Agenda and minutes

Cllr Fleming raised his employment with the NHS in Sheffield.

There were no members of the of the public or press present at the meeting.

The Chair welcomed everyone to the first meeting of the Health Select Commission in the 2015/16 Municipal Year.

Information pack

In addition to the Agenda papers for the meeting, a separate information pack with other documents of interest to the Commission which may not need discussion in the meeting may be circulated.  If any Member wanted to raise an issue or ask a question in relation to any of the papers in the pack they should be raised under Communications.  It included information on the Health and Wellbeing Strategy which was being refreshed and would be on the July agenda.

GP Limited Liability Partnership (GP LLP)

All of the Rotherham GP practices (now reduced from 36 to 35 following a recent merger) had formed a GP LLP which was registered at Companies House.  Currently the LLP was not conducting any business but possible future actions could be to benefit from economies of scale or as a means of attracting investment which had happened elsewhere.

Treeton Medical Practice

This was a long running issue with regard to securing new premises as the present surgery premises were too small for the practice which had a growing patient list and likely to increase substantially with new housing developments close by.  Originally it had been hoped to have a new building near their present site but this had stalled.  Discussions had now commenced with Howarth Estates regarding the medical centre the developer was building at Waverley.  A business plan application form had been submitted to NHS England on 11^th May, 2015.  The practice has not had a response as yet.

Care Quality Commission Inspection of the Rotherham Foundation Trust

It was standard practice after a CQC inspection to hold a Quality Summit with the Hospital, Health commissioners and stakeholders to discuss the findings and improvement plans.  This had been due to take place on 12^th June but had been postponed with a new date to be agreed.  The Chairman, Interim Director of Adult Social Care and Interim Strategic Director Children and Young People’s Services would be invited.

Joint Health and Overview Scrutiny Committee

(1)  Representation

In keeping with previous years, the Select Commission was requested to consider representation on the JHOSC.

Resolved:-  That Councillor Sansome and Councillor Mallinder (substitute) represent Rotherham on the Joint Health and Overview Scrutiny Committee.

(2)  Yorkshire Ambulance Service

The Joint Health and Overview Scrutiny Committee, through Wakefield Council, was also being represented at the Care Quality Commission Quality Summit for the Yorkshire Ambulance Service on 15^th June, 2015.

Health and Wellbeing Board

Councillor Roche, Advisory Cabinet Member, reported that a meeting had taken place with some of the key players to look at how the Board was going to run in the future, membership, agenda items, roles of the Chair and Vice-Chair and integration as much as possible.  The Board would meet at various locations around the Borough and not in the Town Hall.  A report would go to the Board’s July meeting following  ...  view the full minutes text for item 3.

The minutes of the meeting of the Health Select Commission held on 16^th April, 2015, were noted.

Further to Minute Nos. 87 and 89 (Rotherham Foundation Trust Quality Accounts and RDaSH Quality Accounts), it was noted that the Select Commission had submitted its statements for the Quality Accounts for the Foundation Trust, RDaSH and the Yorkshire Ambulance Service in accordance with the deadlines.

It was noted that a progress report on the Continence Review was to be submitted to the July meeting.  Incontinence was often a key factor for people going into residential care but it was not inevitable with age and many forms such as stress and urge incontinence could be treated.  It was also relevant to falls prevention.

Further to Minute No. 88 (Nurses in Special Schools), Tracey McErlain-Burns (Chief Nurse) had spoken with members of the Family Health Directorate regarding the query raised with respect of the level of support that might be provided when a young person leaves education.

The current position was that School Nurses would provide support to young people leaving school/education if requested by that young person or parents or if another partner agency requested it provided the School Nursing Service had accessed their ability to provide ongoing support.  That was provided on a 1:1 ad hoc basis.

Further to Minute No. 90 (Scrutiny Review – RDaSH CAMHS), it was noted that the CAMHS report and the updated response to the Access to GPs review had been approved by the Overview and Scrutiny Management Board.  They would be submitted to Commissioner Manzie and the Health and Wellbeing Board.

Janet Spurling, Scrutiny Officer, presented a report setting out the priorities for Scrutiny and the specific work programme for the Select Commission in light of the changes to the Executive decision making arrangements of the Council.

