Agenda and minutes

To receive any apologies for absence.

Apologies were received from Cllr Edric Hobbs (Cllr Martin Lovell as substitute) and Cllr Tony Robbins (in attendance online).

To approve the minutes from the previous meeting.

Resolved that the minutes of the Scrutiny Committee - Adults and Health held on 21^st November 2024 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 public question was received from Ray Tostevin, chair of Quicksilver Community Group, on the topic of the closure of Yeovil HASU. The question is outlined in Annexe A to the minutes.

A verbal response was provided at the meeting from David McClay, Chief Officer for Strategy, Digital and Integration – NHS Somerset.

To discuss the work programme.

To assist the discussion, the following documents are attached:-

(a)  The Committee’s work programme

(b)  The Committee’s outcome tracker

Please use the following links to view the latest Somerset Council Forward Plans and Executive Forward Plan of planned key decisions that have been published on the Council’s website:

Somerset Council Forward Plans

Somerset Council Executive Forward Plan

There was a request for confirmation that the Suicide Prevention Strategy would be returning to the committee.

To receive the report.

Sukeina Kassam, Director of Primary Care at NHS Somerset ICB, and Matthew Mills, Head of Pharmacy, Optometry and Dentistry, and Jenny Albiston, Dental Strategy Clinical Lead, gave a presentation on the crisis in dentistry services in Somerset. They highlighted the key issues nationally and locally in Somerset and the different workstreams and priority areas to address the crisis.

During the discussion the following points were raised:

• The statistics included in the report are stark
• There is an initial plan from the government but no detailed information on how to solve the problem
• In October 2024, NHS Somerset agreed to incentivise 15 dentists with golden hello payments – why have none been appointed?
  • This approach has been unsuccessful across the South West. In order to receive the payments (over three years) there is a commitment to a large amount of dental activity.
  • If it continues to be unsuccessful there will be a review of the approach to develop a solution with different rules.
  • There is a wider piece of work on making Somerset attractive to people, particularly newly qualified people who would prefer to live in cities.
  • It is also a challenge to recruit private dentists in Somerset, not necessarily an NHS specific issue.
  • The dental contract needs addressing.
  • There are also a lot of complex needs in Somerset.
• Targets have been reduced and yet are still not being met, can you explain this?
  • Dentists have been handing back contracted activity, so it is a reflection of that.
• Is there sufficient training for dentists in universities, is the pipeline of dentists in training sufficient?
  • Bristol has increased their numbers recently but it is a five year course plus a foundation year, so a long pipeline.
• Are we marketing Somerset enough? What is Somerset lacking to attract people here?
  • We are not pushing enough that it is a great place to live and there are opportunities here.
• There is a proposal for a new dental practice to open in Wellington. It would be great for local Members and the community to have more updates and a timeline for this. Local Members may be aware of premises becoming available that might be appropriate.
  • We will review communications and engagement. Don’t want to overpromise and underdeliver.
  • There have been challenges identifying appropriate premises in Wellington, some options identified have been unsuitable because of accessibility, parking, or asbestos. We are awaiting a survey on another building to understand if that is a viable option.
• Can you explain further the emergency line to help Somerset residents?
  • We have worked with 111 to provide them with additional resource for a dedicated dental helpline with urgent need. The 111 team take demographics and do triaging. There’s also a team that offer advice and guidance and support with self-care. There are a small number of appointments for people with urgent need. We don’t have the appointment capacity yet to support those with severe oral and dental decay, we are working on it.
  • We are working on a co-produced model  ...  view the full minutes text for item 105.

To receive the report.

Alison Rowswell, Director of Localities and Strategic Commissioning - NHS Somerset, and Steve Boucher, Head of Operations - SWAST, gave a presentation on Urgent and Emergency Care performance in Somerset, highlighting: the deterioration in ambulance performances and handovers over the winter; that A&E was not hitting performance targets of 76%; that there had been a big increase in demand for A&E and urgent treatment centres; that there had been an improvement in January and February; the challenges relating to discharging patients in hospitals and how that impacts A&E and ambulance performance; the actions in place to improve performance and understand the data; the different areas of focus to reduce delays in hospital.

