Agenda and draft minutes

Health and Adult Social Care Overview and Scrutiny Committee
Monday, 18th January, 2021 6.00 pm

Venue: Microsoft Teams

Contact: Democratic Services  Email: democratic.services@bcpcouncil.gov.uk

Media

Items
No. Item

102.

Apologies

To receive any apologies for absence from Councillors.

Minutes:

Apologies were received from Cllr C Matthews.

103.

Substitute Members

To receive information on any changes in the membership of the Committee.

 

Note – When a member of a Committee is unable to attend a meeting of a Committee or Sub-Committee, the relevant Political Group Leader (or their nominated representative) may, by notice to the Monitoring Officer (or their nominated representative) prior to the meeting, appoint a substitute member from within the same Political Group. The contact details on the front of this agenda should be used for notifications.

 

Minutes:

Cllr S Moore substituted for Cllr C Matthews for this meeting.

104.

Declarations of Interests

Councillors are requested to declare any interests on items included in this agenda. Please refer to the workflow on the preceding page for guidance.

Declarations received will be reported at the meeting.

Minutes:

Councillors made the following declarations of interest:

 

Cllr L-J Evans declared, for transparency, that she was an employee of the

University Hospitals Dorset Foundation Trust.

 

Cllr C Johnson declared, for transparency, that she was a staff nurse at the Royal Bournemouth Hospital.

105.

Confirmation of Minutes pdf icon PDF 182 KB

To confirm the minutes of the meeting held on 30 November 2020.

Minutes:

The minutes of the meeting held on 30 November 2021 were approved as

a correct and accurate record.

106.

Action Sheet pdf icon PDF 198 KB

To note and comment as required on the action sheet which tracks decisions, actions and outcomes arising from previous Committee meetings.

Minutes:

The Committee noted the Action Sheet.

107.

Public Issues

To receive any public questions, statements or petitions submitted in accordance with the Constitution, which is available to view at the following link:

 

https://democracy.bcpcouncil.gov.uk/ieListMeetings.aspx?CommitteeID=151&Info=1&bcr=1  

 

The deadline for the submission of a public question is 4 clear working days before the meeting.

 

The deadline for the submission of a public statement is midday the working day before the meeting.

 

The deadline for the submission of a petition is 10 working days before the meeting.

Minutes:

There were no public questions, statements or petitions received for this meeting.

108.

Portfolio Holders' Update

To receive any updates from the relevant Portfolio Holders on key issues or actions that have been taken since the last meeting, as appropriate.

Minutes:

The Portfolio Holder for Adults and the Portfolio Holder for Covid

Resilience, Public Health and Education provided an update on the work

that had taken place since the last meeting of the Health and Adults Social

Care O&S Committee.

 

The main points of the update from the Portfolio Holder for Adults were as

follows:

 

         The Portfolio Holder for Adults attended the first ‘Champions’ meeting. Many of the Champions sit under the Health remit and all member Champions appeared very briefed. The Portfolio Holder emphasised that no additional pressure was to be added to officers before the Champion roles were clarified. The Champions with a health remit are as follows: Cllr J Bagwell (Disabilities), Cllr D Butler (Learning Disabilities and Community Projects), Cllr M Howell (Wellbeing), Cllr J Edwards (Dementia), Cllr L Fear (Mental Health) and Cllr D Kelsey (Armed Forces).

         On budgetary matters, the main in year budget pressures relate to the costs of care, which are exceeding additional COVID funding provided by the Government. Half of care homes were on ‘suspension’ due to COVID and no placements can therefore be made in these homes.  The Council had received £11.5 million in infection control grants from the Government which has been distributed to care providers to contribute to the costs of PPE and supporting those staff who needed to stay home to isolate. Most of the £4.2 million of mitigating savings were on course to be delivered, however given the requirements of the pandemic, all available staffing resources have been devoted to the pandemic and this has slowed the pace of development of some key developments, such as the Adult Social Care Contact Centre.

         There was an impact from the Scheme 1 hospital discharge scheme which enabled all residents to have fully funded care on hospital discharge from March to August 2020.  Staff in Adult Social Care and the Dorset Clinical Commissioning Group have been carrying out eligibility and financial assessments for people on scheme 1. The real impact of this on the budget would not be clear until the assessments have been carried out and the level of funding received by the Council from the national Scheme 1 pot which is being managed through the NHS has been fully verified.