Since their appointment in March, 2015, the Commissioners had engaged with Elected Members to determine a realistic and focussed Scrutiny programme for 2015/16 clearly identifying the areas they would like Members to prioritise.  It had been discussed and agreed by the Overview and Scrutiny Management Board at its meeting on 24^th April and approved by Council on 22^nd May, 2015 as follows:-

Accordingly, the proposed programme for the Health Select Commission was as follows:-

Initial overviews of Health Services and Adult Social Services

Better Care Fund and the Fund Finances

The Care Act including support for carers

Updates on previous Scrutiny Reviews

Capturing Service User/Patient Feedback and Experience

Children and Young People

Quality Accounts

Year End Performance

Visits to other local authorities and/or Health bodies

Monitoring Previous Scrutiny Reviews

The Commission’s amended Terms of Reference were also submitted for information.

Discussion ensued on the proposed programme and the new way of working with most of the indepth scrutiny being carried out in the meetings by the full Commission rather than in smaller review sub-groups.  The exception would be the Quality Accounts where it was proposed to have three sub-groups for Rotherham Hospital, RDaSH and Yorkshire Ambulance Service respectively.

Resolved:-  (1)  That the overall priorities for Scrutiny for 2015/16 and the focus for Health Select Commission on Health and Social Care integration be noted.

(2)  That the Select Commission’s 2015/16 proposed work programme be approved.

(3)  That the Health Select Commission’s Terms of Reference, as outlined in Appendix C submitted, be noted.

Jacqui Tuffnell, Head of Co-Commissioning, Rotherham Clinical Commissioning Group, to present

Jacqui Tuffnell, Head of Co-Commissioning, Rotherham Clinical Commissioning Group (RCCG), gave a powerpoint presentation on the Primary Care update:-

·           From April, 2015, the RCCG had taken on delegated responsibility for GP practices but not for the whole of Primary Care.  There was the potential for conflicts of interests

·           The Primary Care Sub-Committee met in public on a monthly basis, the meeting papers for which were available on the website.  The Sub-Committee was Chaired by a Lay Member and was made up of members of the RCCG and 3 GPs who were elected to sit on the Sub-Committee to provide advice.  At the point of making a decision, the GPs would leave the room

·           A big piece of work that needed to take place was to set the GP Strategy for Rotherham.  There would only be 1 plan which would align with other strategies such as the Health and Wellbeing Strategy and the Commissioning Strategy.  There were 10 key priorities

-               Quality Driven Services

Services were “RAG” rated so a warning would be received as to which practice’s performance was raising concern.  This was the first time this had been seen and Rotherham was paving the way.  It enabled bench marking of practices as well as the sharing of good practice with others.  The LLP gave practices the opportunity to look at working together rather than in silos.  Work was starting on looking at new models of delivery regarding the integration of Health and Social Care and what possible models could look like

-               Services as local possible

There were a number of challenges associated with this priority.  Rotherham was around the national benchmark level for Doctors but new ways of managing patients were being explored including a new role of associate physician to support GPs in practice and looking at the wider health workforce including pharmacists and therapists. 

The RCCG was also looking at using IT and technology such as Skype.  The Emergency Centre would integrate urgent care and out of hours care seamlessly.

-               Equality of Service Provision

Dependent upon where you lived and the size of your practice, there could be real inequality in relation to the Services provided.  Encouragement was being given to having “baskets” of Services through co-operation between practices so that if a practice did not deliver a particular Service it may be that the practice down the road could do so on their behalf thereby ensuring everyone received the same service.  Some of the commissioning arrangements around Public Health were due to the way it had been divided up; the RCCG wanted to stop those barriers and all work together and avoid whose responsibility for commissioning services

-               Increasing Capacity and Capability

It was hoped that there would be 5,000 more GPs nationally.  Currently once trained, many Doctors opted not to go into GP practice.  It was felt that it should be made easier for those coming back into the country to start practising again as currently you had to retrain to certain degree.  ...  view the full minutes text for item 6.

Graeme Betts, Interim Director, Adult Social Care,  to present

Profession Graeme Betts, Interim Director of Adult Social Services, gave the following powerpoint presentation on Adult Social Care Services:-

Changes in Adult Social Care Nationally – from Dependency to Resilience

-          From institutions to community and home-based services

-          Improvements in supporting people to live their lives independently

-          Greater use of information and advice, one-off interventions and advocacy

-          Greater focus on prevention, early intervention, rehabilitation, recovery and reablement and enablement

-          Greater use of housing-based support, telecare and other technologies

-          Focus on supporting carers

-          Greater use of personal budgets to increase choice and control

-          Better joint working with the NHS

The Challenges facing Adult Social Care

-          Demography

In Health there was a gradual increase in the spending on people as they got older

In Care, the costs were reasonably low until the age of 85 when the costs then soared

