Agenda, decisions and minutes

To receive any apologies for absence.

Apologies were received from Cllr Gill Slocombe, Cllr Rosemary Woods (present online, substitute Cllr Steve Ashton), Cllr Christine Lawrence (substitute Cllr Martin Wale).

To approve the minutes from the previous meeting on Thursday 5^th October, 2023.

Resolved that the minutes of the Scrutiny Committee - Adults and Health held on Thursday 5^th October, 2023 be confirmed as a correct record.

Resolved that the minutes of the Scrutiny Committee - Adults and Health held on Thursday 5^th October, 2023 be confirmed as a correct record.

To approve the Minutes from the Joint Meeting of the Scrutiny Committee – Children and Families and the Scrutiny Committee – Adults and Health on Wednesday 25 October, 2023.

Resolved that the minutes of the Joint Meeting of the Scrutiny Committee – Children and Families and the Scrutiny Committee - Adults and Health held on 25 October 2023 be confirmed as a correct record.

Resolved that the minutes of the Joint Meeting of the Scrutiny Committee – Children and Families and the Scrutiny Committee - Adults and Health held on 25 October 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’.

There were two public questions received. The questions and the responses are provided below.

Eva Bryczkowski:

THE PROPOSED CLOSURE OF YEOVIL HOSPITAL ACUTE STROKE UNIT

·       The fact that NHS Somerset is still looking at ending emergency stroke treatment, given in the first 72 hours, does not bode well for future stroke victims. 

·       The quicker the person is seen, the greater chance of survival, with far less damage and disability if they survive the stroke. 

·       If the stroke unit at Yeovil still remains open, there will be far less expense long term for the NHS as patients will not be so severely affected and less likely to need long term care. 

·       Thus closing down the emergency treatment is a false economy, and there will be far less ability to save lives. 

·       It was reported in BBC news that NHS Somerset's plan is a step in the right direction. 

·       But they are still planning, at this stage, to dilute the service at Yeovil hospital acute stroke unit. 

·       The knock - on effects of this possible dilution will be poorer health outcomes and slower recovery times, leading to greater costs for  adult social care, especially if it is subsidised by the council, incurring more expense for council tax payers in Somerset. 

·       I do wonder whether NHS Somerset/Somerset Council have considered these implications.

QUESTION ONE 

i)               What, specifically, are NHS Somerset going to do about preventing poorer health outcomes, slower recovery times, and the potential risk of rising morbidity for future Somerset stroke patients?

ii)             How are councillors/officers on the Health and Wellbeing Scrutiny Committee going to square the circle financially, regarding the extra cost of subsidised adult social care, and paying expensive consultancy fees, which will lead to a further drain on the adult social care budget, seeing as the council is threatened with a 114 notice and possible bankruptcy?

·       We know that the clear legal duty of the council is to balance the books. 

·       Ratcheting up costs by employing an expensive consultancy firm, which has not proved its worth yet, is the last thing the council needs. 

·       This job should be done by the leading councillors and officers responsible for adult social care. 

·       (Goodness, I'd be happy and I'm sure other people would be willing to do the necessary research and number crunching to avoid our money helping this consultancy firm make even more profits, at the expense of us council tax payers). 

THE CONSULTATION PROCESS 

·       At the end of the Health and Wellbeing Scrutiny Committee held on 31st of May 2023, I spoke up and asked everybody in the room whether they had participated, or came across the consultation process, which was closed on 24th of April 2023.

·       Only 3, maximum 4, people raised their hands. 

·       In response, people from the ICB and Foundation Trust enthusiastically told me that they had put on talking cafes and numerous other ways of consulting people about this. 

QUESTION TWO 

I would like to know what were the parameters of the consultation process:

Which people  ...  view the full minutes text for item 39.

To discuss the report.

The committee discussed the presentation and report and noted the details. They suggested that it could be reviewed as part of a joint Scrutiny Committee with Communities.

The committee received a presentation from Clare Stuart, Health Promotion Manager, Violence Reduction Unit, of the Crime and Disorder Overview report, which covered the approach to community safety, the public health approach to violence, and an overview of statistics and activities around violent and serious crime.

The committee asked a number of questions, many of which were responded to at the meeting, as follows:

·       How do youth groups interact with other agencies, including police and public health? There is an early intervention team and a dedicated role in each area to liaise with youth at risk of violence.

