Agenda and minutes

Vicky Farnworth declared a personal interest regarding Learning Disability as a member of Speak Up.

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

·                    Councillor Marriott – Visit to Rawmarsh School (mental health pilot)

A positive and interesting meeting took place with school staff who explained the work being undertaken and answered a number of questions. The children and young people were now coming forward.  In some cases parents did not like one-on-one meetings so the school had replaced these with a successful coffee morning with 12-15 attendees. It was important that the good work continued.

·                    Councillor Elliott – Visit to new Urgent and Emergency Care Centre at Rotherham Hospital

A visit had been organised on 22nd June 2017 prior to the opening, which included a comprehensive tour and introductory talk.  It was a new and impressive centre built on time and on budget, with good décor, equipment and nursing stations.  Clinical Lead Dr Kay Stenton and Acting Matron Kerry Barnard explained how A&E staff had been consulted on the design and layout of the unit and their ideas incorporated. This was a cutting edge facility and one the people of Rotherham should be proud of.

·                    Schools mental health pilot

Councillor Cusworth would circulate notes from the whole school steering group meeting for information.

An information pack had been circulated to Members.

·                    Yorkshire and Humber Joint Health Overview and Scrutiny Committee

As in previous years the Commission was asked to nominate a representative to the Committee.

Resolved:- That the Chair be confirmed as the representative for RMBC to the Yorkshire and Humber Joint Health Overview and Scrutiny Committee.

Consideration was given to the minutes of the previous meeting of the Health Select Commission held on 15th June, 2017.  Members noted that with regard to Minute No. 6 the text under key messages should say:-

-       Older people play a significant role as care givers

Arising from Minute No. 8 Joint Health Overview and Scrutiny Committee (JHOSC) for the Commissioners Working Together Programme, the Scrutiny Officer provided the following update:

Children’s Surgery and Anaesthesia

The Joint Committee of Clinical Commissioning Groups approved the preferred option for the reconfiguration proposals for children’s surgery and anaesthesia on 28th June.  This proposal was for three hubs - Doncaster Royal Infirmary, Sheffield Children’s Hospital and Pinderfields General Hospital in Wakefield to provide out of hours, emergency surgery for certain sub-specialties. 

Further work on patient numbers showed that this would impact on a relatively small number of children, with the majority of surgical procedures carried out locally.  From a total of approximately 11,000 surgical procedures each year, it would affect between 65 and 106 p.a. across the whole area (approximately 14 in Rotherham).

There were no cost savings with the proposal but rather investment was required for ambulance transfers and for the Managed Clinical Network which would organise and sustain service provision across the area through workforce planning and training etc.

The JHOSC would be meeting on 31st July, 2017 to discuss implementation and future scrutiny.  There would also be an update on timescales for a decision on the proposals for Hyper Acute Stroke, which was likely to be in the autumn following further work on developing the business case, on costs, workforce implications and wider implications for partners.

Resolved:- That the minutes of the previous meeting, held on 15th June, 2017, be approved as a correct record.

To nominate one Member to represent the Select Commission on the above Panel for the 2017/18 Municipal Year

Members would be requested to send expressions of interest to the Chair.

Councillor Roche, Cabinet Member for Adult Social Care and Health, introduced the agenda item highlighting that all local authorities had to produce annual statutory returns.  The performance indicators had to be viewed in the wider context where RMBC was in the top quarter/third of Adult Social Care directorates nationally and ranked second in Yorkshire and Humber on the national statistics.  There were concerns over some measures and for some individual measures Rotherham did not compare so well with the national figures.  Overall the outcomes were mixed and the majority of measures that had declined were the perception measures. Perceptions were important as the Service needed to take users with it in light of some of the other changes that would be brought in to Social Care.

AnneMarie Lubanski, Strategic Director of Adult Care and Housing, and Scott Clayton, Performance & Quality Team Manager, presented a report outlining the provisional year end 2016-17 Key Performance Indicator results for the Adult Social Care elements of the directorate.

The Council had implemented a new case management recording system, Liquid Logic in year, with a go live date in December 2016. Migration and recording onto the new system highlighted some operational and performance reporting challenges.  All national reporting requirements were met in relation to 2016-17.

Performance overall had been mixed with approximately one-third of measures improving and two-thirds declining. Perception results from Service User and Carer surveys accounted for most of the declining performance indicators. Some Indicators, for example the Service user surveys, had declined since last year but not necessarily over the last two years. 

Continued improvements to pathways, embedding of user data recording, plus enhanced reporting functionality during 2017/18 were being delivered.

Year-end benchmarking data would be available later in the year and not all the Adult Social Care Outcome Framework (ASCOF) measures had a provisional result at this stage as mental health data was awaited from RDaSH.

It was important to note that in terms of local waiting times performance measures the data had become unreliable as it was not now reported in the same way.

Discussion ensued with the following issues raised/highlighted:-

·                    Was any KPI data collected monthly? – Reporting periods varied with a mixture of monthly, quarterly (including RDaSH) and annual reporting, such as for reablement.

·                    Where was data recorded regarding people who drop out of the system, possibly homeless people or people no longer with us? – We work actively with some people so they did not need an ongoing personal budget from the Council as they regain independence. If people did not meet Service eligibility criteria they should be signposted elsewhere, such as to the voluntary sector. The Data Protection Act limited data that could be held with stringent record procedures.  Data was held for people who had passed away.  If people had chosen to move away from Rotherham our involvement stopped and hopefully it could also be through greater independence and no longer being in service. This would be captured in reablement data.

·                    Measure No. 14 permanent  ...  view the full minutes text for item 17.

