Agenda and minutes

To receive any apologies for absence.

Apologies were received from Councillor Steve Forster, Councillor Jan Warwick and Councillor Marge Harvey. Councillor Graham Burgess and Councillor Lance Quantrill, as the Conservative standing deputies, were invited but unable to attend. 

Apologies were also received from co-opted member Councillor Trevor Cartwright.

All Members who believe they have a Disclosable Pecuniary Interest in any matter to be considered at the meeting must declare that interest and, having regard to the circumstances described in Part 3 Paragraph 1.5 of the County Council's Members' Code of Conduct, leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with Paragraph 1.6 of the Code. Furthermore all Members with a Non-Pecuniary interest in a matter being considered at the meeting should consider whether such interest should be declared, and having regard to Part 5, Paragraph 2 of the Code, consider whether it is appropriate to leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with the Code.

Members were mindful that where they believed they had a Disclosable Pecuniary Interest in any matter considered at the meeting they must declare that interest at the time of the relevant debate and, having regard to the circumstances described in Part 3, Paragraph 1.5 of the County Council's Members' Code of Conduct, leave the meeting while the matter was discussed, save for exercising any right to speak in accordance with Paragraph 1.6 of the Code. Furthermore Members were mindful that where they believed they had a Non-Pecuniary interest in a matter being considered at the meeting they considered whether such interest should be declared, and having regard to Part 5, Paragraph 2 of the Code, considered whether it was appropriate to leave the meeting whilst the matter was discussed, save for exercising any right to speak in accordance with the Code.

No declarations were made.

To confirm the minutes of the previous meeting

The Minutes of the meeting of the Health and Adult Social Care Select Committee (HASC) held on 17 May 2018 were confirmed as a correct record and signed by the Chairman.

To receive any deputations notified under Standing Order 12.

The Committee did not receive any deputations.

To receive any announcements the Chairman may wish to make.

The Chairman made five announcements:

Chase Community Hospital

The Chairman announced that at the last meeting, the HASC heard about proposals from Hampshire Hospitals NHS Foundation Trust to withdraw some services from the Chase Community Hospital. The HASC deferred making a decision on this proposal and requested the Trust come back to the July meeting with further information. However, this issue was not included on the agenda for this meeting. This was because the engagement activity was ongoing until the end of July and the CCG conversations regarding alternative providers were also ongoing. The Chairman had received assurance that the services would remain in place until the engagement and other discussions had concluded. The Trust and CCG expected to have the information requested by the time of the September HASC meeting, therefore Chase would be placed on that agenda instead.

GP Out of Hours Provision in Portsmouth and South East Hampshire

The Chairman reported that he had been informed of a minor change in service relating to out of hours GP provision in South East Hampshire. A briefing paper would be circulated to HASC Members following the meeting.

Out of Hours GP appointments had been offered at four sites up to the end of the current contract in May 2018: at Gosport War Memorial Hospital, Queen Alexandra Hospital in Portsmouth (QA), Cowplain Health Centre, and Chase Community Hospital in Whitehill & Bordon. Due to Portsmouth City CCG choosing to change their approach with a new contract, appointments would no longer be offered at QA. However, patients living in the South East Hampshire CCG area would continue to be offered appointments in the other three locations, which were likely to be closer to home.

Update: Bulmer House, Petersfield and Masters House, Romsey Day Services Re-provision

At the February HASC meeting the proposed closure of day services provided from Bulmer House and Masters House was considered. Members requested an update on re-provision for the service users affected. A Briefing on this would be circulated following the meeting confirming that alternative provision had been found for all affected service users.

Gosport Independent Panel

The Chairman noted that the Gosport Independent Panel had reported it’s findings on 20 June 2018. The Gosport Independent Panel was set up to address concerns raised by families over a number of years about the care of their relatives in Gosport War Memorial Hospital in the 1990’s and the subsequent investigations into their deaths. The report of the Panel did not make any recommendations, but offered findings for consideration by the Secretary of State for health and the organisations involved. The response of the relevant organisations would be monitored to determine if there was any role for the HASC to follow up these issues.