·       The number of organisations involved are often complex and difficult to know who to speak to, there is a lack of relationship building and local geographical knowledge. They will take that feedback back as an opportunity to reestablish links with the voluntary sector. Regional mapping is a work in progress.

·       Is the data broken down to geographic areas and are there areas of concentration that resources are focused on? There is more detailed data as part of a needs assessment that can be made available to the councillors.

·       Statistics are alarming, given impending cuts to police services are we looking at things getting worse? Resources are limited and it is a challenge, but they are focusing resources in the right place and have bespoke services for victims of certain crimes like sexual violence.

·       The statistics look bad when compared with other councils. The comparison is demographic based, so we are being compared with councils that also have a relatively lower crime rates. There needs to be further analysis on what we can learn from other areas.

·       There are many committees and subcommittees on the Safer Somerset Partnership, and some of them are marked statutory or non-statutory. Is there duplication, and given the financial emergency, are these groups likely to be reduced? Where we have limited resources, we are focusing on understanding who is at risk and working tactically, cluster by cluster, to keep the risk from growing with partnership multi-agency working. We will be looking at where there is crossover and how we can be more efficient and looking at the governance structure overall.

·       Is there still a plan for a review and upgrade of CCTV? CCTV is an operational function and it would be a question for the officer responsible for it.

·       What do ‘recorded crimes’ denote specifically? Once matters are reported to the police, how many crimes are identified. Some things that are reported are not always crimes, and sometimes there will be multiple reports and only one crime, or one report and multiple crimes. The number refers to actual crimes recorded rather than reports.

·       Is it possible to see which crimes are prosecuted, comparatively to recorded? For example, sexual crimes in particularly have a low prosecution rate. We do track that data, in areas, regions, and crime type. We know that it is very low for sexual offences, but we do acknowledge that and we are improving.  ...  view the full minutes text for item 40.

To consider the report.

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

The committee received a presentation from Penny Gower, Service Manager Adults and Public Health Finance, on the current budgetary position, a breakdown of spending, in-year mitigations and the Medium Term Financial Plan.

The committee asked a number of questions, many of which were responded to at the meeting, as follows:

• Can the unachievable savings from the Newton Europe transformation programme of 4.8m be expanded on? As work only started three months ago on the transformation, we were not expecting to make full savings. The savings will be 10m over a two year period, we decided to split that into 5m each year. We accept that this year we will not make those savings, and they will be taken out of reserves and the savings will be made up next year.
• What is Newton Europe? The next agenda item will expand on this, they are experts in Adult Social Care transformation
• Efficiency savings: A councillor attended an assessment meeting around a support plan with two social workers with a difficult situation. Query around how many levels of conversation there are for each assessment, with peer forum and strategic managers needing to approve a respite package not being cut. Is it reasonable to have so many people involved, and what are the cost implications of this? Due to the financial emergency, extra Peer Forums have been put on to look at how we are spending money across children and adults, to ensure we are spending the right amount of money on people and making sure our social workers and ASCPs can make the right decision. The Peer Forum also looks at how packages can be enhanced by the voluntary and community sector. Any care packages over £350 go through the enhanced peer forum. They are creating checks and balances, similar to the Spending Board for the whole council. It is putting in the checks that would be put in place if a Section 114 was filed. Peer Forums are also about ensuring the right outcome for individuals is met. Councillors were invited to join Enhanced Peer Forums to understand the process.
• With staff involved in the increased peer forum work, how ASC dealing with the existing overdue care review backlog? Overdue review backlogs are a national problem, and there is a risk profile for assessments. There is a plan to deal with these backlogs and it is monitored by Somerset Safeguarding Adults Board (SSAB) on a quarterly basis as it is a safeguarding issue.
• Are there risks to the voluntary and community sector as ASC relies on them more? How is that being monitored and managed? If decisions are made to look at what non-statutory work our communities can take up, we will need to look at that. Some of this will be covered in the next item.
• Are there KPIs and performance data this committee will review? Yes, those KPIs and performance reviews are quarterly, and will be discussed in the April Scrutiny Committee.

To consider the report.

The Committee received a presentation which gave information on the methods, progress, savings so far, and the projected savings. They discussed the presentation and noted the details of the report.

It was agreed that there would be a quarterly update on the progress of the transformation programme.

