Agenda and minutes

To receive any apologies for absence.

Apologies were received from Councillors Fran Carpenter, Martin Boiles, Jan Warwick, Rhydian Vaughan, Marge Harvey, and Adam Carew.  Councillors Lance Quantrill and Graham Burgess attended as Conservative Deputies. 

Apologies were also received from co-opted members, Councillors Trevor Cartwright and Alison Finlay.

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 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 Personal Interest in a matter being considered at the meeting should consider, having regard to Part 5, Paragraph 4 of the Code, whether such interest should be declared, and having regard to Part 5, Paragraph 5 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 16 September 2019 were confirmed as a correct record and signed by the Chairman.

There was one matter arising in relation to the Minutes:

The addition of the presence of Councillor Liz Fairhurst, Executive Member for Adult Social Care and Health, and Councillor Judith Grajewski, Executive Member for Public Health at the invitation of 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 one announcement:

The Chairman noted that feedback had been received from Councillors Thornton and Frankum regarding the Adults’ Social Care and Health Tt2021 programme per the request noted on Page 18.  The Chairman’s overall feedback was that he did not wish to affect savings in a way that would eventually generate greater cost down the line.  He thanked the Director of Adults’ Health and Care for responding timely and specifically to all concerns and feedback shared by Members.

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.

None to consider.

There were no proposals to consider.

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.

None to consider.

There were no issues to consider.

To receive an update on the latest position on the proposed integration of Hampshire County Council and Southern Health NHS Foundation Trust Intermediate Care services. 

The Director of Adults’ Health and Care alongside representatives from the NHS and Southern Health Foundation Trust provided a progress update on Integrated Intermediate Care, last presented in May 2019.

Cllr Thornton joined the meeting at 10:09.

The Chairman reviewed the concept of Integrated Intermediate Care (IIC) and Members then heard:

• Joint provision of services is intended to avoid unnecessary admission to acute hospitals and to allow independent living at home as soon as possible. 
• Support is offered free of charge for a time limited period (6 weeks), though generally shorter with step down into a community or care home setting. 
• Rehabilitation, reablement, and recovery are the key elements.
• Hampshire County Council (HCC) and Southern Health Foundation Trust (SHFT) are progressing towards proposals for a single integrated service.
• Commissioning along NHS lines is critical but complex due to lack of consistency in shared information and technology across providers. 
• This is a positive direction and consultations will follow in due course.
• Arrangements covering all aspects and system functions will be choreographed between HCC and NHS with a possible Section 75 and Local Care Partnerships.

Cllr Hayre joined the meeting at 10:14.

• Modelling in terms of whole population and creating an appropriate footprint with acute hospitals requires detailed work and a business plan for ideal outcomes.
• Commissioning and provider perspectives are both critical to success. 
• With the challenges of Tt2021, ensuring services are joined transparently in terms of finances, expectations, and service delivery details is key. 
• Winter planning is now the focus to match additional service demand across the county and ensuring appropriate services and capacity are available for upcoming needs with greater efficiency and productivity. 
• Service structure planning will reduce areas of duplication with a thoughtful and sensitive approach that dovetails together. 
• HCC and SHFT operational and clinical regimes are different but the integrated service needs to be complimentary, robust, and capable.
• Consultation with staff will commence at the turn of the calendar year. 
• New ways of working together are tested in forerunner projects countywide with local access points and an aim for patients to leave acute settings an at earlier stage as the longer they are there, the more they decompensate. 
• To better their chances for recovery and independent living, acute hospital avoidance is key for those who would receive better care at home. 
• Recent collaboration with South Central Ambulance Service (SCAS) has resulted in over 580 people avoiding acute hospitals and easing the pressures on acute, community, and social care providers, with ideal outcomes and benefits. 
• Communication and engagement with all stakeholders are critical to find new ways of working ground up to meet population needs. 
• The detailed business case is the current focus.  There will be consultations in January with legal services, staff, providers, etc., to be brought back to the HASC in March, and the Executive Member for Social Care and Health, before the service going live in April 2020.

Cllr Fairhurst joined the meeting at 10:21am.

In response to questions, Members heard:

• Collaboration, agreements, and  ...  view the full minutes text for item 166.

To receive a final update on the Care Quality Commission (CQC) Local System Review action plan following the local system review which took place in early 2018.  

The Director of Adults’ Health and Care alongside a representative from the Hampshire and Isle of Wight Partnership of CCGs provided a closure report following the local system review in March 2018. 