17 July Member Briefing Health Topic

The Chairman reminded Members that a Member Briefing was due to take place the following week, and encouraged HASC members to attend as one of the topics on the agenda was due to be health related.

The Chairman took items out of order compared to the published agenda.

To receive an update on the response of Hampshire health and care partners to the findings of the CQC Local System Review of the Hampshire Health and Care System.

The Director of Adults Health and Care and a colleague provided a report and supporting presentation regarding the Care Quality Commission (CQC) Local System Review of the Hampshire Health and Care System (see Item 7 in the Minute Book). The Local System Review of Hampshire was one of twenty such reviews the CQC had undertaken to date, looking at how health and care services work together to support care for people aged 65 and over.

Members heard that the CQC had recently published a report summarising the learning from all such reviews they had done to date, entitled ‘Beyond Barriers’. This would be circulated to Members after the meeting.

Members heard how the review in Hampshire had been undertaken, with a report of the findings having been published on 21 June 2018. The findings included areas of strength and eleven recommendations for improvement. The recommendations covered issues such as; the role of the Health and Wellbeing Board to hold the system to account; addressing process differences in different parts of Hampshire; collaborating across partners on workforce challenges; opportunities for more joint commissioning; opportunity to do more in partnership with the voluntary and independent sectors.

An Action Plan to respond to the recommendations was due to be submitted to CQC by 20 July 2018. Oversight of the Action Plan would sit with the Health and Wellbeing Board. It was also planned to introduce an Improvement and Transformation Board to have oversight of a number of cross cutting programmes including work taking place regarding delayed transfers of care.

Members asked questions and further heard that:

·         Opportunities to improve the Health and Wellbeing Board had been recognised in the self assessment. The Joint Health and Wellbeing Strategy was being refreshed, and it was planned for the Board to monitor performance against the Strategy.

·         Actions in the Action Plan had delivery timescales of three, six and twelve months, and achievement would be monitored through the proposed Improvement and Transformation Board. If agreed with partners, it was intended for this Board to start meeting from September 2018 and report up to the Health and Wellbeing Board.

·         There had been examples identified in the review where improvements could be made e.g. the linear nature of the discharge process. Changes to this process were being developed for roll out in the autumn

·         The new approach included changing the culture to an attitude of ‘why not home, why not today’

·         The Council had a financial plan for the next three years, and beyond that a Medium Term Financial Strategy. A Green Paper on social care funding was due from central government in the autumn to address the longer term challenges

·         It was planned to implement new models in September prior to the winter period, so it was hoped this would reduce the impact of winter pressures this year

RESOLVED:

HASC Members note the update.

An Update is requested for the November meeting on progress with the Action Plan.

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

Items for Monitoring

·      Hampshire Hospitals NHS Foundation Trust: Andover Hospital Minor Injuries Unit

Items for Information

·      South Eastern Hampshire CCG and Portsmouth Hospitals NHS Trust: Spinal Surgery Service 

The Chairman took items in a different order to the published agenda, to take items with presenters in attendance first.

South Eastern Hampshire CCG and Portsmouth Hospitals NHS Trust: Spinal Surgery Service

Representatives from the Hampshire and Isle of Wight CCG Partnership and Portsmouth Hospitals NHS Trust presented a report on Spinal Surgery Services in Portsmouth and South East Hampshire (see report, Item 6 in the Minute Book).

Members heard that elective spinal surgery was a single handed service at the Queen Alexandra Hospital in Portsmouth, which impacted waiting lists. Efforts had been made to build the service and recruit additional clinicians, but they had been unable to attract new staff. Commissioners had reviewed what was best for patients and were proposing to move the service to be provided from University Hospital Southampton. This was expected to impact around 204 patients. The proposal had been to the Portsmouth Health Overview and Scrutiny Committee. They agreed that the proposed change does not constitute a substantial change in service and was in the interest of service users. They did ask that service users and local people were provided with clear communications about the changes as they were made. If agreed, it was planned to move the service from October 2018. Patient engagement had been undertaken and concerns expressed were mainly regarding car parking in Southampton. 