         The Council were having to buy in interim beds for care patients for people being discharged at the earliest possible date from hospital. Again, this would be financially significant in 2021/2 as there will be additional costs from the high cost placements made.  At this point, the cost has been estimated at £1.3 million additional funding in the Medium-Term Financial Plan for 2021/22. The Portfolio Holder expected the real cost to be much higher.  It is not yet clear that the additional COVID related grants for the social care sector will continue into 2021/22.

         The Portfolio Holder thanked all officers and the whole adult social care sector for their continued hard work.

 

The main points of the update from the Portfolio Holder for  ...  view the full minutes text for item 108.

109.

COVID-19 Update

(18:30 – 19:00)*

 

For the Committee to receive an update from Adult Social Care Services on COVID-19, to enable the Committee to monitor the ongoing pandemic and scrutinise the ongoing response to COVID-19.

Minutes:

The Director of Public Health for BCP Council introduced the progress report on Public Health and Adult Social Care Response to the COVID-19 Pandemic. The main points raised during the Public Health part of the presentation were as follows:

 

         Since the start of Spring 2020, BCP saw 18,000 cases in total. More than 6000 of these cases had occurred in the most recent two-week period.

         The 7-day infection rate for BCP Council stood at 881 cases per 100,000 between 3 January and 9 January. On the 18 January, the figure had reduced to 831 per 100,000.

         The rate of infection in Over 60s was at 641 per 100,000. This figure had increased to 691 per 100,000 between the period of 8 January to 14 January. This was because of current outbreaks in care homes, which accounted for between one third and one half of all cases in Over 60s.

         The South West regional rate throughout the same period was 385 per 100,000. This was less than the English national rate of 609 per 100,000.

         The epidemic curve of case numbers showed a sharp increase from the week commencing 7 December 2021.

         The infection rate per 100,000 of the population for neighbouring councils, such as Dorset, Southampton, Hampshire, appeared to reach their peak sooner than BCP’s, which continued to increase for up to a week. BCP were now seeing a steady fall in case rates, however it was hoped that the reduction in cases would speed up as the lockdown measures took effect.

         On supporting the wider system, Public Health Dorset were evaluating and planning with the NHS the healthcare capacity required to deal with the number of cases in hospitals. On this, EpiCell modelling was assessing the critical care capacity required for the next 2 – 3 weeks.

         It was believed that the peak impact on hospitals would not to be seen until 24 January 2021. Infections that occurred a week to ten days ago are currently manifesting as hospital admissions at present.

         Media briefings were held to stress the urgency of the issue with the public and communications were of great significance during this latest wave of infections. Therefore, a postcard, agreed with the local outbreak engagement board, was circulated to every household across BCP, advice was given to care homes to encourage family visits only to be enabled in exceptional circumstances such as end of life, and transparent information continued to be published on the Public Health Dorset website and across the social media channels. Signposting to the Public Health England daily updates also occurred as often as possible.

         Testing of Frontline Council employees would start on 18 January 2021 and this would extend to those working in the community who are not covered by other offers.

         The virus seems to now be more transmissible, as observed in care homes and hospital wards. It was stressed that behaviour and adherence to public health measures was of vital  ...  view the full minutes text for item 109.

110.

Home First Programme (including update on the Better Care Fund) pdf icon PDF 401 KB

(19:00-19:30)*

 

For the Committee to consider and scrutinise the local response to the national Hospital Discharge Policy and the Home First approach.

Minutes:

The Committee received an update from Principal Officer for Planning and Quality Assurance who presented the report on the Home First Programme, including an update on Better Care Fund, concerning the new hospital discharge service and the changes, activities and learning yielded from the patient experience.

 

The main points of the presentation were as follows:

 

         The Better Care Fund planning and reporting has been paused during the COVID pandemic.

         The new national discharge policy and operating model commenced on 19 March 2020 in response to the pandemic. The model facilitates hospital discharge when a patient no longer reaches criteria to stay in hospital. New and additional care would be fully funded by the Government during this period and the hospital discharge process would operate from 8am-8pm 7 days a week, working in a multi-disciplinary capacity.

         The hospital discharge policy and model changed on the 1 September 2020 and since then the Home First Programme had been implemented across Dorset.

         From the 1 September, the Government has funded care support for up to 6 weeks after discharge. This would continue up until 31 March 2021. However, it is expected that the Discharge to Assess model will continue beyond 31 March 2021 and any additional funding would sit within the Better Care Fund framework for the next financial year.

 

The operational lead for BCP Council on Home First explained to the Committee that:

 

         Pressures continued to be extremely high on hospital staff.