Members heard:

• The system review identified strengths and continued development areas for an action plan with key elements to implement within a 12-month period.
• IIC (the previous item) was a key action and will be traveling forward alongside other issues being addressed.
• The action plan was signed off by the Health and Wellbeing Board (HWB) and submitted.  A similar report to the one presented here will be going to the Board.
• A response was submitted to the CQC and DHSC, but there has not been continued interest in the outcomes.
• Hampshire was one of 20 areas selected to undertake such a review, based predominantly on the over 65 population and their experiences and pathways.
• Areas of strengths and improvements, as well as positive developments were based on data submitted alongside a week-long field work on the ground.
• The Health and Wellbeing Strategy and Business Plan, local mechanisms, transformation group, and integrated commission board will drive oversight and improvement for shared investments, funding, and pooled resources.
• The Hampshire Together initiative, workforce planning developments, system improvements with regulated care workforce, building on strengths, and setting the conditions to make the work of provider partners possible, is key.
• There is a limited 1-year view into the funding and confirmation of assumptions already made, and the degree of assurance and funding flow is very pertinent. 
• The action plan is closed but progress continues with bigger pieces of work. 

In response to questions, Members heard:

• The HWB oversees the progress on key actions with time scales for delivery.
• A huge campaign has been undertaken to get the word about Connect to Support Hampshire out there with advertising and the support of partners - district and borough councils, libraries, Fire and Rescue, 111, etc.
• People may be using the services but not recognize it as Connect to Support.
• Finance-wise, a 3-year spending round is typical and would be useful. 
• The NHS has a 5-year funding solution subject to meeting performance and other standards.
• Prudent assumptions have proved true but is challenging and difficult to look forward beyond March 2021 whilst waiting for green and white papers.
• CQC have responsibilities across regulated services for health and social care.
• Inspections are being undertaken but in terms of skill and expertise, there are local team provisions providing a window into service quality and provisions.
• Adding CQC intelligence and insight to the County’s own, allows it to remain above the national average and much has been done but there is more to do.
• Carer feedback (formal and informal) are part of the CQC response and has been used to develop a joint carer strategy. 
• Informal carers are a vital resource and they contribute over £60 billion pounds compared to the £20 billion spent on social care.
• The CQC review was initiated due to delay transfer care performance but  ...  view the full minutes text for item 167.

To receive a report from the Hampshire and Isle of Wight (HIOW) Sustainability and Transformation Partnership (STP) Task and Finish Working Group and an update from the HIOW STP on the process and progress in developing an NHS Long Term Strategic Delivery Plan for Hampshire and the Isle of Wight.

Representatives from the Hampshire and Isle of Wight (HIOW) Sustainability and Transformation Partnership (STP) provided an update on the process and progress in developing an NHS Long Term Strategic Delivery Plan for Hampshire and the Isle of Wight, alongside a report from the HIOW STP Task and Finish Working Group.

Members heard:

• Based on the NHS long term plan blueprint for 10 years, a collaborative plan for implementation of expectations are to be submitted 15 November. 
• The current work entails a response for 496 commitments laid out, refining strategy to planned implementation with the greatest value for citizens. 
• While there is some discretion over timing, each item requires implementation.
• Existing engagement work and building on the work of HWBs to meet population needs with a proactive integrated care program in the community and collaboration of social care colleagues. 
• Treating patients seamlessly in the right place at the right time while fostering a culture and behaviour change where the patient can easily access multiple services, accounting for cultural, technology, and competency challenges. 
• Population health management, critical NHS changes and better using capital, digital, workforce resources for networked care and implementation of the direction of travel with a new model of health and care. 
• Working together across providers (addressing workforce and specialization challenges) for 24-7 services to balance capacity and anticipated demand. 
• Promoting learning from each other and implementing safe, sustainable changes by building relationships and collaboration with larger, effective providers.
• Lack of access can cause a period of fragmentation of health.
• Capacity insights are largely unknown but must be understood to mobilize a more rapid response.
• A live capacity and demand model would help manage mismatches and address them with agile responses.
• Digitalizing outpatient activity would save time and transportation costs.
• Coordinated visits would allow for multiple concerns to be addressed in one go.
• Transforming access is a massive issue and focus, including managing mental health out of area beds and collaboration across all services to use bed stock.
• Focus on prevention and managing an aging demographic – live well, age well, live with, rather than suffer with, and a radical approach to prevent ill health.
• STP learning through prevention agenda, considering existing data, shared information, and especially public health collaboration for prevention of pregnant women smoking, new-born care, addressing adverse physical events, care in the right setting, promoting exercise, living well, child reporting, etc.
• Half a billion pounds marked for transformation over the next 5 years but the STP must deliver and spend to improve experiences and focused improvements. 
• Workforce remains the most significant challenge for health and care partners. 
• Better leadership and a strong recruitment position will help establish Hampshire and the Isle of Wight as an attractive place to work and key to working well.
• A bank to allow staff to move seamlessly across positions with dynamic solutions and improved technology at all levels (artificial intelligence, electronic medical records, etc.) will drive efficiency and productivity.
• Well placed digital solutions, cost suppression and thoughtful deployment are profoundly important for  ...  view the full minutes text for item 168.

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.

RESOLVED:

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

The meeting closed at 12:52.