The Committee received a presentation from Mel Lock, Director of Adult Social Care, and Emily Faldon, Newton Europe. The presentation gave information on the methods, progress, savings so far, and the projected savings.

During the discussion, the following questions were asked and answered:

• The transformation programme looks at reablement providers working for Adult Social Care in Somerset Council, what about reablement from within hospital settings, where people are often discharged less able than when they were admitted? There is ongoing work around hospital admissions, but a cultural shift takes time, and while it is part of coming together as a system it is not a part of this transformation programme.
• The data workstream isn’t listed as a financial savings area, why is that? Data isn’t about financial opportunities, it’s about developing understanding and making decisions and performance measuring easier.
• Can you explain the run-rate, the financial benefit realised if it continues indefinitely? If we get this transformation right and keep using this methodology, we will continue to make savings going forward
• What’s the difference between data driven behaviour and evidence-based decision making? They are two ways of explaining the same thing: Giving a team the information to identify what changes are needed and the impact they will have
• On the programme plan, there are delays in two areas due to short-term financial emergency support. How will those delays impact on financial target overall? For preparing for adulthood, rather than starting with 14 year olds, we have prioritised 17 year olds as they produce better short term savings, but we are learning from the work we are doing with this short-term work to build in the longer term plans. For learning disability progression and enablement, we are taking learning from high-cost reviews.
• How are micro-providers involved in this? They continue to be part of the commissioning process and whether we are commissioning the right services.

It was agreed that there would be a quarterly update on the progress of the transformation programme.

To consider the report.

The committee received a report on the stroke service proposal and consultation process, with an overview of the themes of feedback and the next steps.

Cllr Oakes (Chair) proposed that the committee resolve this is not the best proposal for the people of Somerset. Cllr Mike Ashton seconded this, and the proposal was unanimously approved.

It was proposed that the committee should write to the Executive to inform of their decision, and Cllr Bruce proposed that this be delegated to Cllr Oakes and Democratic Services. Cllr John Bailey seconded, and this was unanimously approved.

The committee received a report from Julie Jones, Sara Bonfanti, David McClay and Dr Robert Whiting on the stroke service proposal and consultation process, with an overview of the themes of feedback and the next steps.

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

• What does the 600 patient viability figure for the stroke service mean? The threshold is the ability to do intensive hyperacute treatments as quickly as possible. Large volume centres who do treatments more frequently are able to do them quickly, which is important for strokes. The service also needs to be sufficiently large to have the financial stability to keep the service operating with enough consultants and to provide a high level of service 24 hours, 7 days a week.
• How many patients are currently seen in Yeovil? 400 patients a year.
• The service is demand-led, and Somerset has an aging population, so demand is likely to grow. What does that mean for the future of the service? We have looked at population growth in ten years and what beds and staff will be required in ten years.
• Is it going to be a postcode lottery for stroke services in Somerset? The postcode lottery will be more significant if one of the services did not meet the standards of a Hyper Acute Stroke Unit.
• With speed being important for stroke treatment, there are concerns about the travel time. The travel time between the stroke and getting help would increase by 25 minutes. The longer travel time would be mitigated by faster treatment times once the patient has arrived at the hospital.
• Isn’t it better for services to be balanced between two locations in case one gets overwhelmed? Is there a plan for that? There is already a plan to expand the stroke unit in Musgrove Park Hospital. It has already expanded to be two wards.
• Concerned there are inaccuracies in the report around travel times, as 25 minutes from Yeovil is only feasible when there is no traffic, i.e. at 3am. Particularly with current delays in ambulance times.
• The consultation feedback has been largely negative, with people wanting the Yeovil HACU to stay open.
• Concerns about if there are poorer outcomes as a result of this closure, that will fall on Adult Social Care to provide ongoing care after they are discharged from hospital.
• Does the 600 viability figure take into account rural nature of the population? Yes, and in NHS England Section 9.2, a balance must be considered between travel times and sustainability. Increased travel times for someone to get to a unit that has the qualified staff.
• Has the report taken into account the impact on Adult Social Care?
• The consultation has narrowed it down to one option, have any other options come forward as part of that process and have they been considered? Mobile stroke units were considered, but a trial in South East England has shown they are not cost effective and national guidelines state there is  ...  view the full minutes text for item 43.