         The three areas that take the patient through discharge and recovery are the Hospital, the SPA (the Single Point of Access) and the One Team. This takes the patient being discharged through their journey of discharge, recovery and any further help required.

         There are 5 Cluster teams working across Dorset, for example Bournemouth and Christchurch are Cluster 1 and Poole is Cluster 2. Within this model there are lead experts across health and social care and they look at the discharge process of all those leaving hospital and specifically where in their discharge journey enhancements can be made, for example mutual aid, mapping assessment needs, what data should be collected and learned from, how we can learn from individual, personal journeys and how best to align people to requisite services.

         The situation is changing hourly. Critical care, making sure there is enough critical care capacity and staff, are extremely pressured and only a small percentage of patients are not COVID related.

         In the Discharge to Assess model, there are 4 pathways – patients will go through one of the four pathways. Pathway 0 is for those who do not require any social care. This will account for 50% of discharges. Pathway 1 (45%) is where those discharged require support at home. Pathway 2 (4%) will need a rehabilitation or short-term care in a 24-hour bed-based setting. Pathway 3 (1%) will require ongoing 24-hour nursing care, often in a bedded setting. Long-term care is likely to be required for these individuals.

 

The  ...  view the full minutes text for item 110.

111.

BCP Council Suicide Prevention Plan pdf icon PDF 163 KB

(19:30-20:00)*

 

For the Overview and Scrutiny Committee to scrutinise and review the BCP

Council Suicide Prevention Plan 2021-23.

Additional documents:

Minutes:

The Portfolio Holder for Covid Resilience, Schools and Skills introduced the item and emphasised the sensitivity of the topic and encouraged the panel to feed into the policy development. A partnership approach had been undertaken between the health services, Dorset Council and BCP Council and it was hoped that the final iteration of the plan would be an all-member piece of work.

 

The Assistant Director of Dorset CCG explained the plan and spoke to the report. The main points were as follows:

·       The 2016 Crisis Care Concordat was a national agreement that people in mental health crisis deserved and should receive a higher level of care and support to prevent crises occurring. All statutory partnerships and organisations signed up to the Concordat. Under the Concordat, there had developed two deliverables. The first is the mental health acute care pathway, this has been fully implemented in BCP, along with a 24/7 crisis line. The second deliverable was in response to the National Suicide Prevention Strategy of 2017 and saw a partnership of work take place between SWAST, Dorset Police, the local Councils, voluntary community organisations and others. The work pulled down from the national strategy as it pertained to Dorset and BCP Council areas and received funding for 6 work streams.

·       Realtime surveillance information was also a new, up to date piece of information gathering that gave informative insight into deaths from  suicide and attempts by suicide across the BCP Council area

·       As a result of this, partners have been able to develop their respective plans and BCP Council has worked from the Pan-Dorset plan to develop their own in order to prevent the number of people who attempt suicide and die from suicide.

 

The Committee asked several questions following the presentation. Answers were provided by the Assistant Director of Dorset CCG. The questions and responses included:

 

·       A member emphasised that the cross-working element of the Plan was important and that signposting to correct and relevant services is crucial. The Committee heard that real-time information is key to enabling a targeted approach to trends and themes. This is a vital time to be doing work alongside the real-time surveillance information.

·       One member referred to point 7.1 in the report that stated 77% of people who die through suicide are not involved in any support programmes and therefore do not have any help in place. It was hoped that this plan would enable the Council to reach more people in crisis.

·       A member asked what support was available more widely for people that have been affected by suicide and may be dealing with bereavement. It was explained that a project called Open Door had been developed and was an offer that gives the individual access to relevant organisations. There was also a publication called Help is at Hand which was a free guide on Public Health England’s website and provides information on bereavement support services, funeral arrangements and other practical issues.

·       One member asked whether the real-time surveillance information tracked reasons for  ...  view the full minutes text for item 111.

112.

Forward Plan pdf icon PDF 246 KB

To consider and comment as appropriate on the development of the Committee’s Forward Plan.

Minutes:

The Committee considered the Forward Plan.

 

A member asked a question on scrutiny of the Homelessness Strategy. The Committee were informed that conversations were underway between officers and the Chairs of the three O&S bodies. Prevention of duplication and consideration of pressures on officers were being considered when making the arrangements for the item to be scrutinised. A meeting and date would be confirmed shortly.

 

RESOLVED that the Forward Plan was agreed and approved by the

Committee.