Rotherham’s population was declining with regards to its younger adults – these were the ones that provided informal care to older people

-          Expectations

-          Quality Standards

There had been an incredible rise in the standards of residential care but it came at a cost

-          Safeguarding

Agencies were better at identifying the level of emotional, physical and financial abuse – again at an increased cost

-          Resources

Net expenditure of approximately £70M

Over the past 3 years the Authority had had to make £14M savings

Rotherham Adult Social Care Services was a high spender

Headline Figures 2014/15

-          Over 6,400 people had received a Service during the year (excluding Occupational Therapy only Services)

-          Approximately 4,000 Social Care Assessments or re-assessments were undertaken during the year

-          90% of Service users on Service for more than a year received a review of their needs

-          1,700 adults and older people placed in residential and nursing care

Pyramid of Care

-          Contact received during the year with the outcome

Service Cost £371,517

Age 18-64 – 889

Age 65+ - 1,828

-          In long term Community-based Service

Service Cost £22,399,007

Age 18-64 – 2,051

Age 65+ - 2,204

-          Residential/Nursing Service

Service Cost £22,139,903

Age 18-64 – 234 (Residential 195 and Nursing 39)

Age 65+ - 1,462 (Residential 1,090 and Nursing 372)

Connect to Support Rotherham

-          A website for adults in Rotherham who needed support to live independently

-          The website offered information and advice and was also an e-marketplace offering 1,905 products and 414 services

-          Generated an average 800 hits a month

-          www.connectosupport.org/rotherham

-          Self-serve and channel shift

-          Dependence to Independence

-          Preventative

-          Supported the Care Act through advice and information

-          Had the potential to be further developed to provide personalised guidance, self-assessment, financial assessment, care accounts, support planning and more

Shared Lives

-          Shared Lives offered opportunities for vulnerable adults to live or spend time with approved carers and their families

-          This could be for a few hours or a few days a week (befriending), short stays in the home of the Shared Lives carer or  ...  view the full minutes text for item 7.

Janet Spurling, Scrutiny Officer, presented an update on the progress to date on the final outstanding recommendations of the joint Scrutiny Review.

Since the review was undertaken, NHS restructuring had seen responsibility for Continuing Health Care (CHC), including the budget, transfer to the Rotherham Clinical Commissioning Group (RCCG) who had commissioned the Commissioning Support Unit to carry out assessments and manage the budget.  There was also now greater focus on personalisation of Health and Social Care Services and the development of personal health budgets.

A Senior Management Working Group of both Council and NHS staff had agreed a set of actions to ensure effective multi-disciplinary working and delivering better outcomes for people. 

CHC and Social Care Assessments were completed by Health and Social Care staff presently or recently involved in assessing, reviewing, treating and supporting the individual.  A better working relationship now existed together with a greater understanding of each professional’s role in participating in multi-disciplinary assessments and completing the Decision Support Tool.  Improved engagement had been achieved through attendance at CHC Panels and it was now routine that the Council’s CHC Champions attend ratification panel meetings as part of the Multi-Disciplinary Team and implement joint actions.  The Champions also ensured issues were addressed in a timely manner.

RCCG and Council staff also met regularly to progress work regarding CHC for children with complex needs in relation to assessments and the timing of payments for care packages for children agreed as eligible for CHC funding.

Resolved:-  That the progress on joint working on Continuing Healthcare be noted.

No issues had been raised.

Health, Welfare and Safety Panel

One Member plus a substitute

Meets quarterly on a Friday

(Visit on 19^th June and meeting on 10th July)

Rotherham Local Plan Steering Group

Resolved:-  (1)  That Councillor Sansome and Councillor Mallinder (substitute) represent the Health Select Commission on the Health, Welfare and Safety Panel for the 2015/16 Municipal Year.

(2)  That Councillor Sansome represent the Health Select Commission on the Rotherham Local Plan Steering Group for the 2015/16 Municipal Year.

Discussion on the future meeting times took place.  The opinion of those Members present was split on a morning (9.30 a.m.) and afternoon (3.00 p.m.) starting time.

However, it was noted that a number of apologies had been received for the meeting.

Resolved:-  That an e-mail be sent to the full membership of the Commission seeking the preferred starting time of the Health Select Commission for the 2015/16 Municipal Year.

Thursday, 9^th July, 2015, at 9.30 a.m.

Resolved:-  That the next meeting of the Health Select Commission be held on Thursday, 9^th July, 2015, commencing at 9.30 a.m.