Verbal update by Anne Marie Lubanski, Strategic Director, Adult Care and Housing

AnneMarie Lubanski, Strategic Director of Adult Care and Housing, provided a verbal update on the work to transform Learning Disability Services.

In July a report on Learning Disability and the recommendations within the report were agreed at Cabinet and a number of consultations were now being planned and would be commencing in early September.  No decisions had been taken yet with regard to closure of any centres.

The Directorate had been working with carers of people with learning disabilities to keep them well involved. This included two events where officers talked through the report with the carers as soon as it had been published.

Based on feedback from the earlier consultation, it had been agreed that carers would be involved in designing the consultation, alongside SpeakUp, together with another organisation the Service hoped to procure to provide additional support to people with learning disability through the consultations.

Consideration was also being given to the on-line questionnaires and how these could be done differently, although there had been over 900 responses through the various means. The consultation materials could be shared with the Commission.

It was stressed that this was not just the in-house Learning Disability offer but modernisation of the wider learning disability offer for everyone, although this message was sometimes being lost.

Out of 780 people on Service, across internal and external commissioning, there were around 20 people with complex needs whose packages costed between £160,000 to £250,000 p.a. There was a need to start doing things differently for such packages such as trying and testing the use of technology as a substitute for direct care.

Other challenges in undergoing this transformation and service modernisation, both for Adult Social Care and for families, were highlighted, including:

-              people with learning disabilities perhaps wanting something different to what their families wanted for them 

-              the need for sophisticated conversations and being very clear about the Mental Capacity Act and who made the decision

-              difficult conversations with families

-              difficulties for families when someone with learning disability or autism reached 18 and had the right to choose and the family member was no longer their next of kin

-              as much as carers had parity of esteem through the Care Act the central focus was what the person wanted

-              how new high cost support packages as people come into service may increase budget pressures in Adult Social Care

These were reasons why it was so important that the learning disability offer was widely understood. Our money was locked into very traditional services and it needed to be reiterated that this was not a quick journey but would happen over two to three years.

·                         Clearly improving the quality of provision and driving up standards was important but the other side was the economics, so was cost a driver as well given that in the future there will always be people with complex need and high cost support packages? – The premise of personalisation was about putting the person at the  ...  view the full minutes text for item 18.

Janet Spurling, Scrutiny Officer, presented a report setting out a detailed draft work programme for 2017-18 and provisional memberships for the three NHS Quality Account sub-groups.

Health and Social Care Services were undergoing transformation, including closer integration through joint commissioning, joint posts, locality working and multi-disciplinary teams. This work was an important long term programme that the Health Select Commission had been scrutinising since 2015-16 and would continue to be rolled out over the next few years.

Overall performance of health partners was scrutinised through their quality accounts, with three sub-groups formed for this purpose.  Their work would be supplemented by the quarterly meetings of the Chair and Vice-Chair with the Rotherham NHS Foundation Trust; Rotherham, Doncaster and South Humber NHS Foundation Trust; and Rotherham Clinical Commissioning Group, which have been in place since 2014-2015.

The overall priorities for 2017-18 were:

·                    Rotherham Place Plan – health and social care integration

·                    Adult Social Care performance and development programme

·                    Learning Disability

·                    Child and Adolescent Mental Health
plus

·                    NHS Commissioners Working Together Programme
(through the JHOSC)

Attention was drawn to items in the work programme that linked in with issues raised earlier in the meeting such as implementation of the Carers’ Strategy and Learning Disability transformation.

The April meeting had been earmarked for a spotlight review with a theme to be determined by the Commission. However following a recent seminar on Care Homes and the establishment of a new Quality Board under the auspices of the Health and Wellbeing Board, this could present an opportunity to consider how that work was progressing.

Councillor Roche confirmed that with regard to the Health and Wellbeing Strategy in September this would be a good opportunity for the Commission to be involved at a very early stage in the refresh.

Resolved:- (1) That the draft work programme for 2017-18 be approved.
 
(2) That the proposed membership for the quality account sub-groups for 2017-18 be approved.

(3) That it be noted that if any urgent items emerge during the year this might necessitate a review and re-prioritisation of the work programme.

The summary of discussions at the quarterly briefing with health partners  held on 4^th May, 2017, was noted.

Healthwatch had lobbied Rotherham Clinical Commissioning Group and the Council to produce an Autism Strategy and although not yet in place the new Autism Partnership Board was a first step. 

Councillor Roche confirmed he would report back to the Commission on progress in developing the Autism Strategy.

The Care Quality Commission were undertaking a national review of Child and Adolescent Mental Health Services which was expected to lead swiftly to a Green Paper. Tony Clabby had been asked to sit on the expert advisory group.

Healthwatch sat on the Safeguarding Adults Board and part of their contribution to the Strategy was a guide to Lasting Power of Attorney, a much needed tool as people do not make provision and plan ahead for difficult decisions around care.

Hard copies of the Healthwatch Annual Report were circulated and it was available on the link below:

http://healthwatchrotherham.org.uk/wp-content/uploads/2015/07/Annual-Report-2016-17-Final.pdf

Minutes of meeting held on 31^st May, 2017

Councillor Roche confirmed that new Sensory Impairment Centre on Ship Hill would be opening shortly and a visit could be arranged for Commission Members.

The minutes of the meeting of the Health and Wellbeing Board held on 31^st May, 2017, were noted.

Thursday, 15^th June at 9.30 a.m.

Resolved:- That the next meeting of the Health Select Commission be held on Thursday, 21st September, 2017, commencing at 9.30 a.m.