeping people in their own homes gets communities and VCSEs working really well together, and we want to continue to drive that. We are also looking at how we can use AI to help us going forward. Budget constraints mean we have to innovate.
• How does the underachievement in commissioning relate to an overspend? This is linked to the My Life My Future saving – there is an expected lag in this. Will end up with £10m as two year savings.
• The reference to international recruitment highlights the importance of looking at workforce. There is a workforce board. There are risks to international recruitment, as the Home Office has offered licenses to many people and haven’t always checked if those are appropriate. This leads to risks around modern slavery and corruption. The government has also changed rules, such as not being able to bring a spouse. We are keeping an eye on this. As we are due an election, there may be further changes in the ways of working around this. There is a workforce plan for health but not for social care, but we are pushing with ADASS and Skills for Care to ask political parties to have a workforce plan for social care. Within Somerset Council, we have used a recruitment agency to recruit social workers from southern Africa – currently 15, and seeking another 10. Still working with local universities, but there is very low uptake for social work courses in Somerset. There is potential for a workshop on the workforce plan going forward.
• Cheaper beds are leaving the system and more expensive are coming in. Are we looking ahead and will bed prices come down? 70% of workforce within care is on national minimum wage. It is right that minimum wage increase, but there was no additional funding, and it adds to costs of care homes. Inflation, mortgages, etc. have all gone up and can’t see them reducing. We work closely with providers and provide a lot of support. We don’t have a lot of the big national providers so there are less overheads. We are expecting a levelling off.
• What mitigations are in place for placing people in care within a 30 mile radius of their home? These are  ...  view the full minutes text for item 51.