During the discussion the following points were made:

• In December, when the average handover time was an hour, is that ambulances queueing outside A&E?
  • It can be patient held in vehicle because of no capacity within the Emergency Department, but it can be patients in the department but still in the care of SWAST.
• Why have category 2 and 3 risen so sharply?
  • Because of increased demand and delays with handover, so resources are tied up.
• The times provided are mean averages, it would be useful to have more of a breakdown of that.
• Is the mental health vehicle being utilised well?
  • It’s part of a national programme of work, there is one dedicated to the Somerset ICB area and it is working well. Two or three patients a day, complex patients who would normally be responded to by an ambulance on the scene for hours.
• Given that stroke is classed as a Category 2 and response times aren’t optimum and the closure of the Yeovil HASU, what work is being done to ensure people with a stroke get the most appropriate care as quickly as possible?
  • We are trying to improve responses to different categories as a whole. General improvements to Category 1 and 2 will have an improvement on stroke services.
• The recent trial of GP Urgent Access Service in Martock of six months was seen as a high quality service by people who used it but it was too expensive to continue on. Think it made savings to ambulance and A&E and that should have been factored in.
  • A written response will be provided.
• Is there sufficient staffing for patient flow? Is it a whole system problem?
  • We are looking at ensuring we have the right staffing in place, trying to increase medical staffing.
  • On the Yeovil Hospital site we are piloting an urgent treatment centre trying to direct people quicker through the departments.
  • We are always looking at staffing, but has been impacted by sickness such as flu and respiratory illness and norovirus.

The Chair concluded the discussion and the Committee noted the report.

To receive the report.

Penny Gower, Finance Strategic Partner for Adults and Public Health Finance, gave a presentation on the Quarter 3 position for Adults and Housing. She highlighted: the £4.25m underspend, 1.8% of the total budget and an increase of £428,000 since Month 7, and the different areas of the budget including an overspend in homecare.

She proceeded to hand over to the Executive Director Adults Services & Housing, Mel Lock, who explained that this budget showed housing as part of Adults Services and the risks for budget in the next financial year, including the increase in employer costs in the care provider market and the increase in depleted funds.

During the discussion, the following points were made:

• Linked with the previous report with bed blocking in hospitals, where does the cost of social workers in hospitals to increase the rate of discharge sit?
  • That is within our staffing costs.
  • There is a need to change the culture within hospitals to support discharge.
  • There is some concern with Pathway 1, the majority of delays when there is a delay are only 48 hours.
• Congratulations on the underspend, it is a challenging area of the Council’s expenditure and demand-led. Well done and keep up the good work.
  • One of the things that has been crucial is setting a realistic budget in the first place, a lot of extra money to get it on the right footing with a very successful transformation programme.
  • Very proud of the team and the way they are working.
• Demand has been less than anticipated – this is unpredictable. Can we make it more predictable?
  • We do model demand, we look at trends from the previous year over time, peaks and flows. We have had a difficult winter, we model but we can’t predict.
  • We do know people are staying at home longer, when they go into care later they don’t stay as long but sometimes the cost is higher and we are having to work that through.
• Can you explain the underachievement in grants and pooled income?
  • It is due to the pooled budget relating to Learning Disability, the ICB contribute 25% so where there is an underspend we receive less income from the ICB.
• Two budget lines that include transport are overspent. Can you explain that?
  • That incorporates transport, shard lives, and day services, we would expect that to go up and we do understand why it is increasing.
• Can you give the overall impact of Newton in figures?
  • There was recently a report to Scrutiny and to Executive. We have £10m year on year savings, next year we have £3.9 year on year to achieve. We are also supporting people earlier from transition from Children’s into Adults, giving people the right outcomes.

The Chair concluded the discussion and thanked the presenters. The Committee noted the report.

To receive the report.

Jon Padfield, Service Manager for Policy, Performance, and Assurance, gave a presentation that detailed the measures from the Adult Social Care Outcomes Framework, explaining there was a significant time lag in this data and it was from the 2023/24 financial year.

During the discussion, the following points were made:

• Is it a challenge when someone has chosen to pay for some quite luxurious care and then run out of money?
  • When someone comes forward there’s a financial assessment and a care act assessment. Sometimes difficult conversations take place between individuals and families, we need to take into account the needs of the individual, the finances of the individual, and the finances of the Council.
  • The main conversation is that we don’t want people to go into care too early, we want to help people to stay at home as long as possible, as healthy and independent as possible.
• If self-funders that are choosing somewhere too expensive, is there any process where they can be advised to go elsewhere?
  • Self-funders do pay a different rate that can vary depending on the home.
  • We have been rubbing a series of webinars more recently, would encourage you and members of your communities to look at those, they are on Youtube. Ensuring people have all the information to make the most informed choices.
  • We are also doing work with care homes to support people.
  • There is also a proportion of people who use services with self-directed support, where they have been given a personal budget. We are above regional average.

The Chair concluded the discussion and thanked the presenters. The Committee noted the report.

This item has details of information shared with Committee Members between meetings.

These are:

·       An update from Weston General Hospital

·       A Key Decision taken by the Executive Lead Member

·       An invitation to attend and watch recordings of Adult Social Care Webinars

There are two webinars taking place today that could be promoted. These webinars will continue.