In response to questions, Members heard:

·      Non surgical services for those with back problems e.g. physiotherapy would continue to be provided at the Queen Alexandra Hospital

·      It was expected the surgeon currently undertaking this surgery in Portsmouth would TUPE to Southampton

·      University Hospital Southampton were employing additional staff to manage the additional demand

·      Commissioners would be monitoring the performance of the service following the service move, and could update the committee in future following implementation

RESOLVED

That the Committee:

a.    Agree that the proposed change does not constitute a substantial change in service

2. Agree that the proposed change is in the interest of the service users affected in the Hampshire area

3. Request an electronic update in September 2018 on the engagement undertaken with service users. In September the committee will consider an appropriate date to request an update on implementation of the service change.

d.    Agree to write to University Hospital Southampton regarding ensuring there is sufficient car parking provision to accommodate the additional patients.

Hampshire Hospitals NHS Foundation Trust: Andover Minor Injuries Unit Update

The Committee received a report from the Chief Executive of Hampshire Hospitals NHS Foundation Trust providing an update on staffing the Andover Minor Injuries Unit (see report, Item 6 in the Minute Book).

Members noted that Hampshire Hospitals NHS Foundation Trust provide a Minor Injuries Unit (MIU) at the Andover War Memorial Hospital. In recent years the Trust had implemented a temporary variation to the commissioned opening hours, due to staff absence and vacancies meaning the Unit could not be safely staffed to cover the required hours.The HASC last received an update on the situation in November 2017. At that time  ...  view the full minutes text for item 73.

To consider a report of the Director of Transformation and Governance on issues brought to the attention of the Committee which impact upon the planning, provision and/or operation of health services within Hampshire, or the Hampshire population.

·       Hampshire and Isle of Wight Sustainability and Transformation Plan Update

Hampshire & Isle Of Wight Sustainability and Transformation Partnership Update

The lead officer from the Sustainability and Transformation Partnership Programme Office gave a presentation providing an update on the Hampshire and Isle of Wight Sustainability and Transformation Partnership (see Item 8 in the Minute Book).

Members heard that the Sustainability and Transformation Partnership (STP) was not a statutory organisation, but a collective agreement between existing statutory organisations regarding the case for change in the Hampshire health system and a vehicle for working together on priorities for transformational change in the Hampshire and Isle of Wight area. Examples were given of achievements delivered through partnership working under the STP over the past year.

Plans for 2018/19 included strengthening the 24 clusters of joint care teams, and the introduction of a ‘health passport’ to support staff movement within services in the Hampshire area e.g. to enable recognition of training across organisations. In October 2016 the forecast budget pressure by 2020/21 was £577m. In 2017/18 £165m of savings had been delivered. The challenge for 2018/19 was to save a further £218m. A business plan had been developed to demonstrate how this would be achieved. If there was agreement among partner organisations regarding the changes required, it was planned to start engaging with the public about what the STP would mean for them.

In response to questions, Members heard:

·      A number of providers were moving away from the ‘payment by results’ approach, as this encouraged conversations between parts of the system regarding payments. The system reform agenda promoted seeing NHS funds as a single pot of money locally

·      The STP does not have any delegated powers, it operates on the basis of collective consensus

·      It was recognised that the governance arrangements for the STP could be strengthened to enable management of transformational change. A session with partners was due to take place on 19 July 2018 and it was hoped that a plan would emerge from this

·      The principles for change were usually not controversial, however there could be difficult conversations to come regarding where services end up being provided from

·      An area targeted for potential efficiency savings was back office functions. However, some organisations were resistant to taking a shared approach to provision of these functions. The STP was not intending to suggest a one size fits all approach, there could be different ways to approach making savings in back office functions.  

RESOLVED

That the Committee:

1. Note the Update

2. Request a further update in early 2019.

To consider and approve the Health and Adult Social Care Select Committee Work Programme.

The Director of Transformation and Governance presented the Committee’s work programme (see Item 9 in the Minute Book).

RESOLVED:

That the Committee’s work programme be approved, subject to any amendments agreed at this meeting.